Department of english language and literature

4. The Medical Profession

There are also many different and varied medical professions in Britain as there are in other developed countries in the world. Nevertheless, this chapter deals only with doctors and nurses because they have long been recognized widely as an indispensable and major part of medical care.

4.1. Doctors and the Past

Doctors were influential and had quite a high social status, even in the 17^th century, in spite of having almost no special qualifications. They were really not much more than witch-doctors. Nevertheless, they always required payment for their services even if only for their visit. Some of them did however treat the poor free of charge. Certainly, there were many who had time only for the rich and earned a great deal of money. For instance, the very fashionable London physician, Sir Richard Jebb earned 20,000 guineas between 1779 and 1787¹. Calling for a doctor was really very expensive especially for the poor and therefore poor people scarcely saw a doctor and they usually had no choice but to rely upon on traditional cures.

Nowadays, it is very easy to visit a doctor if one does not feel well but this was not the case in the eighteenth or nineteenth centuries. Three kinds of “doctors” existed at that time - apothecaries, physicians and surgeons. There was quite a difference between these professions.

Apothecaries were basically sellers of various kinds of drugs and pills, who gave some advice to people, especially to the poorer ones. Their social status was much lower than the physicians’. Nevertheless, later, apothecaries were held in higher respect especially in London. (For more information about apothecaries, see chapter “The Seventeenth and Eighteenth Centuries”)

Physicians were the most honoured type of doctors. In the eighteenth century they were always attached to the court and some nobleman could even afford to employ a private physician who was always available when needed.

Surgeons were ranked as much lower than physicians. The reason for that was probably due to the fact that they worked with their hands and their work seemed to be similar to that of the butcher.

Physicians have trained at colleges and universities for many centuries. Until the middle of the nineteenth century, women were not considered eligible to study medicine. Many considered the thought of it indecent. The first British woman who succeeded in being qualified was Elizabeth Garrett Anderson (1836 - 1917). She was educated mainly at home and studied anatomy privately at London Hospital. Anderson wanted at least to take exams at London University but she was refused. Finally, she managed to enrol on the medical register which enabled her to practise the job. In 1873, she even became a member of British Medical Association and remained there as the only woman doctor for the next 19 years. Anderson was one of the pioneers of the first medical school for women in Britain which was opened to women students in London in 1877. Nowadays, the hospital is named after her.

History shows us that the problems of the doctor were not only with the treatment of patients and saving their lives. It was not enough merely to have the desire to become a doctor. Being a woman seemed to be quite an insurmountable difficulty. Fortunately, even seemingly insurmountable difficulties can become surmountable over the course of time.

4.2. Nurses

4.2.1. Nurses in the Past

Nursing too has always been a very demanding profession which is perhaps one of the many reasons why most nurses give up their jobs after only few years. Since the nineteenth century when Florence Nightingale had a great influence on the development of nursing “nurses have an almost saintly image in the minds of the British public,…” Nevertheless, “this image suggests that they are doing their work out of the goodness of their hearts rather than to earn a living wage.”² Therefore, nurses often seek other work which will be better paid because nursing is quite a poorly paid job. Moreover, it is not easy to work with people and burnout syndrome can quickly become a factor. Besides, if the motivation of salary is not sufficient, there is no incentive to stay in work which is quite often considered by many to be more of a mission than a paid job. Although nurses practise their job under the doctor’s supervision, they have to be able to work on their own and carry out numerous procedures. It is very stressful and exhausting to work with people who are seriously ill and therefore anxious and fearful as well. It demands much concentration and the ability to use theoretical knowledge in practise.

Nurse training differed from medical training very significantly before the establishment of the NHS, in other words at the first half of the 20^th century. Whereas medical education was based on university studies, nurse education was provided by nursing schools which were hospital organizations controlled by a matron. The student nurses were an indispensable part of the hospital staff. Training for nursing was shorter and there were many more students studying nursing than those studying to be doctors. The course for nurses took three years, and then nurses had to pass an examination to become a so called state registered nurse (SRN). Nevertheless, if a nurse wanted to excel, she had no choice but to spend another year as a staff nurse to gain a hospital badge. It was the way how to keep nurses. In the 1930s a new system was established. It was “the block system of education” which meant that nurses did not gain knowledge only in a ward but they had to spend several weeks at nursing school. Nurses were expected, apart from other things, to learn some basic techniques at school and then be able to use them in practice and be well disciplined. Moreover, it was believed that the learning at school would be easier for them because they could easily associate theory and practice since they had already had clinical experience. Unfortunately, the intention was not always realised.

As mentioned earlier in this text (2.2 Hospitals), the life of a nurse was not easy. At the beginning of the 20^th century, if a nurse became pregnant, she was dismissed or if she was still a student nurse, her career was ended. Such problems resulted in a regular lack of nurses because pregnancy and marriage were often reckoned as an alternative to nursing.

Nurses’ salaries have been discussed for many years. Even before the NHS was established representatives of nursing were dissatisfied. In 1948, student nurses even demonstrated in the streets to gain a higher training allowance. They were successful. Regrettably, the fight for higher salaries has not always been so successful. Some people, and not only British, think that nursing is something like a mission which is done simply out of the goodness of the women’s hearts rather than a means of making a living.

Britain has always struggled with a shortage of nurses. Therefore, from the nineteenth century onwards there were two classes of nurses; state registered nurses and nursing assistants. The Nurses Act of 1943, among other things, instituted a system of examination and gave nursing assistants legal status, which enabled them to assist registered nurses. Later, they were called state enrolled nurses (SENs). In 1948 there were approximately 20,000 SENs.³ It was very useful for all concerned to create this kind of nurse. Hospitals desperately needed a workforce and the state enrolled nurses could learn very much from training for the register.

Sufficient numbers of trained nurses and doctors was one of the prerequisites in order for the NHS to be successful. Therefore, in 1945 a small working party was founded by the Ministry of Health. The chair was Sir Robert Wood; the members of the party were two senior sisters, a doctor and a social scientist. The main task of the party was to “to look at recruitment, the proper task of a nurse, the training required, the annual intake needed and how it was to be obtained, from where nurses were to be recruited, and how wastage could be minimized.”⁴

“The working party looked at the size of the nursing profession, and its structure in terms of age, educational background, professional qualifications and socio-economic status. It examined recruitment, wastage and the pattern of training. “⁵

Unfortunately, the problem was not solved. There was high recruitment of nurses but also high turnover. Hospitals were predominantly dependant upon employing new students. The problems were caused especially by The Wood Report in 1947 which criticised the training of nurses. It was found out that ‘the mental calibre of the nursing profession’ was not as high as it had been assumed ‘it was only somewhat above the population as a whole’ ⁶ It was shown through research that 54%⁷ of students failed to finish training. Changes were necessary to realise the aim of selecting students more carefully. Besides other techniques, the use of intelligence tests was contemplated. This did not necessarily mean that an applicant, who desired to be a nurse and yet had a lower level of intelligence than required for the job, could not fulfil her dreams. That student could still be recruited, if she was otherwise suitable, but only as an auxiliary to a nurse.

The work of nurses has not been easy. Nurses were required to work shifts because of the necessity of 24-hour service to care for patients. Some hospitals were adapted so that nurses could sleep on the wards or they used to live in nurses’ homes which were situated nearby in a protected environment. It seemed to the Ministry that it had proven to be quite expensive to provide accommodation to nurses, so in 1948 the Ministry recommended that nurses should find their own accommodation.

Different hospitals used different techniques and were suspicious of the techniques or innovations which were developed by other hospitals. They frequently ran out of money so their staff had to be economical e.g. they used to wash bandages. Discipline in hospitals was very strict. “The uniform was spotless, shoes shone, dress hems had to be level with the apron and hems the same height (14 inches, 35 cm). The dress colour, stripes on the hat and the belt colour identified the seniority of the nurse. Hair was neat, caps were worn and make-up forbidden.”⁸ Nurses had to be very obedient and respect hospital rules. (See Appendix 4 for a description of staff nurses at St. George’s Hospital from the first half of the twentieth century.)

Regarding the history of British nurses, two important women must be mentioned. Both of lived in the same century and did the same work but it seems that they were very different from each other.

4.2.1.1. Florence Nightingale (1820 - 1910)

One of the most important and influential women worldwide in the area of medical care is Florence Nightingale. She lived and worked during the nineteenth century through to the turn of the twentieth century. This was when Britain was still a very powerful and self-confident empire. Queen Victoria reigned and that period named after her, called the Victorian age, was considered a time of great social advancement. Florence Nightingale was born in Italy in the city Florence after which she was named. She was known variously as, “an angel of mercy”, ‘the Lady-in-Chief’ or ‘The Lady with the Lamp’. Even in her day songs were being written about her.

Florence was taught at home by her father who was educated at Cambridge University. At the age of twenty-five she decided to become a nurse because she heard the voice of God calling her to this work. Her parents disapproved of her choice. The reason they disapproved was that the job was associated with working class women. Finally, in 1851 Florence’s father gave her permission to begin training as a nurse.

From 1854 to 1856 the Crimean War was fought. It was a war between Imperial Russia and the Alliance (The United Kingdom, France, Ottoman Empire and the Kingdom of Sardinia). In 1854, when the Crimean War began, Florence was appointed by the Minister at War to supervise the introduction of nurses into military hospitals in Turkey. It was quite a difficult task because doctors did not want nurses there, but finally when injured soldiers arrived, nurses had much work to do.

She deserves much credit for her remarkable work predicating the organization of nursing and hospital facilities during the Crimean War and for laying the foundation of modern nursing.

In 1860, she set up the first nursing school at St. Thomas’ Hospital in London. It was called the Nightingale Training School for nurses. The probationer nurses studied there for one year but the learning was mainly practical. They worked in hospital wards under the ward nurse’s supervision.

Florence Nightingale wrote many books about nursing. One of them, considered her best known work, ‘Notes on Nursing’ includes her principles of nursing, which focused on sensitivity to the patient’s needs. The book was first published in 1860, and remains in print even today. Furthermore, it has been translated into eleven foreign languages including Czech. She published around 200 books reports and pamphlets.

Nightingale received many honours in recognition of her hard work. In 1883, she was awarded the Royal Red Cross by Queen Victoria.

Nowadays, the school is called Florence Nightingale School of Nursing and Midwifery. They offer courses of study in how to become a nurse or a midwife as well as others such as flexible education and training for registered health care professionals and undergraduate and postgraduate courses.

4.2.1.2. Mary Jane Seacole (1805 - 1881)

The second woman considered to have been very important in the history of British nursing is Mary Seacole. She was of mixed race. Her father was a Scot and her mother a Jamaican Creole. Mary had no special qualifications neither did she come from a middle class family as Nightingale did. She acquired her skills in nursing from her mother who knew and used traditional Caribbean and African herbal remedies.

Seacole travelled extensively. She spent a year in London because she had relatives there. Moreover, she travelled in The Caribbean, where she visited the English colony of the Bahamas, the Spanish colony of Cuba and also Haiti. She wrote an autobiography about her travels but she omitted to mention some important events which happened at that time, such as the abolition of slavery in 1838.

She was present at the outbreak of a cholera epidemic in 1850 and used her knowledge of cholera contagion theory. She treated the poor who had been infected with cholera for no charge, in Panama in 1849. She shunned using opium in treatment, she preferred “ mustard rubs and poultices, purgative calomel (mercuric chloride), sugars of lead (lead(II) acetate), and rehydration with water boiled with cinnamon.”⁹

Although her medication was not efficient enough, it was better than the methods which were used by the Catholic Church (praying for divine intervention) or the preparations of an inexperienced doctor who was sent there at the command of the Panama Government to help those suffering from cholera. Seacole herself was infected with cholera when the epidemic was almost over. Fortunately, she survived.

As was Florence Nightingale, Mary Seacole was also present at the Crimean War. However, getting there was much more difficult for Seacole than it was for Nightingale. The problem was caused by her dark skin. She asked to be sent to the war as a nurse but she was refused not only by the War Office but by the Quartermaster General and the Medical Department likewise. Due to the refusals, she decided to travel to Crimea at her own expense. She was fortunate not to have to arrange everything on her own. Seacole’s Caribbean acquaintance, Thomas Day, unexpectedly came to London and helped her to accomplish her journey and long-awaited mission. Finally, she arrived in the Crimea and offered her help to Florence Nightingale but she was refused again. Therefore, Seacole resolved to build a “British Hotel” where she took care of wounded soldiers.

After the war, she went back to England. She was decorated for her efforts during the war. She was awarded the British Crimean Medal, the French Legion of Honour and the Turkish Order medal. In July 1857, she published a 200-page autobiographical book called, “Wonderful Adventures of Mrs. Seacole in Many Lands’, in which Seacole wrote about her travels and experiences; the book is considered to be the first autobiography written by a black woman in Britain.

Seacole was commonly known to the British Army as “Mother Seacole”. She was a good woman who deserves much credit for what she did. Despite encountering prejudices (because of her dark skin) which oftentimes prevented her from helping and treating people, she did what she could and helped as many people as she could. She was well known by the end of her life, but still she was overshadowed by Florence Nightingale. Notwithstanding, nowadays, she is held in high honour and she “has become a symbol of racial attitudes and social injustices in Britain.”¹⁰

A statue honouring her was erected in London in 2003. She was placed in first position in an online poll of 100 Great Black Britons taken in February 2004¹¹. An annual prize for nurses, midwives was named in her honour – “Mary Seacole Leadership and Development Awards”; and many other things have been named after her, e.g. The Mary Seacole Centre for Nursing Practice at Thames Valley University in Ealing, London; There is an exhibition celebrating her life which opened at the Florence Nightingale Museum in London in March 2005 as the bi-centenary of Mary’s birth. The exhibition has been so popular that it was to be continued until March 2007.

4.2.2. Nurses and the Present

Nurses and the present is a very wide-ranging topic and therefore, in this chapter it will be mentioned very briefly and marginally, since it is written here only to show the contrast with the past, and for readers to see how much progress has been made in how we understand the profession of nurse.

Nowadays, there are several categories of nurses in Britain. Firstly, two levels of nurses are distinguished in the UK: first level nurses and second level nurses. The first-level nurses study for three or four years. The second group used to study for a mere two years to become a state enrolled nurse (SEN) as was mentioned earlier. However, it is not possible to obtain the SEN qualification at the present time. All nurses have to be registered at the Nursing and Midwifery Council (NMC). Secondly, there are specialist nurses who are well-experienced in their field and have gained extra education. For instance, nurse practitioners, special community public health nurse, nurse consultants, lecturer-practitioners and others. Thirdly, nurses might become managers. This means that they abandon their clinical nursing work and start to work for the NHS in the field of management. This possibility used to be very attractive and even for some nurses, the goal of their professional life. However, today, there are more possibilities available than to simply continue as “an ordinary nurse”. Nurses can become various specialists and focus on the specific fields of nursing they are interested in, such as midwifery or paediatric nursing.

It can be seen from this short description that the field of nursing has developed noticeably. There are many more and varied categories of nurse now than there used to be even a century ago. Nowadays, nurses have to be even more highly educated, which might help nurses to enter better-paid profession in the future.

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Notes 3

1. Patrick, A.J. A History of Britain: The Making of a Nation 1603-1789. Penguin Books 1967, p.206

2. O’Driscoll, James. Britain – The country and its People: An introduction for learners of English. Oxford

University Press, 1996, p. 172

3. Geoffrey Rivett, From Cradle to Grave: fifty years of the NHS, The King’s Fund, London 1998, p. 16

4.-7. Geoffrey Rivett, From Cradle to Grave: fifty years of the NHS, The King’s Fund, London 1998, p. 17

8. Geoffrey Rivett, From Cradle to Grave: fifty years of the NHS, The King’s Fund, London 1998 p. 18

9. http://en.wikipedia.org/wiki/Mary_Seacole

10. http://en.wikipedia.org/wiki/Mary_Seacole

11. http://www.100greatblackbritons.com/results.htm