| Dr. Michael Young, Independent Scholar | The UKAHN Bulletin |
| Volume 7 (1) 2019 | |
You are being initiated into a marvellous work – a profession having sacrifice and service as its keynotes. Sacrifice of self or service for God, and what can be greater work than that.
Miss Chadwick addressing newly qualified nurses, the Class of 1934, at the Vellore Medical School Hospital, Tamil Nadu. (Editorial, NJI, December 1934, pp. 294-296)
Introduction
The Nursing Journal of India (NJI) was first published in 1910 as the official organ of the Trained Nurses Association of India (TNAI) which had been established two years earlier. Membership of the TNAI was open to nurses who had passed successfully a three-year training programme in a general hospital. The objectives of the TNAI were to: uphold in every way the dignity and honour of the nursing profession, to promote a sense of esprit de corps among all nurses, to enable members to take counsel together on matters affecting their profession. (Editorial, NJI, August 1917, p. 164)
Through the NJIthe TNAI campaigned for greater respect for trained nurses and for official recognition of their skills as professionals. The journal also served as a newsletter linking nurses across a country nearly the size of Europe.
This article will identify themes in the NJI illustrating the lives of nurses in British India between 1910 and 1939. It will explore the battle for recognition of nurses at Government of India level, the introduction to its ranks of men and of nurses from the Anglo-Indian and Indian communities, the lack of primary resources solely devoted to mental nursing and the overarching legacy of the influence of Florence Nightingale1.
Nursing in India
In the 1920s and 1930s several correspondents contacted the NJI concerned about the lack of a history of their profession in India. The importance of an organisation of having such a record of its achievements has been highlighted by Peter Nolan, himself a qualified nurse. He wrote that ‘having a history confirms the legitimacy of the service one provides.’ (Nolan, 1993, p.1)
However it was not until 1958, eleven years after the departure of the British, that the first history of nursing in India was produced by Alice Wilkinson (Wilkinson, 1958) a former editor of the NJI. Wilkinson was one of the most experienced and best known nurses in India having been the Nursing Superintendent at St Stephen’s Hospital in Delhi from 1908 to 1938 and the President of the TNAI from 1940 to 1947. Her skills, though, were not those of an objective academic and her slim tome of only 116 pages took the form of an uncritical paean to those women who had shared her vocation.
Wilkinson stated that nursing in India began in about 1500 BC. She declared that by 700 BC Benares had become the centre of medical education in India with the most advanced period for medicine in the sub-continent being from 250 BC to 750 AD. There followed a decline and public hospitals disappeared around 1000 AD before being revived by the British Army. As early as 1707 a hospital had been opened for East India Company soldiers and seamen initiating the nursing link with the military. A key date in the modern history of nursing in India was 1888 when Miss Catharine Grace Loch as Lady Superintendent arrived in Bombay with ten qualified nurses (Healey, 2013, pp. 70-71) to form the Indian Army Nursing Service (Archives, King’s College, London)2.
The first meeting of professional nurses in India took place in Lucknow in 1907 leading to the establishment of the TNAI the following year. Prior to this there had been a number of organisations representing nurses in different parts of India. The Up Country Nursing Association established in 1892 and later renamed the Punjab Nursing Association was intended primarily to support the white European community. In 1906 Lady Minto’s Indian Nursing Association, named after the vicereine who created it, was set up to provide qualified nursing sisters to nurse Europeans in their own homes in remoter stations throughout the Raj. The Association of Nursing Superintendents of India was founded in 1905 for senior nurses only. It combined with the TNAI for the purpose of affiliation to the International Council of Nurses in 1912 and the two bodies were formally amalgamated under the TNAI name in 1922.
Wilkinson catalogued the creation of hospitals in India up to Partition in 1947. Her panegyric made only minor references to the inadequacies of the nursing service as identified by the Bhore Report of 1946 (Government of India, Bhore Report, 1946). Sir Joseph Bhore, a senior member of the Indian Civil Service, had been charged by the Government of India with determining the state of health care services as the end of the Raj approached. Bhore criticisedthe provision, or more accurately the lack, of medical care across the country and its generally poor quality. Commenting on nurses his report told of ‘inadequate numbers and insufficient training alike [which] contributed to make the standard of service of an extremely low order.’ By the outbreak of the Second World War there was only one trained nurse per 50-60,000 people in India (Wilkinson, 1958, p. 86). Whilst the nursing profession cannot be held responsible for the poor state of nursing services across colonial India the Bhore Report had confirmed its weakness. It had failed to make a consistent impact on the colonial authorities for improvements in nurse provision.
The traditional view of nursing history such as Wilkinson’s has been criticised by Anne Borsay and Pamela Dale as too preoccupied with elite figures and national organisations, as too focussed on female nurses and as stereotypical when discussing class and race. (Borsay and Dale, 2015, p. 4) The NJI can also be faulted for these obsessions together with its deep interest in royalty. As illustrated below the journal never criticised the empire but focussed on the practicalities of nursing tasks. The agency of the professional role enabled imperialism to continue unquestioned in the background.
Methodology
Much of the information for this article was taken from copies of the NJIlocated at the British Library. A recent historian of modern Indian nursing has described the NJI as an almost unique resource in women’s history being a virtually uninterrupted month by month record of women’s organisational work and professional identity (Healey, 2010, p. 56). This article makes use of this valuable paper archive to address the impact of the NJI in making the female nursing voice heard in colonial India from its origins in 1910 to 1939 when the outbreak of the Second World War accelerated the end of the Raj. The few male voices published were usually asserting the fundamental importance of religion to nursing care or gave a male psychiatrist’s view of what he demanded from a female nurse.
Academic criticism from scholars currently working in the field of nursing in the British Empire will be employed to give context to the findings of the article. The sources for the history of mental nursing in India are sparse as the present author has learnt whilst researching there in the last few years for his PhD.
The Nursing Journal of India – early days and common themes.
The NJIwas A5 in size and normally consisted of 20 to 28 pages of copy. In its first few years it led a precarious existence as it struggled to find a consistent long term editor. The issue for May and June 1919 was a combined one and, because of the demands of her military duties, Miss Bonser had to give up the editorial role and she signed off with a rousing half page quotation from Kipling’s If. Her optimism proved successful and the journalrecommenced publication in March 1920. It has continued as a monthly to the present day.
Several common themes in its content emerged in the first dozen years of the journal. There was an assumption in the early years that its readership were practising Christians with prayer being an important part of their lives. The NJIpromoted Christian ideals and gave a Christianised discourse of duty, service, and humility. Thus each edition contained a homily, entitled ‘For the Quiet Hour,’ sometimes three pages long, based on a passage from the Bible. Significantly ‘For the Quiet Hour’ gradually reduced in size until by the mid 1930s it only occupied a third of a page. By then more space was dedicated to articles on practical nursing, reflecting the professional priorities of the journal’s editors. Clearly evident was the pride amongst its readership in their status as being qualified British nurses in a generally hostile physical environment. Its patriotism and loyalty to King and Empire was accompanied by great interest in European royalty in descriptions of their weddings and coronations. Originally the NJI maintained the air of an informal and enthusiastically produced school magazine created for a small number of female British professionals with common origins and interests, though spread across a vast sub-continent.
As the First World War progressed the NJI began to give greater coverage to the expanding role played by nurses in caring for the allied wounded in Europe. The journal carried its first ever photograph in March 1918 which accompanied an article by Miss C. B. Allinson entitled ‘A Day with the Warriors’ (Allinson,NJI, March 1918, pp. 6-8) it pictured the Karachi War Hospital which had been designed to cater for wounded Indian soldiers from the actions in Mesopotamia.
Two specific articles are useful in helping understand the underlying imperial ethos of the publication. The July 1916 edition published a three page sermon on death. It began by asking nurses to reflect on ‘the passing of our great warrior-statesman, Lord Kitchener’ who had recently drowned at sea. It continued with the need to have a strong Christian faith whilst nursing wounded soldiers who might not survive (MAC, NJI, July 1916, pp. 136-138). In September 1917 (Anonymous, NJI, September 1917, pp, 195-196) the NJI reported that large numbers of portraits of Her Majesty Queen Mary had been received by the vicereine, Lady Chelmsford. These were for distribution amongst the widows, mothers and daughters of Indian officers and soldiers who had been killed during hostilities in Europe and Mesopotamia. Each portrait was accompanied by a note of thanks from the Queen and her expression of deepest sympathy for their loss for their service to the British Empire. There were no records in the journal of the recipients’ response to their gifts. The news was related by the journal without question or challenge.
Each edition had an original poem which was often a nurse’s nostalgic view of Home, as Britain was generally known. The monthly Letters to the Editor page might describe interesting surgical operations which the writer had attended or a nurse’s holiday in Kashmir or Europe. A practical section entitled ‘When Found Make A Note Of’ encouraged readers to send in practical suggestions to make daily life in India easier. Thus instructions on how to make Beef Tea Custard for Invalids or how to prevent snakes entering hospitals were shared with a readership likely to be confronted regularly by such challenges. Many nurses in India were inveterate letter writers who might have welcomed the advice that a packet of letters sealed with the white of an egg could not be steamed open. The letters reinforced the notion of a community enthusiastically sharing their experiences, enjoying their imperial sojourn and their professional development despite the hardships of daily living.
Alongside these more practical contributions was educational material intended to develop nursing skills. Every edition had articles, often reprinted from British nursing and medical journals, giving information on such matters as how to recognise various diseases to be found in India such as blackwater fever or rabies or how to nurse particular conditions. Other topics ranged from an outline of recent knowledge linking insects with infectious diseases, to techniques in the nursing of venereal diseases or the management of complications in shoulder fractures as the tone of the journal became more scientific. The growing importance for nursing of the developments in psychology became regular features. Articles were sometimes serialised and so, for example, an original paper on tuberculosis by Lt Col S E Evans of the Indian Medical Service was printed in eleven parts across editions in 1916 and 1917. Monthly pages were dedicated to Health Visitors and Midwives which illustrated the breadth in interests of the NJIreadership. A Student Nurses Association affiliated to the TNAI was set up in 1930 followed by regular articles contributed by its members. The latter were no doubt stimulated by the frequent publication in the NJI of recent questions from Indian nursing examination papers. In 1927 the NJI had an appointments vacant section and was later to establish an employment bureau for nurses in India.
The journal carried regular adverts, presumably to ensure extra funding for its continuation. These were geared at the duties of nurses and included contributions for Glaxo which ‘builds bonnie babies because it agrees with them just like breast milk’ and ‘is the food on which the children of 5 Royal Nurseries have been successfully reared.’ The British Express Dairy Butter based in Bombay pronounced that its product was ‘fresh and absolutely pure’ and not ‘dangerous.’
One characteristic of the NJIwas its international outlook. Developments in nursing in the USA, and the white dominions, and in Britain itself, were covered regularly.InHealey’s view the internationalism of nurses defined a role for them in the cultural project of imperialism. She saw the nursing leadership developing and sustaining an international ethos which enabled them to look abroad and to ignore nationalism in India. They were prepared to criticise government but only in its relation to their own profession.
The presence of Florence Nightingale
The legacy of Florence Nightingale permeated the NJI. She never went to India but, through her numerous contacts at the highest levels in Britain and India, she proved to be a very powerful, inspirational influence on the nursing profession there (Mowbray, 2008). She made a major contribution to the Royal Sanitary Commission on the Health of the Army in India in 1863 which led to improvements in hospital hygiene and a consequently dramatic reduction in mortality rates amongst soldiers being treated in hospital (Bostridge, 2009). She met or corresponded with every viceroy from the first one appointed in 1858 until 1899 and received India Office papers regularly until 1906. Her advice was generally welcomed as many of these imperial envoys had little knowledge of the sub-continent before their departure (Mowbray, 2008).
The motto of the TNAI was ‘Lighted to Lighten’ and the Nightingale lamp became the permanent symbol of the organisation and was depicted on each editorial page of the NJI. It continued after 1947, being superimposed on a map of the newly independent India.
The symbolism was carried through all levels. The NJI felt it important enough to acknowledge the death of a ward orderly who had worked with Nightingale in the Crimea 60 years earlier. At the TNAI annual meeting in 1932 a brick from Nightingale’s house in South Street, London, where she lived and died, was acquired for the organisation and displayed at the meeting (Editorial, NJI, January 1933, p. 29). The NJIreported in 1933 that a ‘Florence Nightingale Corner’ had been created in a Calcutta hospital as a place for reflection and inspiration (Editorial, NJI,January 1933, p. 28). The journal recommended that its installation should be repeated across all hospitals in India. In the mid 1930s the TNAI set up standing committees to promote aspects of its work, one of which was the Florence Nightingale Nursing Committee which championed nurse training.
In May 1934 a Cabaret and Dance in aid of the Florence Nightingale Fund had been held at the Lady Curzon Hospital in Bangalore. The Fund raised money for the education of Indian nurses. The event was described in detail in the August edition. It began with a pageant of nurses in the uniform of different hospitals from past and present times. It featured nurses dressed as Florence Nightingale, Edith Cavell and other women who had contributed to nursing history (Anonymous, NJI, August 1934, pp. 196-197).
Nightingale’s continued importance as a role model was seen from personal experience. In 2015, as part of his Ph D research I visited the Deans of two separate schools of nursing in Gujarat. Each had busts and photographs of Florence Nightingale garlanded with fresh flowers in a prominent position in their offices. The traditional reverence for the founder of their modern profession was instilled by the frequent references to her in the pages of the NJIfrom its inception. The strength of her influence exists over 70 years after Independence and the headquarters of the TNAI remains on Florence Nightingale Lane, New Delhi.
The campaign for nurse registration in India
Nurse Registration Acts had been passed for England and Wales, Ireland and Scotland in 1919. Since the eighteenth-century India had been divided for administrative purposes into the three Presidencies of Bengal, Bombay and Madras. Registration of nurses had been achieved in Madras and Bombay, and also in the neighbouring colony of Burma, by 1930 but not in Bengal until 1935. In Madras and Bombay the governments had made a reciprocal agreement with the British government that qualifications and experience of nurses trained and employed in these two presidencies would be recognised in Britain. This meant that nurses could transfer back to Britain and begin work there immediately. This did not, however, apply to those who had trained and worked in Bengal. Nursing in India developed in a piecemeal manner in these three regions and its influence varied in each. Nurse training in south India was dominated by Christian missions of numerous denominations from various European, American and the white imperial dominions. Until the late 1920s when training courses in India were better established this requirement excluded most men in India, most Indians and many of those who worked in mental hospitals.
A TNAI goal, promoted consistently in the NJI, was to achieve the India-wide registration of trained nurses. It was seen as the essential foundation on which to construct a modern nursing profession. In September 1916 the editor of the NJI Mrs M Barr informed her readership that the first fully equipped and staffed British field hospital had been sent to Moscow to be attached to the Russian army. Her delight in this innovation was tempered by her regret that it had been placed in the charge of two titled British ladies neither of whom were trained nurses. She declared that ‘When State Registration [of nurses] is an accomplished fact such a thing would be impossible’ (Editorial, NJI, September, 1916, p. 188).
A further editorial, December 1916, highlighted the challenges presented to the nursing profession by the employment of Voluntary Aid Detachments (VAD) as part of the war effort. The TNAIdescribed VADs as ‘not nurses in the hospital sense of the word’ and therefore they should not be regarded as such by the authorities or by themselves, and should not be paid the same as qualified nurses. To the NJI they were ‘helpers’ and were ‘untrained or very partially trained.’ The journal accepted that they might be well-intentioned but they were sometimes ignorant or unskilful and such ignorance had led to the loss of limbs amongst soldiers (Editorial, NJI, December 1916, p. 242).
A third editorial in February 1918 described VADs as posing a serious risk to the whole profession if they did not undergo a recognised training course. The editor said that the VAD training consisted of only six weeks of lectures in First Aid and Home Nursing before working on hospital wards. For this, she said, the VADs were paid ‘a very high salary’ sometimes higher than that of trained nurses. In February 1917 she argued that the employment of efficient, though unqualified, housekeepers would remove unnecessary duties from the matrons of hospital wards enabling the latter to spend more time practising their skills (Editorial, NJI, February 1917, pp. 28-29). She summarised the desired objective proposing that under State Registration: nurses will become a recognised power with definite aims. Their strength and unity will be brought to bear on all vexatious problems and the best solutions found (Editorial, NJI, March 1917, p. 55). Such an outcome would ensure that their voice would be heard clearly and forcefully.
In March 1934 the NJIreported that The Statesman, an influential weekly newspaper in Calcutta had issued an editorial supporting the Bengal Nurses Registration Bill which had been proposed by the provincial legislature (Editorial, NJI, March 1934, pp. 58-59). It was enacted the following year. The campaign had little effect on government and the anomaly remained which meant a nurse trained in Calcutta could not work in Britain under a reciprocal agreement whereas a nurse trained and qualified in Madras could.
This inability to influence government highlighted the lack of legitimacy proposed by Nolan. It was recognised in 1934 by Miss Chadwick in her presidential address to the TNAI annual conference. She lamented the fact that the nursing service ’does not have a name amongst Governments of India’ and that it was ‘a subordinate medical service,’ that is secondary to the medical profession (Editorial, NJI, January 1935, pp. 5-6). Nurses had realised, in the manner of Nolan’s assertion, that a definitive history of their discipline might give them greater credibility and authority in the world of health care in India.
The frustrations continued and in February 1939 the editor of the NJI expressed her anger that the TNAI had not been consulted by the Madras Government in its proposal to reorganise its provincial nursing service (Editorial, NJI, February 1939, p. 30). She stressed that nurses in India owed all the progress of their profession to the work of its association. However, the failure of the TNAI to be recognised as a consultative body indicated its lack of importance, and its lack of a name, in the eyes of government.
Indian and Anglo-Indian nurses
From its outset the NJI was aware of the difficulty of promoting the profession amongst Indians. In March 1918 Miss Wingate observed that Indian girls presented difficulties not faced by English girls seeking a nursing career. For Indians, she stated, it was not ‘a noble calling that any girl of however high a family may well be proud to take up,’ as might be the case in Britain. This prevented many middle class women joining the profession. In India, she said, ‘the old idea that work of any kind is degrading, dies hard’ (Wingate, NJI, March 1918, pp. 69-70). Miss Wingate was also aware that an Indian girl carrying out a nurse’s duty might break caste through touching people or objects and so diminish her status within her family and community.
Language describing attitudes and actions towards Indians was not always restrained. In an anonymous article about nursing in a zenana hospital, a women-only hospital into which men were not normally allowed entry, in 1900 a British nurse wrote of a three-day strike by Indian nurses who had refused to cooperate with English lady doctors and deliberately avoided the nursing sister. Eventually the latter located the ‘leader of the opposition’ and gave her ‘a good beating … so much so that she hurt her own hand in the process’ (Anonymous, NJI,January 1917, pp. 9-11).The sister believed her physical intervention had worked and was justified as it led to a general improvement in the work of the Indian nurses who began to take a pride in their appearance.
Yet times were changing and Indian women were being more accepted and given responsibilities equivalent to British nurses. Thus, as a practical example, in July 1917 a letter to the editor considered the advisability of Indian nurses being allowed to give hypodermic injections to patients (Letters to the Editor, NJI, July 1917, p.153). After deliberation the author concluded that such skilled practices by Indians were acceptable. During the 1930s the increasing importance of Indians for the nursing profession in India was becoming apparent. The first article by an Anglo-Indian came in 1931 when Miss Lavinia Mewa Raw wrote of the pride in her vocation in becoming a nurse (Raw, NJI, September 1931, pp. 229-233). A photograph of her was included, the first time any author had been so honoured.
Such changes were consolidated when the NJI reported that in 1933, for the first time, one of the two delegates from India to the International Council of Nurses conference was an Indian (Editorial, NJI,June 1933, p. 166). The event was held that year in Paris and Brussels. This was a landmark event highlighting a move towards racial equality and contrasting with the beatings of 1900. The numbers of Indians joining the TNAI was increasing. In September 1934 its membership was 808 of whom 110 had Indian names (List, January 1935, NJI, Endpiece). It is highly likely that more were Anglo-Indian but their names were often similar to British nurses and hid their origins on paper.
In 1934 the NJIrecorded that there were now 116 recognised Schools of Nursing in India of which 66 were based in Mission Hospitals (News item, NJI, February 1934, p. 37). In 1934 Miss Chadwick, the President of the TNAI, gave each newly qualified nurse their own lamp at a lamp-lighting ceremony in Vellore. She urged them to take the Florence Nightingale Pledge and go forth boldly to a life of self-sacrifice and service. The list of recipients indicated that their names were mostly Indian, evidence of the growing importance of non-white nurses in the country and by the early 1930s there was the occasional journal page in Hindi.
Official endorsement of the importance of Indians to the nursing profession came in 1936 when an Indian, the Maharani of Travancore, became patroness of the TNAI. The NJI printed a full-page photograph of her. Previously the patroness had always been a titled British woman, either the vicereine or the wife of a governor-general.
Further evidence that the TNAI had moved away from its initial narrow roots and was beginning to tackle the issues raised through the growing diversity of its membership came in May 1936. An article was published by Miss Mottram of Redfern Memorial Hospital in Mysore entitled ‘Vernacular Education’ (Miss Mottram, NJI,May 1936, p. 87). Training for nurses was in English as were the text books. The first language of many trained nurses was not English but they needed, especially in rural areas, to use vernacular languages so that their patients could understand their directions. Miss Mottram stressed that it was vital that nurses had a sound awareness of local words which might assist their caring duties.
The difficulties inherent in running the TNAI were highlighted in 1934 when the logistics in organising its executive committee were revealed (Editorial, NJI, February 1934, p. 37). In July 1932 the meeting was held at Nagpur close to the geographical centre of India. All the delegates made a round trip of more than 1500 miles and all their journeys took more than 24 hours. However, by 1935 the TNAI was confident and financially viable enough to appoint its first full time paid secretary, Miss Diane Hartley, who also edited the NJI(Editorial, NJI, December 1935, p. 229).
All the delegates in Nagpur in 1932 appeared to have been British. However, by 1939 of the seven provincial secretaries for the TNAI, three appeared to have Indian names showing how Indians were becoming more significant to the profession in India. By the end of the Second World War 80% of qualified nurses were Anglo-Indian or Indian and Anglo-Indians still form a substantial number of the professional body of nurses in India today.
One weakness of nurse organisation seemed to be its philosophy of self-effacement. In Healey’s view the profession’s emphasis on service and self-sacrifice had created the stigmatisation of nurses and generated a tradition of low pay and exploitation (Healey, 2013, p, 75). Some private ‘nursing homes’ had been exposed as brothels and the NJI periodically alerted their readers to the dangers of being considered as prostitutes in parts of India, because of the sometimes intimate tasks they performed as part of their duties (See, for example, News item, NJI, February 1939, p. 50). Healey believed that nuns had unintentionally played a significant role in this devaluing of the nurse’s position especially in South India where the former played a key role in nurse education. She argued that nuns, with their strict rules of poverty and obedience, had reinforced the low status of nurses (Healey, 2013, p. 35).
Male nurses and the power problem
Male power of the kind displayed by male doctors was a problem for the female nursing establishment in India. Nurses generally deferred to doctors as will be illustrated below in their relationship with psychiatrists. One intervention indicated, however, that some were prepared to voice their opposition at high level to the dominant male hierarchy. In 1913 twelve nurses took the serious step of writing to Lord Willingdon, the Governor of Bombay, to protest at the high handedness of the doctors with whom they worked (Harrison, 2009, p. 28). His responses are not known so there can only be speculation as to the impact of this rare breach of deference to medics.
By the mid 1930s the TNAI had become a firmly established representative body for qualified nurses. Addressing its annual conference in 1935 its president, Miss Frodsham, declared that one of the main issues for her profession was that the power of selection for new nurses, or for their promotion, lay solely with men, the hospital surgeons (Miss Frodsham,NJI, January 1936, pp. 7-8). She said that nursing superintendents, who were all women, should have the power of appointment. She recognised, though, that the nursing profession lacked the courage to challenge this male power.
Whilst the power of male doctors was visible and understood there had developed a tradition of men carrying out nursing duties in military and psychiatric hospitals. Their status was generally low and they were often regarded as unskilled assistants or servants. In 1894 Miss Loch initiated training for ward orderlies. The latter were mostly serving soldiers who volunteered to do four hour shifts in a hospital to relieve the tedium in barracks before the excitement of military activities (Miss Loch, Nursing Record, 27thSeptember 1888, p. 348).
Throughout the 1920s references in the NJIto male nurses were rare and usually related to serving soldiers acting as ward orderlies. However new ground was broken in August 1937 when an editorial announced that a ‘Men Nurses’ section was to be included for the first time (Editorial, NJI, August 1937, p. 236). The first article was six pages long and contained a report of a Nurses Auxiliary conference by a man who had attended. The first page related to the proceedings but the remaining five took the form of a travelogue describing how much he had enjoyed the countryside which had been new to him. In November 1937 there were articles on the work of male nurses in each of the three British armed services, in the London County Council and at Long Grove Mental Hospital in Epsom. In the same edition another male nurse wrote about his work nursing patients with oral cancer (Anonymous, NJI, November 1937).
The new approach was consolidated when in June 1938 when a double size edition was produced ‘dealing entirely with the work of ‘Men Nurses’ (Anonymous, NJI, June 1938). The journal recorded that the TNAI now had 20 male members of which 17 were classed as ‘Local,’ which suggested they were Anglo-Indian or Indian, and three as ‘Overseas,’ who may have done military service. A ‘Local’ difficulty identified was that although Christian missions were the main source of employment for male nurses only a few accepted men on the three-year training course required for TNAI membership.
The NJI and mental nursing
At the back of each copy of the journal was a list of new TNAI members and at least annually the full list of nurses and their addresses or workplaces was printed. The list indicated hardly any members being based in mental hospitals in the time period considered in this paper. This reflected the general indifference of the NJIto mental nursing and did little to promote those in mental hospitals joining the ranks of qualified nurses. It asserted that men had worked successfully in TB sanatoria and in mental hospitals, implying that these were more suitable spheres for the male caring role (Miss Watts, NJI,November 1931, p. 286). An eight page article in 1923, which was unusually long for the NJI, on past and future of nursing in India made no reference at all to mental nursing as if it did not feature in the plans of the TNAI (Anonymous, NJI, January 1923, pp. 28-35).
What male psychiatrists required of female mental nurses was clear. In April 1923 Dr Butcher of the Indian Medical Service gave his opinion on the qualities required of a nurse whom he assumed was female. She had to be tall and strong as ‘maniacs … have an uncanny way of trying to take advantage of a short person.’ He asserted that ‘she must be cheerful and patient; a nervous woman is quite useless.’ She also had to be wary of ‘melancholics’ who were educated and so might be able to conceal their mental suffering (Butcher, NJI, April 1923, pp. 87-92).
In 1930 Lt Col Owen Berkeley-Hill, the medical superintendent of the European Mental Hospital at Ranchi in northern India issued Some principles of mental nursing.He dictated a comprehensivelist of qualities which he required from a nurse. She had to be female, as because of modern treatments and medication men were no longer needed in the role. She must have a God-given gift of saying and doing, without hesitation or apparent effort, exactly the right thing in the right way and at the right time.And she need ‘not always [be] the cleverest or the best educated woman’ (Berkeley-Hill, NJI, June 1930, p. 127). This truly perfect Angel on the ward was needed, and would profit if she adhered to male medical instruction. Berkeley-Hill was invited to address the TNAI Annual Conference in 1932 where he spoke on The Psychology of Nursing. Adding to his earlier instructions he stressed that the nurse must know her own faults, both conscious and unconscious, to be successful in her duties (Berkeley-Hill, NJI, January 1933, p. 18).
Despite Berkeley-Hill’s dismissal of the need for male mental nurses there were some employed in India. In one letter to the NJI a Mr R. A. Andrews objected strongly to being called an ‘Overseer’ or a ‘Mental Attendant,’ terms which were in use a century before (Andrews,NJI, April 1927). He wrote that he had studied and qualified in England and had practised nursing in the USA where he was allowed to use the initials R.N. (Registered Nurse). He wished to be recognised in India as a qualified and experienced professional.
Training for mental nurses in India was limited. In 1933 Miss Masters reported that she did not know of any mental hospital in India which had a school of mental nursing attached to it (Masters, NJI, December 1933, p. 368). Various references had been made in the journal indicating that the provision of mental nurse training relied on the interests of psychiatrists in lecturing on the topic.
Conclusion
The article has considered the role of the NJI in the professional development of nursing in India between 1910 and 1939. The NJIcan be criticised for its preoccupation with elitism and organisational structures together with its deep interest in royalty. Nevertheless, it proved successful in giving nurses a voice by linking them together across India and by responding to individual interests and so maintaining a loyal, professional readership. The journal was able to combine its strength as a community newsletter with that of an educator in new scientific techniques of nursing.
However, this research has identified that the NJI had less success in promoting the status of the nursing profession in India and clearly failed in achieving a single registration body for the country. It published articles which showed that nurses recognised their inferior position in terms of power and influence when compared to the male dominated medical profession. The NJIgradually embraced the rising number of Anglo-Indians and Indians including men who sought to become respected nurses.
The journal maintained an international outlook but never challenged imperialism. Until 1939 at least it maintained the front of a proud profession doing ‘marvellous work’ where the imperial project was a given. This study of the NJI has revealed a journal which never quite seemed comfortable with the changes growing around it in India.
References
Primary sources
Government of India:
http://www.nhp.gov.in/sites/default/files/pdf/Bhore_Committee_Report_VOL-1.pdf The Bhore Report, The Report of the Health Survey and Development CommitteeGovernment of India, Calcutta, 1946, pp. 169-172. (Accessed 3rdSeptember 2018).
The Nursing Journal of India:
Allinson, Miss C. B. (March 1918) NJI, ‘A Day with the Warriors,’ vol. ix, no. 3,
pp. 6-8.
Andrews, Mr R. A. (April 1927) ‘Letter to the Editor,’ NJI, vol. xviii, no. 4.
Anonymous(June 1938) NJI, vol. xxix, no. 6.
Anonymous (August 1934) ‘Cabaret and Dance at Bangalore in Aid of Florence Nightingale Fund,’ NJI, vol. xxv, no. 8, pp. 196-197.
Anonymous, (January 1923), ‘Indian Nursing- Its past and its future,’ NJI, vol. xiv, no. 1, pp. 28-35.
Anonymous, News item, (February 1934) NJI, vol. xxv, no. 2, p. 37.
Anonymous, News item, (February1939) NJI, vol. xxx, no. 2, p. 50.
Anonymous, (January 1917) ‘Nurses and Nursing in a Zenana Hospital in 1900,’ NJI, vol. viii, no. 1, pp. 9-11.
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- From 1911 the official definition of Anglo-Indian was someone of mixed British and Indian racial heritage having a British relative on the male side and this definition is used in this article
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