Anthropology and Nursing

Pat Holden, Jenny Littlewood, Pat Holden, Jenny Littlewood

• Publisher: Routledge
• Year: 2015
• ISBN:
  9781317401506
• Edition: 1
• Topic: Scienze sociali
• Subtopic: Sociologia

Nursing has been described as the most 'natural' female occupation of all, embodying the so-called feminine ideals of tenderness and caring. Yet these ideals are juxtaposed with images of nurses as sex objects, or as ruthlessly efficient harridans. How have these very different images been constructed? And how do they relate to the reality of nursing - the close contact with blood, urine and faeces, and the involvement with the rites of birth, illness and death? This book, first published in 1991, explores the alternative ways different societies have developed to reconcile these contradictions. Using contemporary, historical and cross-cultural case material, the contributors trace the historical development of the role, and investigate the expected qualities of nurses within different cultural settings, such as India, Uganda and Japan. They look closely at 'the nurse' as a social construct, and demonstrate how the stereotypes relate to a particular society's notions of gender. Designed primarily for anthropologists and sociologists interested in health, illness and systems of health care, this book challenges some of the myths of traditional nursing studies and provides an original perspective on doctor/nurse/patient relationships.

Chapter One
Using the Past: Nursing and the Medical Profession in Ancient Greece

HELEN KING

Ancient and modern medicine are far removed from one another. And the difference is one not only of detail, but of fundamental outlook.

(Edelstein 1931: 110)

Since the publication in 1980 of Celia Davies's volume, Rewriting Nursing History, the development has continued of a new anthropology and history of nursing to replace the traditional model of 'progress out of the dark ages to the present, modern times' (Davies 1980: 11): the Sarah Gamp to Florence Nightingale model questioned by one of the contributors to Davies's collection, Katherine Williams. Modern nursing is usually thought to have emerged from its 'dark ages' only in the mid-nineteenth century, and in view of this it may seem that the study of classical Greek medicine has little to contribute. In this chapter, however, I want not only to look at the limited role played by the ancient Greeks in the construction of the nursing past used by traditional histories of nursing and medicine, but also to suggest a much wider range of contributions which this particular historical period could make to the new anthropology and history of nursing.

The argument falls into three parts. It is first necessary to make some introductory remarks about healing in the ancient world, in order to provide a background from which to approach the very different picture given by the highly schematic, 'broadbrush' (Davies 1980: 11) histories used by the medical and nursing professions. The second part considers nursing and the ancient world in more detail, using the social position of medicine in ancient Greece to suggest why it is institutionally inappropriate for the nursing profession to try to find precursors in the classical Greek world. The final part uses the limited sources available in a more controversial way, trying to uncover wider ideologies of male and female, and suggesting the range of cultural material affecting the position of nursing in any society.

Healers and Actors

In contrast to what generations of medical men and women writing to convince us of the antiquity of their professions would have us believe, the professional position of medical practitioners in the ancient world was most unlike that with which we are familiar today. The needs of a professional history have combined with the traditionally high valuation of classical Greek civilisation to produce a very selective picture of rational, empirical medicine in which, as Joly puts it, Hippocratic medicine is seen as 'very close to contemporary medicine', if not in some ways superior to it (1983:29).

Recent work by classical scholars, however, allows us to reassess the position of the medical practitioners whose writings, dating from the fifth century BC onwards, survive in the texts known as the Hippocratic corpus.¹These are the iatroi, usually translated as 'doctors' or 'physicians', but which simply means 'healers' (Van Brock 1961). We cannot know how far their type of healing differed from the therapies offered by other healers in the society, but what is significantly different is the way in which they try to set themselves apart from other groups concerned with health (Lloyd 1979: 37-49). Briefly, the iatroi are all male; they have an image of their own craft which makes it into a coherent system of cause and effect rather than an ad hoc combination of unexplained remedies; and although they place their work in the context of the divinely established order of the universe,²they do not regard any particular deity as responsible for the cures which they effect.

Their main claim for the sort of medicine which they practise covers all of these points, and has even wider implications. They claim that what they do is a techne, and it is important to understand what this means, since it is directly comparable to claims made by medical groups in other periods and societies. In the fifth century BC, the definition of what was and what was not a techne occupied drama as well as philosophy. In Aeschylus' play Prometheus, the culture hero describes medicine as the greatest of all the technai. In the distant past, if someone suffered from a disease, he could not be cured; but Prometheus has shown men 'how to drive away diseases' (478—83). Many Hippocratic medical texts are attempts to demonstrate that medicine is a techne; Regimen 1.12—24 (Jones 1923: 4.250—62) places it in a long list of all the technai. But why does it matter so much to have this status? A techne has been defined as a 'practical activity that required intellectual competence as well as manual dexterity, was based on scientific knowledge, produced results that it was possible to verify, and was governed by well-defined rules that could be transmitted by teaching' (Ferrari and Vegetti 1983: 202; cf. Edelstein 1931: 106). This definition does not go far enough, for a techne also has a particular place in Greek culture and thought. It concerns man's ability to rise above the level of the beasts and to approach the status of a god. One view of the development from past to present current in classical Greece held that, by acquiring the skills of the technai, man gradually climbed from a bestial past to the present level of civilisation (cf. Cole 1967). In a way, the technai thus define what it is to be human; they are thought to be at the core of civilised Greek life.

The iatroi produce written texts describing their cases and remedies and discussing the nature of disease, thus demonstrating their intellectual as well as manual skills. Prose-writing is, however, at a very early stage in the fifth century (Lonie 1981; Lloyd 1983: 115-19), and the way in which they write and argue shows that they are also adept in the art of speaking (Jouanna 1984); of presenting an argument verbally in order to defeat a rival in public debate (Lloyd 1979: 96—8) or to persuade the client or potential client of the value of their therapies. Many of these therapies are in themselves highly dramatic forms of display. In a famous text, a writer condemns those who practise the spectacular therapy of succussion on a ladder, in which the patient is tied to a ladder and violently shaken. This could be done for many reasons; for example, to reduce fractures (On Joints 42-4/Withington 3.282—8), for prolapse of the womb (Diseases of Women 3.248/L 8.462), or to induce labour (Diseases of Women 1.68/L 8.142—4). It is known to be dangerous (Epidemics 5.103/L 5.258), but is continued because of its power to impress 'the crowds'; even the writer who condemns it admits that sometimes it is very useful (On Joints 42—4/Widiington 3.282—8; Edelstein 1931: 94). Another writer advises his fellow iatroi not to use 'theatrical' bandages, because they imply quackery (The Doctor 4/L 9.208—10).

The element of theatre in medical presentation of self is explicit in some of these texts. Healers who deceive the crowds are described as being easily recognised by their extravagant clothing, elaborate perfume, and habit of quoting the poets (Decorum 2/Jones 2.280; Precepts 10, 12/Jones 1.326; Lloyd 1979: 89—90). Another writer compares those who have only 'the appearance, dress and mask' of doctors with non-speaking parts in tragedy, played by people unable to act, but masked and costumed in character (Law 1/Jones 2.262). However, the simple undecorated clothes and pleasant perfumes recommended by the writers of the same texts (Decorum 3/Jones 2.280; The Doctor 1/Jones 2.310) could themselves be regarded as the costume necessary in order to assume a role.³

The Hippocratic healer is thus orator and actor as much as writer and scholar. He accepts the 'well-defined rules' of his techne and certain basic principles - perhaps some version of the four humours, or the principles of hot, cold, wet, and dry-but feels free to innovate within these and to disagree in public with other practitioners in order to attract a clientele, while claiming all the time that he is part of a fully developed craft established in the past (e.g. Places in man 46/L 6.342). Others professing the same craft may disagree on how far one can go in playing to the crowds, but there is nobody to enforce standards, and no system of training which hands out diplomas to the successful; anyone can claim to be a iatros. The iatros is thus much closer to what we would class as a travelling quack than to the members of the British Medical Association.

Blame and Glory

What of nursing within this? Wet nurses and children's nurses certainly existed in the ancient world (cf. Herfst 1922; on the Roman world, Joshel 1986); hospital nurses did not exist, because there were no hospitals. My remarks here will be restricted to the field of nursing the sick at home. In his article on doctors in the ancient world for the Daremberg and Saglio encyclopaedia of antiquity, Reinach devotes one sentence to nursing in the ancient world: 'It goes without saying that women, being so to speak born sick-bed attendants and nurses, have at all times carried out these functions' (1904: s.v. Medicus 1682—3). Jones writes more cautiously: 'The conclusion we are tempted to draw ... is that the task of nursing fell to the women, whether slaves or free, of the household' (1923: xxx). Deloughery too assumes that, in the ancient Greek world, nursing was 'an incidental household duty' (1977: 8—9). The assumptions behind such statements, and the cultural differences which they hide, need to be examined further.

The medical profession in later historical periods has made much of its Hippocratic origins, seeing the great Hippocrates as a superb doctor (according to whatever criteria of superb doctors are currently in fashion); rational, positivist, empirical. Histories of nursing have an obvious debt to the errors of traditional medical history. In particular, they praise Hippocrates for his powers of careful observation of the course of a disease — which, for nursing history, is translated as his discovery of 'patient-centred medicine' (Dolan 1978: 34, based on a 1958 rewriting of Goodnow 1919; but see Edelstein 1931: 88 n.3) — and they repeat the idea that he led medicine out of the sphere of religion into that of science. To quote from a standard history of nursing: 'Hippocrates ... stands out as a real person. The chief contribution of his school was to render the magic of medicine into a science' (Jensen 1943: 35; repeated in the 8th edition of Deloughery 1977: 8—9). This is entirely a medical myth; although Plato's Phaedrus 270b-c and Protagoras 311b-c show that Hippocrates existed as a healer, writer, and instructor famous in his own time, it is difficult to use the Platonic description of the 'Hippocratic method' to show beyond any doubt that any particular text of the Hippocratic corpus was by this writer (Smith 1979; cf. Joly 1983; Mansfield 1983). The rational parts of Hippocratic medicine have historically been over-emphasised at the expense of the sections where remedies are, in our terms, purely magical—the rat droppings and stag's penis school of medicine (Lloyd 1983: 132) — and the idea of the move from religious to scientific healing under the auspices of Hippocrates and his followers is historically inaccurate, since the temple medicine of Asklepios flourishes with and after Hippocratic medicine (Lloyd 1979: 40—6).

In its overviews of ancient medicine, the nursing profession thus follows the historically inaccurate picture of classical Greek medicine propounded by the medical profession and by positivist histories of science, under which medicine in the Hippocratic period is misrepresented as an established and carefully regulated profession, bringing rationality where there was superstition and empirical observation where there was blind dogma. Like medical history, nursing history uses Hippocratic medicine as a precursor, so that histories of nursing invariably have a section on 'Greece'; even if they preface it with perfectly accurate remarks such as that of Guthrie, who writes that 'Hippocrates does not refer to nurses as such' (1953: xi), they invariably find some aspect of Hippocratic medicine which can be used to provide an origin for the profession. Dock and Stewart, for example, suggest that Hippocrates detailed the technique of 'what we now call nursing' (4th edition 1938: 32). In a more recent work we read that the Greeks were:

the first Western group to become conscious of the need for a trained nurse. Though they met this need with apprentices and attendants rather than a separate occupational group, merely that the need was recognised is extremely important in the history of nursing.

(Bullough and Bullough 1979: 19; cf. Dolan 1978: 33—4)

I would now like to look at what such histories include in these sections, and at their implicit assumptions.

One view found in histories of nursing is that there must have been nurses of some sort in the ancient world; who else could have performed the tasks which we now associate with the nurse? A doctor would not have time to bandage, bathe, mix drugs, sponge the patient and apply poultices (Robinson 1946: 20; cf. Jones 1931: xxx). 'Women doubtless did much noble, if unnoticed work among the sick' (Pavey 1938: 61). In the ancient world, care of the sick was ideally performed by other members of the household or, as in Thucydides' description of the plague, by one's friends (2.51). In some cases, the carer would thus be female; but is there anything to suggest a preference for women in this role? In the classical Greek period, the age of Hippocratic medicine, one source which merits mention in the histories of nursing is the advice of Ischomachos to his young wife on household management, which includes the assumption that it is the duty of the wife to ensure that sick slaves are cared for (Xenophon Oikonomikos 7.37). It should however be noted that she is apparently not expected to care for them herself.

Another famous example of women in a 'nursing' role comes from a legal case of the mid-fourth century BC in which a sick man, Phrastor, who has quarrelled with his own family and has no children, is eventually cared for by his estranged wife and her mother. They come to his home bringing 'things suitable for the illness',⁴ and they 'watch over' him. There is no mention of a healer being summoned,⁵ although the patient is so ill that 'his sickness, his childlessness, the care [therapeia ] of the women and his enmity towards his own kin' persuade him to recognise as legitimate his son by his estranged wife. The important phrase for the history of nursing can be translated as: 'You yourselves know how valuable a woman is in illness, being there to help a sick person' ([Demosthenes]...