ABSTRACT
The origins of modern nursing cannot be understood by focusing exclusively on the development of the occupation as a profession or on studies of the handful of women who battled for its recognition. Such an approach, while undoubtedly having a place in nursing history, produces institutionalized accounts based on a public image constructed by its leaders, thus subsuming the reality of what happened on the wards. This approach cannot address questions about the lives of nurses who worked in the voluntary hospitals, and who burgeoned in number in the second half of the nineteenth century. Questions concerning the origins of women who became nurses, their motives for choosing that occupation, the experience of being nurses in the second half of the nineteenth century, and how their lives unfolded as a result, remain unaddressed by the traditional historiography. Yet such questions, if they were to be asked, could shed light on the nature of nursing and would also contribute to an understanding of the experience of working women in Victorian Britain. Little attention has been paid to nursing by women’s historians or labour historians. This may be because its development appears – on the surface – to offer no great breakthroughs, insights or paradigm shifts. Just as it might be argued that the history of the family has been overlooked, as a result of its association with the everyday and the mundane, perhaps the same fate has befallen nursing, with its close connection to domesticity. The portrayal of nurses as self-sacrificing angels has served to repel further late twentieth-century feminist historians for whom traditional religious allegiance and seeming conventionality present little attraction. This study seeks to redress some of these omissions. It is based in the tradition of microhistory, and answers Maggs’ call to study nursing from below. It further develops his use of hospital records by including data derived from census records. The prosopographical techniques employed have introduced a new methodology to the discipline. This book demonstrates that novel questions – previously considered unanswerable as a consequence of the dearth of direct evidence – can be addressed by linking information from a variety of sources. A study of nursing from below, as presented here, reveals new testimony on the lives of ordinary women;
evidence which challenges the traditional assumptions on the experience of Victorian women. The approach is unique in several respects. It is the first to reconstruct the lives of a group of Victorian nurses, tracing them as children with their families, through adulthood and into retirement. The combination of information from archival nursing records and data extracted from decennial census records has generated unprecedented detail on a cohort of nurses in the second half of the nineteenth century. It has enabled, for the first time, the class structure and profile of a nursing department at a major Victorian voluntary hospital to be monitored over a 50-year period. The results challenge many of the traditional views of Victorian nursing. Solidly working-class in the 1850s, by the end of the century the Nursing Department at St George’s had experienced an influx of middle-class women. Despite the rhetoric of nurse leaders (suggesting a wholesale gentrification had occurred), St George’s nurses continued to come from a wide range of backgrounds. The hospital accepted women into its Nursing Department based solely on their suitability for the work and treated all women the same. Significantly, it had no ‘special probationer schemes’, as was common at other prestigious London hospitals. By the mid-1890s, it was reportedly rejecting 600 applicants a year, but half its probationers still came from the ‘labour aristocracy’, suggesting that these women were being positively selected, rather than accepted through lack of more suitable alternatives. Middle-class women who joined the hospital may have been prepared to overlook its lack of special provision in return for its address in one of the most salubrious environs of London. This desirable situation may also have had a positive influence on working-class women looking to improve their station in life, and to work in one of London’s more pleasant areas. In other respects, late nineteenth-century St George’s nurses conformed more closely to the ‘ideal nurse’. They became younger as the century progressed, and thus recruits were more likely to be unmarried. These attributes were a function of a recruitment policy designed to reduce costs, rather than the result of an ideological belief that young, single women made better (or more malleable) nurses. As the hospital increasingly relied on probationers to nurse the wards, and filled its vacancies from this pool, the average age of members of its Nursing Department naturally fell. At the same time, the likelihood of these women being married also declined. The introduction of the probationer scheme was associated with a desire to improve the quality of the Nursing Department, but was arguably more closely aligned to a need to address instability in the department. For the first 20 years, it served more as a fixed-term contract (preventing women from leaving) than as a method of attracting a ‘better class’ of woman through the provision of specialized training. The very late appearance of compulsory lectures – and even later introduction of examinations
– is testament to this. As the probationer scheme was expanded, it conferred an additional benefit on the hospital, in reducing the cost of care for increasing numbers of patients. By the end of the century, the majority of nurses on the wards were probationers, who earned considerably less than their qualified colleagues. The economic benefit of the scheme was, without doubt, one of main motivators behind its introduction to an organization constantly struggling to maintain financial equilibrium. Analysis of nursing records has indicated that the most frequent reason for a nurse to leave the hospital was to take up a new job. Dismissal became increasingly unimportant as the perceived general behaviour of nurses improved, while loss to marriage was never the major problem described in the popular press. Equally, the level of resignations due to ill health was relatively low throughout the period, while the death rate among nurses appeared to be roughly equal to that of women of a similar age in the community at large. This is not to say that the health of nurses was unimportant. The hospital lost a large number of working days to sickness, and took several initiatives to improve the health of its nurses, including the provision of more suitable accommodation and increasing off-duty time. It has been possible to trace the careers of some of the women who left the hospital to take up new jobs. The results indicate that they were willing to move around the country in pursuit of their next post. By the 1890s, it is clear that some saw nursing as a starting point for adventure and advancement, moving overseas to places as far afield as India, Burma, South Africa and Brazil, often to take up superintendent posts. In the early years of this study the department was blighted by a high turnover in staff, many nurses staying for less than a year. They left expressing dissatisfaction with the work, with their colleagues or managers, or with their living conditions. The probationer scheme (backed up by other initiatives including the internal recruitment policy and provision of improved accommodation) brought stability to the department, and by the early 1890s, the hospital trained more nurses than it had vacant staff positions. The rejected, newly qualified nurses took their highly prized certificates and went in search of work within the burgeoning healthcare sector. While some were clearly seeking promotion (which had become an elusive goal within the hospital as a direct result of its success in improving staff retention) others may simply have been looking for a fresh environment in which to practise their newly acquired skills. Few women, having invested a significant amount of time in their training, left nursing for other careers. The lifecycle data indicate that those entering the hospital often brought with them experience from other sectors (such as teaching and domestic service), but, by the end of the century, were rarely found to move into these areas after leaving. Of those women who could be traced in subsequent censuses, by the end of the century only 10 per cent were found in non-nursing roles, and many of those could be said to have
retired. This was a marked difference from earlier in the century, when a significant number moved into other occupations, in particular, domestic service. It is possible that these women were using nursing to improve their opportunities of obtaining more senior positions in a domestic household. The data is not robust enough to support conclusively such a contention, but it is a plausible argument that the skills acquired whilst working in an hospital might have prepared a woman to take on senior roles, such as housekeeper, in a large private house. By the end of the century, however, a move into domestic service was much less likely, suggesting that nursing was becoming a career for women, with a clearly defined structure, rather than a branch of domestic service, as it had been regarded in the 1850s and 1860s. A further aspect of nurses’ lives came to light in the course of analysing database records. Some evidence of networks between St George’s nurses has begun to emerge. There are instances of families (mothers and daughters) working at the hospital, examples of women whose families were neighbours arriving at the hospital within a short period of time, and instances of contemporaries from the hospital located in later censuses at the same address. The importance of these networks warrants further study, especially in the light of the assertion, by some historians, that nurses did not form close supportive communities. The use of St George’s administrative archives alongside data from Nurse Registers has enabled the monitoring of the effect of management initiatives on nursing staff. Thus, a correlation has been demonstrated between the extensive revisions of the system of nursing (which took place during the 1870s) with instability and dissatisfaction within the department; the fragility of the relationship between a matron and her nurses has also been exposed. The study has revealed some insights into the character of the women the hospital employed. The tendency to ill-discipline was gradually eradicated through the entrenchment of the hospital’s policy to limit recruitment to probationers, and to fill all senior vacancies internally. However, this is not to assume that these women fit neatly into the Victorian image of nurses as docile, passive and submissive. There are enough examples of St George’s nurses speaking out on their own behalf, to cast strong doubts on that view. They petitioned for pay rises, more time off duty and improved living conditions; preferring to present their case to the male managers personally, rather than rely on the intercession of the Matron or doctors. Despite proudly declaring itself to be the first hospital to invite Florence Nightingale to be an honorary governor, St George’s appeared to have an ambiguous and inconsistent view of her system of nursing. In 1869, it was described as possessing a ‘modern’ Nursing Department, having recruited a lady superintendent to manage it; but by 1897, it was regarded as ‘old’, with an ‘old style’ matron. It was one of the first to introduce a three-year probationary period, but was among the last of the major London
hospitals to formalize training, with a detailed curriculum backed up by theory and practical exams. When examinations were introduced in the early 1890s, the poor performance of probationers – especially in basic procedures such as bandaging and wound dressing – revealed deep-rooted deficiencies in the Nursing Department, suggesting that progress to develop ‘new nursing’ was slow. Little evidence remains to assess this progress, although the doctors increasingly declared themselves happy with the standard of nursing in the hospital. However, the large number of reforms instigated by Miss Smedley (after her appointment as Matron at the end of the century) and particularly her reluctance to use internal promotion suggests a low opinion of the quality of nursing. How much of the perceived deficiency can be laid at the door of Mrs Coster, who presided over the department for half of the whole period of this study, is difficult to ascertain. Her voice is rarely heard in the minutes (unlike her very vocal successor), but there are indications that she was of the ‘old school’, and may not have been sympathetic to reform. The evidence from St George’s has been compared with published information regarding nursing at other London hospitals, although it should be noted that no nursing department (with the possible exception of St Thomas’), has been investigated in the same depth. One invaluable source is the Charles Booth archive, held at the London School of Economics. It contains a unique collection of interviews with leading matrons from London hospitals in the mid-1890s. Original transcripts present these influential women’s views on a range of topics, from the type of women who entered the service to the policies of the hospitals for which they worked. They reveal the conflicting opinions of nurse leaders at the end of the century, and illustrate the often contradictory relationship between the public presentation of nursing and its reality. The relationship between a hospital and its nurses has been described by many historians as being patriarchal, infantilizing the women and placing them in a subordinate role. The overall impression of the nurses at St George’s, and their relationship with the hospital’s male managers, is somewhat different. Although the managers did exhibit this type of behaviour, in their control of the nurses’ free time, for instance, or in their response to inappropriate relationships, there is a lack of rhetoric in the archival records to suggest that the moral element of nursing (so heavily emphasized by Nightingale and her followers) was overly stressed. As Smedley’s comment regarding nurses’ entertainment in the late century suggests (see p. 133), they believed their nurses were mature, intelligent women, capable of taking responsibility for their own lives. Where male managers did intervene, it was the hospital’s reputation, rather than the women’s well-being, which was their primary concern. In the late nineteenth-century, nurses at St George’s came from an increasingly diverse background, but once within the hospital walls, they formed Christopher Maggs’ melting pot, with the only hierarchy of
importance being that of the Nursing Department. To middle-class women, the hospital offered a respectable occupation with training and prospects, which enabled them to support themselves and break free from the often stultifying family life which might otherwise have been their lot. To working-class women, it offered a respectable job and promotion prospects. It also presented a chance to rise up the social hierarchy of Victorian England. The classless nature of the Nursing Department at St George’s seems to contradict the image portrayed in Victorian literature, suggesting that contemporary accounts were based on the rhetoric of the reform movement, rather than reality of the wards. There is no doubt that women flooded into nursing in the last decade of the nineteenth century. Historians have argued as to the causes of this increased popularity (particularly among the middle classes) of an occupation previously characterized – or caricatured – as inhabited by old, unskilled widows. Opportunities for women had emerged in many different occupational fields as the century came to a close. They moved in large numbers into commercial offices and the civil service as clerks, telegraph operators and telephonists; into teaching, at all levels; and into the retail trade as shop assistants. Smaller numbers made inroads as doctors, dispensers and librarians (Jordan 1999: Holcombe 1973). With these seemingly more respectable (and easier) options open to women who either wanted to work, or were forced to (through their personal circumstances), why did so many choose nursing; and what can their choice tell us about the type of women who did so? While many of the jobs listed above (outwardly at least) appear more attractive than nursing, they shared characteristics which may have made them less appealing. In the case of office work, for instance, historians of women’s labour have argued that women were only accepted into commercial offices under very tightly controlled conditions. Admitted into ‘women-only’ departments, which undertook the company’s routine and mundane clerical work, female workers were paid low wages (in comparison to their male counterparts) while access to promotion into even junior managerial roles was blocked (Anderson 1988). Unlike in nursing, employers seemed to relish the inevitability of marriage among their female employees, as illustrated by the comment from Frank Scudamore, an early proponent of female telegraphy operators in the Post Office:
Permanently established civil servants invariably expect their remuneration to increase with their years of service. . . . Women, however, will solve these difficulties for the Department by retiring for the purpose of getting married as soon as they get the chance.
