History of Nursing

Mary Adelaide Nutting, who was originally from Canada, was a graduate of the Johns Hopkins Training School for Nurses, the first university-based training institution for nurses, founded in 1890. In 1893 she was appointed Assistant Superintendent of Nurses at Johns Hopkins Hospital; the following year she was promoted to Principal of the Hospital's School for Nurses, and served in post until 1907 at which time she moved to Teacher's College, Columbia. At Teacher's College she was appointed Professor of Institutional Administration and in 1910 Professor of Nursing and Health. In addition to various professorial appointments, Nutting was President of the American Federation of Nurses and a Member of the International Council of Nurses, founded in London in 1899 by Ethel Bedford Fenwick, whose photograph graces the frontispiece of volume three and who shared Lavinia Dock's belief that the 'Nurse Question' and the 'Woman Question' were one and the same. Lavinia L. Dock received her nurse education at Bellevue, the first American training school for nurses, established in 1873 at Bellevue Hospital in New York City (two other schools, New Haven and Massachusetts General, were also established in 1873). Dock's nursing career began in 1890 when she was appointed assistant to Isabel Hampton, Superintendent of Nurses at Johns Hopkins. She was a member of the Nurses' Settlement, New York, Secretary of the American Federation of Nurses and of the International Council of Nurses, Honorary Member of the Matrons' Council of Great Britain and Ireland, and of the German Nurses' Association. A zealous feminist, Dock was also a member of the National Women's Party which campaigned for the equal rights amendment introduced in 1923. She acquired an in-depth knowledge of the international nursing scene, which was to prove beneficial to the writing of A History of Nursing, and visited London several times to work with Bedford Fenwick. 

Nutting and Dock knew their subject intimately; in fact they were their subject. They were actively involved in reform of nursing in America, and structured their narrative around political and professional issues with which, both as nurses and women, they were concerned. This proximity was to simul-taneously prove both beneficial and detrimental to the writing of the series, as it has to many a historian, professional and amateur, who is investigating a topic in which he or she has a vested interest. 

The history of nursing that Nutting and Dock constructed is a personal one; there is passion and commitment in the narrative, and while this allowed a 'good story' to be told it also compromised attempts at objective analysis, which, as any 'serious' academic knows, must inform a scholarly interpretation of the past. But then A History of Nursing was not written to be either objective or analytical, and its content is as much contemporary and political as it is historic, heroic and medical. It enlightens the reader, who would in all likelihood be a qualified nurse or student nurse, about nursing, and expresses faith in the continuation of the reforms initiated by Florence Nightingale and her progressive contemporaries in the nineteenth century. A History of Nursing is an account of nursing's escape from the darkness of antediluvian practice to the illumination of 'modern' medicine in the age of reform, and it is structured according to the early twentieth-century genre of history writing: hagiographic and Whiggish and reflective of 'progress'. A History of Nursing is constituted along the lines of Lytton Strachey's erudite Eminent Victorians, which imparted information about the past via the lives of noteworthy individuals, and which, while being methodologically unsophisticated, is a classic in its own right. Structurally simplistic A History of Nursing may be, but within the tale there lies a politically-charged critique of the subordination of women and nurses; this has the effect of transforming a seemingly innocuous history of one example of women's work into an endorsement of women's suffrage and the state registration of nurses, two contentious issues that were being debated at the turn of the twentieth century. 

In the introduction, Nutting and Dock claim to have embarked upon their history of nursing in order to chronicle its 'touching and often heroic' past,¹ 'from the earliest times' of Greece (which is considered particularly advanced given its Nightingale-like penchant for fresh air) and Rome to 'the present', which, at the time of the publication of volumes three and four, was 1912. In between the 'early times' and the 'present' there lies a meandering and somewhat repetitive narrative of the 'darkness and barbarism' of the Middle Ages, a period which saw the repression of women and nurses and the rise of the 'witch' phenomenon; the stagnation of eighteenth-century medicine, which is stereotypically characterized by unhygienic hospitals and bumbling physicians;² and the 'light and humanitarianism' brought to nineteenth-century medicine by the Pastor Fliedner and Florence Nightingale reforms. Interspersed with this Euro-centric history are accounts of nursing in North America, New Zealand, Australia, Spain, India, Ceylon, China, Japan, Korea, Cuba and the Philippines. While many indigenous peoples are shown to have a natural affinity for nursing ' 'noble' savages of North America and 'gentle, delicate Japanese women' ' progress in the field comes from Europeans, most trained under the Nightingale system. This is a story not only of 'light' coming to nursing, but of various white European and American nurses bringing the 'light' to the unenlightened. Comments such as 'Like other Southern Races [in the United States], the Negro nurses have been chiefly led at first by those of a more experienced race'³ say as much about early twentieth-century attitudes towards race as they do about nursing. 

The religious dimension of nursing and the role played by various religious orders and the Deaconess movement in the development of 'modern' Edwardian health care is emphasized, as is the conflict between sacred and secular elements in the transition of nursing from calling to learned profession. The secularization of nursing is explained by the appearance in London in 1860 of Florence Nightingale's school at St Thomas's Hospital, which offered the probationer comprehensive medical and nurse training and provided the pedagogical leverage necessary for worldwide progress.⁴ Given the importance of empire to the Edwardian identity, missionary nursing in Asia, Africa and India is given a prominent position in the discussion, as is the role of individual women, such as Lady Dufferin in 1880s India. The missionary impulse is also recognized in the development of visiting nursing and district nursing, although the story of the latter is skewed with an over-emphasis upon the 'secular' Queen's District Nurses, founded in England in 1887, and an absence of detailed discussion surrounding Ellen Ranyard's religiously inspired Bible Women Nurses and the Church Army. Military nursing is discussed in its medieval and modern manifestations, which allows the women to introduce what is still an under-researched topic: male nursing. Male nurses are also discussed in reference to developments within hospital nursing, as medical attendants, clerks and dressers, but they are peripheral rather than central figures in what is essentially a female history. 

The volumes also introduce contemporary debate surrounding the education, organization and state registration of nurses. Ethel Bedford Fenwick had been the driving force behind registration in England since the 1880s (it was eventually achieved in 1923), and was one of nursing's heroines: 'From our modern point of view', Nutting and Dock write, 'her contribution to the nursing movement has been as important as Miss Nightingale's.'⁵ In America the demand for registration came from those whom the historian Nancy Tomes terms the 'hospital-based nursing elite'⁶ ' Isabel Hampton, Adelaide Nutting and Lavinia Dock (whom Tomes liberally praises as 'one of nursing's first (and best) historians').⁷ These women were concerned with what they saw as disunity and disorganization among trained nurses and the proliferation of their untrained counterparts against whom they competed for jobs and who, because they were untrained and therefore cheap to employ, lowered the standard of nursing. Nutting and Dock saw themselves as 'progressive' pro-registrationists in battle with the 'reactionaries', various authorities in metropolitan hospitals, doctors, and some nurses, who considered registration as trades unionism and interference in hospital management. The struggle for state registration, still ongoing when Nutting and Dock wrote their history, is related in great detail and interweaves issues connected with female education and the legal advancement of women. 

Heuristically, A History of Nursing served to make nurses aware of their heritage and of nurse pioneers whose stories had been, to borrow a term from one prominent feminist academic, 'hidden from history' because they were female stories.⁸ In the introduction to volume one Nutting and Dock lament: 'In attempting to study the history of nursing, which must always have existed in some form, however rude, we find long ages of silence on the subject, doubtless because of this tendency of historians to overlook what was usual and homely.'⁹ For 'usual and homely' read 'female'. Women, the two concluded, were lost from view, peripheral to history because their commonplace activities did not warrant inclusion in a discipline which studied the achievements of great men and the impact of great political events.¹⁰ As women's historians have discovered in recent years, it has been left to women to uncover their past; the same holds true for nurses, and this explains why so many of the early nurse histories that appeared from the mid nineteenth century were insular, celebratory and self-congratulatory. Nineteenth-century histories announced nursing's arrival in heroic accounts of past triumphs which focused on the role of the individual nurse engaged in what Nutting and Dock referred to as 'pioneer struggle'. Early nurse histories were neither evaluative nor critical, except of those individuals, mainly physicians, hospital bureaucrats, and men, who opposed reform.¹¹ And yet, these embryonic histories serve as important cultural and historical benchmarks for the writings of subsequent nurse historians and, like Strachey's Eminent Victorians mentioned at the beginning of this introduction, many early publications have become classics in their own right. 

A History of Nursing conformed to the existing stylistic mould, and can be considered, alongside contemporaneous studies such as Sarah Tooley's The History of Nursing in the British Empire, as a classic example of early nursing history. There is nothing outstanding in the four volumes; content is commonplace and boasts none of the diversity, or the interdisciplinary approach and polemical sophistication introduced into the field in recent years by the likes of Celia Davies, Christopher Maggs and Anne Marie Rafferty in England and Bonnie and Vern Bullough in America.¹² But this intellectual naivety does not compromise the work's value as a piece of history to be studied as history. A History of Nursing was for many years paradigmatic,¹³ and the modern reader can still learn from it. The four volumes are important not for the empirical information they impart, but for the specifically Edwardian and, one could add, feminist interpretation they provide, and they contribute to our understanding of the evolution of nurse historiography. 

Adelaide Nutting and Lavinia Dock wrote a history of great women battling against the odds and male prejudice. We learn of, among countless others, Mrs Wardroper, Agnes Jones, Florence Lees, Dorothea Dix, the Canadians M. A. Snively and Norah Livingston, the Scotswoman Rachel Frances Lumsden, who pioneered the idea of registration in Scotland, and the American Linda Richards, who founded the first Japanese school for nurses in 1885. Florence Nightingale, mythic 'lady with the lamp' and hospital and nurse reformer, dominates the four volumes. It is she who is credited with changing attitudes towards nursing and disease, she who symbolized what reformed nursing was, she who paved the way for all others to follow. Nightingale is portrayed as far and above those with whom she worked and often conflicted, 'the red-tape men, whose dense mediocrity was too rudely shocked by her electric intelligence'.¹⁴ She is compared rather too generously to that nineteenth-century scientific luminary Louis Pasteur, 'each a seer and prophet of health and of disease prevention', two 'noble pillars' in medical history.¹⁵ What Nutting and Dock fail to recognize is that the two medical pioneers approached the aetiology and treatment of disease in different and opposing ways; Pasteur advocated germ theory, while Nightingale endorsed sanitation and believed that fresh air could help cure many an ill. It would have been closer to the truth had Nutting and Dock suggested that Nightingale, like her contemporary public health campaigner and Poor Law Commissioner Edwin Chadwick, was from the old, pre-germ theory, 'sanitary' school, and Pasteur from the new. 

One can be forgiven for assuming at first glance that A History of Nursing is simply a benign narrative accompanied by an extensive collection of illustrations of hospitals and portraits of nurses. Between the lines of the uncomplicated story, potted biographies and quaint images, there exists a feminist subtext, one which will be familiar to those aware of the content of much late twentieth-century feminist scholarship. This feminist slant is only to be expected from Dock who was as committed to women's rights as she was to nurses' rights. Bullough and Bullough argue that Dock 'perhaps more than any other nursing leader, recognized the importance of the women's rights movement for nursing; and she was willing to work, march, and be jailed for her beliefs.'¹⁶ Nutting and Dock make allusions throughout their work to the political and professional systems which, since the Middle Ages, have taken advantage of and undervalued women in general and nurses in particular. They constantly reiterate that women have had to struggle to achieve what little they now have (remember that when A History of Nursing was published women still lacked political rights, employment rights, and were treated differently from men in cases of divorce and child custody). Every achievement in nursing, from state regulated training in Germany to women's involvement in the Red Cross and the foundation of the British Nurses Association, is seen as part of the Woman Question. The now familiar refrain that nurses receive little pay for the hard work they do¹⁷ is central to the women's criticisms, and they chose to include countless cases, not just connected with nursing, of women facing and overcoming male prejudice when forging careers for themselves. Elizabeth Garrett's fight in nineteenth-century America to qualify as a doctor serves as one obvious and, for Nutting and Dock, relatively recent example of the overwhelming cultural, economic, educational and professional odds that are stacked against ambitious women. The authors launch a vitriolic attack on what they see as an exploitative patriarchal system that has demeaned and undervalued their sex and their occupation. They make it clear that nurses have been exploited because they have not been organized, and that the only way that things will change is if nurses are registered by the state.¹⁸

The feminist message in A History of Nursing, like that in most pre-suffrage women's rights publications, is that no improvement, either in women's lot or in the services provided for the powerless, in this case the sick and needy, will be forthcoming 'until women attain full citizenship', acquired through political enfranchisement.¹⁹ Nutting and Dock caustically allude to the existence, worldwide, of a two-tier system of health care, one for the rich and one for the poor,²⁰ which at its best offers basic and substandard care and at its worse no care at all. Workhouse nurses and cottage nurses, who were often the sole medical care-givers for the destitute, the most vulnerable and powerless in society, and who because of their unsavoury qualities and lack of formal training dragged down the entire nursing profession, come in for virulent criticism.²¹ Improvement would be forthcoming only once women had the political clout to reform workhouse infirmaries and once qualified nurses were registered by the state.²²

Nutting and Dock make their female readers aware of their social responsibilities as women towards the needy, and encourage nurses to take advantage of expanding social services provided by local governments by becoming involved in what they call 'social service nursing'. As school nurses, community nurses, visiting nurses, tubercular nurses, etc., their responsibilities are increasing; they are assuming the mantle of defenders of civic order and national health, and owe it to their pioneering predecessors to take up the challenges that are offered to them, to promote nursing and serve as professional examples for others to follow. Dock castigates nurse organizations for not becoming involved in controversial areas of public health, such as venereal disease, and argues that in order to safeguard society nurses must take an interest in 'moral prophylaxis', act as medical and moral arbiters, and become 'a powerful force in helping to combat these social plagues and teach moral hygiene'.²³ At the turn of the twentieth century venereal disease was deemed a national threat and had, for over three decades, galvanized feminist debate surrounding the sexual double standard and victimization of women, wives and prostitutes who suffered physically from the sexual demands made upon them by men. Well into the twentieth century, despite the discovery of salvarsan, gonorrhea and syphilis were difficult to treat medically; the debilities suffered by those who contracted sexually transmitted diseases were deemed by physicians as transmissible to the next generation and therefore guaranteed 'racial suicide'. Much anxiety rested with the impact that venereal disease would have upon the stability of the family, of society, and, in Britain, upon the Empire.²⁴ Given her strong feminist sympathies, it was only to be expected that Dock would use her history of nursing to demand that nurses help turn the degenerative tide around before it had widespread disastrous effects. 

The political and feminist dimensions of early nursing histories is something that Anne Marie Rafferty and other nurse historians have commented upon. Nurse leaders and their supporters, Rafferty argues, politicized their history and used it as part of their campaign for suffrage and registration.²⁵ Christopher Maggs is able to see beyond the narrow, amateurish, celebratory tone of many studies to argue that they expressed overlapping concerns and contributed to contemporary debate about such issues as power, women's roles, the division of labour and family and professional relations.²⁶ This politicization offsets the naive dilettantism of the early interpretations, and injects them with a sophistication that would otherwise be absent.²⁷ Sophistication of argument was, however, embryonic and we must remember that it would take many years for the personal reflections of early nurse historians to mature into informed academic analysis. 

One must appreciate the time and effort that it took for Nutting and Dock to research and write their history of nursing. The first two volumes consumed fifteen years of the women's lives. The work involved in tracking down information eventually proved too onerous for Nutting; she absented herself from the preparation of the final two volumes in order to fulfil her professional responsibilities as head of the Department of Nursing and Health at Teacher's College. By the time she reached the final two volumes, Dock had decided to alleviate the pressures of international research by relying on contributions from various nursing colleagues. Such a collaborative approach made Dock's work easier, and yet, in an age without email and the internet, international communication was slow and production of the work piecemeal. 

The task of compiling information was made especially difficult for the two women by the absence of a central, or even several central, archival repositories; in the opening years of the twentieth century, nursing archives, as we know them today, did not exist. Only in the mid nineteenth century had information pertaining to specifically general or hospital nurses and nursing been deemed worthy of conservation. Even when this was collected, most of it remained uncatalogued, unidentifiable and dispersed throughout various collections; information about community nursing and voluntary or philanthropic initiatives would not have been recorded at all.²⁸ Perusal of the bibliographies that appear in volumes two and four of A History of Nursing indicate the scant information that was available for Nutting and Dock to consult: no hospital archives, or records of poor law infirmaries or philanthropic nursing organizations are listed. The women seem to have relied upon the copious and highly subjective writings of various 'pioneers' (Nightingale and Bedford Fenwick figure prominently), personal reminiscences, biographies and extant general histories. 

Problems with resources for nursing history continue to this day. As recently as 1983 one American scholar working in the field remarked that there was as yet no comprehensive guide to nurse archives in the United States.²⁹ The situation is very similar in the United Kingdom where resources are dispersed and records often incomplete. Scholars who work in the field need to be broad-minded when trawling through research material. While proving frustrating, this has at least had the positive effect of encouraging interdisciplinary interpretations: 'Sources of nursing history', Steven Black, editor of the International History of Nursing Journal recently commented, 'are not so plentiful that nurse historians can afford to ignore any references to nurses in the past.'³⁰ Hence the increasing tendency to use what is considered to be non-traditional nursing and medical research material, for example literature and images. 

Since the 1960s there has been a distinct shift in the way that we approach the history of nursing. Then, most nursing histories were texts written by nurses for nurses; information was relayed in an unchallenging, intellectually staid, chronological way. Publications that appeared during the 'first wave' of academic activity, from the mid nineteenth to the mid twentieth centuries, were utilitarian; they conveyed basic empirical information, but did little to stimulate discussion and debate. Recent years have been characterized by an energetic cross-fertilization of ideas from academics in diverse disciplines, interested not just in facts and figures, but in the role of theory and methodology in researching and writing nursing's past.³¹ For example, discourse analysis and Foucauldian approaches to understanding institutionalized power relationships have informed James Davies and Angela Cushing's analysis of the dynamics of leadership and professionalization in nursing in mid twentieth-century America; other scholars have focused upon the extent to which gender is involved in delineating power relations and encouraging or discouraging professional development.³² Provocative questions surrounding the empirical content of extant publications and methodological approaches to uncovering nursing's past have been raised in many interdisciplinary publications. Can we integrate the history of nursing into the history of medicine, or should it be studied in isolation? Do we write the history of nursing, or nursing history? Is midwifery and maternity care a part of the history of nursing? What about health visiting? To what extent should we apply the theory and methodology that informs other disciplines, such as sociology and gender studies, to nursing? How, given nursing's close relationship to domestic work and 'mothering', can we define what nursing was/is? And does reaching a definition of what is essentially a gendered occupation become more complex when we consider the role played by male nurses? These are challenging questions to ask and answer, and they require a complete re-evaluation of the ways in which we have traditionally conceived of and interpreted nursing's past. 

For several years, academics promoting nursing history have optimistically argued that the discipline is about to embark upon an innovative journey. In 1983 Ellen Condliffe Lagemann wrote that 'the history of nursing is very much in ferment'.³³ Two years earlier, Celia Davies, who has written extensively about nursing in its historical and contemporary dimensions, was confident that 'radical approaches to conventional themes'³⁴ had arrived. New perspectives have indeed been brought to old subjects, which have been placed not only in their medical and nursing contexts, but in their social, political, economic, sociological, anthropological and cross-cultural contexts as well. Such developments insist upon an awareness and appreciation of inter-disciplinary approaches to studying the past, and there has been promising work published in the edited collections by, for example, Anne Hudson Jones and Pat Holden and Jenny Littlewood. In recent years there has been a broadening of the issues being studied; a broadening of the contexts in which they are being studied; and a broadening of cross-disciplinary interpretations, all of which bode well for future developments. Nursing itself has shifted from being a vocational subject to being a research-based academic discipline replete with scholarly degrees, debate, national and international collaboration, research students, and an expansion of scholarly journals.³⁵ This pedagogical shift should encourage and legitimate change. However, the field is proving somewhat resistant to these developments, and historians are still promising that nursing is on the cusp of innovative research. At the end of 1999 Stephen Black announced in his editorial in the International History of Nursing Journal that 'interest in the history of nursing is palpably on the increase'.³⁶

It is sobering to consider that such pronouncements have been made for almost two decades, and that we are still waiting for the wave of research, that should result from current internationalist and cross-disciplinary debate, to crash upon our scholarly shores. Nurse historians seem to be teetering on the edge of innovation; they need to cast caution to the wind and throw themselves into it with the same enthusiasm and fearlessness that made Mary Adelaide Nutting and Lavinia Dock's A History of Nursing a pioneering effort. 

2 Ulrich Truhler and Cay-Radiger Proll have shown that in the eighteenth century hospitals were not as bad as has traditionally been suggested. They offered what they were designed to provide: comfort and, to the best of their ability, the alleviation of pain. See Ulrich Truhler and Cay-Radiger Proll, "The Rise of the Modern Hospital", in Irvine Loudon (ed.), Western Medicine. An Illustrated History (Oxford University Press, 1997), pp. 160-75. 

3 Vol. 3, p. 196. 

4 Sacred or spiritual aspects of nursing did not cease to exist with the arrival of St Thomas's, and it is questionable whether one can mark the completion of the secularization of nursing as occurring in 1860, a time characterized by continuing medical ignorance and a tendency towards defining good health as physical and spiritual well-being. Current moves to incorporate holistic nursing into medical care reinforce the sacred or spiritual aspects of nursing. See, for example, F. K. Prochaska, "Body and Soul: Bible Nurses and the Poor in Victorian London", Historical Research, vol. 60 (1987), pp. 337-48; Lori Williamson, "Soul Sisters: The St John and Ranyard Nurse in Nineteenth- Century London", International History of Nursing Journal, vol. 2, no. 2 (winter 1996), pp. 33-49. On holistic nursing see Geertje Boschma, Ambivalence About Nursing's Expertise: The Role of a Gendered Holistic Ideology in Nursing, 1890-1990, in Anne Marie Rafferty, Jane Robinson and Ruth Elkan (eds.), Nursing History and the Politics of Welfare (London: Routledge, 1997), pp. 164-76; Barbara Montgomery Dossey, Lynn Kegan, Cathie E. Guzzetta and Leslie Gooding Kolkmeier, Holistic Nursing. A Handbook for Practice, 2nd edition (Maryland: Aspen Publishers, Inc., 1995); Verna Benner Carson, Spiritual Dimensions of Nursing Practice (Pennsylvania: W. B. Saunders Company, 1989). 

5 Vol. 3, pp. 31-2. It is interesting to note that Nightingale was anti-registration and clashed with Bedford Fenwick, and many others, over the issue. 

6 Nancy Tomes, "The Silent Battle: Nurse Registration in New York State, 1902-1920", in Ellen Condliffe Lagemann (ed.), Nursing History: New Perspectives, New Possibilities (New York: Teacher's College Press, 1983), p. 110. 

7 Ibid., p. 109. 

8 It is no coincidence that the titles of many women's history books written in the 1970s and 1980s reflected the political considerations of contemporary women's place in society and in history. See, for example, Sheila Rowbotham, Hidden From History; Dale Spender, Women of Ideas and What Men Have Done to Them; Renate Bridenthal and Claudia Koonz, Becoming Visible; Berenice A. Carroll, Liberating Women's History. Many of these books were written during the time that radical feminist scholars were demanding that history be replaced by herstory. Condliffe Lagemann comments on the connection between developments in women's history and the history of nursing. See Ellen Condliffe Lagemann, "Introduction - Nursing History: New Perspectives, New Possibilities", in Condliffe Lagemann (ed.), Nursing History, pp. 1-12, esp. p. 2.

 9 Vol. 1, p. 7. 

10 For the development of history see Arthur Marwick, The Nature of History, 3rd ed. (London: Macmillan, 1989); John Tosh, The Pursuit of History. Aims, Methods & New Directions in the Study of Modern History, 2nd ed. (London and New York: Longman, 1996); E. H. Carr, What is History? (London: Penguin Books, 1986). 

11 Numerous academics have commented on the "evaluative, indeed largely congratulatory" tone of nursing history. See, for example, Celia Davies, "Introduction: the Contemporary Challenge in Nursing History", in Celia Davies (ed.), Rewriting Nursing History (London: Croom Helm, 1980), p. 11; Katherine Williams, "From Sarah Gamp to Florence Nightingale: a Critical Study of Hospital Nursing Systems from 1840 to 1897", in Davies (ed.), Rewriting Nursing History, pp. 42-53. 

12 See, for example, Davies (ed.), Rewriting Nursing History; Christopher Maggs (ed.), Nursing History: The State of the Art (London: Croom Helm, 1987); Rafferty, Robinson and Elkan (eds.), Nursing History and the Politics of Welfare; Pat Holden and Jenny Littlewood (eds.), Anthropology and Nursing (London and New York: Routledge, 1991); Bonnie Bullough and Vern Bullough, The Care of the Sick. The Emergence of Modern Nursing (London: Croom Helm, 1979); V. L. Bullough, "Men, Women and Nursing History", Journal of Professional Nursing, vol. 10, no. 3 (May-June, 1994); Anne Hudson Jones, Images of Nurses: Perspectives from History, Art and Literature (Philadelphia: University of Pennsylvania Press, 1988).

 13 See Mary Ann Dzuback, "Nursing Historiography, 1960-1980. An Annotated Bibliography", in Condliffe Lagemann (ed.), Nursing History, p. 181. 

14 Vol. 2, p. 165. 

15 Vol. 3, p. 281. 

16 Bullough and Bullough, Care of the Sick, p. 142. Dock believed that the campaigns for nurses' rights and women's rights were interrelated, and she encouraged her colleagues to support the battle for enfranchisement. The American Nursing Association was not willing to endorse equal rights, and did so only after Dock's death in 1956. 

17 Vol. 3, p. 16; see also vol. 4, p. 44. 

18 Vol. 3, pp. 33-4. 

19 Ibid., p. 228. Many nineteenth-century philanthropic women experienced opposition to their involvement in workhouse reform. See, for example, Lori Williamson, Power and Protest. Frances Power Cobbe and Victorian Society (London: Rivers Oram Press, forthcoming 2000). 

20 An all too familiar criticism of the British health care system today!

 21 Louisa Twining and Frances Power Cobbe wrote eye-watering criticisms of workhouse infirmaries; contemporary novelists, such as Charles Dickens, also reinforced stereotypes. See Louisa Twining, "Workhouse Cruelties", Nineteenth Century, vol. 28 (1890), pp. 709-14; Frances Power Cobbe, The Sick in Workhouses (London: J. Nisbet and Company, 1861); Frances Power Cobbe, Workhouse as an Hospital (London: Emily Faithfull and Company, 1861). Many historians, such as M. W. Flinn, believe that want of well-trained workhouse nurses was "the greatest handicap" of poor law hospitals. See M. W. Flinn, "Medical Services Under the New Poor Law", in Derek Fraser (ed.), The New Poor Law in the Nineteenth Century (London: Macmillan, 1976), pp. 45-66. 

22 The decades-long attempts of male Poor Law Guardians and local government officials to thwart the efforts of female reformers, such as Louisa Twining and Frances Power Cobbe in England and female members of the Hospitals Committee of New York's State Charities Aid Association, are cited as apposite examples of male prejudice to female involvement in public life. 

23 Vol. 3, p. 22. Dock was outspoken on venereal diseases, and in 1910 penned Hygiene and Morality, a Manual Giving an Outline of the Medical, Social and Legal Aspects of the Venereal Diseases. 

24 For a detailed discussion see, for example, Lucy Bland, Banishing the Beast. English Feminism & Sexual Morality, 1885-1914 (London: Penguin Books, 1995). 

25 See Anne Marie Rafferty, "Historical Perspectives", in B. Vaughan and K. Robinson (eds.), Knowledge for Nursing Practice (Oxford: Butterworth Heinemann, 1992), pp. 26-41. 

26 "Their histories were written as political statements and not just as rather self-congratulatory pieces of rhetoric." Christopher Maggs, "Nursing History: Contemporary Practice and Contemporary Concerns", in Maggs (ed.), Nursing History: The State of the Art, p. 3. 

27 See, for example, ibid. 

28 See Lesley A. Hall, "Nurses in the Archives: Archival Sources for Nursing History", in Rafferty, Robinson and Elkan (eds.), Nursing History and the Politics of Welfare, pp. 259-73. 

29 Dzuback, "Nursing Historiography", pp. 181-210. There have been attempts made to collect nurse archives, for example the nursing archive at Boston University's Mugar Memorial Library; the Rockefeller Archive Centre in Pocantico Hills, New York; the archives at Teacher's College, Columbia University which include the Adelaide Nutting Historical Nursing Collection. The Royal College of Nurses and the Wellcome Institute for the History of Medicine have made similar progress with cataloguing nurse archives in the United Kingdom. 

30 International History of Nursing Journal, vol. 5, no. 1 (winter 1999), p. 3. 

31 See, for example, the contributions from Angela Cushing and Christopher Maggs in the International History of Nursing Journal, vol. 2, no. 2 (winter 1996). 

32 See James Davies and Angela Cushing, "Nursing Leadership in the US, 1950s-1970s: A Discourse Analysis", International History of Nursing Journal, vol. 5, no. 1 (winter 1999), pp. 12-18; Cynthia Q. Woods, "From Individual Dedication to Social Activism: Historical Development of Nursing Professionalism", in Maggs (ed.), Nursing History: The State of the Art, pp. 153-75.

 33 Condliffe Lagemann, "Introduction - Nursing History", p. 1. 

34 Davies (ed.), Rewriting Nursing History. 

35 Anne Summers discusses the academic model of nursing in her contribution to Loudon's Western Medicine. See Anne Summers, "Nurses and Ancillaries in the Christian Era", in Loudon, Western Medicine, pp. 202-205. 

36 International History of Nursing Journal, vol. 5, no. 1 (winter 1999), p. 3.