One hundred years of wartime nursing practices, 1854–1953

Jane Brooks, Christine Hallett, Jane Brooks, Christine Hallett

• Publisher: Manchester University Press
• Year: 2015
• Print ISBN: 9780719091421
• eBook ISBN: 9781526101525
• Edition: 1
• Topic: Literature
• Subtopic: English Literary Criticism
• Index: Literature

This book examines the work that nurses of many differing nations undertook during the Crimean War, the Boer War, the Spanish Civil War, both World Wars and the Korean War. It makes an excellent and timely contribution to the growing discipline of nursing wartime work. In its exploration of multiple nursing roles during the wars, it considers the responsiveness of nursing work, as crisis scenarios gave rise to improvisation and the – sometimes quite dramatic – breaking of practice boundaries. The originality of the text lies not only in the breadth of wartime practices considered, but also the international scope of both the contributors and the nurses they consider. It will therefore appeal to academics and students in the history of nursing and war, nursing work and the history of medicine and war from across the globe.

Part I

Gentlemen’s wars

1

Class, gender and professional expertise: British military nursing in the Crimean War

Carol Helmstadter

Modern historians have suggested that nursing in the Crimean War was largely a form of housekeeping and that the only major contributions made by the female nurses whom the government sent to the East were the introduction of night nursing and small personal attentions to the soldiers.¹ Certainly, the roots of hospital nursing did lie in domestic service but did military nursing in the 1850s really largely consist of household duties? War and other emergencies test the mettle of nurses, often increasing their competencies, expanding their scope of practice and demonstrating more publicly the abilities of a historically undervalued profession. The Crimean War 1853–56 provides an especially interesting example because nursing itself was undergoing a profound transformation at the time.

At the beginning of the nineteenth century nurses were fundamentally charwomen who primarily did the laundry, cleaning, sewing and cooking. These were indeed their principal duties but they did help with the less important parts of patient care – ambulation and cleaning up after all the bleedings, vomitings, purgings, and washing incontinent patients.² These nurses needed absolutely no qualifications or hospital experience to be hired at full salary and they reported to a matron who was not a nurse but rather a housekeeper who had no responsibility for nursing care.³

By 1854, however, the new scientific medicine had become established in the London teaching hospitals, transforming British medicine and shifting the centre for medical research and education from Edinburgh to London. Because it treated more acutely ill patients and used supportive, as opposed to depleting, therapies the new hospital practice made the old nurses obsolete.⁴ The new medicine required reliable, clinically experienced nurses who could take responsibility for critically ill patients and carry out medical orders intelligently and with good judgement. By the 1850s some hospital nurses and some religious Sisters met these criteria but they formed a tiny minority of the nursing workforce. As a result, the hospital nurses whom the British government sent to nurse the soldiers during the Crimean War were a very disparate group. Some were very much like the nurses at the beginning of the century while others were highly competent practitioners; most fell between the two extremes.⁵ Unlike contemporary American hospitals, which often employed male nurses in the men’s wards, in the British hospitals nurses were all women because they evolved from charwomen.⁶

1.1 Koulali Hospital Ward 1856

This chapter explores the importance of nursing knowledge in the mid-nineteenth century context of a different understanding of disease and a different construction of women’s role in a society that was becoming increasingly defined by social class. I look first at the way disease was understood and treated and what that meant for what nurses had to know. I then consider two barriers that prevented the public from grasping that efficient nursing required the kind of knowledge base which, at that time, could only be gained through clinical experience. The first barrier was the persistence of the image of nurses as working-class women who really were essentially domestic servants at the beginning of the nineteenth century. At midcentury they retained their housekeeping duties: cleaning, laundry, mending and, in addition, cooking. Although by 1854 in order to deemed competent nurses had to have a very considerable base of specific nursing knowledge, the nurses’ multiple roles were confusing to the public. Second, the Victorian construction of gender and the concept of women as naturally and innately accomplished nurses was in direct opposition to an understanding of nursing as based on clinical knowledge.

A different understanding of disease and hence of nursing care

In the Crimean War four different combatants, Britain, France, Sardinia and the Ottoman Empire fought Russia on two continents in many locations but, because it is so well documented, this chapter deals only with British nursing on the Black Sea littoral. When Britain and France declared war on Russia at the end of March 1854 the Turks were already fighting the Russians. A Russian army had invaded Ottoman territory in Bulgaria and was besieging the fortress of Silistria on the Danube. Hoping to prevent the Russians from advancing further into Bulgaria, British and French troops began landing in Varna in June 1854. However, in that same month diplomatic pressure forced the Russians to withdraw their troops, leaving the allied armies in Bulgaria with no enemy to fight. The allies then decided to invade the Crimea and destroy the powerful Russian naval base of Sevastopol.⁷ The siege of Sevastopol would become the most publicised part of the war.

The British army was a very sick army when it left Bulgaria for the Crimea. Bowel disease had always been the primary medical problem of field armies but it was even worse in 1854 because the Crimean campaign coincided with one of the four worst nineteenth-century cholera pandemics.⁸ So many soldiers died of cholera in Varna that there was no time for funerals. The bodies were simply carted out of the hospital at night and thrown into pits.⁹ At that time doctors identified three kinds of bowel disease: diarrhoea, dysentery and cholera. They classified diarrhoea into five categories, each requiring a different treatment. Choleraic diarrhoea was treated with drugs including castor oil; summer diarrhoea was treated with laxatives, mercury and ipecac in mild cases, and in more severe cases with leeches, blisters and poultices; congestive diarrhoea was treated with warmth, rest, fomentations, analgesics, diaphoretics and mercurials; atonic diarrhoea was treated with drugs; scorbutic diarrhoea received the same treatment as dysentery. Dysentery, which was characterized by blood and mucus in the stool, and cholera, diagnosed by rice water stools, were treated with rest, warmth, nutritious diet, drugs, fomentations, poulticing and massage.¹⁰

What did nursing care consist of in the 1850s, what did nurses need to know and what were fomentations, mercurials and blisters? Patient care was based on a different understanding of disease and its causation. Doctors believed morbid materials, derived from miasmas or from a poor or immoral life style, invaded the body and were the cause of the various illnesses. Symptoms such as vomiting, diarrhoea, rashes and open sores were the body’s way of ejecting the diseaseproducing matter and were actually wholesome efforts of the body to heal itself. Therefore doctors tried to encourage these processes with emetics, cathartics, or by creating open sores with chemicals.¹¹ Hence many treatments nurses administered were very different from modern therapies.

Mercury compounds were a mainstay of treatment in the earlier part of the century. Doctors prescribed huge doses because mercury was considered efficacious for almost all ailments.¹² An extreme example is the salivating treatment, considered a cure for syphillis. Nurses gave increasing amounts of mercury until the patients suffered severe mercury poisoning, spitting out 2½–3 pints of saliva a day.¹³ Alcohol was considered a stimulant, and since it was believed that most people died of exhaustion rather than of cardiac or respiratory arrest, doctors prescribed enormous amounts of wine and brandy.¹⁴

A blister was essentially an open sore, usually produced by a poultice made with mustard or Spanish fly, or sometimes doctors just poured nitrous acid directly onto the skin. Open sores were believed to attract the morbid materials causing the disease and allow them to escape from the body. A blister at the nape of the neck, for example, was thought to relieve cerebral inflammation.¹⁵ George Lawson, a young army surgeon, was smitten with Crimean fever in May 1855. ‘I have … had a very severe attack of fever,’ he wrote his parents’, and am now suffering from the results, and the treatment. I am … very weak, but what troubles me most is a terrible sore state of the back of the neck from continued blistering …’¹⁶ In the same month Florence Nightingale also suffered a near-fatal attack of Crimean fever. When her friend Selena Bracebridge came to Balaclava to take her back to Scutari, Nightingale wrote her family: ‘I think seeing her did me more good than all their [the doctors’] blisters.’¹⁷

Blisters were left on as long as 12 or even 24 hours and caused excruciating pain. If left on too long, they could create third-degree burns. They had to be dressed in the same way as wounds – with poultices, usually made of bread or linseed. Blisters were standard treatments for fevers and were also used as stimulants to promote the energies of the nervous and circulatory systems or of particular organs.¹⁸ Poultices were a major method of dressing blisters and surgical and other wounds. Hospital nurses were still making 14 or 15 poultices a day in the 1870s because nearly all wounds became infected and required dressing.¹⁹

Fomentations consisted of flannels soaked in hot water that was usually medicated, and then applied to the affected part or wound. If not properly applied they could do more harm than good. For example, the Crimean War surgeons trusted only Rev. Mother Francis Bridgeman and her team of experienced nuns to apply chloroform fomentations. The sisters soaked blankets cut into small pieces in boiling water, had the orderlies wring them almost dry, then applied them to the soldier’s abdomen, and finally, sprinkled chloroform on them. Then they gave the soldier a bit of ice and some brandy to settle his stomach.²⁰

We now know that symptoms such as open sores, diarrhoea, or vomiting do not cure disease and we would never deliberately create wounds or treat diarrhoea with castor oil, emetics, or mercurials, but it is important to remember that in the 1850s the...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright
• Contents
• List of figures
• Contributors
• Acknowledgements
• Abbreviations
• Introduction: The practice of nursing and the exigencies of war: Jane Brooks and Christine E. Hallett
• Part I Gentlemen’s wars
• Part II Industrial war
• Part III Technological warfare
• Select bibliography
• Index