Guest post by Dr Thomas Harding, RN, PhD.
NSWNMA will host a forum on men in nursing this Wednesday 19 September. Here Thomas Harding looks back over the centuries at men’s role in caring for the sick and wounded. This is an edited version of Dr Harding’s paper. He can be contacted care of NSWNMA for the fully referenced version.
Even though men played a significant role in caring for the sick in colonial Australia, their contribution has received little attention. However, what emerges across a wide range of historical documents is that substantial numbers of men were employed in roles which entailed the provision of nursing care throughout Australia in the 19th century. Men’s lack of visibility in nursing history is not unique to Australia – worldwide it is difficult to find well-documented records of men’s provision of nursing care.
The modern era of nursing emerged in the late 19th century following the reforms initiated by Florence Nightingale. Nightingale’s philosophies led to the profession of nursing becoming associated with women and the disappearance of men from the role.
Nursing has become so associated with women that modern schools of nursing try to attract men with posters such as this, created in Oregon in 2002.
Two influences played a pre-eminent role in the evolution of modern nursing and men’s involvement in care of the ill: Christianity and warfare.
The foundation of the monastic movement in Christianity created not only centres of religious learning and devotion, but also centres of healing – nursing the sick was an important function of the monastic ideal.
With respect to warfare, men had long been involved in caring for the sick and wounded – for example, men were trained to nurse the soldiers of the Roman Empire.
The most famous association of nursing and warfare lies in the figure of Florence Nightingale. Before she went to the Crimea, male orderlies nursed the British soldiers, although they had no training, except through experience and by working closely with surgeons.
Hospital in a field during the American Civil War – men tend the wounded
In the American Civil War, men were also involved in caring for the sick and injured; the Confederate army designated 30 men per regiment to care for the wounded and remove those from the field who could not walk. The title of nurse, however, was only awarded to the women organised by Dorothea Dix, who was appointed Superintendent of the Female Nurses in the Union Army by the Secretary of War.
There were also groups of male volunteers on both sides who served as nurses. The most famous of these was the poet Walt Whitman. He is unusual in that he left a personal account of the care of the sick during the Civil War from a male perspective: two collections of poems, Drum-taps (1865) and Sequel to Drum-taps (1865-6), and a memoir, Specimen Days in America (1887). One of his most famous poems from this period is ‘The Wound Dresser’, which 150 years later still resonates as it describes activities and emotions that nurses continue to experience.
Nursing in colonial NSW
There is evidence that nursing care in colonial hospitals was provided by a mix of both males and females, mainly without formal training until the late 19th century. A history of Parramatta Hospital (1790-1818) reveals that “the sick of the day were cared for by incompetents, for the most part drunken men and in some cases drunken women”.
At the Sydney Infirmary (1820-1860): “Wardsmen cared for the male patients. These wardsmen were usually discharged or convalescent patients who had shown aptitude for the duties while they had been patients in the hospital.”
Stewards and nurses from the Brooklyn Navy Yard Hospital, US, approx 1901.
The use of the word ‘wardsman’ illustrates one of the mechanisms by which men’s contribution to nursing has been rendered invisible. The title ‘nurse’ became associated almost exclusively with women, while men delivering care similar to or identical with that of their female colleagues were variously titled wardsmen, stewards, orderlies, porters and attendants, etc. Often the work they undertook was circumscribed, such as the provision of care to groups of male patients which might have offended the sensibilities of a woman.
Wardsman of the Tate Hospital, Mr Montgomery, 1905 (State Library of Queensland)
The Nightingale Reforms: the exclusion of men
Sir Henry Parkes, the Colonial Secretary, was concerned about the appalling conditions at the Sydney Infirmary and requested Florence Nightingale to send qualified nurses to remedy the situation. In 1868, Lucy Osburn and five other Nightingale-trained nurses arrived in the colony.
Nightingale’s vision of nurses was decidedly female: “every woman is a nurse”.
The Nightingale model became ascendant in Australia and established nursing as a predominantly female profession. While an all-female nursing workforce became the norm in metropolitan areas, this was not the reality for all hospitals, particularly in rural areas.
While there were no legislative barriers to men becoming nurses, entry into schools of nursing was dependent on gaining the approval of the Matron. It appears that in metropolitan Sydney, at least, this was difficult to obtain. For example, at the Royal Prince Alfred Hospital (RPAH) in 1950, despite a shortage of nursing tutors, the application of two qualified Tutor Sisters – a married couple – from England was rejected because the Board was not prepared to employ a man.
Middlewood Hospital, Sheffield, England, school of nursing 1970s: Harold Johnson principal tutor teaching. (Photo by nurse Brian Holford). Men were present in nursing in the UK in larger numbers than in Australia at this time.
In fact, the first male nurse was not employed at RPA until 1966 with the appointment of Lance Waddington. It was a further three years before a man was accepted for general training at RPA and it was not until the 1970s that men were accepted for training at St Vincent’s Hospital (1972) and Manly Hospitals (1975). It is interesting to compare this with the example of Lismore Base Hospital, where the first male nurse Charles Burgess graduated in 1951 and through the 1960s and 1970s a handful of men followed in his path.
Men have had a long and significant association with nursing but it has been poorly documented, partly because of the problems with the nomenclature used to describe men in nursing roles. Men’s active involvement in nursing lessened in the late 19th century and Nightingale and her disciples certainly contributed to this phenomenon. The movement of men out of nursing also needs to be considered within the context of the dominant ideology of the Victorian era. This period saw the establishment of powerful male and female stereotypes, which are still influential today and acted to gender nursing as female.