The Servant Image of the Nurse

The Renaissance and the Reformation (occurring from the 14th through the 16th centuries) followed the Middle Ages. During the Renaissance, also known as the Age of Discovery, a new impetus was given to education, and, to some extent, to medical education. For example, Ambroïse Paré (1510–1590), a French surgeon, revived the method of tying blood vessels to stop hemorrhaging, believing that procedures based on acute observation were better than those based on ancient doctrines. Andreas Vesalium (1514–1564) published a treatise of surgery and anatomy that refuted the teachings of Galen, who up to that point had been the undisputed authority on medicine. Nursing education, however, was all but nonexistent during this period. The Reformation, a religious movement inspired by the work of Martin Luther, began in Germany in 1517. It resulted in a revolt against the supremacy of the Pope and the formation of Protestant churches across Europe. Monasteries were closed, religious orders were dissolved, and the work of women in these orders became almost extinct. The Reformation brought about a change in the role of women. The Protestant Church, which stood for freedom of religion and thought, did not grant much freedom to women. During the Reformation, women were deemed subordinate to men and were no longer venerated by their churches, but encouraged toward charitable activities. Their role was defined within the confines of the home; their duties were those of bearing children and caring for the home. Work in hospitals no longer appealed to women of high birth. Hospital care was relegated to uncommon women, a group comprising prisoners, prostitutes, and drunks. Women faced with earning their own living were forced to work as domestic servants; although nursing was considered a domestic service, it was not a desirable one. The nurse was regarded as the most menial of servants. Pay was poor, the hours were long, and the work was strenuous. Nursing care was not subject to inspection and was not governed by standards. The same bed linen might be used for several patients, even though suppurating wounds were common. Thus began what may be called the “Dark Ages” of nursing. Charles Dickens (1936) described the image of nurses and nursing during this time through the characters of Sairey Gamp and Betsy Prig in his book Martin Chuzzlewit, which was written in 1843:
She was a fat old woman, this Mrs. Gamp, with a husky voice and a moist eye, which she had a
remarkable power of turning up, and only showing the white of it. Having very little neck, it cost her
some trouble to look over herself, if one may say so, at those to whom she talked. She wore a very
rusty black gown, rather the worse for snuff, and a shawl and bonnet to correspond…. The face of Mrs.
Gamp—the nose in particular—was somewhat red and swollen, and it was difficult to enjoy her society
without becoming conscious of a smell of spirits. Like most persons who have attained to great
eminence in their profession, she took to hers very kindly; insomuch, that setting aside her natural
predilections as a woman, she went to a lying-in or a lying-out with equal zest and relish (p. 318).
Mrs. Prig was of the Gamp build, but not so fat; and her voice was deeper and more like a man’s.
She had also a beard.
The 16th and 17th centuries found Europe devastated by famine, plague, filth, and horror. In England, for example, King Henry VIII effectively had eliminated organized monastic relief provided to orphans and other displaced persons. Throughout Europe, vagrancy and begging abounded; those caught begging were often severely punished by being branded, beaten, or chained in galleys where they served as oarsmen. Knowledge of hygiene was insufficient; the poor suffered the most. This servant image remains in modern day health care, as some individuals treat nurses as maids and others are unwilling to enter nursing because of the image. In the first World War, the International Red Cross tried to combat this image and produced a recruiting poster with the image of a Red Cross nurse on the battlefield and the statement, “Neither a nanny, nor a maid; A professional nurse” written in three languages.