Dr. Jane Brooks, University of Manchester The UKAHN Bulletin
Volume 7 (1) 2019

Book Cover, District NurseSusan Cohen’s new book Images of the Past: The District Nurse is a lively narrative featuring some truly beautiful and provocative images. Virtually all the pictures are produced by courtesy of the Queen’s Nursing Institute and the QNI is to be commended for maintaining such a fascinating archive and for allowing the illustrations to be used in this book. Cohen is well known in academic circles for her excellent monograph on Eleanor Rathbone. In this meticulously researched volume she demonstrates an ability to move into writing for the interested public. She takes a broadly chronological approach starting with the early inspiration of William Rathbone in Liverpool, his employment of the excellent Mrs Robinson, his correspondence with Florence Nightingale and the first district nurses. Cohen cogently describes the somewhat ad hoc developments of the DN service throughout the country, which eventually culminated in the Queen Victoria’s Jubilee Nursing Institute Royal Charter in 1889 Chapters 2 and 3 consider the early years of ‘life on the district’ and the hardships that nurses, who had chosen this work, endured. Indeed, the reader may wonder why so many women chose this profession at all. Their work was arduous, often without the support of a doctor, their modes of transport varied and not always ideal and the homes they were given could leave much to be desired. Yet, the images Cohen offers in the book belie these difficulties, the nurses look interested in their work and patients, and content with life.

The book then takes the reader through two world wars and the inter-war period. I found it particularly interesting to read about the impact of those DNs left on the home front. Although nurses in the First World War were encouraged into active service, in the Second World War, they were actively discouraged and the 1943 Rules of Engagement order all but prevented experienced DNs from joining the military nursing services. The story is perhaps no more poignant when Cohen turns to those nurses who remained on the Channel Islands during the German occupation from 1940-45. This element of the narrative adds a novel dimension for those who have not read about the hardships of the Islands’ inhabitants. It also demonstrates that nurses faced the same consequences for dissension as other Islanders when they too secretly maintained a radio. The final chapters take the reader through the post-war era and the new NHS. Throughout the book Cohen enables the reader to appreciate the difficulties in funding skilled nursing for the sick poor. Each chapter offers vignettes of fund-raising activities, transport woes and the difficulties in asking patients and their families to pay subscriptions to a District Nursing Association. With the arrival of the NHS, whilst transport remained a perennial problem, funds were now available. This was a huge relief to many DNs as they no longer had to ask their patients for money. There were other changes, most particularly the introduction of men into district nursing and the increasing collaborations across nations that helped to create an international community of nurses.

Susan Cohen is to be commended for this book. However, I have two thoughts, first the focus on the QNI detracts from the work of other district nursing associations not affiliated to the QNI. Secondly the relationships between the doctor and DN, which were sometimes fraught, are dealt with too quickly. But these are minor issues. I have discussed the narrative here, but the book should also be seen for its fascinating images, which are difficult to describe in a review.