Discovery and Development, 1860-75: Lister and Pasteur » Nightingale, Hospitals and the Training of Nurses

Nursing before Nightingale

In the mid-19th century, most British hospitals were charities, paid for by donations. Nursing had no standard training. Many nurses were poorly paid women who learned on the job, and nursing had a poor reputation. Charles Dickens made the stereotype famous with his character Sairey Gamp, a careless, drunken nurse. Real nurses were often better than this, but the image stuck.

Hospitals were also badly designed. Wards could be crowded, dark and stuffy, with little fresh air. People at the time believed in miasma, the idea that disease spread through bad air, so dirty, smelly wards were seen as a real danger.

Nightingale was already famous for her work in the Crimean War. After the war she used that fame to change hospitals and nursing at home.

Key terms:

• Probationer: a nurse in training, learning the job before she is fully qualified.
• Matron: the woman in charge of the nurses in a hospital.
• Pavilion ward: a long, narrow hospital ward in its own separate block, with tall windows on both sides to let in light and fresh air.
• Voluntary hospital: a hospital paid for by charity and donations, not by the government.

Notes on Nursing, 1859

In 1859 Nightingale published Notes on Nursing. It was written in plain English for ordinary people, not just doctors. It sold very well, and it became a guide for nurses and for women caring for the sick at home.

She also published Notes on Hospitals in 1859, which explained how hospitals should be built and run.

The Nightingale School, 1860

After the Crimean War the public raised a large sum of money for Nightingale, called the Nightingale Fund. She used it to open the Nightingale Training School for nurses at St Thomas' Hospital in London in 1860.

• Who joined? Young women of good character, who trained as probationers for a year.
• What did they learn? They lived together in a home and learned practical nursing on the wards from the matron and the ward sisters. They also had lessons from doctors, and kept records of their work and progress.
• What happened next? Trained nurses were sent to work in hospitals in Britain and abroad, and many became matrons themselves, passing on the same methods.

This was a big change. Nursing began to look like a respectable career for women, with training and standards. The school did not suddenly change every hospital, but it began a steady spread of trained nurses.

Better hospitals

Nightingale also pushed for new hospital design. She backed the pavilion ward, with separate blocks joined by corridors, tall windows opposite each other, and space between the beds. The aim was plenty of air, light and cleanliness. St Thomas' Hospital itself moved to a new site by the River Thames at Lambeth, opened in 1871, and was built on this pavilion plan.

Some of her thinking was wrong, because she still believed in miasma rather than germs. But her stress on clean, airy wards and careful nursing helped to cut infection, and it fitted well with the later discovery that germs caused disease.

Change and continuity

There was real change. Nursing became a trained profession and more hospitals were cleaner and better designed. But there was continuity too. Most hospitals stayed charities, doctors were mostly men, and progress was slow. Many hospitals and workhouse infirmaries kept untrained nurses for years, and surgery was still dangerous.

Exam-style question

Explain two causes of the rise of nursing as a trained profession in the years c1860 to c1880. [8 marks]

Remember: one cause on its own can score no more than half marks, so give two. For each, give precise facts and explain how it led to the outcome.