My doctoral work on naval and military nursing in the British empire c. 1763-1830 focuses on five dimensions of nursing care, the military/naval medical system, and the relationship between nurses, nursing, and the state. This work helps to dispel the image of the pre-Nightingale nurse as a drunken caricature.
Cleanliness and Preventative Medicine
Medical practitioners and early modern British society viewed nursing as a female task, one often performed by female family members for their loved ones. The work of nursing — cleaning the bodies, body linen, and bedding of the sick, preparing and feeding patients correct diet, and ensuring the cleanliness of rooms — used skills that women were typically viewed as possessing. This gendered view of nursing work ensured that nurses working in naval and regimental hospitals were women. Yet, these women should not be relegated to a domestic rather than a medical role. The same tasks listed above were distinctly medical within the framework of early modern medicine with cleanliness and ventilation the vanguard of preventing contagion in hospitals.
Ventilation and Healthy Environments
Eighteenth-century medical practitioners believed that environmental factors either promoted or hindered recovery through a direct relationship between the environment and a patient’s constitution. These ideas continued to be influential into the nineteenth century when medical practitioners discussed best practices to prevent the build-up of noxious effluvia (vapours given off by the sick body) in their enclosed institutions. In some hospitals, mechanical ventilators were installed to circulate the air, but for most, open windows enabled fresh breezes to enter wards. Medical practitioners have often been credited, in their own writings and by medical historians, with improving hospital ventilation. But in fact, the everyday work of ventilation, and air purification through fumigation, was in the hands of nurses as an extension of maintaining the domestic space.
Race and Nursing
European eighteenth-century understandings of health and disease in the West Indies culminated in the belief that the region was particularly deadly to newly arrived British settlers and military personnel unseasoned to the climate. This belief appeared to be borne out in the deaths due to disease of thousands of troops sent to the region during the Revolutionary and Napoleonic War period. European women and Euro-settler women were not seen as capable to provide nursing care to the sick in military and naval hospitals. Instead enslaved African and Afro-Caribbean women employed as nurses in these institutions. Focusing on a case study of Bermuda Naval Hospital I consider how concepts of immunity influenced the selection of Black nurses to care for these diseased sailors, how the use of slaves in naval hospitals conformed to local societal expectations and conceptions of Black labour, and the integration of these women within the wider labour market of the islands.
By conceiving of eighteenth-century naval hospitals along household rather than martial lines it is possible to better understand the organisation of the hospitals themselves and the role of nurses. With Plymouth Naval Hospital as a case study, I argue that contemporaries conceived of naval hospitals along household lines and thought of nurses and other non-medical officers as servants. I have collected 1419 naval nurses’ pay list information into a database with 18784 individual entries, in order to perform a quantitive analysis of the collective nursing staff and individual nurses’ careers. I merge this quantitive information with journals, letters, and reports to show how the number of nurses responded to the military needs of the state, the importance of nurses to the functioning of the hospital, and their role in exercising authority in the wards.
Coupled with understandings of cleanliness and preventative medicine studying changes to regulatory practices over time shows how nursing in naval hospitals became more medicalised in the period of the Revolutionary and Napoleonic Wars. The absence of change in nursing regulations within military medicine, while likely due to the lack of permanent general hospitals, suggests that significant reform was necessary in order to continue to meet the needs of an imperial nineteenth-century army. The discrepancy between regulatory practices in the army and the navy demonstrates the different conceptual and practical frameworks of the military and naval medical systems and provides a clue to the need for Nightingale’s Crimean nursing reforms.