Nurses in Opera - 28 Dec 2024

Fifth in a Series of Ten Blogs offering A Short History of Nursing from antiquity through the mid-twentieth century. Part 1 – From Sacred to Secular – covers nursing in ancient times through the Crimean War. Part 2 – From Civilian to Military – continues with the establishment of the
Saint Thomas School of Nursing through World War II.

A Short History of Nursing
Through World War II

Part 1 From Sacred to Secular Nurses
Florence Nightingale and the First Stirrings of War

The story of Florence Nightingale (1829–1910) is a familiar one and need not be dwelt on past an overview leading to her nursing duty during the Crimean War and the opening of the Nightingale School of Nursing at Saint Thomas Hospital in London on her return. Chafing at her privileged and confined upbringing and perceiving a calling from God to do something special with her life, Nightingale trained as a nurse at Kaiserwerth for three months in 1851 despite her family’s objections. In 1853 Elizabeth Herbert, wife of Nightingale’s friend Sidney Herbert, Secretary at War for the British government, contacted Florence about filling the position of Superintendent at the Institution for the Care of Sick Gentlewomen in Distressed Circumstances in London, where Nightingale worked for just over a year, without pay; a £500 annual allowance from her father covered her living expenses. Nightingale brought in Mrs. Mary Clarke, previously matron of a Sheffield workhouse, as housekeeper under her and dismissed most of the nurses; even the remaining ones were unsatisfactory with slovenly habits and lack of punctuality. 1 Nightingale had put in her notice after a year to leave that post in search of more fulfilling work in which to train nurses in a London teaching hospital when in 1854 Britain joined the Crimean War in an alliance with France against Russian intent to gain access to the Mediterranean, which threatened Britain’s main route to India.

When the dispatches that The Times correspondent William Howard Russell sent from the war zone exposed the appalling treatment of the sick and wounded British soldiers and asked why no English nurses were at the front, the reading public’s outrage led the Government to take notice of the situation. Nightingale was among those who responded to her nation’s call. Using her connections, she obtained authorization from the Army Medical Department to travel to Scutari. Sidney Herbert convinced the Duke of Newcastle responsible for operational conduct of the war that Nightingale could handle the job of overseeing women nurses in a high-risk military environment. 2 High risk in this case meant the ability of nurses to defend themselves against sexual advances of medical staff and patients. 3 The scheme fit in nicely with Elizabeth Herbert’s desire to advance nursing reform and to create job opportunities for women like Nightingale. 4 Thus in October 1854 Nightingale took thirty-eight volunteer nurses from England to Scutari, among them the six nurses from Saint John’s House, ten Roman Catholic Sisters, eight Anglican Sisters of Mercy, and fourteen nurses from various hospitals. In December, without Nightingale’s knowledge, Herbert sent an additional forty-six nurses to the front, among them fifteen nuns under their Mother Superior Francis Bridgeman, twenty-four nurses, and nine ladies.

Foreseeing difficulties in finding enough qualified women – Mark Bostridge notes household servants, kitchen maids, monthly nurses, and matrons among the applicants – and in supervising them, Nightingale had wanted to travel with fewer nurses. 5 She felt that her authority had been undermined and offered her resignation to Herbert but did not follow through with it. For his part, Herbert thought Nightingale capable of managing a larger staff. According to Bostridge:

By the end of the war, the total number of nurses who had served in the East had swelled the original figure of thirty-eight by almost six-fold. The larger proportion of these women nursed outside the area of Florence Nightingale’s superintendence and, consequently, without reference to her standards of professional practice. By February 1855, Florence herself was requesting more nurses from the War Office. 6

What Herbert could not envision were the problems with Victorian class prejudice and sectarian strife that nurses of different social classes and religious backgrounds would present. Nightingale encountered issues from the beginning. The nuns, who answered only to their mother superiors, did not want to associate with the working-class nurses. The working-class nurses baulked at the domestic work that comprised a large part of their nursing tasks and the restrictions placed on them when off duty. Saint John’s House sisters were viewed as pretentious. Some nurses lacked the stamina or discipline to endure the privations of wartime nursing; some turned to alcohol and daily drinking. Five nuns were returned to England “after having revealed themselves to be totally devoid of any nursing experience”; many more did not survive the duration of the war, whether from death, illness, resignation, or dismissal for inappropriate conduct. 7 Nightingale estimated that well under half of her nurses worked effectively; the rest were “completely undisciplined.” 8

Realizing that “the slightest outbreak of disobedience could seriously jeopardize the success of the whole operation,” Nightingale instilled draconian measures to prevent fraternization and to curb intoxication. 9 The wards were off limits to nurses at night; only Nightingale made nightly rounds, with her lamp, along up to four miles of beds accommodating over two thousand patients. 10 This was the extent of her actual nursing, for Nightingale’s position placed her in the role of matron who oversaw supplies, staffing, and patient care. As Superintendent of the Female Nursing Establishment of the English General Hospitals in Turkey and also Purveyor-Auxiliary, Nightingale’s mission “was balanced delicately on a knife’s edge,” Bostridge writes. “As a woman, she had been granted a field of action that was unprecedented in the Army’s history, yet she behaved at all times with scrupulous attention to Army regulations to ensure that neither she nor her staff could be accused of infringing them.” 11

It is beyond the scope of this blog to cover the scholarly debate concerning the effect of Nightingale and her nurses’ ministrations on the health of the hospitalized British soldiers at Scutari. Others have discussed the findings of the Sanitary Commission sent to Scutari in the spring of 1855, that the Barrack Hospital had been built over a large cesspool caused by clogged sewers that in turn emitted poisonous gasses that were trapped inside unventilated wards. 12 It was not, as Nightingale originally thought, a lack of adequate food and supplies that contributed to the high mortality rate at her hospital, nor were the hygienic measures that she instituted adequate to ameliorate the situation, though they were important to patient comfort. More relevant is how Nightingale’s experience in the Crimean War affected the future of nurse training and nursing reform in England on her return, which is the topic of the next blog.

To learn how the history of nursing was reflected on the opera stage, see Judith Barger, The Nurse in History and Opera: From Servant to Sister (Lexington Books, 2024).

Notes

Bostridge, Florence Nightingale, 184, 194.
Hugh Small, Florence Nightingale: Avenging Angel (New York: St. Martin’s, 1998), 17; see also The Times [London], 15 and 22 September 1854.
Small, Florence Nightingale, 17.
Ibid.
Bostridge, Florence Nightingale, 208.
Ibid., 244.
Ibid., 235, 233.
Ibid., 233.
9. , 235.
Ibid., 226
Ibid., 224.
For more current Nightingale research, see Small, Florence Nightingale and Bostridge, Florence Nightingale.