Because of their “feminine folly or feebleness,” nurses could never be entrusted with drugs m the dispensary or gain any medical knowledge, die Lancet wrote, fasted, they should be tutored only in subject matter that would make them “useful to physicians.”12 In a letter to the Times, physicians presented a clear expression of medicine’s view of nurses. “The medical argument is … that nursing is merely one of the means of cure, like the administration of medicines or the performance of operations; and that, like these, it can only be rightly carried out under absolute and unconditional subjection, in every principle and detail, to the doctor who is responsible for the case.
This view of nursing precluded even elite lady nurses’ control over the nursing work force. Doctors contended that because they were women, nurses—although constitutionally designed to cooperate with men were constitutionally unable to cooperate with and thus manage or lead other women. Many prominent physicians weighed in on this subject, including John Braxton Hicks, who identified the contractions that are often confused with the advent of labor.
At the thought of nurses having control over nursing, Hicks must have experienced his own spasms. In an article in the British Medical Journal, he painted a dire portrait of power-mad nursing superintendents who failed to grasp that the nursing staff is “naturally the handmaid” of physicians. If she worked in a nursing hierarchy controlled by an independent matron or superintendent, the ordinary bedside nurse, he warned, would look “to the matron more as her center” and would be “less interested in pleasing the medical authorities.” Such a system, Hicks contended, could not be tolerated.
Sir William Gull, consulting physician to Guy’s Hospital, asserted that “there is no proper duty which tie nurse has to perform, even to the placing of a pillow, which does not or may not involve a principle, and a principle which can be only properly met by one who has had the advantage of medical instruction. It is a fundamental and dangerous error to maintain that any system of nursing has sources of knowledge not derived from the profession.”15
In a fascinating study of the secularization and professionalization of nursing in France, Katrine Schulte’s describes the debate about the.
Anger, “do physicians know this when they are interns and residents and 57 so quickly forget it when they become attendings and are too busy to round with the nurse, or even bother to talk to us to get critical information about their patients?”
To answer that question we have to go back to the nineteenth century, when nurse-doctor relationships were established in the hospital. Most hospitals in the early nineteenth century were not devoted either to medical teaching or practice. They were charitable, philanthropic institutions dedicated to caring for the sick poor and sometimes simply to housing the destitute.1 Indeed, with the exception of physicians trained in the large medically run hospitals in Paris, Edinburgh, Berlin, and other cities in Europe and North America, most doctors had no formal institutional training. “Medical training varied from classical university education and the study of Greek and Latin medical texts, on the one hand, to broom- and-apron apprenticeship in an apothecary’s shop, on the other—and sometimes involved no recognizable education at all,” according to M. Jeanne Peterson.2 Doctors enjoyed little prestige and suffered from a rather poor public image. Competition for patients was cutthroat and doctors trying to eke out a living in the countryside or large cities were attacking each other rather than seeking to bolster the public’s trust in the profession.3
With only a few exceptions, doctors didn’t run hospitals. Church- or community-run hospitals gave doctors space to observe and treat the sick, but clerics or community authorities controlled them. Physicians, as the nursing historian Joan Lynaugh has described them, were “welcome visitors in these hospitals,” with the operative term being “visitor.” While nurses were sometimes actual live in residents of these hospitals, some physicians never even set foot in them.4 They cared for their patients in the patients’ homes or in their offices. (When possible, surgeons did use hospital facilities for obvious reasons). In Protestant countries, hospital boards of trustees or governors—made up of affluent or influential laymen employed physicians. The lay boards made all the major decisions about how the hospital functioned and chose which poor patients were worthy enough to be admitted. As Lynaugh vividly explains, “the town drunk couldn’t necessarily get admitted, but a productive working man could.”
In the late nineteenth century, all of this began to change. Scientists and physicians were gaining more knowledge of anatomy, physiology, and chemistry. They were learning more about contagion and how to relieve pain. They developed more accurate diagnostic equipment and devised treatments that actually did less harm than good. The hospital started to view patients through a different lens. To the new, scientifically minded.