Each of us learns about history in different ways. We hear stories and read texts. Sometimes we might ask people about their experiences. A lot of what we have come to accept as nursing’s history derives from popular culture, such as movies and television. Thinking about an ‘image’ representative of nursing’s history, the Australian imagination might picture a neatly frocked Florence Nightingale, carrying a burning lamp in the military wards of Scutari in the Crimean War in the 1850s. We might see a nurse soothing the brow of an injured soldier in World War I, or picture Sister Kenny, the controversial Australian woman who applied novel treatment regimes to children affected by polio. What do these images say about nursing’s history?

These are romantic impressions to say the least. It is likely that most of us have not questioned whether there is any accuracy or objectivity to these images of nursing’s history. This is not surprising, as stories of Nightingale, Kenny and noble nurses have been told and retold. They have come to be accepted as how nursing ‘was’. Commonly accepted interpretations of history are also known as ‘received’ histories. Received histories of nursing summarise this complex history as follows. Before Miss Nightingale’s influence and the later professionalisation of nursing, the care of the sick and childbearing women was unskilled work of low status. The installation of structured training schemes and, later, nursing’s professionalising movement, transformed nursing into a profession for educated women. Received histories, lauding the transformation of nursing from old to new, from darkness to light, were recorded by nurse luminaries in the United States of America by Adelaide Nutting and Lavinia Dock (1907), and in Britain by Sarah Tooley (1906). Nurses in Australia (Webster 1942) and in New Zealand (Maclean 1932) reiterated this triumphal tale.

However, in recalling history as a narrative of progress, received histories inevitably have drawbacks. While they champion the achievements of individuals and celebrate progress, they leave out the more mundane, the contribution of everyday nurses, and those aspects of history which do not ‘fit’ the story of progress. In so doing, nursing becomes distanced from the society it serves. It becomes distanced from the political times in which nurses have lived and worked, from those in which nursing has evolved, from other professions, and from nursing as practice. Until very recently, received accounts of nursing’s history were accepted as accurate. They are now being challenged.

Recent scholarship in nursing history has questioned the tale of nursing’s triumphs over ignorant nurses through professionalisation and the Nightingale influence. This scholarship applies critical inquiry to history (Dean 1994). Critical history rejects assumptions such as the idea that history is about progress, or that complex events can be explained simply (Connolly 2004). Critical history throws a wide net to examine issues, events, processes and the people who received histories have ignored, so that nursing’s history may be seen in a different light.

One example of groups whose contribution to nursing has not been noted in received histories of nursing is Aboriginal nurses like Sadie Corner (pictured) and Lowitja (Lois)

Sadie Corner. Reproduced with the permission of the Salvation Army Australia, Southern Territory Archives and Museum, Melbourne.

O’Donohue, who overcame considerable odds to train as nurses and work in Australia’s white healthcare system. To explore this and other fascinating and instructive aspects of nursing history would entail a story of politics, race, social attitudes and geography. It is one of many in Australian nursing history waiting to be told, using the tools of critical history.

In the early Christian era and beyond, care in hospices (early forms of hospitals) was performed by religious communities to those on spiritual pilgrimages (Nelson 2000). Religious orders sought to emulate the work of Jesus Christ in tending to his flock by caring for strangers, the sick poor, providing them a place of refuge, giving nourishment, tending the infirm, and perhaps applying palliative treatments (Nelson 2000). One group of nurses who have sustained this care is the Catholic religious order, the Sisters of Charity of St Vincent de Paul, mentioned later in this chapter. However, the care of the sick poor was not the sole domain of Catholic organisations. Protestant female followers of Christianity, such as Elizabeth Fry, Jane Shaw Stewart, Agnes Jones and Sister Dora [Pattison], in the nineteenth century formed nursing ‘sisterhoods’ through which nursing care was provided to the sick poor in a similar way (Summers 1989). Thus, nursing’s foundations can be found in care in the sick poor as strangers, provided by religious orders as ‘an integral part of Christian practice’ (Nelson 2000:3).

There is of course, another form of care that is not concerned with the Christian practice of caring for strangers. That care is familial care, undertaken conventionally by women as extensions of their roles as wives and mothers (Summers 1988). In the following discussion, familial care is considered within the context of the nineteenth century, a period when Britain was expanding its empire, establishing colonies around the world. With colonial expansion, the customs, conventions and system of government of Britain were carried to new horizons. What was happening in Britain, therefore, impacted on its colonies, including Australia and New Zealand.

For those with family to attend them, for centuries the person’s home or ‘domicile’ had been the primary domain for the care of the sick, the dying and the place for birth (Summers 1989). This caring work was undertaken as part of familial duties, usually by women; by the nineteenth century and for those who could afford to pay, it was possible to engage a secular (non-religious) nurse to watch over the patient (Summers 1989). These nurses had varying backgrounds, with some relying on their experience of childbearing and rearing, while others, particularly those practising midwifery, were educated by apprenticeship (Evenden 2000). In mid-nineteenth century Britain, popular culture opened a window on the world of the domiciliary nurse via the writings of the social commentator, Charles Dickens. Through one of his serialised novels, The Life and Adventures of Martin Chuzzlewit, published in 1843, Dickens brought to the imagination of the reading public two memorable characters who symbolised all that was perceived to be wrong with nurses and nursing (Grehan 2004).

The Life and Adventures of Martin Chuzzlewit introduced Mrs Sarah Gamp and her friend Betsy Prig. Gamp was a domiciliary nurse and midwife in London attending births, the sick and the deceased; Prig was a hospital nurse who moonlighted as a ‘private’ nurse in people’s homes. Gamp and Prig were depicted as middle-aged, fat, uncouth, drunken, ignorant, unrefined and untrustworthy attendants. Accompanying Dickens’ text were graphic pen and ink sketches of Mrs Gamp and Betsy Prig, leaving little to readers’ imaginations. Dickens’ narratives helped to build perceptions that many nurses were unsuited to the important duty of caring for the sick and for childbearing women, adding to calls for reforms in hospital and private nursing (Grehan 2004).

Calls for a new style of nurse must be considered, not as a result of, but within the context of other developments in society in the nineteenth century. For example, in the Western world at this time, medicine was developing new understandings of diseases and ways to treat them. The modern hospital was the place where medicine’s innovations were carried out; innovations in surgery called for a team of people to guarantee their success (Rosenberg 1987). Nurses providing after care for operation cases needed to be cooperative, literate and diligent, and they needed to be able to observe changes in the patient’s state, using new technologies such as the thermometer (Grehan 2004). Nurses who could perform the new skills required of them were not always easy to find, particularly in the colonies. To understand the development of what is considered in received history to be the era of modern nursing, our discussion continues in the geographic location of colonial Australia and New Zealand.

As was the case in Britain, governments in Australia tended to leave the responsibility of healthcare to individuals (Grehan 2004). We know from private diaries, letters and administrative documents, including birth registers and coronial inquests, that a variety of people were available to attend the infirm and childbearing women. For example, doctors, nurses, midwives, herbalists, oculists, druggists and dentists were just some of those advertising in the town of Melbourne in 1847 (Port Phillip Almanac and Business Directory). Who the patient chose depended on who was available, what the purchaser expected of his or her care, and what he or she was willing to pay (Martyr 2002).

Birth, for example, was a time when women needed help. Doctors and experienced attendants were not always available, especially in isolated rural areas. Local women often filled this gap, attending births as a neighbourly gesture, or sometimes as paid employment (Grehan & Nelson 2005). A study of births registered in an isolated rural district of New South Wales found that, in the period 1856 to 1896, women were recorded as the primary birth attendant in almost half of the births (Strachan 2001). In some ways, this array of persons was the ultimate in consumer ‘choice’. In reality, however, obtaining an attendant at birth or at times of sickness was a risky business, because there was no real way to measure the qualifications or skills of an attendant. Some nurses were known to have undertaken formal education in midwifery; others had the experience of having their family to rely on (Grehan 2003). Others had no experience whatsoever (Peel 2006).

In the colonial world, where employment for women was hard to find, nursing and midwifery was easily adopted when family circumstances changed. For instance, the Australian nurse historian, Joan Durdin, writes that Mrs Elizabeth Knight, a well-respected midwife in the Mount Gambier region of South Australia, began work at the age of 70 after the death of her husband (Durdin 1991). Women attending others as paid work were known as ‘handywomen’, in the same way that a handyman performs a multitude of tasks around a house (Grehan 2004). These women combined the roles of tending the sick, preparing the dead for burial, acting as midwife, and sometimes running the local postal service too (Forth et al 1998).

As it was in Britain, institutional healthcare in the colonies was a product of the charity sector; some hospitals and asylums in the colonial world were part of the government’s management of prisoners and those deemed to be lunatics (Martyr 2002). Where colonists expanded the white frontier, voluntary hospitals were established in response to industrial catastrophes, such as mining disasters (Collins 1999), but what institutional care was available depended on the geographic locality, the size of the population and its perceived need. The Melbourne Lying-in Hospital and Infirmary for Diseases Peculiar to Women and Children, for example, was established in 1856 for the indigent in the colony of Victoria, mirroring similar institutions in Britain, Scotland and Ireland (McCalman 1998).

The voluntary hospitals, also called ‘charitable institutions’, were established by philanthropically minded people and funded by subscription, so that, in return for their financial support, subscribers were able to recommend people for the institution’s charity (McCalman 1998). However, hospitals were thought to harbour miasmas, noxious vapours said to emanate from suppurating wounds, ill-ventilated rooms, cesspits and cemeteries (Nelson 1998). According to mid-nineteenth century medical orthodoxy, diseases were a result of absorption of miasmas; the practice of ‘sanitary’ science was the method to minimise them (Nelson 1998). Sanitary science and miasmatic theory demanded an extensive regime of cleanliness and ventilation practices for this purpose, and the exclusion of certain conditions from hospital admission. Among them were smallpox and forms of cancer (Bashford 1998). Pregnant women were excluded from hospital admission, too, because healthy people were thought to be at risk from miasmas.