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Catholic women played large roles in health and healing in medieval and early modern Europe.[17] A life as a nun was a prestigious role; wealthy families provided dowries for their daughters, and these funded the convents, while the nuns provided free nursing care for the poor.[18] Meanwhile, in Catholic lands such as France, rich families continued to fund convents and monasteries, and enrolled their daughters as nuns who provided free health services to the poor. Nursing was a religious role for the nurse, and there was little call for science.[19] Middle East The Eastern Orthodox Church had established many hospitals in the middle east, but following the rise of Islam from the 7th century, Arabic medicine developed in this region, where a number of important advances were made and an Islamic tradition of nursing begun. Arab ideas were later influential in Europe. The famous Knights Hospitaller arose as a group of individuals associated with an Amalfitan hospital in Jerusalem, which was built to provide care for poor, sick or injured Christian pilgrims to the Holy Land. Following the capture of the city by Crusaders, the order became a military as well as infirmarian order.[20] Roman Catholic orders such as the Franciscans stressed tending the sick, especially during the devastating plagues.[21] Early modern Europe Catholic Europe The Catholic elites provided hospital services because of their theology of salvation that good works were the route to heaven. The same theology holds strong into the 21st century. In Catholic areas, the tradition of nursing sisters continued uninterrupted. Several orders of nuns provided nursing services in hospitals.[22] A leadership role was taken by the Daughters of Charity of Saint Vincent de Paul, founded in France in 1633.[23] New orders of Catholic nuns expanded the range of activities and reached new areas. For example in rural Brittany in France, the Daughters of the Holy Spirit, created in 1706, played a central role. New opportunity for nuns as charitable practitioners were created by devout nobles on their own estates. The nuns provided comprehensive care for the sick poor on their patrons' estates, acting not only as nurses, but took on expanded roles as physicians, surgeons, and apothecaries. The French Catholics in New France (Canada) and New Orleans continued these traditions. During the French Revolution, most of the orders of nurses were shut down and there was no organized nursing care to replace them.[24] However the demand for their nursing services remained strong, and after 1800 the sisters reappeared and resumed their work in hospitals and on rural estates. They were tolerated by officials because they had widespread support and were the link between elite physicians and distrustful peasants who needed help.[25] Protestantism closes the hospitals The Protestant reformers, led by Martin Luther, rejected the notion that rich men could gain God's grace through good works—and thereby escape purgatory—by providing cash endowments to charitable institutions. They also rejected the Catholic idea that the poor patients earned grace and salvation through their suffering.[26] Protestants generally closed all the convents[27] and most of the hospitals, sending women home to become housewives, often against their will.<[28] On the other hand, local officials recognized the public value of hospitals, and some were continued in Protestant lands, but without monks or nuns and in the control of local governments.[29] In London, the crown allowed two hospitals to continue their charitable work, under nonreligious control of city officials.[30] The convents were all shut down but Harkness finds that women—some of them former nuns—were part of a new system that delivered essential medical services to people outside their family. They were employed by parishes and hospitals, as well as by private families, and provided nursing care as well as some medical, pharmaceutical, and surgical services.[31] In the 16th century, Protestant reformers shut down the monasteries and convents, though they allowed a few to continue in operation. Those nuns who had been serving as nurses were given pensions or told to get married and stay home.[32] Between 1600 to 1800, Protestant Europe had a few noticeable hospitals, but no regular system of nursing. The weakened public role of women left female practitioners restricted to assisting neighbors and family in an unpaid and unrecognized capacity.[33] Modern nursing Modern nursing began in the 19th century in Germany and Britain, and spread worldwide by 1900. Deaconess Main article: Deaconess Phoebe, the nurse mentioned in the New Testament, was a deaconess. The role had virtually died out centuries before, but was revived in Germany in 1836 when Theodor Fliedner and his wife Friederike Münster opened the first deaconess motherhouse in Kaiserswerth on the Rhine. The diaconate was soon brought to England and Scandinavia, Kaiserswerth model. The women obligated themselves for 5 years of service, receiving room, board, uniforms, pocket money, and lifelong care. The uniform was the usual dress of the married woman. There were variations, such as an emphasis on preparing women for marriage through training in nursing, child care, social work and housework. In the Anglican Church, the diaconate was an auxiliary to the pastorate, and there were no mother houses. By 1890 there were over 5,000 deaconesses in Protestant Europe, chiefly Germany Scandinavia and England. In World War II, diaconates in war zones sustained heavy damage. As eastern Europe fell to communism, most diaconates were shut down, and 7000 deaconesses became refugees in West Germany. By 1957, in Germany there were 46,000 deaconesses and 10,000 associates. Other countries reported a total of 14,000 deaconesses, most of them Lutherans. In the United States and Canada 1550 women were counted, half of them in the Methodist Church.[34] Between 1880 and 1915, 62 training schools were opened in the United States. The lack of training had weakened Passavant's programs. However recruiting became increasingly difficult after 1910 as women preferred graduate nursing schools or the social work curriculum offered by state universities.[35] Nightingale's Britain The Crimean War was a significant development in nursing history when English nurse Florence Nightingale laid the foundations of professional nursing with the principles summarised in the book Notes on Nursing. Other important nurses in the development of the profession include: Nightingale's revelation of the abysmal nursing care afforded soldiers in the Crimean War energizer reformers. Queen Victoria in 1860 ordered a hospital to be built to train Army nurses and surgeons, the Royal Victoria Hospital. The hospital opened in 1863 in Netley and admitted and cared for military patients. Beginning in 1866, nurses were formally appointed to Military General Hospitals. The Army Nursing Service (ANS) oversaw the work of the nurses starting in 1881. These military nurses were sent overseas beginning with the First Boer War (often called Zulu War) from 1879 to 1881.[36] They were also dispatched to serve during the Egyptian Campaign in 1882 and the Sudan War of 1883 to 1884. During the Sudan War members of the Army Nursing Service nursed in hospital ships on the Nile as well as the Citadel in Cairo. Almost 2000 nurses served during the second Boer War, the Anglo-Boer War of 1899 to 1902, alongside nurses who were part of the colonial armies of Australia, Canada and New Zealand. They served in tented field hospitals. 23 Army Nursing sisters from Britain lost their lives from disease outbreaks.[37] Canada Canadian nursing dates all the way back to 1639 in Quebec with the Augustine nuns.These nuns were trying to open up a mission that cared for the spiritual and physical needs of patients. The establishment of this mission created the first nursing apprenticeship training in North America.[38] In the nineteenth century there were some Catholic orders of nursing that were trying to spread their message across Canada. These women had only an occasional consultations with a physician. Towards the end of the nineteenth century hospital care and medical services had been improved and expanded. Much of this was due to the Nightingale model, which prevailed in English Canada. In 1874 the first formal nursing training program was started at the General and Marine Hospital in St. Catharines in Ontario.[38] Many programs popped up in hospitals across Canada after this one was established. Graduates and teachers from these programs began to fight for licensing legislation, nursing journals, university training for nurses, and for professional organizations for nurses. The first instance of Canadian nurses and the military was in 1885 with the Northwest Rebellion. Some nurses came out to aid the wounded. In 1901 Canadian nurses were officially part of the Royal Canadian Army Medical Corps.[38] Georgina Fane Pope and Margaret C. MacDonald were the first nurses officially recognized as military nurses.[38] In the late nineteenth and early twentieth centuries women made inroads into various professions including teaching, journalism, social work, and public health. These advances included the establishment of a Women’s Medical College in Toronto (and in Kingston, Ontario) in 1883, attributed in part to the persistence of Emily Stowe, the first female doctor to practice in Canada. Stowe’s daughter, Augusta Stowe-Gullen, became the first woman to graduate from a Canadian medical school.[39] Apart from a token few, women were outsiders to the male-dominated medical profession. As physicians became better organized, they successfully had laws passed to control the practice of medicine and pharmacy and banning marginal and traditional practitioners. Midwifery—practiced along traditional lines by women—was restricted and practically died out by 1900.[40] Even so the great majority of childbirths took pace at home until the 1920s, when hospitals became preferred, especially by women who were better educated, more modern, and more trusting in modern medicine.[41] Prairie provinces In the Prairie provinces, the first homesteaders relied on themselves for medical services. Poverty and geographic isolation empowered women to learn and practice medical care with the herbs, roots, and berries that worked for their mothers. They prayed for divine intervention but also practiced supernatural magic that provided as much psychological as physical relief. The reliance on homeopathic remedies continued as trained nurses and doctors and how-to manuals slowly reached the homesteaders in the early 20th century.[42] After 1900 medicine and especially nursing modernized and became well organized. The Lethbridge Nursing Mission in Alberta was a representative Canadian voluntary mission. It was founded, independent of the Victorian Order of Nurses, in 1909 by Jessie Turnbull Robinson. A former nurse, Robinson was elected as president of the Lethbridge Relief Society and began district nursing services aimed at poor women and children. The mission was governed by a volunteer board of women directors and began by raising money for its first year of service through charitable donations and payments from the Metropolitan Life Insurance Company. The mission also blended social work with nursing, becoming the dispenser of unemployment relief.[43] Richardson (1998) examines the social, political, economic, class, and professional factors that contributed to ideological and practical differences between leaders of the Alberta Association of Graduate Nurses (AAGN), established in 1916, and the United Farm Women of Alberta (UFWA), founded in 1915, regarding the promotion and acceptance of midwifery as a recognized subspecialty of registered nurses. Accusing the AAGN of ignoring the medical needs of rural Alberta women, the leaders of the UFWA worked to improve economic and living conditions of women farmers. Irene Parlby, the UFWA's first president, lobbied for the establishment of a provincial Department of Public Health, government-provided hospitals and doctors, and passage of a law to permit nurses to qualify as registered midwives. The AAGN leadership opposed midwife certification, arguing that nursing curricula left no room for midwife study, and thus nurses were not qualified to participate in home births. In 1919 the AAGN compromised with the UFWA, and they worked together for the passage of the Public Health Nurses Act that allowed nurses to serve as midwives in regions without doctors. Thus, Alberta's District Nursing Service, created in 1919 to coordinate the province's women's health resources, resulted chiefly from the organized, persistent political activism of UFWA members and only minimally from the actions of professional nursing groups clearly uninterested in rural Canadians' medical needs.[44] The Alberta District Nursing Service administered health care in the predominantly rural and impoverished areas of Alberta in the first half of the 20th century. Founded in 1919 to meet maternal and emergency medical needs by the United Farm Women (UFWA), the Nursing Service treated prairie settlers living in primitive areas lacking doctors and hospitals. Nurses provided prenatal care, worked as midwives, performed minor surgery, conducted medical inspections of schoolchildren, and sponsored immunization programs. The post-Second World War discovery of large oil and gas reserves resulted in economic prosperity and the expansion of local medical services. The passage of provincial health and universal hospital insurance in 1957 precipitated the eventual phasing out of the obsolete District Nursing Service in 1976.[45] Recent trends After World War II, the health care system expanded and was nationalized with medicare. Currently there are 260,000 nurses in Canada but they face the same difficulties as most countries, as technology advances and the aging population requires more nursing care.Hi. New Zealand New Zealand was the first country to regulate nurses nationally, with adoption of the Nurses Registration Act on the 12 September 1901. It was here in New Zealand that Ellen Dougherty became the first registered nurse.[46] France Professionalization of nursing in France came in the late 19th and early 20th century. In 1870 France's 1,500 hospitals were operated by 11,000 Catholic sisters; by 1911 there were 15,000 nuns representing over 200 religious orders. Government policy after 1900 was to secularize public institutions, and diminish the role the Catholic Church. The lay staff was enlarged from 14,000 1890 to 95,000 in 1911. This political goal came in conflict with the need to maintain better quality of medical care in antiquated facilities.[47] Many doctors, while personally anti-clerical, realized their dependence on the Catholic sisters. Most lay nurses came from peasant or working-class families and were poorly trained. Faced with the long hours and low pay, many soon married and left the field, while the Catholic sisters had renounced marriage and saw nursing as their God-given vocation. New government-operated nursing schools turned out nonreligous nurses who were slated for supervisory roles. During the World War, an outpouring of patriotic volunteers brought large numbers of untrained middle-class women into the military hospitals. They left when the war ended but the long-term effect was to heighten the prestige of nursing. In 1922 the government issued a national diploma for nursing.[48] United States Nursing professionalized rapidly in the late 19th century as larger hospitals set up nursing schools that attracted ambitious women from middle- and working-class backgrounds. Agnes Elizabeth Jones and Linda Richards established quality nursing schools in the U.S. and Japan; Linda Richards was officially America's first professionally trained nurse, graduating in 1873 from the New England Hospital for Women and Children in Boston In the early 1900s, the autonomous, nursing-controlled, Nightingale-era schools came to an end. Schools became controlled by hospitals, and formal "book learning" was discouraged in favor of clinical experience. Hospitals used student nurses as cheap labor. Clara Barton and the American Red Cross Clara Barton gained fame for her nursing work during the American Civil War; admires hailed her as the 'Angel of the Battlefield".[49] In 1869, during her trip to Geneva, Switzerland, Barton was introduced to the Red Cross and Dr. Appia; who later would invite her to be the representative for the American branch of the Red Cross and even help her find financial beneficiaries for the start of the American Red Cross. She was influenced by Henry Dunant's book A Memory of Solferino, which called for the formation of national societies to provide relief voluntarily on a neutral basis. At the beginning of the Franco-Prussian War, in 1870, she assisted the Grand Duchess of Baden in the preparation of military hospitals, and gave the Red Cross society much aid during the war. At the joint request of the German authorities and the Strasbourg Comité de Secours, she superintended the supplying of work to the poor of Strasbourg in 1871, after the Siege of Paris, and in 1871 had charge of the public distribution of supplies to the destitute people of Paris.[50][51] When Barton returned to the United States, she inaugurated a movement to gain recognition for the International Committee of the Red Cross by the United States government.[52] In 1873, she began work on this project. In 1878, she met with President Rutherford B. Hayes, who expressed the opinion of most Americans at that time which was the U.S. would never again face a calamity like the Civil War. Barton finally succeeded during the administration of President Chester Arthur, using the argument that the new American Red Cross could respond to crises other than war such as earthquakes, forest fires, and hurricanes. Barton became President of the American branch of the society, which held its first official meeting in 1881.[53] Clara Barton was honored with a U.S. commemorative stamp, issued in 1948 The Red Cross helped in the floods on the Ohio river, provided Texas with food and supplies during the famine of 1887 and took workers to Illinois in 1888 after a tornado and that same year to Florida for the yellow fever epidemic. Within days after the Johnstown Flood in 1889, Barton led her team of 50 doctors and nurses in response.[54] In 1897, responding to the humanitarian crisis in the Ottoman Empire in the aftermath of the Hamidian Massacres, Barton sailed to Constantinople and after long negotiations with Abdul Hamid II, opened the first American International Red Cross headquarters in the heart of Turkey. Barton herself traveled along with five other Red Cross expeditions to the Armenian provinces in the spring of 1896, providing relief and humanitarian aid. The society's role changed with the advent of the Spanish-American War during which it aided refugees and prisoners.[55] Barton's last field operation as President of the American Red Cross was helping victims of the Galveston hurricane in 1900. The operation established an orphanage for children. As criticism arose of her careless management of the American Red Cross, plus her advancing age, Barton had to resign as president in 1904, at the age of 83. She had been forced out of office by a new generation of all-male scientific-experts who reflected the realistic efficiency of the Progressive Era rather than her idealistic humanitarianism. After resigning, Barton founded the National First Aid Society.[56] Hospitals The number of hospitals grew from 149 in 1873 to 4,400 in 1910 (with 420,000 beds)[57] to 6,300 in 1933, primarily because the public trusted hospitals more and could afford more intensive and professional care.[58] They were operated by city, state and federal agencies, by churches, by stand-alone non-profits, and by for-profit enterprises run by a local doctor. All the major denominations built hospitals; in 1915, the Catholic Church ran 541, staffed primarily by unpaid nuns.[59] The others sometimes had a small cadre of deaconesses as staff. Most larger hospitals operated a school of nursing, which provided training to young women, who in turn did much of the staffing on an unpaid basis. The number of active graduate nurses rose rapidly from 51,000 in 1910 to 375,000 in 1940 and 700,000 in 1970.[60] The Protestant churches reentered the health field, especially by setting up orders of women, called deaconesses who dedicated themselves to nursing services. The modern deaconess movement began in Germany in 1836 when Theodor Fliedner and his wife opened the first deaconess motherhouse in Kaiserswerth on the Rhine. It became a model and within a half century were over 5,000 deaconesses in Europe. The Chursh of England named its first deaconess in 1862. The North London Deaconess Institution trained deaconesses for other dioceses and some served overseas.[61] William Passavant in 1849 brought the first four deaconesses to Pittsburgh, in the United States, after visiting Kaiserswerth. They worked at the Pittsburgh Infirmary (now Passavant Hospital).[62] The American Methodists – the largest Protestant denomination—engaged in large-scale missionary activity in Asia and elsewhere in the world, making medical services a priority as early as the 1850s. Methodists in America took note, and began opening their own charitable institutions such as orphanages and old people's homes after 1860. In the 1880s, Methodists began opening hospitals in the United States, which served people of all religious backgrounds beliefs. By 1895 13 hospitals were in operation in major cities. well [63] In 1884, U.S. Lutherans, particularly John D. Lankenau, brought seven sisters from Germany to run the German Hospital in Philadelphia. By 1963, the Lutheran Church in America had centers for deaconess work in Philadelphia, Baltimore, and Omaha.[64] Medieval hospitals in Europe followed a similar pattern to the Byzantine. They were religious communities, with care provided by monks and nuns. (An old French term for hospital is hôtel-Dieu, "hostel of God.") Some were attached to monasteries; others were independent and had their own endowments, usually of property, which provided income for their support. Some hospitals were multi-functional while others were founded for specific purposes such as leper hospitals, or as refuges for the poor, or for pilgrims: not all cared for the sick. The first Spanish hospital, founded by the Catholic Visigoth bishop Masona in 580AD at Mérida, was a xenodochium designed as an inn for travellers (mostly pilgrims to the shrine of Eulalia of Mérida) as well as a hospital for citizens and local farmers. The hospital's endowment consisted of farms to feed its patients and guests. From the account given by Paul the Deacon we learn that this hospital was supplied with physicians and nurses, whose mission included the care the sick wherever they were found, "slave or free, Christian or Jew." [11] During the late 700s and early 800s, Emperor Charlemagne decreed that those hospitals which had been well conducted before his time and had fallen into decay should be restored in accordance with the needs of the time.[12] He further ordered that a hospital should be attached to each cathedral and monastery.[13] During the tenth century the monasteries became a dominant factor in hospital work. The famous Benedictine Abbey of Cluny, founded in 910, set the example which was widely imitated throughout France and Germany. Besides its infirmary for the religious, each monastery had a hospital in which externs were cared for. These were in charge of the eleemosynarius, whose duties, carefully prescribed by the rule, included every sort of service that the visitor or patient could require. As the eleemosynarius was obliged to seek out the sick and needy in the neighborhood, each monastery became a center for the relief of suffering. Among the monasteries notable in this respect were those of the Benedictines at Corbie in Picardy, Hirschau, Braunweiler, Deutz, Ilsenburg, Liesborn, Pram, and Fulda; those of the Cistercians at Arnsberg, Baumgarten, Eberbach, Himmenrode, Herrnalb, Volkenrode, and Walkenried. No less efficient was the work done by the diocesan clergy in accordance with the disciplinary enactments of the councils of Aachen (817, 836), which prescribed that a hospital should be maintained in connection with each collegiate church. The canons were obliged to contribute towards the support of the hospital, and one of their number had charge of the inmates. As these hospitals were located in cities, more numerous demands were made upon them than upon those attached to the monasteries. In this movement the bishop naturally took the lead, hence the hospitals founded by Heribert (died 1021) in Cologne, Godard (died 1038) in Hildesheim, Conrad (died 975) in Constance, and Ulrich (died 973) in Augsburg. But similar provision was made by the other churches; thus at Trier the hospitals of St. Maximin, St. Matthew, St. Simeon, and St. James took their names from the churches to which they were attached. During the period 1207–1577 no less than 155 hospitals were founded in Germany.[14] The Ospedale Maggiore, traditionally named Ca' Granda (i.e. Big House), in Milan, northern Italy, was constructed to house one of the first community hospitals, the largest such undertaking of the fifteenth century. Commissioned by Francesco Sforza in 1456 and designed by Antonio Filarete it is among the first examples of Renaissance architecture in Lombardy. The Normans brought their hospital system along when they conquered England in 1066. By merging with traditional land-tenure and customs, the new charitable houses became popular and were distinct from both English monasteries and French hospitals. They dispensed alms and some medicine, and were generously endowed by the nobility and gentry who counted on them for spiritual rewards after death.[15] According to Geoffrey Blainey, the Catholic Church in Europe provided many of the services of a welfare state: "It conducted hospitals for the old and orphanages for the young; hospices for the sick of all ages; places for the lepers; and hostels or inns where pilgrims could buy a cheap bed and meal". It supplied food to the population during famine and distributed food to the poor. This welfare system the church funded through collecting taxes on a large scale and possessing large farmlands and estates.[16] The first known nurse, Phoebe, was mentioned in Romans 16:1. During the early years of the Christian Church, St. Paul sent a deaconess Phoebe to Rome as the first visiting nurse. She took care of both women and men.[2] The declaration of Christianity as accepted religion in the Roman Empire drove an expansion of the provision of care. Following the First Council of Nicaea in 325 AD, construction of a hospital in every cathedral town was begun. Among the earliest were those built by the physician Saint Sampson in Constantinople and by Basil, bishop of Caesarea in modern-day Turkey. Called the "Basilias", the latter resembled a city and included housing for doctors and nurses and separate buildings for various classes of patients.[3] There was a separate section for lepers.[4] Some hospitals maintained libraries and training programs, and doctors compiled their medical and pharmacological studies in manuscripts. Thus in-patient medical care in the sense of what we today consider a hospital, was an invention driven by Christian mercy and Byzantine innovation.[5] Byzantine hospital staff included the Chief Physician (archiatroi), professional nurses (hypourgoi) and orderlies (hyperetai). By the twelfth century, Constantinople had two well-organized hospitals, staffed by doctors who were both male and female. Facilities included systematic treatment procedures and specialized wards for various diseases.[6] From its earliest days, and following the edicts of Jesus, Christianity had encouraged its devotees to tend the sick. Priests were often also physicians. According to the historian Geoffrey Blainey, while pagan religions seldom offered help to the infirm, the early Christians were willing to nurse the sick and take food to them - notably during the smallpox epidemic of AD 165-180 and the measles outbreak of around AD 250 and that "In nursing the sick and dying, regardless of religion, the Christians won friends and sympathisers".[7] Christian emphasis on practical charity gave rise to the development of systematic nursing and hospitals after the end of the persecution of the early church.[8] Ancient church leaders like St. Benedict of Nursia (480) emphasised medicine as an aid to the provision of hospitality.[9] Ancient Catholic orders like the Dominicans and Carmelites have long lived in religious communities that work for the care of the sick.[10] Before the foundation of modern nursing, nuns and the military often provided nursing-like services.[1] The religious and military roots of modern nursing remain in evidence today in many countries, for example in the United Kingdom, senior female nurses are known as sisters. Nurses execute the "Orders" of other health care professionals in addition to being responsible for their own practice. |
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