Reviewed by Sue Hawkins
There is a huge lacuna in the historiography of the history of pre-reform nursing and nurses in England so Alannah Tomkins’ new book would be welcomed in any event. However, this book is a more than a simple gap-filler: it is a treasure trove of information and analysis which makes use of a dizzying array of primary sources and archival material to create a picture of nursing in this era. In the process Alannah has challenged the few previous attempts to investigate the subject, which are primarily based on post-reform writers with their own agendas, and as a result she is able to overturn existing stereotypes of these nurses as slovenly drunkards with a cruel streak. The book is worth reading for the bibliography alone.
The introductory chapter provides an excellent overview of the challenges of writing pre-reform nursing history and will be especially useful for readers who are new to the subject (which, given the lack of previous work, will be most readers); and then develops into a review of the historiography of the subject, which she describes in the most part as being ‘ahistorical’ in nature (with one or two obvious exceptions).
Alannah tackles the question of what or who is considered to be a nurse in this period and argues for a wide definition of the role. Rather than taking a chronological approach, she separates these pre-reform nurses into the locations in which they worked and studies each using a series of themes which run through the various chapters and are addressed through detailed and exhaustive archival research. Themes include relationships between nurses and their patients, their colleagues and other individuals they work with; the burden of the work, both physical and emotional; who these nurses were, their conditions of service and their working conditions. Within the latter, the idea of nursing as ‘dirty work’ occurs frequently: danger from infection, the handling of bodies, dirty laundry and, most frequently, the handling of the ubiquitous chamber pot – which gives rise to significant revulsion among nurses – all recur throughout.
Chapter one focusses on ‘domestic’ nursing, comparing the experiences of the often-unpaid care provided by family members, friends or colleagues, with that of paid nurses brought in to care for a sick family member in the home setting. While on the whole members of the former group are presented in the records as selfless carers, the latter are tainted by dint of their paid status and associated lack of emotional commitment to their patients. Alannah introduces the concept of the ‘anti-nurse’ to explain this phenomenon and makes a good case for this idea of ‘bad nursing’ being used by nurse reformers in the nineteenth century as a stark counterpoint to their ‘new’ nurses’. Many of the themes introduced in this chapter are picked up in subsequent chapters, which enables comparison across locations, identifying the similarities between them, and also areas of difference.
In chapters two and three, the location switches to institutional settings including the two oldest hospitals in London, St Thomas’ and St Bartholomew’s (chapter two) and the newly established provincial infirmaries (chapter three) which began to emerge during in the eighteenth century. This chapter particularly reflects the incredible archival research undertaken by the author: surveying nursing provision in thirty-six provincial hospitals using hospital records and histories. In chapter four the lens moves again to consider nursing provision in long-stay institutions focussing on the Royal Hospital Chelsea – an institution which cared for wounded and aged soldiers.
Up to this point, the nurses we encounter are mainly female, but Alannah argues that there is evidence of male nurses across all of the locations and time periods she has studied. In chapter five she discusses the difficulty in identifying male nurses, which she blames on a reluctance on the men’s part to acknowledge or record their own participation. Despite these difficulties, assiduous research has enabled her to identify some men who did take up nursing roles, from fathers taking care of their sick children in the domestic setting, prisoners taking care of fellow prisoners, and perhaps most well-documented, men working as ‘keepers’ in insane asylums. She describes men as ‘smuggling’ nursing into their other roles, as a ‘silent addition to their portfolio of labour’ (p. 250); and finds that while asylum keepers were indeed often cruel and violent, there are records of the opposite. Alannah argues that much of the brutality associated with keepers may have originated in the stress placed upon them.
The book closes with a study of military nurses and nursing during the French revolutionary wars of the late eighteenth and early nineteenth centuries (chapter six). Here, Alannah has a richer vein of material with which to work, and she produces a number of studies of individual women. Even here the archive accounts of soldiers’ wives, local women and paid nurses in military hospitals who undertook care of the wounded are few and far between; the work of women who travelled overseas with their military husbands are rarely included in the latter’s memoirs, and the women themselves rarely produced memoirs of their own. But more is known about the extraordinary response in Brussels in the aftermath of the Battle of Waterloo, which included large numbers of ladies of high social standing, who took up the nursing of the battle-wounded. Many accounts of these experiences survive, and Alannah suggests that their experiences and written accounts could be partly responsible for the later move to gentrify nursing.
It is impossible in a short review to include all the revealing evidence and new arguments contained in this book. Through her exhaustive research and refusal to accept previous (lazy) stereotypes, Alannah has been able to uncover a more nuanced account of nursing in the ‘pre-reform’ era, and to identify links between that period and what came next. It is a hugely important piece of work, and like Alannah, I hope this book spurs on future historians to follow her lead, to cast aside assumptions and stereotypes of twentieth century historians and, using her techniques, continue the search for the ‘real’ pre-reform nurses.