She was born into the Army and devoted her life to saving the lives of others, no matter how difficult the conditions. She ran a tight ship, by the book, but not without compassion. The war gave her a husband and took him away. Psychiatrist Dr. Sydney Freeman described her as “on the outside, all discipline and strength and on the inside, six kinds of passion looking for an exit.” Her colleague Dr. Charles Winchester found her to be “part seductress, part Atilla the Hun.” Most people just called her Hot Lips. My name’s…
There has never been a time without nurses, though what a nurse is and what they do has changed dramatically over time. The noun nurse was originally a woman who breastfed other women’s babies, as in wet-nurse–the Latin word nutire means to suckle. It wouldn’t be until the 16th century before the word meant primarily or exclusively someone who cares for the sick. That’s not to say medical nursing wasn’t happening, it just hadn’t taken on its modern name. The first known written reference to nursing as a profession dates to about 300 CE. At the time, the Roman Empire sought to build a hospital in each town under its rule. That’s a lot of hospitals, which means they would need a lot of staff. Then as now, nurses outnumber doctors by a wide margin. The Middle Ages in Europe saw another boost in nurse numbers, owing to a push from the Catholic church for more and better medical care–you know, the whole ‘healing the sick’ thing. Throughout the 10th and 11th centuries, hospitals began to be included as part of monasteries and convents, and the nurses provided a wider range of medical care than they had before. Then Henry VIII of England got it in his head to close the monasteries and with them went the hospitals and the jobs of the nurses, to say nothing of the health of the people in the area. Luckily, other parts of Europe where the Catholic church remained a dominant force, kept their hospitals and their nurses.
“Modern nursing” could be said to have started during the Crimean War of the 1850s, with arguably the best-recognized name in nursing history, Florence Nightingale, who we’ll talk more about later. The role of nurses expanded as nurses were needed on the front lines of wars, where poor hygiene led to infections that could be more fatal than the injuries. Nightingale campaigned to improve the hygiene of the hospitals treating wounded soldiers, which drastically reduced the number of deaths from infections. Doctors were reluctant to listen to her, but you can’t argue with results. Professional nursing leapt forward a decade later with the opening of the very first nursing school in London, where new nurses could receive training and education *before they were sent into the field. At the turn of the last century, Dr. Anita Newcomb McGee and colleagues pushed for the creation of the United States Army Nurse Corps (ANC), which became a permanent unit in the Army. A year later, the New York Nurses Association laid the groundwork for the first nurse practices act, which ignited a movement to require nursing professionals to have some form of medical degree before working. This would protect not only the patients from being tended by unqualified nurses, but also protected the nurses from being thrown into situations they were not trained for. By 1921, all 48 extant states required standardized training and licensing. This began a shift in nursing duties. Prior to the modern era, nursing encompasses anything you might think of as woman’s work, like washing the hospital laundry. As nurses became more highly trained in medicine, the housekeeper expectations began to wane. The war to end all wars and its sequel caused such a huge demand for nurses so quickly that nurses were again caring for patients without sufficient preparation. This underscored the need for the many nursing schools that have been established since.
This was of course a very broad overview of the experiences of hundreds of thousands, maybe even millions, of people across history. And a Eurocentric one, I’ll cop to that. Let’s pinkie-promise we’ll look into the history of nursing in the Middle East, where medicine was leagues ahead of Europe. In the multitudes of nurses, a few names stand out. Well, not a few, many names stand out, but it’s only a half-hour show. Let’s start with a name we’ve probably all heard references, but perhaps didn’t know enough about, the aforementioned Florence Nightingale. Nightingale was born in 1820 to a wealthy British family living in Italy who named her for the city of her birth, Florence. She trained at the Institute of St. Vincent de Paul, in Alexandria, Egypt as well as school in Germany and in France, before volunteerings as Superintendent of the amazingly named Establishment for Gentlewomen. Then came the Crimean War in 1854. For the benefit of several listeners, and the host to be honest, Crimea is a peninsula in the Black Sea currently claimed by Ukraine and the Crimean war saw the Russian Empire lose to an alliance of the Ottoman Empire, France, Britain and Sardinia.
The conditions that Nightingale and 38 nurses found in the military hospitals in Turkey were dire. Wounded soldiers underwent operations in unsanitary conditions; sick soldiers found themselves sharing food and beds with vermin; cholera, typhus, and other diseases had a field day. This was the period of the miasma theory of infection, that sickness spread through bad air or strong smells; germ theory was still a decade away, so even doctors wouldn’t believe that they were contributing to the problem. The mortality rate in military hospitals was *7 times higher than on the actual battlefield. It was a statistic like that that Nightingale, schooled in mathematics, used to prove that changes in sanitary conditions did save lives. She implemented changes that seem like no-brainers today,like regular cleaning of floors and the wearing of surgical caps. She and her nurses reformed the hospital with a standard sanitization process and patient mortality dropped from 42% to 2%. Civilian hospitals back in England took note and followed her example and the idea spread from there all over the world, saving an uncountable number of lives.
Nightingale wasn’t the only notable nurse to serve in the Crimean War. The soldiers there also benefited from the care of Mary Seacole, born in 1805 to a Scottish soldier and a free black Jamaican woman who was skilled in traditional medicine. Although they were “free”, Mary’s family had few civil rights–they were not allowed to vote, hold public office or enter a number of professions. Seacole had the wanderlust and left Jamaica for places as disparate as Haiti and England, always expanding her knowledge of traditional medicine with each place she visited. She was in London when she learned how the troops were suffering. Seacole approached the War Office and asked to volunteer. They refused her. Anyone willing to go out on a limb and guess why? Mary Seacole wouldn’t be dissuaded. She went to Crimea on her own dime, where she helped distribute medicine in military hospitals and nursed the wounded on the battlefield. The soldiers began to refer to her as ‘Mother Seacole’. Her reputation rivaled that of Nightingale. Working in a warzone takes its toll on a person, and Seacole was sick and destitute when she returned to England. The media caught wind of her troubles and her heroic story and too. In 1857, a century plus before LiveAid, people actually organized a benefit festival to raise money for Mother Seacole, which was attended by thousands of people.
Popping back to Nightingale for a moment. Her passions weren’t limited to sanitation. She advocated for famine relief in India and opened the Nightingale Training School for Nurses at St Thomas’ Hospital in London, but her greatest contribution to medical history could be said to be her writings. Nightingale wrote in simple English so that her medical knowledge could be available to anyone who could read. Many nurses to this day read Nightingale’s Notes on Nursing, just one of over 150 books and pamphlets she wrote, which is filled with timeless wisdom on patient care. Despite her prolificness and the importance of her writings, there wouldn’t be another nursing theory published until 1948, when Hildegard Peplau, whose career included working as an Army nurse during WWII, published Interpersonal Relations in Nursing. It took her four years to get the book published because it wasn’t co-authored by a doctor and that just wasn’t done. Peplau was also an advocate for mental health care and mental health law reform.
Another advocate for mental health was Dorothea Dix. Dix, born in New England in 1802, initially focused her life on education, beginning a teaching career at age 14 and opening a school for girls, and a free school for girls who could not afford to attend the main school. Dix found herself Sunday School at the East Cambridge women’s prison. It was there that she saw the appalling treatment inflicted on the prisoners, many of whom were mentally ill, and she began to travel to research the conditions in other prisons and poorhouses. This tour led Dix to write “Memorial”, a report of the egregious human rights violations she had found, which she presented to the state legislature. The legislature passed laws expanding and improving Massechusett’s mental hospital system. Dix then performed similar investigations and presentations in other states, including New Hampshire, Louisiana, and North Carolina. The end result of her work was increased awareness across the southern U.S. (and eventually the entire country) that the mentally ill deserve fair treatment and considerate care. She also helped advance the specialty of psychiatric nursing. The only thing that kept her from her crusade was the Civil War, where she was assigned to be the superintendent of nurses. As soon as the war was over, she resumed her work and would keep writing for the rest of her life, even after she became too ill to travel.
Elsewhere in the Civil War, struggling to bring aid and comfort to troops, was Clara Barton. Like Dix, Barton was born in Mass, though twenty years later, and worked as a teacher before founding her own school. When the Civil War started, Barton petitioned government leaders to let her organize volunteer medical services and bring supplies to soldiers in need. She then asked the public for help through donations, not only monetary but even bed sheets and old towels to make into bandages. Barton spoke publicly about her experience in the war, speeches that garnered her enough recognition that she was allowed to speak directly to *two US presidents, Hayes and Arthur. Post-Bellum, Barton spent a few years in Europe, where she was introduced to the Red Cross in Geneva, Switzerland. When she returned to America, she began working to establish a Red Cross in the United States, a task that took nearly a decade. Initially, the American Red Cross only helped soldiers in need of medical care, but Barton realized there was more good they could do, such as the disaster relief that is synonymous with the Red Cross today. Barton would serve as the American Red Cross president for more than twenty years, while also working for civil rights, education, prison reform, and women’s suffrage.
Education is the linchpin of these life-saving stories, and it holds true for Susie King Taylor. For Taylor, education was more precious than it could have been for Dix, Barton or their peers. Taylor was born a slave in Georgia in 1848. It was expressly, harshly illegal to teach slaves to read, so Taylor was educated in secret. During the war, a teenage Taylor found herself among thousands of African-American who had fled the plantations they were held on to seek refuge in the Union states. She was made a laundress by Union forces enlisting black soldiers for a new regiment, the First South Carolina Volunteers, but within days became a teacher to the freed slaves of the unit. The unit’s white abolitionist colonel, Thomas Wentworth Higginson, wrote of his men, “Their love of the spelling-book is perfectly inexhaustible.” On the flip side, the soldiers taught her to use a musket and she was a good shot. When the Volunteers saw action, Taylor shifted again, this time from teacher to nurse, making her the first African-American Army nurse. She served until the end of the war, when she and her soldier husband were mustered out. The memoirs of her life can be read in the Reminiscences of My Life in Camp with the 33d United States Colored Troops Late 1st S. C. Volunteers, the only civil war memoir written by a woman of color. There’s one thing about her amazing story that’s been bugging me since I researched this episode and it’s the picture that’s used on every article. She looks like an actress I know I’ve seen repeatedly, but I can’t put my finger on her. Hop into the show notes for a link and see if you can set me straight. You can also find the link of the website. While you’re there, be sure you go to /trivia to play our weekly quiz. Last week’s prizes were donated by Deepwater Gaming and this week’s comes from Fireside Games. You can play every week.
As the war was ending in the States, life was just beginning for Edith Cavill, who was born to a poor family in England in 1865. Cavell from an early age that she wanted to have a life that would mean something to other people. It’s probably what led her to become a nurse at age 20. In her forties, she was appointed the matron, a position analogous to head nurse or charge nurse, of the Berkendael Medical Institute in Brussels, Belgium. After WWI began and Germany invaded Belgium, Cavell struggled to maintain the standards in hospitals, not only in the facilities themselves, which had been converted to a Central Powers military hospital, but in making sure her nurses treated all human life equally. Allied soldiers who were wounded and starving started coming to Cavell’s hospital for help. Not only did Cavell and her nurses treat the Allied soldiers, she hid them and helped them secure money and fake documents to get out of the country. No good deed goes unpunished, and Cavell was found out, arrested, and sentenced to death. Her execution received worldwide condemnation and extensive press coverage. The night before her execution, she said, “Patriotism is not enough. I must have no hatred or bitterness towards anyone.” These words were later inscribed on a memorial to her near Trafalgar Square.
Mary Breckenridge’s life started on an easier foot, her being the daughter of a US Congressman and a granddaughter of the Vice President of the United States and raised with the wealth and privilege you expect. That included world travel and the best schools, but could not shield her from being a young widow, losing two children, and divorcing her second husband. Those losses drove her to devote her life to helping others and pursue a career in nursing. She traveled to Washington D.C. where she was able to care for people who were ill because of the 1918 influenza epidemic. Side rant: we need to stop calling it the Spanish flu. It didn’t come from Spain. The best data we have now indicates it started in Kansas. It was assigned to Spain because they reported on it freely while they were neutral during WWI. Back on track. Breckinridge joined the Comité Americain pour les Régions Dévastées de France (American Committee for Devastated France) and received permission to organize a visiting nurse program with women trained as nurses and midwives. When she returned to the States in 1921, there were no schools of midwifery in the United States. No trained midwives means higher infant mortality rates in areas with few doctors. Breckenridge worked hard to become a certified midwife, and in 1925, she launched The Kentucky Committee for Mothers and Babies (later called the Frontier Nursing Service) to provide nursing and midwifery to the isolated communities of the Appalachian mountains. Addressing a similar need, there’s an amazing story of a program in India that trains women of the Untouchables class to provide health care and education to people in rural villages, particularly when it comes to dispelling dangerous superstitions around prenatal and postnatal care. You can hear all about it on patreon. For the duration of the covid crisis, to thank our members for continuing their financial support, all members of all levels, like our newest member Maria, receive all rewards. I’ve been out of work for two month and those twos and fews are really appreciated.
Here’s yet another Mary, Mary Ezra Mahoney. Did I miss my calling or something? (Mary is my given name.) Born in Dorchester, Massachusetts in 1845, dreamed of becoming a nurse, but she was African-American. Her first fifteen years working for the New England Hospital for Women and Children were as a cook, janitor, washerwoman and a temporary nurse’s aide. When she turned 33 years old, she entered the hospital’s 16-month Nursing Program. Of 42 students who enrolled, only four of them passed the program. She became the first ever African American in history to earn a professional nursing license when she received her nursing certification in 1879. Mahoney served as a private care nurse for the next 30 years all along the Eastern Seaboard and joined the predominantly white Nurses Associated Alumnae of the United States and Canada, later known as the American Nurses Association. The pallor of the room wasn’t lost of Mahoney, so she co-founded the National Association of Colored Graduate Nurses (NACGN) in New York. Mahoney is widely recognized as a pioneer who opened the door of opportunity for many black women who were interested in the nursing career.
Mahoney’s struggle would be shared by Mabel Keaton Staupers. Like Mahony, Seacole, and Taylor, Staupers had to overcome ingrained and systemic racial prejudices in her quest to help others during the Great Depression and World War I, even though she graduated nursing school with honors. In 1922, she became the executive secretary for the Harlem Tuberculosis Committee, a Tuberculosis and Health Association unit in New York. In this important post, she saw more clearly the wide disparity between black and white in areas like access to quality healthcare and the treatment of black nurses in professional organizations like the American Nurses Association. Stauper joined the NACGN as executive secretary. This provided her a more stable platform on which to help black nurses. Her efforts saw tangible results when the government integrated the U.S. Army Nurses Corps after the attack on Pearl Harbor. Even after WWII was won, Staupers fight continued and she successfully secured full membership for black nurses in the ANA.
Oh, my, there are so many amazing nurses. Let me broad-stroke a few more. British nurse Linda Richards laid the foundation for our modern medical record-keeping. “Okay, that’s kind of underwhelming,” you say, but oh so important. Before Richards put her analytic mind to the problem, each patient was a mystery, like a soap opera amnesiac, every time they went to a new doctor, or even a doctor they hadn’t seen in a while. As someone with a chronic illness who has seen many doctors and had many different tests and tried many different drugs in the past few years, I appreciate this. Margaret Sanger was a nurse who recognized the importance of empowering women to control how many children they have and when. She distributed information about birth control, even when it was against the law, and was behind the testing of the first birth control pill. Her entry does get an asterisk, though, as the initial testing of the pill took advantage of illiterate women with limited English and the doctors involved didn’t autopsy the women who died. Virginia Lynch is the mother of forensic nursing. Never heard of forensic nursing before? Neither had I and I’m a forensic science nut. Forensic nurses aspects of biological, psychological, sociological, spiritual, and cultural nursing to help victims who’ve suffered injury or violence, living or dead. Some work with medical examiners to advocate for the deceased; others work in psychiatric or mental health facilities. They perform forensic examinations, collect evidence, and educate and counsel victims of assault, as well as testifying in court. Some are even nurse consultants for the courts. Hazel W. Johnson-Brown was the first African-American chief of the Army Nurse Corps, appointed in 1979. This put her in command of 7,000 men and women in the Army National Guard and Army Reserves, as well as overseeing medical centers, clinics, and hospitals in the US, Panama, Germany, Italy, Japan, and Korea.
Speaking of Army nurses in Korea….yeah, I managed to work MASH into this episode and I can back up that decision, because this week I learned that Major Margaret “Hot Lips” Houlihan is based on a real person. More than one, actually. The book, movie, and TV show MASH was based on the experiences of the MASH units in the Korean War, MASH of course standing for mobile army surgical hospital. The Army had figured out that the faster wounded soldiers could be treated, the better their chances were. The introduction of MASH units in WWII had almost halved deaths from major trauma. More than 1,500 nurses served on the Korean peninsula, all of them women since men were not allowed to serve as nurses in the Army Corps until 1955. Among those women was a group nicknamed the Lucky 13. They deployed with the Army’s 7thInfantry Division to the 1stMobile Army Surgical Hospital (M.A.S.H.) on September 15th, 1950. En route to Pusan, the unit came under enemy fire and were forced to take cover. Chief Nurse Major Eunice Coleman wrote about that day a few weeks later: “The whole sky was lit up by gunfire and burning vehicles. About sun-up we got out of the ditch and started treating the wounded. All that day, until 1500, we worked on the roadside; operating and treating for shock. We lost eight men and quite a number of supplies and vehicles. When all was clear, the convoy started again and arrived at Pusan by midnight.” The treated 360 wounded when their supposed capacity was only for 60. After this event they began calling themselves the ‘Lucky Thirteen’. Among the Lucky 13 were Janie Hall and Elizabeth Thurness, sometimes identified as “Hotlips” Hammerly. The character of Margaret Houlihan’s looks were based on Thurness and her attitude on Hall. Hall, in fact, consulted on the show and writers were able to draw on her directly. Sadly, I couldn’t find much else about the women, though you can find a photo of them linked in the show notes. In fact, most of what I found was the same sentence copy-pasted on dozens of websites.
That takes us from nurses in uniforms to still nurses in uniforms, I suppose. It was Florence Nightingale, again, who gave us standardized nursing uniforms. Prior to that, a nurse would be wearing her own close, or her nun’s habit if she were part of a religious order. Nightingale’s uniforms were full-length, long-sleeved dresses and aprons were meant to protect nurses from illness. It was a good thought, though it’s a pity they didn’t know to include masks and gloves. In the early 1900’s, many nurse uniforms included a cape. These were originally introduced for warmth when treating patients outside, in those wars we’re so fond of, but were adopted for year-round wear. They also made it easy to identify a nurse’s country, hospital and rank at a glance. This was around the same time that uniforms moved away from the dark greys of nun’s habits and moved toward clean and pure-looking, stain-taunting white. Apart from the symbolism, I can find no other reason to wear white in a job where you’re liable to get puked, pooped, or bled on on any given day. Uniform dresses stayed stuffy and long until World War II, when skirts and sleeves got shorter. This not only improved mobility, but used less material that might be needed elsewhere in the war effort. Speaking of donating to the cause, if you’d like to help nurses get some of the PPE they need, Build RVA, the makerspace that is my husband’s other wife is making face shields to donate to local hospitals. They cost $1.30 each to make, so if you donate $13, that’s 10 more masks to protect nurses and other healthcare workers from direct contamination to help their limited mask supply last longer. Click the link in the show notes or go to https://bit.ly/buildfaceshields. Another benefit of a uniform made of less fabric is less yardage to harbor and spread bacteria. In fact, be wary of doctors wearing neckties. Since ties don’t get sent to the cleaner’s unless something gets on them, they’re basically boldly-patterned petri dishes swinging from room to room. A 2004 study at the New York Hospital Medical Center of Queens cultured the neckties of doctors and medical students. Nearly half were found to harbor potentially infectious bacteria, including MRSA. So if your doctor walks in wearing a snazzy bowtie, or better yet no tie at all, give him a hi-five. Not during the pandemic, obviously. Maybe shoot him some finger guns.
The next wave of change in nurse uniforms came with the feminist revolution of the 60’s and the influx of male nurses in the 70’s. Suddenly, there was a real need for pants for nurses. There was even a pantsuit made in the 70’s, but I don’t think anyone specifically needed that. In the 1980’s, practical, comfortable, easily washable operating room scrubs began to filter out into other parts of the hospital. If you’ve ever wondered why blue and green scrubs seem so ubiquitous, it’s because they are. The contrast of the cooler colors helps reduce eyestrain for the surgeons and staff during operations when they’re staring for hours into the red goop that is human anatomy.
There was another piece of the uniform that predated Nightingale and held on for a *long time–the nurse’s cap. They too began with nuns and were adopted into Nightingale’s official uniform. The veil that covers a nun’s hair isn’t her habit, it’s her whimple, and I dare you to find a more delightful word to roll around your mouth. After the Crimean war, students at the Nightingale Training School at St. Thomas’ Hospital began to disdain the longer, bonnet-like caps in favor of shorter, square-shaped caps. Different nursing programs and hospitals offered their own caps. A new nurse might be assigned something with ruffles and frills called a Flossie, a starched stiff box-like cap, the Bellevue “fluff,” or a simple knotted kerchiefs. In fact, if you knew whose caps were whose, you could wake up in a hospital and know immediately where you were.
Caps were bestowed to both student and graduate nurses in a rite of passage known as a capping ceremony. There might not be a single ceremony at graduation, but a few along the way as students hit different milestones–it varied by schools. Sometimes the caps would change completely, other times stripes or colors would be added, like a karate belt.Early capping ceremonies were often held in churches, where, before the students’ friends and families, they’d be “capped” by an instructor or by a mentor student, usually referred to as a “big sister.” Being capped symbolized attaining the knowledge and skills needed to serve their patients. Like a high school graduation, there would be speeches and happy tears. As one speaker at a 1938 graduation powerfully expressed, “the nurse’s cap means to you what the soldier’s uniform means to him. When this cap is pinned on your head, it means you have become a member of one of the noblest professions and have subscribed to its ideals of service. You are no longer merely an individual responsible for her own acts; you are part of the nursing profession.”
But times changed, as they’ll do. Hats, once an essential component of every outfit, fell out of fashion, and women were no longer as keen to dress in ways that could be interpreted as making them look subservient. Plus the caps were often fussy, starched things that couldn’t be washed with the rest of the uniform, so they might not get washed at all if they didn’t look dirty. And like the doctor’s ties, they contributed to hospital-borne infections. The cap had to go. But still, they serve as a powerful reminder of the hard work performed and the obstacles overcome by generations of nurses. “I may never wear [my cap], says RN Bonnie Miller, “but I earned it.”
And that’s…Taking next week off, listen to nurse podcasts, like Stat! (shocking trauma and treatments), the Q word, EMCrit and especially People are Wild If you want Remember….Thanks…