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19th Century Nursing in England

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19th Century Nursing in England: Foundations for Change

The Reformation had brought with it serious repercussion in the development of health care in Protestant countries. The rejection of the Catholic Church carried with it a rejection of most of the institutions and orders which the Church had given rise to, including the orders dedicated to the care and recuperation of the sick and injured. As a result, the health care standards in all Protestant countries fell dramatically, and those who dedicated their lives to helping the sick were often denigrated publicly. It was up to a handful of individuals within the Protestant countries to turn the tide and re-establish the nursing profession within the population.


The first well-known figure among the health care reformers was Elizabeth Fry. Influenced by her Quaker background, Fry realized a burden for the poor, the sick, and the destitute at the age of eighteen. Her work revolved heavily around the prison system, where she worked to advocate for the release of women and children who had not yet received a trial. Simultaneously, she began a program of home visitation among the sick in her town while also campaigning for the abolishment of capital punishment. In the field of health care, Fry’s most noticeable achievement came with the establishment of a training school for nurses in 1840, the first of its kind in England. The training received was minimal, with no set curriculum and a course period of varying lengths, but usually no longer than a month.


Ironically Germany, the birthplace of the Protestant movement which had caused the development of nursing to stall in the first place, would also see a significant contribution to the nursing profession through the efforts of one individual. Theodor Fliedner was born in 1800, and began his working life as a pastor. When his home church could no longer support his work, he began a series of travels that would lay the groundwork for his work upon returning to his home country. Primary among his influences were the Netherlands Mennonites and their tradition of deacons, as well as his contemporary Elizabeth Fry and her work in England. In 1836, upon returning to Germany, Fliedner would establish the Deaconesses Institute at Kaiserswerth. The idea behind this institute was to train young women to seek out and help the sick within their localities.


Together, the contributions of Fry and Fliedner would have a great impact on perhaps the most important single person in any profession.

Florence Nightingale

Florence Nightingale was born in 1820 to a very wealthy British family (although she herself was born in Italy). At this time in England, hospitals and other institutions were largely regarded as holding places for the poor and destitute by the well-to-do in society. The women who took care of the people in these institutions were regarded almost equally as low, along the same lines as military camp followers (who also often had a vital role in patient recuperation). It was due to this that Nightingale’s family raised their strenuous objections when she announced her intention to become a nurse when she reached her early twenties. It is generally believed that Nightingale attributed her desire to a belief that she was being divinely called, through an experience which occurred when she was 17. By the time she had reached 25, she had gained extensive experience in the care and recuperation of the infirm. Her basic training included a short stint in Fliedner’s Deaconesses Institute (she would later return there for the full three month program when she was 31). Other training occurred in many different countries, and through her experiences she codified what she believed were the basic principles of the nurse’s foundation: tenderness, goodness, sympathy, and kindness (the traditional pillars of nursing) were complemented in her thinking by knowledge and skill. Despite her religious dedication, Nightingale was also committed to the establishment of nursing as a secular career for women.


The Crimean War, which was fought between the Russians on one side and the French, the British, and the Turks on the other, was what would push Nightingale’s agenda for nursing to the front of the national (and international) consciousness. The British in particular were known for losing more men from the poor health care they received than from the injuries suffered at the hands of the enemy. Hearing of this, Nightingale recruited a group of 38 nurses from Fry’s school in England and went to Scutari (many of these recruits turned out to have a very poor training and were sent back to England by Nightingale). Only one doctor showed any inclination to pay any attention to Nightingale or her nurses during the first months of their stint, while the others rejected her requisition requests and her attempts to clean up the conditions. Eventually, however, her personal commitment won the attention of the soldiers and their doctors and her requests were met. While the sanitary conditions were improved, however, the death tolls due to illnesses were not. It was not until the British flushed out the sewers and otherwise cleaned up the conditions around the hospital that the death rates began to fall.


When Nightingale returned to England, her studies of the events in the Crimean War would lead her to conclude that cleanliness and sanitary conditions were of paramount concern for the health profession. She would advocate for the continued training of nurses and doctors in standards of cleanliness in publications such as Miss Nightingale’s Scheme for Uniform Hospital Statistics and Notes on Nursing. In the meantime, her achievements in Turkey had gained national attention, and the “Nightingale Fund” was established in order to secure funds for the opening of training facilities for nurses. With this money, Nightingale was able to open the Nightingale School at St. Thomas’s Hospital in 1860.


The contributions of individuals, and Florence Nightingale in particular, helped to recover the reputation and standards of the practice of nursing within Protestant countries. Due to England’s continuing close ties to the United States of America and other current and former colonies, her ideas on training and her standards for nursing became internationally recognized.

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