Lads and Ladies, Contenders on the Ward—How Trained Nurses became Primary Caregivers to Soldiers during the Second Anglo-Boer War

Lads and Ladies, Contenders on the Ward—How Trained Nurses became Primary Caregivers to... Summary This paper looks at the contest between trained nurses, orderlies and society ladies to occupy the role of primary caregivers to soldiers, especially in military hospitals, in the Second Anglo-Boer War, 1899–1902. It considers how nurses won the right to the post due to their training and position on wards in civilian hospitals. In gaining this position military hospitals and patient care would not be the same. Yet orderlies and society ladies had a part to play in the running of military hospitals and the nurses were dependent on both these groups to provide the best possible care to their patients. SecondAnglo-Boer War, Military Nursing, Orderlies, Ladies ‘they can’t be looked after properly, as there are not enough nurses. … We have orderlies to help us, but they are very careless. It makes my heart ache to see the poor men so weak and ill.’1 Nursing in the Second Anglo-Boer War can be seen as something of a watershed in modern military nursing.2 It was in this theatre of war that nurses would carve out a meaningful role for themselves as skilled primary caregivers in military hospitals, after consolidating their position against challengers. This paper will investigate the relationships the nurses had with the two other groups contesting occupancy and/or control of the hospital ward—the orderlies and the ‘amateur lady nurses’. It will demonstrate how the skills, knowledge and character of professional nurses gave them legitimacy to operate effectively at the clinical level in the military/medical sphere, while still being under the authority of male, military and medical figures. Trained nurses came mainly from Britain, Australia, New Zealand and Canada to serve in the South African conflict. Some came as part of official contingents such as the Army Nursing Service (ANS), who were connected to, but not part of the British Army or the Royal Medical Army Corps (RAMC), the Princess Christian Army Nursing Service Reserve (PCANSR), colonial cohorts, as staff of private hospitals or as independent travellers.3 Their motives were varied. Some came seeking adventure, others came to serve the Empire, but all came to give professional care to the wounded and sick. In addition there were local nurses and various religious nursing sisterhoods already working in the war zone.4 The religious sisters could not be under army control in the same way that other nurses were, and although under the supervision of their order, the convents functioned with some independence.5 It should also be recognised that the trained nurses were not a homogenous group and there were some underlying tensions between different groups of nurses, especially between the Army Nursing Service nurses and the newly recruited nurses. Many of the latter brought with them modern civilian standards of clinical care and were accustomed to nursing patients at the bedside rather than at a supervisory level that was the norm in peacetime for the ANS nurses.6 The work of the ANS nurse was something of an enigma. As Ann Summers has observed, ‘an army sister could be clearer about what she should not do than what she should. … The Regulations gave her, instead of concretely defined duties, a set of responsibilities which were subject to a variety of interpretations.’7 The result in practice was, as one British nurse commented, ‘ [A]n Army sister … may do as little as she likes or she may work herself to death.’8 Jane Lempriere, a Victorian nurse who travelled independently to South Africa, observed, ‘It is puzzling to define the work the sister does. She has all anxiety and worry.’9 The cumulative effect perhaps made the ANS nurses more aloof than the newly recruited nurses. Both Florence Suttaby writing under the pseudonym of Sister X10 and Laura Woolcott, a New Zealand nurse, wrote of the dismissive nature of the some of the military nurses that they encountered. Newly recruited nurses were accustomed to stricter scrutiny by a civilian nursing and medical hierarchy. As Martha Bidmead, head of the South Australian contingent of nurses observed: The Netley Sisters [ANS], who pretty well rule this place [Wynburg], are accustomed to be as mere lay figures or figureheads. They do nothing but take temperature, give stimulants, and sometimes wash a patient’s hands and face if his temperature is very high. So they do not look with exactly loving eyes on the civilian sisters, who are accustomed to and expect to work.11 Another source of tension that should also be considered was between the colonial nurses and the British nurses. Charlotte Dale in her thesis argues that this was to some degree due to the restrictive role given to the British army nurses as well as the colonial nurses’ place in the system.12 Nellie Gould, head of the New South Wales nursing contingent, records the Principal Medical Officer’s response when she presented her papers on behalf of the NSW nurses at No 6 British General Hospital at Johannesburg, ‘“My God, Australian Sisters, what shall we do.” On my asking the reason [for this exclamation], he said … [he] understood we could not work with the R.A.M.C. Sisters’.13 Despite some unpleasantries, it appears that the nurses managed to work together and separate themselves from the untrained women.14 The two main groups who were challenging for legitimacy to work as primary caregivers in the ward were untrained upper class women attracted by the thrill of war and/or philanthropic intentions, and army medical orderlies who had traditionally undertaken much of the routine ‘nursing’ work for the army. However, to reduce the situation to a contest between these groups and the trained nurses is a gross over-simplification, as the nurses were to some extent reliant on both groups. Orderlies were essential in the running of the hospital especially when many of the hospitals were of a temporary, makeshift nature. Benevolent ladies also provided the nurses with considerable support and were instrumental in supplying goods to hospitals, often through informal networks. More importantly both groups could be utilised in the provision of patient care. Early Medical/Military Problems Before we can enter into any discussion of the position of the nurses and their challengers, it is important to contextualise their situation within the bigger picture of the conditions facing the army and its inability to provide adequate medical and health services. The physical problems facing the army were immense. The early months of 1900 brought conditions rife for the outbreak of enteric fever/typhoid in South Africa. Just how rapidly the disease spread can be seen in the fact that on 12 January 1900 there were only 120 cases out of a total army strength of 117,914, yet by 25 May there were 6,084 patients with typhoid out of 217,533.15 Massed troops and contaminated water exacerbated the spread of disease.16 Conditions were particularly poor in Bloemfontein and further north of the town.17 The poor positioning of hospitals on unhealthy soil or at a distance from a fresh water supply, brought its own set of problems.18 There were also problems with obtaining supplies—either through scarcity or ‘red tape’ that surrounded much of the army medical service. Lady De Crespigny recorded a typical scenario. ‘[T]he South train wharfs were full of comforts of all kinds for the troops, but red tape again came in. I asked to be allowed to have goods to send up the hospitals … but I was politely refused.’19 There were also escalating tensions between the regular army doctors and civilian or newly enlisted doctors due to the poor treatment meted out to the patients. Private Humphries wrote of a hospital in Bloemfontein, There was an awful row between the civilian doctors attached to the military hospitals and the army doctors. The civilian doctors sent in en masse and asked to be transferred. The principal medical officer enquired the reason and they replied that the treatment of the patients was such they refused to have anything more to do with it. Of course they were right and there was a royal row.20 Theatre of War as Masculinist Space The war zone was not totally a male space. War zones could not be totally exclusive of women—civilian women, victims of war, camp followers and nurses were clustered at the periphery, but were without significant power. The Boer War theatre can be considered masculinist because men controlled it. However conditions such as poor facilities for the wounded, the advancements in medical treatment and surgical procedures such as the treatment of typhoid, the use of asepsis technique in the operating theatre and in wound management and pressure through newspaper articles primarily in Britain,21 made it possible for trained female nurses to become more mobile and venture legitimately further into the specific masculinist space of the military hospital. However in order for female nurses to function effectively as primary clinical caregivers in such a space, would mean that they would need some control and unrestricted access to the wards. For this to occur, some control would have to be relinquished by the men. Some of the control excercised by the male management concerned the extraordinary regulations limiting the time nurses spent on the ward and restrictions on their duties at the commencement of the war.22 According to historian Ann Summers, nurses ‘were given no authority over the orderlies … [but] were responsible for the personal cleanliness of the patients in their wards [and] that medicines, diets and extras [were] supplied to the patients.’23 Yet this operational responsibility was unachievable simply because they had no power to enforce either orders or discipline. Sister X wrote how ‘[T]he Army Sister also gave me a few hints as to what I was not to do—I was not to wash the patients, and was not to make their beds. I had nothing to do with their diet (except seeing they got their food); nor was the responsibility of having my wards clean even within my province.’24 The reasons given against the increase and/or the extended use of nurses, such as accommodation concerns, propriety and physical danger, when there was an obvious clinical need for more nurses, are additional evidence of this anxiety concerning the position of female nurses in military hospitals.25 The differences between civil and military hospital culture must also be considered. At the turn of the century the civilian hospital ward became a safer setting for nursing the sick. This space could be regulated and managed and gave some nurses considerable control within that space. Indeed the concept of the senior nurse as ‘mother of the ward’ translated control from the private sphere of the household to the public arena. Historian Christopher Maggs takes the analogy further. ‘In the hospital world the doctor assumed the role of the father and in his absence … the functions of the father were subsumed under the functions of the mother, the senior nurse. Obeying the senior nurses … was obeying the doctor.’26 This was also expanded to include the later notion expounded by Mrs Bedford Fenwick, editor of the Nursing Record and Hospital World, positioning nursing as a science, as a complement, a helpmeet to medicine.27 This meant that in practice there was more emphasis on nurses operating from a knowledge and skills base, while at the same time not negating the older benevolent ‘mother of the ward’ agenda. Throughout the later decades of the nineteenth century, nurses were contesting men’s entitlement to all space, specifically hospital space. They wished not just to occupy it but they sought legitimacy to operate with power within it. General hospitals, although controlled by men, afforded senior nurses considerable authority within the micro sphere of the hospital wards. In addition, nurses established their own hospitals or nursing homes, where they had considerably more power over the space, while not negating the medical authority of the doctors.28 At the other end of the spectrum were the hospitals attached to convents. These were controlled by women, were frequently bought through the religious community’s own money and men such as doctors and priests had limited access.29 These environments were the antithesis of the military hospital. The military hospital was part of the military sphere, controlled by male army officials and government bodies, with even medical personnel having only limited power. Summers chronicles the attempts by doctors, over the latter half of the nineteenth century, to extend the female nurses’ time on the ward, yet it was only by the 1890s that female nurses were in attendance through the day.30 Military hospitals were an extension of barracks life. For the sake of practicality, several of the hospitals were built physically close to barracks.31 They were managed along the lines of military sensibilities, which were not always compatible with quality medical and nursing care. One of the observations that emerged from the Royal Commission appointed to consider and report upon the care and the treatment of the sick and wounded during the South African campaign 1901, was that, ‘there was a tendency … to treat the hospital too much like a barrack and to regard the patients too much as soldiers and not enough as patients’.32 While during peacetime the flaws of the military hospital system were less obvious, a war status was another matter entirely. The number and types of admissions were considerably different and would require a different approach to nursing. The duties of the orderlies reflected this difference; as such they were soldiers first and nursing personnel second. ‘The orderly nurse [male] may be ordered out of the ward … to go on drill … or some other fatigue duty.’33 They also answered to the Sergeant Major or Ward Master rather than the supervisory nurse.34 The military hospital with its language and its approach to the sick and their care was not only far removed from its civilian counterpart, but it was almost exclusively a well-secured masculinist space. And it was into this space at the end of the nineteenth century that the predominantly newly recruited trained nurses were about to enter. The resulting clash would radically alter the way the army nursing system would be constructed for the twentieth century. A Slight Shift When Sister X began nursing in Maritzburg in December 1899, she was confronted with a system that was actively hostile to female nurses. The orderlies were often rude, set in their ways and unwilling to take instructions from the nurses. The nurses also faced restrictions on their ward time and the range of their tasks and they had limited internal support for their position.35 The nurses were also excluded from many of the instructions for patients’ treatments that were issued on doctors’ rounds. Sister X wrote, [W]hispered undertones went on between him [doctor] and the orderly about matters that we had always been accustomed to attend to, and we began to wonder why we were there at all. Things of the greatest importance, that require skilled hands, were in the hands of young ignorant orderlies. We were aghast, but not consulted.36 By March and April of the following year there was a slight change in the status of the nurses. Burdett-Coutts wrote, ‘female nursing is welcome at No 3 [British General Hospital] and there are many enlightened officers of the Royal Army Medical Corps who hold the same view; but the traditions and practice of that body are tinged with a strong prejudice against it’.37 This slim change, brought about mainly by the import of civilian and/or younger doctors into the army, afforded the nurses, if not more authority, then at least slightly more recognition and greater actual control of the orderlies on the ward.38 As the war progressed, it appears that nurses gained more control over the orderlies and the ward and expected orderlies to carry out tasks according to their instructions.39 The increasing number of nurses also enhanced their position, allowing them the opportunity to do more clinical nursing rather than supervising—although there was almost always a chronic shortage of nurses, especially in the north. Orderlies At the outset and throughout the early stages of the war the medical orderlies, who were attached to the RAMC, were the primary patient caregivers in military hospitals. The few Army Nursing Service nurses who had limited access to the wards acted mainly in a supervisory capacity. That this system was in place points to the outmoded ethos in the military/medical sphere. In comparison, the civilian hospital and health care sphere had established a distinct nursing system that involved trained people delivering quality patient care. The irony cannot be lost. Nightingale’s work associated with the war in the Crimea was a vital catalyst to the emergence of modern nursing. Yet it was in the military sphere that modern female nursing was most lacking. Any discussion surrounding the orderlies who were working in South Africa has to take into consideration that they were not a homogeneous group. There were RAMC orderlies from the military hospitals in England, untrained recruits, refugees, volunteers from the Yeomanry, St John’s Ambulance men, medical students and even convalescent patients.40 Some orderlies did not particularly want to be either bedside carers or even orderlies at all and were there under duress—in response to military orders or as convalescents. Others saw working in a hospital as a ‘soft option’ to being sent back to the front.41 Many of the best RAMC orderlies were sent to work in the field hospitals at the front rather than the base and stationary hospitals where the majority of the nurses were stationed.42 This difference amongst orderlies accounts for the discrepancies in contemporary descriptions of them and their work. Conan Doyle wrote to The Times about St John’s Ambulance volunteers recruited from a northern English town who were working as orderlies, observing ‘for solid work and quiet courage you will not beat him in that gallant Army’.43 Nothing could be a greater contrast than some of the descriptions of orderlies given by the nurses. As far as Gertrude Fletcher, an Australian nurse working with the Princess Christian Army Nursing Reserve was concerned, ‘[W]hen you have good conscientious orderlies it is bad enough, but when they are lazy and untrained it is awful.’44 Nurses’ Claims as Primary Carer At the turn of the twentieth century, nursing was a skilled female occupation imbued with middle-class feminine benevolence, character and education standards.45 Nurses made their claims to displace orderlies as primary bedside carers on the basis of their knowledge and training, their character and their gender. These three qualities were interrelated and were steeped in middle-class ideology. Alison Bashford suggests that at the end of the nineteenth century ‘nursing and middle class femininity had come to be so closely related as to be mutually defining’.46 The idea of nurses being of good character, respectable and reliable was a major plank of Nightingale style nursing, which elevated nurses from servant status and permitted them to have intimate physical contact with patients, devoid of a sexual agenda. Concomitant with this was the notion of the nurse, as a middle-class female operating from an agency of benevolence. Anne Marie Rafferty notes how the reformed, middle-class nurse was ‘[A]bove and beyond reproach, the new nurse’s crystalline character became a beacon of Christian piety and virtue, and her demeanour and deportment were signifiers of her class.’47 Accordingly, contemporary nursing education included ‘instil[l]ing a rigid code of behaviour and self-discipline in the woman’ appropriate to values associated with middle-class femininity.48 The skill and knowledge that the nurses brought with them from the civilian sphere were honed over three years of training that included both practical and theoretical components of patient care and was incomparably better than the training of the sparsely trained orderlies. ‘Marshburgh’ highlighted the difference between the training of a nurse and an army medical orderly in late 1898. ‘The sister is practically an officer, highly educated and well trained before entering the Service. The ward-orderly may have been a labourer for the fields. We cram him through a six months’ course of drill, first-aid, and nursing, and then present him to the Army as the finished article.’49 While both orderlies and nurses were trained to obey, there was a difference between the blind obedience to orders and regulations of the army and that of the trained nursing sphere, which also included an applied knowledge base from which decisions could be made. As Sister X exclaimed with characteristic bluntness, ‘[I]f only they [the orderlies] acted more intelligently! … But what can you expect from men … who are not allowed to think but only to obey!’50 The popular press and the writings of the nurses are filled with stories about orderlies showing their scant knowledge of patient care, food and ward hygiene. ‘He thinks it quite superfluous … to make a bed or to wash the feeding cups, and would not dream of doing either if left to himself.’51 Australian nurse Gertrude Fletcher commented on the stupidity of one orderly, who, when told by the Sister to give ‘half milk and half barley water’ to the patients, gave milk to one side of the ward and barley water to the other side!52 While the Surgeon-General insisted that orderlies were ‘trained with a great deal of care, and graded to their natural ability and tact, that their training followed the system outlined in the ‘Manual for the R.A.M.C.’ and that they were ‘not enlisted without certificates of character’, the degree to which orderlies were trained to give good nursing care was questionable.53 As Julia Anderson, a nurse from the Victorian (Australia) contingent observed, ‘[T]he men who take up this work are not as a rule of sufficient training or education to appreciate, as a trained nurse can, the gravity of the work.’54 Unknown correspondent ‘Marshburgh’ cited in the Nursing Record and Hospital World discussed the ideal of army orderly training but then added, ‘the young recruit is pitch forked into a ward to sink or swim, as the fates decide. More often than not what he learns of actual nursing he is taught by the patient.’55 In addition, many of the orderlies with whom the nurses came into contact were in fact new recruits, or ‘ordinary soldiers, quite as stiff as my pro [probationary] days at Barts’, as one nurse wrote, and it was therefore not surprising that they had little notion of hospital procedures or routines.56 As the enteric epidemic began to take its toll, the orderlies’ lack of experience in caring for very sick patients became far more telling. PCANSR nurse Eleanor Lawrence wrote, each man seemed to need individual nursing if he was to have a chance of pulling round; the orderlies (though very willing) had everything to learn of ward duties; they could not even undress these men … much less had they any idea of washing them; a delirious man was a new experience to them, and if he got out of bed and lay on the floor, the orderly would go and ask the Sister what he had better do!57 Knowledge, Training and Skills As a result of their inadequate training, many orderlies had little knowledge of the practical nursing procedures that were regularly practised by the nurses. The administration of sponge baths, a keystone of bedside care, ensuring the patient minimal discomfort, was not always carried out with due attention. Leaving patients wet or using the same washing water for several patients was not unknown. According to one patient, ‘they won’t be bothered to get fresh water each time, so they wash us all in the same water—such a drop too!’58 The practices of aseptic technique as well as safe food handling by the orderlies were also far from optimal.59 The physical environment, the massed number of troops very often in a vulnerable physical condition, also increased the potential for contagious diseases or infections, making the use of hygiene procedures even more crucial. Many orderlies had little insight into the aetiology or pathology of diseases and therefore gave inappropriate nursing care. Martha Bidmead, head of the South Australian contingent of nurses described such treatment: Their way of nursing enteric [patients] are marvelous, that is the only word for it. I am sure your cap would stand upright, and your hair. … Imagine an enormous thick blanket underneath the sheet on which they lie the enteric patient … no mackintosh, a thick sheet, another heavy military blanket, and a monster quilt above all. Then they [the patients] wear a shirt and a tick twilled one as well! And some of them with temperatures of 105 and 106 degrees [sic].60 Orderlies were also known to disregard nurses’ instructions regarding food restrictions and/or the ambulatory status of very sick patients.61 While such actions against treatment protocols could have serious consequences for patients, it also meant that the nurse as supervisor could not trust the orderlies as agents to deliver appropriate care. Disturbing reports filtered through to the nursing and general media by the middle of 1900. The medicine glass was a broken measuring glass, and I am sure had not been washed for weeks, for all round the outside edge there was a thick rim of dried saliva, and the discharge from sore lips, … making it a disgusting thing to take in one’s hands let alone one’s lips. All sorts of medicine were administered out of the same glass and even the thought of it made me sick.62 While the orderlies may have been lax about hygiene, drug administration and practical nursing procedures, what was more disturbing was the lack compassionate nursing care, especially for the very sick and dying. Trooper Outridge, wrote of his ordeal and that of another suffering patient, in an account that was printed in both British and Australian newspapers. I was told to lie down on the bare ground … after about five minutes I felt someone crawling over me … and saw what seemed to be a skeleton. It was only a poor fellow in the extremes of enteric fever. He was delirious, and I called to the orderlies … to lift the man off me. ‘Oh, go to sleep’, was the reply I got. ‘He won’t hurt you.’ The manner in which the orderlies treated that poor fellow was shocking in its brutality. On the third day he asked for a necessary [sic], and the orderly replied, ‘Shut your mouth and don’t bother me’. I heard him cry, ‘Orderly, I’m going to die’ … ‘Wish to God you — well die’, was the answer the poor fellow got [sic]. He died the next day.63 In contrast, the ‘Colonial Volunteer’ wrote of the care given by sisters and civil surgeons, ‘many a poor fellow in their care has entered the next world quite happy in mind because he was not treated as a dog during the last moments of his career in this world’.64 Character One of the main planks of reformed nursing was that the character of the ‘new’ nurse was above reproach.65 Although the Surgeon-General maintained that orderlies were required to have a certificate of character, this would have been far short of the strict ‘character’ requirements, scrutinised and honed over three years of Nightingale style nurse training. As mentioned previously, many of the best RAMC orderlies were stationed on the front line rather than at base hospitals where untrained soldiers often took their places. Unfortunately there were many reports of unscrupulous orderlies. The nurses reported orderlies for laziness, drunkenness and gambling on duty, at times directly affecting patient care. Sister X recalled, I learnt that Pay Day was a day thirst riots! ‘Getting drunk’, they call it. … There had been regular brawls, even open fights … another had tried to remove the splint off the shattered arm of one of the patients, thinking he was doing him a good turn.66 Dishonesty, bribes and stealing patients’ belongings were not uncommon. A Canadian solider who spoke of many of the orderlies as ‘dirty and unprincipled’ reported that ‘while I was helpless with enteric some of the rascally orderlies had been busy with my belongings, for when I came to myself I found that every penny I possessed had been stolen’.67 An account by an Australian soldier reported in The Nursing Mirror and Hospital World contrasts the difference between the orderlies and the doctors and nurses with regard to integrity on the ward. Doctors and nurses did everything possible, but the hospital orderlies behaved shockingly. They took the luxuries ordered for the patients, drank the brandy when it was ordered, and were always on the look out to make something. The Corporal ‘missed’ all his belongings while in hospital, but kept his eye on the belt of a dying Imperial Yeoman which contained £140. When the poor fellow died he literally rescued it from an orderly who was endeavoring to hide it, and got it returned through the nurse and doctor to the deceased’s friends in England.68 Gender So entrenched was the idea that nursing was inherently female that the behaviour of the orderlies was never compared to the ‘Sarah Gamp’ nurse typology, despite the many real and implied similarities. The orderlies were described as ‘dirty and unprincipled’ or ‘uncouth and uncivil’ but never akin to the stereotypical untrained female nurse.69 Their less than exemplary execution of nursing procedures was often excused because of their gender.70 According to Lord WoIseley, ‘[A] man … cannot … administer to the little comforts of the sufferer in the same way that a woman does. Often when I have been bundled about like a log by a rough, hairy orderly, I have felt I would give all I possessed for the tender care and gentle hands of a woman.’71 There were various reports by soldiers who spoke of the care by female nurses, often in contrast to the care given by orderlies. While the concept of the ‘naturalness of nursing’ to women was not new in the civilian sphere, this idea was moving to the military sphere and the position of female nurses in the military. Burdett-Coutts, reporting on his time in South Africa, wrote in The Times that the ‘absence or totally inadequate supply of female nurses … is a violation of nature; for nursing … the actual handiwork of the process … is woman’s work, not man’s’.72 Because nursing was deemed ‘natural’ for women, it therefore followed that it should be ‘natural’ for women to nurse in the military sphere, Florence Nightingale being repeatedly held up as the model.73 The Governor of South Australia, Lord Tennyson, in a timely speech to the annual meeting of the District Trained Nursing Society in Adelaide, South Australia in July 1900, discussed how ‘Nursing has been, from the earliest times, the prerogative of women’ and that women had a ‘natural instinct for and skill in surgery and nursing’.74 Strongly rebutting claims that men preferred to be nursed by orderlies, Burdett-Coutts, echoing Lord Woseley replied, Any man who has been seriously ill knows the difference between a rough-hewn orderly with horny hands and creaking boots, smelling of tobacco and other things, moving about his bed, tending him with a man’s touch, and the real ministering angel, the female nurse. It is not the poor orderly’s fault, he does his best; but he is built that way.75 Pursuant to the idea of the female nurse as ‘natural’, were the attributes assigned to female nurses, simply because they were female. How nurses moved, smelt, touched and conducted themselves was idealised and feminised. Major Reay wrote ‘the Florence Nightingales of today, moved noiselessly and deliberately about their duties. Sweetest of women these, their work the noblest on God’s fair earth.’76 Descriptions of nurses as ‘perfect dears’ and ‘nothing is too much trouble for them’ only enhanced the idealised position of nurses.77 The reality was somewhat different—nurses did smoke, did lose their temper and due to the nature of their work had very sore and rough hands, and even Tennyson acknowledged that all nurses were not the ‘ideal’.78 Soldiers believed that they were receiving better care simply because they were nursed by female nurses. As Sergeant Legge wrote, after receiving a serious wound, ‘Sister Speed of Timaru is looking after me, so I know I’m all right.’79 In comparing the care given by orderlies and nurses, it is important to take into account that nurses were generally not positioned in the field hospitals close to the front. The conditions there were necessarily less than desirable, more dangerous and there would have been an overwhelming number of incoming casualties. The care received at a stationary or base hospital by nurses might well be deemed superior.80 The Nurses’ Need for Orderlies Despite the failings of many of the orderlies as carers, the nurses did acknowledge the hard work performed by some of them and the difficulties that an orderly’s job entailed. Bidmead observed, ‘[T]he orderlies are wardsmaids, kitchenmaids, charwomen and probationers combined. And have such hard lives of it.’81 They had a difficult night shift system that frequently saw them working long hours. Nurses often preferred to work with new recruits, as they were eager and anxious to perform well, rather than with regular RAMC orderlies who could be set in their ways.82 Those nurses coming from civilian hospitals were more accustomed to working with probationer nurses, who were similar to the inexperienced orderlies. There were also some very conscientious orderlies who worked hard, negotiated the ‘red tape’ and cared about the patients. While medical students often served as surgical dressers with surgeons at the field hospitals they were also very useful orderlies.83 It would be fair to say that the nurses were reliant on the orderlies to help deliver a high standard of care. Due to the physical layout of many of the hospitals as tent cities, and the scarcity of nurses, the nurses utilised the orderlies to monitor the status of patients and inform them of any patients whose condition deteriorated.84 This often required a degree of uneasy trust on the part of the nurse.85 E. J. Wood wrote of the delicate balance she maintained with a medical student orderly. ‘I have a very critical case … and a 1st class orderly is on it. I wish I was [on it] myself as then I should know it was all right. One does not like to interfere with these medical students too much, though I do sometimes and they seem to take it very well.’86 Orderlies were also vital to the maintenance of hygiene standards; having to dispose of wastes a considerable distance from the wards. Everything has to be carried to a certain place outside the camp to be disinfected before being got rid of … when you remember that the Camp is about a quarter of a mile across … these poor orderlies are kept trotting all the time … for nothing is ever left near the hut even for a short time.87 Ladies The nurses received significant support from middle-class and upper-class women. At one end of the scale, there was organisational support, for example that of women such as Lady Curzon with her organisation and support of the Yeomanry hospitals.88 At the other, there was the direct assistance of women like Mrs Rutherfood, who according to Queensland nurse Beatrice Huston was ‘like a mother to us’.89 Writing of her time in Kimberley Lady Maud Rolleston commented, ‘I found an occupation ready for me, which was to try make things a little easier for these splendid women [nurses].’90 For many nurses these women facilitated their work, helping with ward work and/or supporting the nurses. They took on the role of ‘caring for the carer’, which was vital for it enabled the nurses to continue with their work. Ther support often took the form of housekeeping, accommodation and providing meals. The Australian nurses, wrote of those who helped including, ‘a lady [Mrs Rutherford] kindly offered to house keep for us and look after us … so good and kind. … Mrs Sim is … a sweet woman, and a great help. … The ladies here are very kind.’91 The women who are mentioned most were often in situ because they had been living there prior to the war perhaps through some family connection—a colonel’s wife or daughter.92 Offering such assistance was a way for them to serve the cause. Miss Cairncross meets every ambulance train coming down … and gives them fresh milk, flowers or fruit, and the nurses and patients say it is the greatest boon and blessing. She spent her own money as long as it lasted, and then asked her neighbours to help her … one could see by the welcome the nurses gave her how much they looked forward to seeing her.93 The auxiliary support that these women provided for patients and convalescents was considerable and allowed nurses to care for the very sick and seriously injured. Maud Rolleston commented on a patient she frequently visited, ‘[T]he nurses … were very much attached to him … but they had other work to do, and though they could give him their care, they could not give him their time.’94 Visiting patients and supplying ‘extras’ greatly assisted, not only the nurses, but also the well-being of patients. Sister X observed, ‘Mrs K (wife of General K) … does no end of good work—brings fans, fly-papers, eau-de-cologne etc. The men love it.’95 ‘Amateur Nurses’ In addition to orderlies, benevolent women and trained nurses who all provided approved services in hospitals, there was a group that surgeon Frederick Treves, in a speech to the Reform Club, spoke of as, ‘the large and insistent crowd of amateur nurses in South Africa [who] were an absolute terror to the army surgeons. They were worse, in fact, than a plague of flies.’96 In discussing these women, Treves publicly identified one of the main challengers in the contest for a legitimate position in military hospitals. He also soon had to issue a hasty clarification differentiating between the ‘troublesome horde of amateur busybodies … the splendid work done by the nurses … [and] ladies who have by their generous efforts done so much to relieve the sufferings of our sick and wounded soldiers.’97 The initial identification of this group of ‘amateur nurses’ occurred quite early with many upper-class women flocking to South Africa within the first few months of the war. Denied other opportunities, these women saw nursing soldiers as a means of active participation in the war effort.98 Their motives were mixed. Some genuinely wanted to help out in the war effort. Others, it seemed were more interested in the social life. There were also considerable numbers of upper-class men who were attracted to the thrill of war, without actually wanting to get involved. The legitimacy of their position was, however, less tenuous and less debatable; many had commissions in the army and could therefore be ordered back to duty. The Mount Nelson Hotel in Cape Town was a popular haunt of many, ‘socially and ambitious onlookers who had been attracted to South Africa by the excitement’.99 The upper-class women who were not ‘connected’ to the army were, however, less controllable than their male counterparts and could not be ordered back. Many had little regard for military authority, which included refusing to accept restrictions on travel and the military control of specific areas.100 Such controlled space often included hospitals, much to the chagrin of Lady Sykes, who described a hospital at Wynberg as being guarded like a gaol.101 Some untrained society women were, however, sent into military areas. The Nursing Record and Hospital World published the following from an unnamed army nurse, who wrote disparagingly, ‘[M]any of these amateurs were actually sent to the front. “Somebody” in authority had the courage to send several of them back to the headquarters responsible for their appointment.’102 Some women attempted to use their social connections to give them immunity to travel into military controlled areas. Mrs Dickenson, who was the sister of the Earl of Stradbroke, travelled with the South Australian nursing contingent on the passage to South Africa, ostensibly to write newspaper articles ‘dealing with matters from a woman’s standpoint’ for The Advertiser in Adelaide, as well as to visit her sons.103 She ‘intend[ed] … to make her way to Pretoria. She does not think she will have much difficulty, with the help of influential friends in getting there.’104 It is useful to compare the difference in the attitudes of the ‘amateurs’ and the trained nurses to being under the control of the military authorities. Nurses trained in hospitals were accustomed to obeying orders and made the shift from obedience exclusively within the medical sphere to also include the military sphere. The response of the trained nurses when they were refused permission to travel to specific areas was disappointment but also an acquiescence to the military authorities; as demonstrated by the Canadian nurses who were prohibited from following the Canadian contingent.105 Historical Precedents of Ladies as Benevolent Caregivers The Nursing Record and Hospital World was particularly indignant in its reporting on the nursing aspirations of several upper-class British ladies including, ‘[L]ady Sykes [who] “intends to takes lessons in nursing” upon her arrival at the Cape, and then proceed to the front’ [inverted commas in original].106 Yet while the ideas and ambitions of Lady Sykes and her ilk might have been misplaced, there were strong historical precedents that cannot be ignored. Nightingale, as the heroine of the Crimea, had only minimal nursing training in Germany. They were also drawing on an earlier gendered discourse that considered philanthropy—such as caring for the sick—as a suitable activity for middle- and upper-class women. The ‘lady as nurse’ also featured in romantic historical fiction, for example Rebecca in Ivanhoe.107 There is no doubt that many women were looking for adventure and excitement, as well as fulfilling a philanthropic motive, and the historical precedent and contemporary reports made nursing appear a viable channel by which to facilitate both. That these women, their families and perhaps even sections of the media did not recognise nursing as an emerging profession, nor even an occupation that required specific skills and knowledge, but saw it more as a philanthropic gesture by middle- and upper-class women, further highlights the fact that nursing was yet to secure professional or even semi-professional status. This lack of appropriate status, in the public sphere at least, was due in part to the gendered nature of nursing and to its subordinate (‘help-meet’) status to medicine, which did have undisputed professional standing. The gendered nature of the amateur/professional status of nursing and medicine was demonstrated in this comparison by an army nurse, I notice that amateur surgeons and physicians have not been appointed. It would never occur to the authorities to select a surgical staff from untrained society men. A thrill of indignation would go through Great Britain were it announced that the Earl of ___, had been put in charge of the operating theatre of a base hospital.108 Yet while it was considered totally inappropriate to have an untrained Earl as a surgeon or PMO, many untrained women were placed, or attempted to procure placements, in hospitals as nurses. Training The Nursing Record and Hospital World dutifully reported how ‘lady amateurs’ avoided paying for their passage and were taking the place of trained nurses in positions where their lack of clinical skills would be exposed. An unnamed Army Nurse wrote the following: ‘in many instances the War Office authorizes only a certain number of nurses in hospitals and transports. When society women with no technical training, take these posts, they fill posts which ought to be filled by certificated nurses.’109 As a consequence, the letter continued, trained nurses ‘are too few in number and terribly over-worked by doing their own and the amateurs’ duties’.110 It was in the clinical setting that the redefinition of the nurse’s role as skilled practitioner acutely came to the fore. Nurses were no longer solely caring, benevolent ladies. Perhaps even a generation previously, it was possible for educated women to become trained nurses with only a modicum of practical training and study. By the turn of the century, advances in medical and surgical procedures made specialised nursing skills necessary.111 In the army hospital, the sheer volume of patients as well as the severity of their illnesses and wounds meant that nurses required more knowledge and skills than ‘taking the patient’s temperature and pulse correctly and … accurately reporting’.112 E. J. Wood wrote of a wounded Colonel Ross who was ‘due to have a tracheotomy performed … and then the tissues wired together’, after having 'about three-quarters of his lower jaw shot away’.113 Nursing such a patient required significant skill (wound care, maintenance of airway, calm reassurance) and Wood records ‘specialling’ him (that is caring for the one patient only) for some time pre- and post-operatively.114 Gertrude Fletcher’s account of her work in ordering her new ward as patients were arriving demonstrated considerable ward management, triage and organisational skills.115 Similarly ‘JA’s’ work on the veldt highlighted skills in autonomous nursing practice and ingenuity.116 The role of the nurses in the clinical setting was much more complex and demanding than providing benevolent care alone. The need for skilled nursing staff was also becoming more recognised by medical doctors, especially from the civilian sphere, who were working in South Africa. Surgeons Mr Watson Cheyne and Frederick Treves both strongly and publicly advocated for the benefits of trained female nurses.117 Clinton Dent, of St Georges Hospital, writing as a special war correspondent for the British Medical Journal, advised that abdominal cases should be ‘specialled’, and even went so far as to say that good nursing could ‘absolutely determine’ patient outcomes.118 He also clearly delineated between care given by orderlies, benevolent care by untrained women and effective nursing practice. However hard these men [orderlies] work … they seem incapable of bestowing … unremitting, watchful care that a nurse … always has in her power to give. … There is not much romance about a patient with a urinary or a foecal [sic] fistula. … Most women can effectively sit by the bedside of a patient, fan away the flies, and put eau-de-cologne on a forehead, persisting in these simple duties with a great patience that appeals … to the sympathies of those who do not understand what nursing really is, or can be. But the hard-working, practical, conscientious woman, who can keep one of these distressing cases dry, who can ward off bed sores, and who … does a world of invaluable work that does not show, and does not appeal to anyone save the medical officer, [and the patient?] gets little credit for what is real nursing.119 Not only did the ‘amateur’ nurses lack clinical skills, but many also conducted themselves in a less than professional manner. One patient reported, ‘[A]ll these untrained females are no good at all; all they did was to sit on the officer’s beds and flirt. One ass muddled about for a whole week with my arm.’120 Many also appeared more interested in ‘nursing’ officers rather than ordinary ‘Tommies’.121 There are several references to society women masquerading as nurses wearing fancy uniforms, or ‘posing as ministering angels in Parisian gowns and headgear’.122 Society women, such as Mrs Chamberlain, who was seen wearing both the Canadian and the British army nurses’ uniform caused some consternation, as uniforms were a means by which nurses could be readily distinguished from lay figures.123 One of the few recorded criticisms of ‘amateurs’ by Australian nurses came from Martha Bidmead who, in a private letter to a friend, wrote with considerable candour and informality. Concerning the pretentious nature of a certain lady-nurse, she confided, I saw Mrs Dick Chamberlain, sister-in-law of the great English politician. She was in a Canadian nurse’s uniform, and had a white cape with lace. … [S]he has grey hair and a very haughty expression of countenance. … I should imagine she would probably write a book about it all. She looks that sort of woman.124 Perhaps further reluctance to criticise upper-class women, or the absence of open criticism, is due in part to the fact that the Australian nurses were benefiting from the patronage of several of them in Australia, for example Lady Brown and Janet, Lady Clarke. Administrative Challenge Another area where upper-class women were threatening to usurp control was in hospital administration. This claim was harder to deny as many civilian hospitals still held to the practice of shorter period of training for ‘lady nurses’ to take up managerial roles. ‘Several of the best known London hospitals accepted a certain number of so called “lady nurses” who paid down a sum of money’, noted Fletcher. ‘After a few months experience it was not unusual for these “lady nurses” to be appointed to administrative posts in other hospitals.’125 The Nursing Record and Hospital World as a professional journal contested the suitability of society ladies taking up positions of authority, both in England (particularly in regard to the selection of nursing staff) and in the hospitals in South Africa. The objection of the journal and of nurses in South Africa was not that these women were involved in the war effort, rather that some were specifically challenging the position of the trained nurse as a clinical and administrative practitioner. ‘They [lady amateurs] get in everyone’s way, and have no intention of working. Their idea is to take posts of authority and “boss” the trained nurses.’126 The Nursing Record and Hospital World noted how, on the hospital ship Maine, it was reported that ‘Lady Randolph Churchill superintended all the arrangements … and personally directed the berthing. Lady Randolph was here, there and everywhere, flitting about amongst the invalids, like a “ministering angel”.’127 The nursing journal commented with some irony, ‘[W]e hope this does not indicate the very able, thoroughly trained Superintendent of Nursing, Miss Hibbard, is incapacitated for duty by ill-health.’128 Many upper-class women were accustomed to running large, complex households and, perhaps more pragmatically, were serving on hospital committees or providing (or their families were providing) financial backing to fund hospitals in South Africa.129 Although The Nursing Record and Hospital World rejected outright the idea of lay women assisting the nurses in South Africa, even it conceded that ‘practical women with a knowledge of domestic management’ could supervise the linen stocks and domestic department, in army hospitals.130 The Threat to the Image of Nurses The nurses were well aware of the ‘plague of amateur nurses’ with references to them in diaries and letters. E. J. Wood wrote of Lady Roberts, ‘She has made herself rather obnoxious with her interference in hospital affairs. … (One of the plague).’131 In her writings, Sister X clearly differentiates between those who were helpful and those who were less so. ‘We do not find the ladies at all in the way; but then there are a very nice lot round here all anxious to do what they can to help but not interfere, which makes the distinction [italics in the original].’132 The protestations by The Nursing Record and Hospital World about society ladies working as ‘amateur’ nurses and about the suitable qualifications of the nurses or the committees who chose them, appears a little excessive, but they need to be placed into context. The journal and its adherents were aiming to advance nursing. First, it worked to uphold the gains of the past, of the first generation of modern nursing: it presented nursing as a middle-/upper-class philanthropic and feminine occupation, implying certain personal characteristics—devotion, cleanliness, obedience, integrity and an absence of any sexual agenda, especially between nurse and patient. Secondly, the journal also wanted to propel nursing into the future, developing it as a professional career, rather than an occupation. The intrusion into modern nursing by society women was inherently more threatening than the ‘Sarah Gamps’ that modern nurses had replaced because ‘society’ women were articulate, had influential families and friends and could use money as a means of gaining entry into the sphere of military hospitals in South Africa. (Most society ‘nurses’ were interested only in ‘nursing’ in South Africa in association with the war effort rather than being involved with nursing in the civilian sphere either in South Africa or in England.) This threat at a clinical level and, perhaps less so, at an administrative level (which was more complex due to the nature of the private funding of hospitals in South Africa by wealthy families) could be tackled by constructing nursing as a closed profession—based on a specific set of knowledge and skills gained over three years training and certification. It could also be used as a means of furthering their legitimacy to function and operate with some authority within the military hospital. Public support by respected civilian medical doctors for trained nurses and their opposition against ‘society’ nurses was an additional important factor. Another facet of this threat was that at the commencement of the war the army nursing sphere was not particularly secure. However, the war acted as a catalyst to propel military nursing into the twentieth century. The actions of the ‘society’ women actually highlight not only how far nursing had progressed from feminine benevolence, but also how valuable trained nurses could be to the military medical sphere. They were becoming essential to successful patient outcomes in both surgical and medical treatment in military hospitals. In addition, by having nurses attached to or connected to the army, rather than being freelance, the military authorities had considerable more control over them when operating within the military and within a war zone. Something to Say ‘Amateur’ nurses became the butt of many jokes in both the military and civilian public life.133 But despite this, some of them also brought articulate and valid testament to the poor conditions that the wounded were often subjected to and had the means, financially and socially, to be effective patient advocates. Letters and witness accounts printed in the public sphere challenged the glowing accounts of how the wounded were treated and called for better conditions. Lady de Crespigny, writing in the Essex Herald, an article reprinted in the Australian press, recalled a train journey where ‘the wounded had no one in charge of them to assist them … and no food for their journey’.134 Throughout the journey, Lady de Crespigny tried to obtain food and comforts for the wounded with mixed results. As previously noted, she also wrote about the ‘red tape’ that delayed much needed goods reaching the hospitals. Similarly, The Times featured an extract of a letter, written by a ‘lady’ at Thaba Nabu (near Bloemfontein), I found the poor men who had been wounded and brought in the day before had not had their wounds dressed. Sick and wounded alike were lying with the sore and tired bodies on the hard floor. … I was angry at all the lies and pictures they put into the papers about the splendid way the wounded are being nursed. … I do think the whole A.M.C should be kicked.135 On her return to England, the ubiquitous Mrs Richard Chamberlain, in a reflection of her own upper-class status, wrote to Lord Roberts and urged women with loved ones in South Africa to lobby their own members with regard to the state of military hospitals.136 She also gave evidence to the South African Hospitals Commission. The account in the Daily Mail, and reprinted in The Adelaide Observer, pilloried her appearance at the examination, commenting that although she was ‘a sadly trying witness, she made a charming picture’.137 Despite this, however, Mrs Chamberlain did make some pertinent and stinging observations that were probably very reflective of the medical military environment. Of the questioning of the commission she commented, ‘you are doing … what everyone did in South Africa, trying to make things as awkward as you can. You are behaving not as if you were judges, but as if you were the counsel for the defence of the army doctors.’138 Conclusion Nurses successfully contested the position of primary carers in the army hospitals because they were able to deliver a high standard of nursing care and often brought ‘order out of chaos’. This came about because of their skills, ethics, knowledge base and lengthy training. While many of the amateur, society ladies who came to ‘nurse’ the wounded were educated and articulate, they did not possess the required knowledge and expertise. Their ineptitude as clinical practitioners not only brought derision, but highlighted the gap between trained nurses and amateurs. It should also be remembered that many of the trained nurses who went to South Africa were very often the elite, most highly skilled and experienced and as such would arguably have been able to offer the highest quality of nursing possible. Although female nurses still had to face prejudices from within the upper echelons of the army sphere, they had strong and increasingly vocal advocates in the many doctors imported into the army from civilian hospitals. These doctors knew the advantages that good nursing care could offer their patients. However, the nurses needed both the orderlies and the benevolent upper-class women in order to provide the best possible care to their patients. Orderlies supplied many of the ancillary services essential to the provision of good care practices. Benevolent ladies became auxiliary carers and support workers for the nurses. The role of ‘carer to the carer’ was also of paramount importance in enabling nurses to continue in their work. Articulate and assertive, many upper-class ladies became effective patient advocates demanding better care and conditions for injured and sick army personnel. The army hospital would never be the same again. Acknowledgements In writing this paper I wish to thank the following: Professor Barbara Caine for her knowledge and patience in supervising my thesis; Dr Pauline Payne for her generosity in time and advice; and Kim Dell, research assistant (Bachelor of Health Science Program). 1 Sister Mansfield, ‘Ladysmith after the Siege’, The Queenslander, 21 July 1900, 128. 2 This article is largely taken from my PhD Thesis, ‘“… So give three cheers for our sisters”, the role and status of Australian nurses in the second Anglo-Boer war, 1899–1902’ (unpublished, Monash University, Melbourne, 2010). 3 On the RAMC, see Kieron Spiers, Queen Alexandra’s Royal Army Nursing Corps, <http://britisharmynurses.com/index.php/nursesandnursing/nursing>, accessed January 2017. 4 Adams ‘“… So Give Three Cheers for our Sisters”’, 74–83. 5 Charlotte Serle, The History of the Development of Nursing in South Africa, 1652–1960 (Cape Town, Struick, 1965) 203. 6 Adams, ‘“… So give three cheers”’, 35. 7 Ann Summers, Angels and Citizens—British Women as Military Nurses 1854–1914 (London: Routledge & Keegan Paul 1988), 102–4. 8 Unknown British Nurse cited in Summers, Angels and Citizens, 101. 9 Jane Lempriere, cited in Adams, ‘“… So give three cheers”’, 37. 10 On Florence Suttaby, see Keiron Spires, cited in Charlotte Dale’s thesis ‘Raising Professional Confidence: The Influence of the Anglo-Boer War (1899–1902) on the Development and Recognition of Nursing as a Profession’ (University of Manchester, 2013), 97. On Laura Woolcott, see Adams, ‘“… So give three cheers”’, 35–7. 11 ‘The Nursing Sisters—Life in a Hospital Camp’, The Adelaide Observer, 2 June 1900,7–9. See also Dale, ‘Raising Professional Confidence’, 95. 12 Dale, ‘Raising Professional Confidence’, 110. 13 Ellen Gould, ‘Report by Miss E J Gould, New South Wales assistance asked in connection with the collection of the historical material for Australian Army Nursing Service, AIF’, Canberra, Australian War Memorial, AWM41 [172], 1933, 1. (The ANS nurses were attached to RAMC—Royal Army Medical Corps). 14 Adams, ‘“… So give three cheers for our sisters”’, 103 and Dale, ‘Raising professional Confidence’, 113. 15 Serle, The History of the Development of Nursing in South Africa, 187. 16 J. C. de Villiers, ‘The Medical Aspect of the Anglo-Boer War, 1899–1902 part II’, Military History Journal, 1984, 2; See also Serle, The History of the Development of Nursing in South Africa, 187;Georgina Fane Pope, ‘Nursing in South Africa during the Boer War, 1899–1900’, The American Journal of Nursing, 1902, 3, 10–14, at 12. 17 S. A. Watt, ‘The Anglo-Boer War: The Medical Arrangements and Implications Thereof during the British Occupation of Bloemfontein: March–August 1900’, The South African Military History Society Journal, 1992, 9; Martha Bidmead, ‘Our Nurses at the Front—An Interesting Diary’, The Adelaide Observer, 9 June 1900, 7–8; ‘Report by Miss J Gould Australian War Memorial’, AWM41 [172], 1933, 1. 18 Sister Rawson, ‘The Victorian Nurses—Letter from the Sister in Charge’, The Argus, 25 June 1900, 5; Stephen Pagaard, ‘Disease and the British Army in South Africa, 1899–1900’, Military Affairs, 1986, 50, 71–76, at 72. 19 Lady De Crespigny, quoted in ‘The Military Hospital Scandals’, The Adelaide Observer, 13 October 1900, 42; See also Sr Peter in Anna Rogers, While You’re Away, New Zealand Nurses at War 1899–1948 (Auckland: Auckland University Press, 2003), 22–3. 20 I. G. P. Humphries, quoted in ‘The Military Hospital Scandals’, 42. 22 See Summers, Angels and Citizens, 99. 23 Summers, Angels and Citizens, 99. 24 Sister X, The Tragedy and Comedy of War Hospitals (London: John Murray, 1906), 6. 25 Adams, ‘“… So Give Three Cheers”’, 67–9. 26 Christopher Maggs, The Origins of General Nursing (London: Croom Helm, 1983),13. See also Dale, ‘Raising Professional Confidence’, 26. 27 Mrs Bedford Fenwick, ‘Editorial’, Nursing Record and Hospital World, 16 December 1899, 486. 28 See for example Mary Nicolay, in Adams, ‘“… So give three cheers”’, 160. 29 Adams, ‘“… So give three cheers”’, 39. 30 Summers, Angels and Citizens, 103. 31 For the early buildings of army hospitals, see Juliet Piggott, Queen Alexandra’s Royal Army Nursing Corps (London: Leo Cooper Ltd, 1990), 16. 32 Serle, The History of the Development of Nursing in South Africa, 185. 33 Summers, Angels and Citizens, 104. 34 Gertrude Fletcher, Some Memories and Extracts from the Life of a Nurse (private publication, 1949, nfd), 91. 35 Although, according to Burdett-Coutts, ‘the chief ward master … supports the nurses by his authority’, this was not always the case (Mr Burdett-Coutts MP, ‘Our Wars and Wounded. VII’, The Times, 29 June 1900, 14; See also Sister X, The Tragedy and Comedy of War Hospitals, ch. 1. 36 Sister X, The Tragedy and Comedy of War Hospitals, 20. 37 Burdett-Coutts, ‘Our Wars and Wounded. VII’; See also Sister X, The Tragedy and Comedy of War Hospitals, 23. 38 For example, Fletcher, Some Memories and Extracts from the Life of a Nurse, 87; Boer War—Manuscript note book containing continuous dated extracts from letters written by an army nursing sister serving in South Africa 1900–1901 (London: Wellcome Trust Centre) (most probably E. J. Wood), 13. 39 For example, Fletcher, Some Memories and Extracts from the Life of a Nurse, 86f and Martha Bidmead, ‘The Nursing Sisters—Life in a Hospital Camp’ The Adelaide Observer, 2 June 1900, 7. 40 Sister X, The Tragedy and Comedy of War Hospitals, 26 and 127; Dr Conan Doyle in ‘Mr. Burdett-Coutts’s [sic] charges’, The Times, 6 July 1900, 7; ‘JA’, ‘Some experiences of a Victorian nurse in South Africa’, Una, 1903, 1, 31–3, at 32; Dr A. E. Morrison in ‘Mr. Burdett-Coutts’s [sic] charges’, 8; ‘Medical Services of the Australian Contingent’, The Adelaide Observer, 28 April 1900, 11. 41 Boer War—Manuscript note book containing continuous dated extracts from letters, 59. 42 Bidmead, ‘The Nursing Sisters’, 7–9. 43 Conan Doyle in ‘Mr. Burdett-Coutts’s [sic] charges’, 8. 44 Fletcher, Some Memories and Extracts from the Life of a Nurse, 91. See also Sister X, The Tragedy and Comedy of War Hospitals, 32. 45 Sioban Nelson, ‘From Salvation to Civics: Service to the Sick in Nursing Discourse’, Social Science and Medicine, 2001, 53, 1217–18. 46 Alison Bashford, Purity and Pollution (Basingstoke: Macmillan, 1998), 65. 47 Anne Marie Rafferty, ‘The Seduction of History and the Nursing Diaspora’, Health and History, 2005, 7, 3. 48 Maggs, The Origins of General Nursing, 13. 49 ‘Marshburgh’, in Broad Arrow, the Naval and Military Gazette, cited in The Nursing Record and Hospital World, 24 December 1898, 513. 50 Sister X, The Tragedy and Comedy of War Hospitals, 18. 51 Sister X, The Tragedy and Comedy of War Hospitals, 26–7. 52 Fletcher, Some Memories and Extracts from the Life of a Nurse, 91–2. 53 Surgeon-General, ‘Nursing the Sick and Wounded—Letters to the Editor’, The Times, 25 January 1900, 12. 54 ‘JA’, ‘Some Experiences of a Victorian Nurse in South Africa’, 32. See also Sister X, The Tragedy and Comedy of War Hospitals, 26. 55 ‘Marshburgh’, in Broad Arrow, the Naval and Military Gazette, 513. 56 Letter from Miss Hancock, Army Medical History Museum, Ashvale, 18 May 1900, see also Sister X, The Tragedy and Comedy of War Hospitals, 26. 57 E. C. Lawrence, A Nurse’s Life in War and Peace (London: Smith, Elder & Co, 1912), 162–3. 58 Sister X, The Tragedy and Comedy of War Hospitals, 123. 59 Peter, in Rogers, While You’re Away, 22. 60 Bidmead, ‘The Nursing Sisters’, See also Sister X, The Tragedy and Comedy of War Hospitals, 119. 61 Sister X, The Tragedy and Comedy of War Hospitals, 23, 79 and 122. 62 ‘A Colonial Volunteer’s Experiences’ in ‘Army Nursing Notes’, The Nursing Record and Hospital World, 28 July 1900, 74. 63 ‘The Military Hospital Scandals’, The Adelaide Observer, 13 October 1900, 43. 64 ‘A Colonial Volunteer’s Experiences’, 74. 65 Anne Marie Rafferty, ‘The Seduction of History and the Nursing Diaspora’, 1–2. 66 Sister X, The Tragedy and Comedy of War Hospitals, 26. See also Fletcher, Some Memories and Extracts from the Life of a Nurse, 91, Boer War—Manuscript note book containing continuous dated extracts from letters, 59; and Lance-Corporal Phil. Alexander, ‘Life in Hospital’, The Adelaide Observer, 15 September 1900, 41. 67 ‘Mr Burdett-Coutts Charges’, 8, See also, for example, ‘A Colonial Volunteer’s Experiences’, 44. 68 The Nursing Record and Hospital World, 1 September 1900, 175. 69 A Canadian soldier, ‘Mr Burdett-Coutts charges’, 48 and ‘A Colonial Volunteer’s Experiences’, 44. 70 Burdett-Coutts, ‘Our War and our Wounded’; Sister X, The Tragedy and Comedy of War Hospitals, 23. 71 Lord Wolseley, ‘Army Nursing Notes’, The Nursing Record and Hospital World, 15 September 1900, 209. 72 Burdett-Coutts, ‘Our Wars and our Wounded’, 14. 73 Ibid.; ‘The Governor on Nursing’, The Adelaide Observer, 28 July 1900, 16. 74 Ibid. 75 Burdett-Coutts, ‘Our Wars and our Wounded’, 14. 76 W. T. Reay (Maj), Australians in War with the Australian Regiment from Melbourne to Bloemfontein (Melbourne: A H Massina & Co, 1900), 63. 77 ‘A Glimpse of War’ The Advertiser, 4 January 1900, 5. 78 See for example, ‘Our Nurses in Africa’, The Adelaide Observer, 19 January 1901, 41, Boer War—Manuscript note book containing continuous dated extracts from letters, 20, 22; ‘The Governor on Nursing’. 79 Sergeant Legge, quoted in Rogers, While You’re Away, 29. 80 See Adams ‘“… So give three cheers”’, ch. 7. 81 Bidmead, ‘The Nursing Sisters’. 82 Ibid. 83 Boer War—Manuscript note book containing continuous dated extracts from letters, 27. 84 Sister X, The Tragedy and Comedy of War Hospitals, 62–3; Bidmead, ‘The Nursing Sisters’. 85 Boer War—Manuscript note book containing continuous dated extracts from letters, 27. 86 Ibid. 87 Fletcher, Some Memories and Extracts from the Life of a Nurse, 91. 88 S. A. Watt, ‘Deelfontein (A hospital in the Karoo during the Anglo-Boer War, a cemetery today)’, Military History Journal, 7, 1. 89 Beatrice Huston, ‘Hospital Work in South Africa, a Letter from Nurse Huston’, The Queenslander, 1 September 1900, 498. 90 Maud Rolleston, Yeoman Service; Being the Diary of the Wife of an Imperial Yeomanry Officer During the Boer War (London: Smith, Elder, 1901), 101–2. 91 Huston, ‘Hospital Work in South Africa’. 92 See for instance, Beatrice Huston, ‘With the wounded at Rondobosch’, The Queenslander, 16 June 1900, 1138. 93 Rolleston, Yeoman Service, 54–5. 94 Rolleston, Yeoman Service, 135, 154f. 95 Sister X, The Tragedy and Comedy of War Hospitals, 94. 96 ‘A Plague of Amateur Nurses’, The Adelaide Observer, 5 May 1900, 5. 97 Frederick Treves, ‘To the Editor of The Times’, The Times, 2 May 1900, 8. 98 ‘Nurses in South Africa’, British Medical Journal, 3 February 1900, 280–3. 99 Karel Schoeman (ed.), Witnesses to War (Cape Town: Human and Rousseau, 1998), 73. 100 Captain Jones in Schoeman (ed.), Witnesses to War, 73–4. 101 ‘Professional Review’, The Nursing Record and Hospital World, 9 June 1900, 461. 102 Extract of letter from unnamed army nurse, The Nursing Record and Hospital World, 19 May 1900, 9. 103 ‘A Lady War Correspondent’, The Advertiser, 20 February 1900, 4. 104 Ibid. 105 Fane Pope, ‘Nursing in South Africa during the Boer War’, 10. 106 ‘Army Nursing Notes’. The Nursing Record and Hospital Times, 18 November 1899, 410; see also, ‘Army Nursing Notes’, The Nursing Record and Hospital World, 31 March 1900, 251, concerning Lady Ormonde who was going to South Africa to see family and was ‘anxious to do a little nursing on her own account’. 107 ‘The Governor on Nursing’. 108 Extract from letter, author unnamed, ‘Army Nursing Notes’, The Nursing Record and Hospital World, 19 May 1900, 399. 109 Ibid., See also, ‘An Officer’s Wife’, ‘Fine Lady Nurses’, and ‘Letters to the Editor’, The Nursing Record and Hospital World, 10 February 1900, 123. 110 Ibid. 111 On contemporary advances in procedures, see Emonoel Lee, To the Bitter End, Photographic History of the Boer War 1899–1902 (Harmondsworth: Penguin, 1985), 68. 112 Maggs, The Origins of General Nursing, 13. 113 Boer War—Manuscript notebook containing continuous dated extracts from letters, 9–14 November 1900, 46–7. 114 Ibid. 115 Fletcher, Some Memories and Extracts from the Life of a Nurse, 86ff. 116 ‘JA’ ‘Some experiences of a Victorian nurse in South Africa’, 31. See also Sister X, The Tragedy and Comedy of War Hospitals, 63. 117 ‘Army Nursing Notes’ The Nursing Record and Hospital World, 28 July 1900, 73. 118 ‘Army Nursing Notes’, The Nursing Record and Hospital World, 12 May 1900, 376. 119 Ibid. 120 ‘An Officer’s Wife’ and ‘Fine Lady Nurses’, 123. 121 Report from Fletcher Robinson, in the Express in the Nursing Record and Hospital World, 5 May 1900, 356. 122 ‘An Officer’s Wife’, 123. 123 Bidmead, ‘Our Nurses at the Front’, 8 and ‘Army Nursing Notes’, The Nursing Record and Hospital World, 31 March 1900, 252. 124 Martha Bidmead, ‘The Nursing Sisters’, The Adelaide Observer, 2 June 1890, 7. 125 Fletcher, Some Memories and Extracts from the Life of a Nurse, x. 126 Extract from letter of unnamed army nurse (9 August 1900). 127 The Nursing Record and Hospital World, 10 February 1900, 114. 128 Ibid. 129 An example would be Lady Chesham, in S. A. Watt, ‘The Anglo-Boer War: The Medical Arrangements and Implications thereof’, 1, 4. 130 ‘The Domestic Department’, The Nursing Record and Hospital World, 10 February 1900, 116. 131 Boer War—Manuscript notebook containing continuous dated extracts from letters, 17. 132 Sister X, The Tragedy and Comedy of War Hospitals, 21. 133 See for example, ‘The Army Hospital, a Talkative Woman’, The Adelaide Observer, 29 December 1900, 7; ‘The Plague of Women’, The Nursing Record and Hospital World, 12 May 1900, 387. 134 Lady De Crespigny, ‘The Military Hospital Scandals’, The Adelaide Observer, 13 October 1900, 42. 135 ‘Mr Burdett-Coutts’s charges’, The Times, 4 July 1900, 9. 136 ‘Army Nursing Notes’, The Nursing Record and Hospital World, 2 June 1900, 437. 137 ‘The Army Hospital, a Talkative Woman’, 7. 138 Ibid. © The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Social History of Medicine Oxford University Press

Lads and Ladies, Contenders on the Ward—How Trained Nurses became Primary Caregivers to Soldiers during the Second Anglo-Boer War

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© The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine.
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Abstract

Summary This paper looks at the contest between trained nurses, orderlies and society ladies to occupy the role of primary caregivers to soldiers, especially in military hospitals, in the Second Anglo-Boer War, 1899–1902. It considers how nurses won the right to the post due to their training and position on wards in civilian hospitals. In gaining this position military hospitals and patient care would not be the same. Yet orderlies and society ladies had a part to play in the running of military hospitals and the nurses were dependent on both these groups to provide the best possible care to their patients. SecondAnglo-Boer War, Military Nursing, Orderlies, Ladies ‘they can’t be looked after properly, as there are not enough nurses. … We have orderlies to help us, but they are very careless. It makes my heart ache to see the poor men so weak and ill.’1 Nursing in the Second Anglo-Boer War can be seen as something of a watershed in modern military nursing.2 It was in this theatre of war that nurses would carve out a meaningful role for themselves as skilled primary caregivers in military hospitals, after consolidating their position against challengers. This paper will investigate the relationships the nurses had with the two other groups contesting occupancy and/or control of the hospital ward—the orderlies and the ‘amateur lady nurses’. It will demonstrate how the skills, knowledge and character of professional nurses gave them legitimacy to operate effectively at the clinical level in the military/medical sphere, while still being under the authority of male, military and medical figures. Trained nurses came mainly from Britain, Australia, New Zealand and Canada to serve in the South African conflict. Some came as part of official contingents such as the Army Nursing Service (ANS), who were connected to, but not part of the British Army or the Royal Medical Army Corps (RAMC), the Princess Christian Army Nursing Service Reserve (PCANSR), colonial cohorts, as staff of private hospitals or as independent travellers.3 Their motives were varied. Some came seeking adventure, others came to serve the Empire, but all came to give professional care to the wounded and sick. In addition there were local nurses and various religious nursing sisterhoods already working in the war zone.4 The religious sisters could not be under army control in the same way that other nurses were, and although under the supervision of their order, the convents functioned with some independence.5 It should also be recognised that the trained nurses were not a homogenous group and there were some underlying tensions between different groups of nurses, especially between the Army Nursing Service nurses and the newly recruited nurses. Many of the latter brought with them modern civilian standards of clinical care and were accustomed to nursing patients at the bedside rather than at a supervisory level that was the norm in peacetime for the ANS nurses.6 The work of the ANS nurse was something of an enigma. As Ann Summers has observed, ‘an army sister could be clearer about what she should not do than what she should. … The Regulations gave her, instead of concretely defined duties, a set of responsibilities which were subject to a variety of interpretations.’7 The result in practice was, as one British nurse commented, ‘ [A]n Army sister … may do as little as she likes or she may work herself to death.’8 Jane Lempriere, a Victorian nurse who travelled independently to South Africa, observed, ‘It is puzzling to define the work the sister does. She has all anxiety and worry.’9 The cumulative effect perhaps made the ANS nurses more aloof than the newly recruited nurses. Both Florence Suttaby writing under the pseudonym of Sister X10 and Laura Woolcott, a New Zealand nurse, wrote of the dismissive nature of the some of the military nurses that they encountered. Newly recruited nurses were accustomed to stricter scrutiny by a civilian nursing and medical hierarchy. As Martha Bidmead, head of the South Australian contingent of nurses observed: The Netley Sisters [ANS], who pretty well rule this place [Wynburg], are accustomed to be as mere lay figures or figureheads. They do nothing but take temperature, give stimulants, and sometimes wash a patient’s hands and face if his temperature is very high. So they do not look with exactly loving eyes on the civilian sisters, who are accustomed to and expect to work.11 Another source of tension that should also be considered was between the colonial nurses and the British nurses. Charlotte Dale in her thesis argues that this was to some degree due to the restrictive role given to the British army nurses as well as the colonial nurses’ place in the system.12 Nellie Gould, head of the New South Wales nursing contingent, records the Principal Medical Officer’s response when she presented her papers on behalf of the NSW nurses at No 6 British General Hospital at Johannesburg, ‘“My God, Australian Sisters, what shall we do.” On my asking the reason [for this exclamation], he said … [he] understood we could not work with the R.A.M.C. Sisters’.13 Despite some unpleasantries, it appears that the nurses managed to work together and separate themselves from the untrained women.14 The two main groups who were challenging for legitimacy to work as primary caregivers in the ward were untrained upper class women attracted by the thrill of war and/or philanthropic intentions, and army medical orderlies who had traditionally undertaken much of the routine ‘nursing’ work for the army. However, to reduce the situation to a contest between these groups and the trained nurses is a gross over-simplification, as the nurses were to some extent reliant on both groups. Orderlies were essential in the running of the hospital especially when many of the hospitals were of a temporary, makeshift nature. Benevolent ladies also provided the nurses with considerable support and were instrumental in supplying goods to hospitals, often through informal networks. More importantly both groups could be utilised in the provision of patient care. Early Medical/Military Problems Before we can enter into any discussion of the position of the nurses and their challengers, it is important to contextualise their situation within the bigger picture of the conditions facing the army and its inability to provide adequate medical and health services. The physical problems facing the army were immense. The early months of 1900 brought conditions rife for the outbreak of enteric fever/typhoid in South Africa. Just how rapidly the disease spread can be seen in the fact that on 12 January 1900 there were only 120 cases out of a total army strength of 117,914, yet by 25 May there were 6,084 patients with typhoid out of 217,533.15 Massed troops and contaminated water exacerbated the spread of disease.16 Conditions were particularly poor in Bloemfontein and further north of the town.17 The poor positioning of hospitals on unhealthy soil or at a distance from a fresh water supply, brought its own set of problems.18 There were also problems with obtaining supplies—either through scarcity or ‘red tape’ that surrounded much of the army medical service. Lady De Crespigny recorded a typical scenario. ‘[T]he South train wharfs were full of comforts of all kinds for the troops, but red tape again came in. I asked to be allowed to have goods to send up the hospitals … but I was politely refused.’19 There were also escalating tensions between the regular army doctors and civilian or newly enlisted doctors due to the poor treatment meted out to the patients. Private Humphries wrote of a hospital in Bloemfontein, There was an awful row between the civilian doctors attached to the military hospitals and the army doctors. The civilian doctors sent in en masse and asked to be transferred. The principal medical officer enquired the reason and they replied that the treatment of the patients was such they refused to have anything more to do with it. Of course they were right and there was a royal row.20 Theatre of War as Masculinist Space The war zone was not totally a male space. War zones could not be totally exclusive of women—civilian women, victims of war, camp followers and nurses were clustered at the periphery, but were without significant power. The Boer War theatre can be considered masculinist because men controlled it. However conditions such as poor facilities for the wounded, the advancements in medical treatment and surgical procedures such as the treatment of typhoid, the use of asepsis technique in the operating theatre and in wound management and pressure through newspaper articles primarily in Britain,21 made it possible for trained female nurses to become more mobile and venture legitimately further into the specific masculinist space of the military hospital. However in order for female nurses to function effectively as primary clinical caregivers in such a space, would mean that they would need some control and unrestricted access to the wards. For this to occur, some control would have to be relinquished by the men. Some of the control excercised by the male management concerned the extraordinary regulations limiting the time nurses spent on the ward and restrictions on their duties at the commencement of the war.22 According to historian Ann Summers, nurses ‘were given no authority over the orderlies … [but] were responsible for the personal cleanliness of the patients in their wards [and] that medicines, diets and extras [were] supplied to the patients.’23 Yet this operational responsibility was unachievable simply because they had no power to enforce either orders or discipline. Sister X wrote how ‘[T]he Army Sister also gave me a few hints as to what I was not to do—I was not to wash the patients, and was not to make their beds. I had nothing to do with their diet (except seeing they got their food); nor was the responsibility of having my wards clean even within my province.’24 The reasons given against the increase and/or the extended use of nurses, such as accommodation concerns, propriety and physical danger, when there was an obvious clinical need for more nurses, are additional evidence of this anxiety concerning the position of female nurses in military hospitals.25 The differences between civil and military hospital culture must also be considered. At the turn of the century the civilian hospital ward became a safer setting for nursing the sick. This space could be regulated and managed and gave some nurses considerable control within that space. Indeed the concept of the senior nurse as ‘mother of the ward’ translated control from the private sphere of the household to the public arena. Historian Christopher Maggs takes the analogy further. ‘In the hospital world the doctor assumed the role of the father and in his absence … the functions of the father were subsumed under the functions of the mother, the senior nurse. Obeying the senior nurses … was obeying the doctor.’26 This was also expanded to include the later notion expounded by Mrs Bedford Fenwick, editor of the Nursing Record and Hospital World, positioning nursing as a science, as a complement, a helpmeet to medicine.27 This meant that in practice there was more emphasis on nurses operating from a knowledge and skills base, while at the same time not negating the older benevolent ‘mother of the ward’ agenda. Throughout the later decades of the nineteenth century, nurses were contesting men’s entitlement to all space, specifically hospital space. They wished not just to occupy it but they sought legitimacy to operate with power within it. General hospitals, although controlled by men, afforded senior nurses considerable authority within the micro sphere of the hospital wards. In addition, nurses established their own hospitals or nursing homes, where they had considerably more power over the space, while not negating the medical authority of the doctors.28 At the other end of the spectrum were the hospitals attached to convents. These were controlled by women, were frequently bought through the religious community’s own money and men such as doctors and priests had limited access.29 These environments were the antithesis of the military hospital. The military hospital was part of the military sphere, controlled by male army officials and government bodies, with even medical personnel having only limited power. Summers chronicles the attempts by doctors, over the latter half of the nineteenth century, to extend the female nurses’ time on the ward, yet it was only by the 1890s that female nurses were in attendance through the day.30 Military hospitals were an extension of barracks life. For the sake of practicality, several of the hospitals were built physically close to barracks.31 They were managed along the lines of military sensibilities, which were not always compatible with quality medical and nursing care. One of the observations that emerged from the Royal Commission appointed to consider and report upon the care and the treatment of the sick and wounded during the South African campaign 1901, was that, ‘there was a tendency … to treat the hospital too much like a barrack and to regard the patients too much as soldiers and not enough as patients’.32 While during peacetime the flaws of the military hospital system were less obvious, a war status was another matter entirely. The number and types of admissions were considerably different and would require a different approach to nursing. The duties of the orderlies reflected this difference; as such they were soldiers first and nursing personnel second. ‘The orderly nurse [male] may be ordered out of the ward … to go on drill … or some other fatigue duty.’33 They also answered to the Sergeant Major or Ward Master rather than the supervisory nurse.34 The military hospital with its language and its approach to the sick and their care was not only far removed from its civilian counterpart, but it was almost exclusively a well-secured masculinist space. And it was into this space at the end of the nineteenth century that the predominantly newly recruited trained nurses were about to enter. The resulting clash would radically alter the way the army nursing system would be constructed for the twentieth century. A Slight Shift When Sister X began nursing in Maritzburg in December 1899, she was confronted with a system that was actively hostile to female nurses. The orderlies were often rude, set in their ways and unwilling to take instructions from the nurses. The nurses also faced restrictions on their ward time and the range of their tasks and they had limited internal support for their position.35 The nurses were also excluded from many of the instructions for patients’ treatments that were issued on doctors’ rounds. Sister X wrote, [W]hispered undertones went on between him [doctor] and the orderly about matters that we had always been accustomed to attend to, and we began to wonder why we were there at all. Things of the greatest importance, that require skilled hands, were in the hands of young ignorant orderlies. We were aghast, but not consulted.36 By March and April of the following year there was a slight change in the status of the nurses. Burdett-Coutts wrote, ‘female nursing is welcome at No 3 [British General Hospital] and there are many enlightened officers of the Royal Army Medical Corps who hold the same view; but the traditions and practice of that body are tinged with a strong prejudice against it’.37 This slim change, brought about mainly by the import of civilian and/or younger doctors into the army, afforded the nurses, if not more authority, then at least slightly more recognition and greater actual control of the orderlies on the ward.38 As the war progressed, it appears that nurses gained more control over the orderlies and the ward and expected orderlies to carry out tasks according to their instructions.39 The increasing number of nurses also enhanced their position, allowing them the opportunity to do more clinical nursing rather than supervising—although there was almost always a chronic shortage of nurses, especially in the north. Orderlies At the outset and throughout the early stages of the war the medical orderlies, who were attached to the RAMC, were the primary patient caregivers in military hospitals. The few Army Nursing Service nurses who had limited access to the wards acted mainly in a supervisory capacity. That this system was in place points to the outmoded ethos in the military/medical sphere. In comparison, the civilian hospital and health care sphere had established a distinct nursing system that involved trained people delivering quality patient care. The irony cannot be lost. Nightingale’s work associated with the war in the Crimea was a vital catalyst to the emergence of modern nursing. Yet it was in the military sphere that modern female nursing was most lacking. Any discussion surrounding the orderlies who were working in South Africa has to take into consideration that they were not a homogeneous group. There were RAMC orderlies from the military hospitals in England, untrained recruits, refugees, volunteers from the Yeomanry, St John’s Ambulance men, medical students and even convalescent patients.40 Some orderlies did not particularly want to be either bedside carers or even orderlies at all and were there under duress—in response to military orders or as convalescents. Others saw working in a hospital as a ‘soft option’ to being sent back to the front.41 Many of the best RAMC orderlies were sent to work in the field hospitals at the front rather than the base and stationary hospitals where the majority of the nurses were stationed.42 This difference amongst orderlies accounts for the discrepancies in contemporary descriptions of them and their work. Conan Doyle wrote to The Times about St John’s Ambulance volunteers recruited from a northern English town who were working as orderlies, observing ‘for solid work and quiet courage you will not beat him in that gallant Army’.43 Nothing could be a greater contrast than some of the descriptions of orderlies given by the nurses. As far as Gertrude Fletcher, an Australian nurse working with the Princess Christian Army Nursing Reserve was concerned, ‘[W]hen you have good conscientious orderlies it is bad enough, but when they are lazy and untrained it is awful.’44 Nurses’ Claims as Primary Carer At the turn of the twentieth century, nursing was a skilled female occupation imbued with middle-class feminine benevolence, character and education standards.45 Nurses made their claims to displace orderlies as primary bedside carers on the basis of their knowledge and training, their character and their gender. These three qualities were interrelated and were steeped in middle-class ideology. Alison Bashford suggests that at the end of the nineteenth century ‘nursing and middle class femininity had come to be so closely related as to be mutually defining’.46 The idea of nurses being of good character, respectable and reliable was a major plank of Nightingale style nursing, which elevated nurses from servant status and permitted them to have intimate physical contact with patients, devoid of a sexual agenda. Concomitant with this was the notion of the nurse, as a middle-class female operating from an agency of benevolence. Anne Marie Rafferty notes how the reformed, middle-class nurse was ‘[A]bove and beyond reproach, the new nurse’s crystalline character became a beacon of Christian piety and virtue, and her demeanour and deportment were signifiers of her class.’47 Accordingly, contemporary nursing education included ‘instil[l]ing a rigid code of behaviour and self-discipline in the woman’ appropriate to values associated with middle-class femininity.48 The skill and knowledge that the nurses brought with them from the civilian sphere were honed over three years of training that included both practical and theoretical components of patient care and was incomparably better than the training of the sparsely trained orderlies. ‘Marshburgh’ highlighted the difference between the training of a nurse and an army medical orderly in late 1898. ‘The sister is practically an officer, highly educated and well trained before entering the Service. The ward-orderly may have been a labourer for the fields. We cram him through a six months’ course of drill, first-aid, and nursing, and then present him to the Army as the finished article.’49 While both orderlies and nurses were trained to obey, there was a difference between the blind obedience to orders and regulations of the army and that of the trained nursing sphere, which also included an applied knowledge base from which decisions could be made. As Sister X exclaimed with characteristic bluntness, ‘[I]f only they [the orderlies] acted more intelligently! … But what can you expect from men … who are not allowed to think but only to obey!’50 The popular press and the writings of the nurses are filled with stories about orderlies showing their scant knowledge of patient care, food and ward hygiene. ‘He thinks it quite superfluous … to make a bed or to wash the feeding cups, and would not dream of doing either if left to himself.’51 Australian nurse Gertrude Fletcher commented on the stupidity of one orderly, who, when told by the Sister to give ‘half milk and half barley water’ to the patients, gave milk to one side of the ward and barley water to the other side!52 While the Surgeon-General insisted that orderlies were ‘trained with a great deal of care, and graded to their natural ability and tact, that their training followed the system outlined in the ‘Manual for the R.A.M.C.’ and that they were ‘not enlisted without certificates of character’, the degree to which orderlies were trained to give good nursing care was questionable.53 As Julia Anderson, a nurse from the Victorian (Australia) contingent observed, ‘[T]he men who take up this work are not as a rule of sufficient training or education to appreciate, as a trained nurse can, the gravity of the work.’54 Unknown correspondent ‘Marshburgh’ cited in the Nursing Record and Hospital World discussed the ideal of army orderly training but then added, ‘the young recruit is pitch forked into a ward to sink or swim, as the fates decide. More often than not what he learns of actual nursing he is taught by the patient.’55 In addition, many of the orderlies with whom the nurses came into contact were in fact new recruits, or ‘ordinary soldiers, quite as stiff as my pro [probationary] days at Barts’, as one nurse wrote, and it was therefore not surprising that they had little notion of hospital procedures or routines.56 As the enteric epidemic began to take its toll, the orderlies’ lack of experience in caring for very sick patients became far more telling. PCANSR nurse Eleanor Lawrence wrote, each man seemed to need individual nursing if he was to have a chance of pulling round; the orderlies (though very willing) had everything to learn of ward duties; they could not even undress these men … much less had they any idea of washing them; a delirious man was a new experience to them, and if he got out of bed and lay on the floor, the orderly would go and ask the Sister what he had better do!57 Knowledge, Training and Skills As a result of their inadequate training, many orderlies had little knowledge of the practical nursing procedures that were regularly practised by the nurses. The administration of sponge baths, a keystone of bedside care, ensuring the patient minimal discomfort, was not always carried out with due attention. Leaving patients wet or using the same washing water for several patients was not unknown. According to one patient, ‘they won’t be bothered to get fresh water each time, so they wash us all in the same water—such a drop too!’58 The practices of aseptic technique as well as safe food handling by the orderlies were also far from optimal.59 The physical environment, the massed number of troops very often in a vulnerable physical condition, also increased the potential for contagious diseases or infections, making the use of hygiene procedures even more crucial. Many orderlies had little insight into the aetiology or pathology of diseases and therefore gave inappropriate nursing care. Martha Bidmead, head of the South Australian contingent of nurses described such treatment: Their way of nursing enteric [patients] are marvelous, that is the only word for it. I am sure your cap would stand upright, and your hair. … Imagine an enormous thick blanket underneath the sheet on which they lie the enteric patient … no mackintosh, a thick sheet, another heavy military blanket, and a monster quilt above all. Then they [the patients] wear a shirt and a tick twilled one as well! And some of them with temperatures of 105 and 106 degrees [sic].60 Orderlies were also known to disregard nurses’ instructions regarding food restrictions and/or the ambulatory status of very sick patients.61 While such actions against treatment protocols could have serious consequences for patients, it also meant that the nurse as supervisor could not trust the orderlies as agents to deliver appropriate care. Disturbing reports filtered through to the nursing and general media by the middle of 1900. The medicine glass was a broken measuring glass, and I am sure had not been washed for weeks, for all round the outside edge there was a thick rim of dried saliva, and the discharge from sore lips, … making it a disgusting thing to take in one’s hands let alone one’s lips. All sorts of medicine were administered out of the same glass and even the thought of it made me sick.62 While the orderlies may have been lax about hygiene, drug administration and practical nursing procedures, what was more disturbing was the lack compassionate nursing care, especially for the very sick and dying. Trooper Outridge, wrote of his ordeal and that of another suffering patient, in an account that was printed in both British and Australian newspapers. I was told to lie down on the bare ground … after about five minutes I felt someone crawling over me … and saw what seemed to be a skeleton. It was only a poor fellow in the extremes of enteric fever. He was delirious, and I called to the orderlies … to lift the man off me. ‘Oh, go to sleep’, was the reply I got. ‘He won’t hurt you.’ The manner in which the orderlies treated that poor fellow was shocking in its brutality. On the third day he asked for a necessary [sic], and the orderly replied, ‘Shut your mouth and don’t bother me’. I heard him cry, ‘Orderly, I’m going to die’ … ‘Wish to God you — well die’, was the answer the poor fellow got [sic]. He died the next day.63 In contrast, the ‘Colonial Volunteer’ wrote of the care given by sisters and civil surgeons, ‘many a poor fellow in their care has entered the next world quite happy in mind because he was not treated as a dog during the last moments of his career in this world’.64 Character One of the main planks of reformed nursing was that the character of the ‘new’ nurse was above reproach.65 Although the Surgeon-General maintained that orderlies were required to have a certificate of character, this would have been far short of the strict ‘character’ requirements, scrutinised and honed over three years of Nightingale style nurse training. As mentioned previously, many of the best RAMC orderlies were stationed on the front line rather than at base hospitals where untrained soldiers often took their places. Unfortunately there were many reports of unscrupulous orderlies. The nurses reported orderlies for laziness, drunkenness and gambling on duty, at times directly affecting patient care. Sister X recalled, I learnt that Pay Day was a day thirst riots! ‘Getting drunk’, they call it. … There had been regular brawls, even open fights … another had tried to remove the splint off the shattered arm of one of the patients, thinking he was doing him a good turn.66 Dishonesty, bribes and stealing patients’ belongings were not uncommon. A Canadian solider who spoke of many of the orderlies as ‘dirty and unprincipled’ reported that ‘while I was helpless with enteric some of the rascally orderlies had been busy with my belongings, for when I came to myself I found that every penny I possessed had been stolen’.67 An account by an Australian soldier reported in The Nursing Mirror and Hospital World contrasts the difference between the orderlies and the doctors and nurses with regard to integrity on the ward. Doctors and nurses did everything possible, but the hospital orderlies behaved shockingly. They took the luxuries ordered for the patients, drank the brandy when it was ordered, and were always on the look out to make something. The Corporal ‘missed’ all his belongings while in hospital, but kept his eye on the belt of a dying Imperial Yeoman which contained £140. When the poor fellow died he literally rescued it from an orderly who was endeavoring to hide it, and got it returned through the nurse and doctor to the deceased’s friends in England.68 Gender So entrenched was the idea that nursing was inherently female that the behaviour of the orderlies was never compared to the ‘Sarah Gamp’ nurse typology, despite the many real and implied similarities. The orderlies were described as ‘dirty and unprincipled’ or ‘uncouth and uncivil’ but never akin to the stereotypical untrained female nurse.69 Their less than exemplary execution of nursing procedures was often excused because of their gender.70 According to Lord WoIseley, ‘[A] man … cannot … administer to the little comforts of the sufferer in the same way that a woman does. Often when I have been bundled about like a log by a rough, hairy orderly, I have felt I would give all I possessed for the tender care and gentle hands of a woman.’71 There were various reports by soldiers who spoke of the care by female nurses, often in contrast to the care given by orderlies. While the concept of the ‘naturalness of nursing’ to women was not new in the civilian sphere, this idea was moving to the military sphere and the position of female nurses in the military. Burdett-Coutts, reporting on his time in South Africa, wrote in The Times that the ‘absence or totally inadequate supply of female nurses … is a violation of nature; for nursing … the actual handiwork of the process … is woman’s work, not man’s’.72 Because nursing was deemed ‘natural’ for women, it therefore followed that it should be ‘natural’ for women to nurse in the military sphere, Florence Nightingale being repeatedly held up as the model.73 The Governor of South Australia, Lord Tennyson, in a timely speech to the annual meeting of the District Trained Nursing Society in Adelaide, South Australia in July 1900, discussed how ‘Nursing has been, from the earliest times, the prerogative of women’ and that women had a ‘natural instinct for and skill in surgery and nursing’.74 Strongly rebutting claims that men preferred to be nursed by orderlies, Burdett-Coutts, echoing Lord Woseley replied, Any man who has been seriously ill knows the difference between a rough-hewn orderly with horny hands and creaking boots, smelling of tobacco and other things, moving about his bed, tending him with a man’s touch, and the real ministering angel, the female nurse. It is not the poor orderly’s fault, he does his best; but he is built that way.75 Pursuant to the idea of the female nurse as ‘natural’, were the attributes assigned to female nurses, simply because they were female. How nurses moved, smelt, touched and conducted themselves was idealised and feminised. Major Reay wrote ‘the Florence Nightingales of today, moved noiselessly and deliberately about their duties. Sweetest of women these, their work the noblest on God’s fair earth.’76 Descriptions of nurses as ‘perfect dears’ and ‘nothing is too much trouble for them’ only enhanced the idealised position of nurses.77 The reality was somewhat different—nurses did smoke, did lose their temper and due to the nature of their work had very sore and rough hands, and even Tennyson acknowledged that all nurses were not the ‘ideal’.78 Soldiers believed that they were receiving better care simply because they were nursed by female nurses. As Sergeant Legge wrote, after receiving a serious wound, ‘Sister Speed of Timaru is looking after me, so I know I’m all right.’79 In comparing the care given by orderlies and nurses, it is important to take into account that nurses were generally not positioned in the field hospitals close to the front. The conditions there were necessarily less than desirable, more dangerous and there would have been an overwhelming number of incoming casualties. The care received at a stationary or base hospital by nurses might well be deemed superior.80 The Nurses’ Need for Orderlies Despite the failings of many of the orderlies as carers, the nurses did acknowledge the hard work performed by some of them and the difficulties that an orderly’s job entailed. Bidmead observed, ‘[T]he orderlies are wardsmaids, kitchenmaids, charwomen and probationers combined. And have such hard lives of it.’81 They had a difficult night shift system that frequently saw them working long hours. Nurses often preferred to work with new recruits, as they were eager and anxious to perform well, rather than with regular RAMC orderlies who could be set in their ways.82 Those nurses coming from civilian hospitals were more accustomed to working with probationer nurses, who were similar to the inexperienced orderlies. There were also some very conscientious orderlies who worked hard, negotiated the ‘red tape’ and cared about the patients. While medical students often served as surgical dressers with surgeons at the field hospitals they were also very useful orderlies.83 It would be fair to say that the nurses were reliant on the orderlies to help deliver a high standard of care. Due to the physical layout of many of the hospitals as tent cities, and the scarcity of nurses, the nurses utilised the orderlies to monitor the status of patients and inform them of any patients whose condition deteriorated.84 This often required a degree of uneasy trust on the part of the nurse.85 E. J. Wood wrote of the delicate balance she maintained with a medical student orderly. ‘I have a very critical case … and a 1st class orderly is on it. I wish I was [on it] myself as then I should know it was all right. One does not like to interfere with these medical students too much, though I do sometimes and they seem to take it very well.’86 Orderlies were also vital to the maintenance of hygiene standards; having to dispose of wastes a considerable distance from the wards. Everything has to be carried to a certain place outside the camp to be disinfected before being got rid of … when you remember that the Camp is about a quarter of a mile across … these poor orderlies are kept trotting all the time … for nothing is ever left near the hut even for a short time.87 Ladies The nurses received significant support from middle-class and upper-class women. At one end of the scale, there was organisational support, for example that of women such as Lady Curzon with her organisation and support of the Yeomanry hospitals.88 At the other, there was the direct assistance of women like Mrs Rutherfood, who according to Queensland nurse Beatrice Huston was ‘like a mother to us’.89 Writing of her time in Kimberley Lady Maud Rolleston commented, ‘I found an occupation ready for me, which was to try make things a little easier for these splendid women [nurses].’90 For many nurses these women facilitated their work, helping with ward work and/or supporting the nurses. They took on the role of ‘caring for the carer’, which was vital for it enabled the nurses to continue with their work. Ther support often took the form of housekeeping, accommodation and providing meals. The Australian nurses, wrote of those who helped including, ‘a lady [Mrs Rutherford] kindly offered to house keep for us and look after us … so good and kind. … Mrs Sim is … a sweet woman, and a great help. … The ladies here are very kind.’91 The women who are mentioned most were often in situ because they had been living there prior to the war perhaps through some family connection—a colonel’s wife or daughter.92 Offering such assistance was a way for them to serve the cause. Miss Cairncross meets every ambulance train coming down … and gives them fresh milk, flowers or fruit, and the nurses and patients say it is the greatest boon and blessing. She spent her own money as long as it lasted, and then asked her neighbours to help her … one could see by the welcome the nurses gave her how much they looked forward to seeing her.93 The auxiliary support that these women provided for patients and convalescents was considerable and allowed nurses to care for the very sick and seriously injured. Maud Rolleston commented on a patient she frequently visited, ‘[T]he nurses … were very much attached to him … but they had other work to do, and though they could give him their care, they could not give him their time.’94 Visiting patients and supplying ‘extras’ greatly assisted, not only the nurses, but also the well-being of patients. Sister X observed, ‘Mrs K (wife of General K) … does no end of good work—brings fans, fly-papers, eau-de-cologne etc. The men love it.’95 ‘Amateur Nurses’ In addition to orderlies, benevolent women and trained nurses who all provided approved services in hospitals, there was a group that surgeon Frederick Treves, in a speech to the Reform Club, spoke of as, ‘the large and insistent crowd of amateur nurses in South Africa [who] were an absolute terror to the army surgeons. They were worse, in fact, than a plague of flies.’96 In discussing these women, Treves publicly identified one of the main challengers in the contest for a legitimate position in military hospitals. He also soon had to issue a hasty clarification differentiating between the ‘troublesome horde of amateur busybodies … the splendid work done by the nurses … [and] ladies who have by their generous efforts done so much to relieve the sufferings of our sick and wounded soldiers.’97 The initial identification of this group of ‘amateur nurses’ occurred quite early with many upper-class women flocking to South Africa within the first few months of the war. Denied other opportunities, these women saw nursing soldiers as a means of active participation in the war effort.98 Their motives were mixed. Some genuinely wanted to help out in the war effort. Others, it seemed were more interested in the social life. There were also considerable numbers of upper-class men who were attracted to the thrill of war, without actually wanting to get involved. The legitimacy of their position was, however, less tenuous and less debatable; many had commissions in the army and could therefore be ordered back to duty. The Mount Nelson Hotel in Cape Town was a popular haunt of many, ‘socially and ambitious onlookers who had been attracted to South Africa by the excitement’.99 The upper-class women who were not ‘connected’ to the army were, however, less controllable than their male counterparts and could not be ordered back. Many had little regard for military authority, which included refusing to accept restrictions on travel and the military control of specific areas.100 Such controlled space often included hospitals, much to the chagrin of Lady Sykes, who described a hospital at Wynberg as being guarded like a gaol.101 Some untrained society women were, however, sent into military areas. The Nursing Record and Hospital World published the following from an unnamed army nurse, who wrote disparagingly, ‘[M]any of these amateurs were actually sent to the front. “Somebody” in authority had the courage to send several of them back to the headquarters responsible for their appointment.’102 Some women attempted to use their social connections to give them immunity to travel into military controlled areas. Mrs Dickenson, who was the sister of the Earl of Stradbroke, travelled with the South Australian nursing contingent on the passage to South Africa, ostensibly to write newspaper articles ‘dealing with matters from a woman’s standpoint’ for The Advertiser in Adelaide, as well as to visit her sons.103 She ‘intend[ed] … to make her way to Pretoria. She does not think she will have much difficulty, with the help of influential friends in getting there.’104 It is useful to compare the difference in the attitudes of the ‘amateurs’ and the trained nurses to being under the control of the military authorities. Nurses trained in hospitals were accustomed to obeying orders and made the shift from obedience exclusively within the medical sphere to also include the military sphere. The response of the trained nurses when they were refused permission to travel to specific areas was disappointment but also an acquiescence to the military authorities; as demonstrated by the Canadian nurses who were prohibited from following the Canadian contingent.105 Historical Precedents of Ladies as Benevolent Caregivers The Nursing Record and Hospital World was particularly indignant in its reporting on the nursing aspirations of several upper-class British ladies including, ‘[L]ady Sykes [who] “intends to takes lessons in nursing” upon her arrival at the Cape, and then proceed to the front’ [inverted commas in original].106 Yet while the ideas and ambitions of Lady Sykes and her ilk might have been misplaced, there were strong historical precedents that cannot be ignored. Nightingale, as the heroine of the Crimea, had only minimal nursing training in Germany. They were also drawing on an earlier gendered discourse that considered philanthropy—such as caring for the sick—as a suitable activity for middle- and upper-class women. The ‘lady as nurse’ also featured in romantic historical fiction, for example Rebecca in Ivanhoe.107 There is no doubt that many women were looking for adventure and excitement, as well as fulfilling a philanthropic motive, and the historical precedent and contemporary reports made nursing appear a viable channel by which to facilitate both. That these women, their families and perhaps even sections of the media did not recognise nursing as an emerging profession, nor even an occupation that required specific skills and knowledge, but saw it more as a philanthropic gesture by middle- and upper-class women, further highlights the fact that nursing was yet to secure professional or even semi-professional status. This lack of appropriate status, in the public sphere at least, was due in part to the gendered nature of nursing and to its subordinate (‘help-meet’) status to medicine, which did have undisputed professional standing. The gendered nature of the amateur/professional status of nursing and medicine was demonstrated in this comparison by an army nurse, I notice that amateur surgeons and physicians have not been appointed. It would never occur to the authorities to select a surgical staff from untrained society men. A thrill of indignation would go through Great Britain were it announced that the Earl of ___, had been put in charge of the operating theatre of a base hospital.108 Yet while it was considered totally inappropriate to have an untrained Earl as a surgeon or PMO, many untrained women were placed, or attempted to procure placements, in hospitals as nurses. Training The Nursing Record and Hospital World dutifully reported how ‘lady amateurs’ avoided paying for their passage and were taking the place of trained nurses in positions where their lack of clinical skills would be exposed. An unnamed Army Nurse wrote the following: ‘in many instances the War Office authorizes only a certain number of nurses in hospitals and transports. When society women with no technical training, take these posts, they fill posts which ought to be filled by certificated nurses.’109 As a consequence, the letter continued, trained nurses ‘are too few in number and terribly over-worked by doing their own and the amateurs’ duties’.110 It was in the clinical setting that the redefinition of the nurse’s role as skilled practitioner acutely came to the fore. Nurses were no longer solely caring, benevolent ladies. Perhaps even a generation previously, it was possible for educated women to become trained nurses with only a modicum of practical training and study. By the turn of the century, advances in medical and surgical procedures made specialised nursing skills necessary.111 In the army hospital, the sheer volume of patients as well as the severity of their illnesses and wounds meant that nurses required more knowledge and skills than ‘taking the patient’s temperature and pulse correctly and … accurately reporting’.112 E. J. Wood wrote of a wounded Colonel Ross who was ‘due to have a tracheotomy performed … and then the tissues wired together’, after having 'about three-quarters of his lower jaw shot away’.113 Nursing such a patient required significant skill (wound care, maintenance of airway, calm reassurance) and Wood records ‘specialling’ him (that is caring for the one patient only) for some time pre- and post-operatively.114 Gertrude Fletcher’s account of her work in ordering her new ward as patients were arriving demonstrated considerable ward management, triage and organisational skills.115 Similarly ‘JA’s’ work on the veldt highlighted skills in autonomous nursing practice and ingenuity.116 The role of the nurses in the clinical setting was much more complex and demanding than providing benevolent care alone. The need for skilled nursing staff was also becoming more recognised by medical doctors, especially from the civilian sphere, who were working in South Africa. Surgeons Mr Watson Cheyne and Frederick Treves both strongly and publicly advocated for the benefits of trained female nurses.117 Clinton Dent, of St Georges Hospital, writing as a special war correspondent for the British Medical Journal, advised that abdominal cases should be ‘specialled’, and even went so far as to say that good nursing could ‘absolutely determine’ patient outcomes.118 He also clearly delineated between care given by orderlies, benevolent care by untrained women and effective nursing practice. However hard these men [orderlies] work … they seem incapable of bestowing … unremitting, watchful care that a nurse … always has in her power to give. … There is not much romance about a patient with a urinary or a foecal [sic] fistula. … Most women can effectively sit by the bedside of a patient, fan away the flies, and put eau-de-cologne on a forehead, persisting in these simple duties with a great patience that appeals … to the sympathies of those who do not understand what nursing really is, or can be. But the hard-working, practical, conscientious woman, who can keep one of these distressing cases dry, who can ward off bed sores, and who … does a world of invaluable work that does not show, and does not appeal to anyone save the medical officer, [and the patient?] gets little credit for what is real nursing.119 Not only did the ‘amateur’ nurses lack clinical skills, but many also conducted themselves in a less than professional manner. One patient reported, ‘[A]ll these untrained females are no good at all; all they did was to sit on the officer’s beds and flirt. One ass muddled about for a whole week with my arm.’120 Many also appeared more interested in ‘nursing’ officers rather than ordinary ‘Tommies’.121 There are several references to society women masquerading as nurses wearing fancy uniforms, or ‘posing as ministering angels in Parisian gowns and headgear’.122 Society women, such as Mrs Chamberlain, who was seen wearing both the Canadian and the British army nurses’ uniform caused some consternation, as uniforms were a means by which nurses could be readily distinguished from lay figures.123 One of the few recorded criticisms of ‘amateurs’ by Australian nurses came from Martha Bidmead who, in a private letter to a friend, wrote with considerable candour and informality. Concerning the pretentious nature of a certain lady-nurse, she confided, I saw Mrs Dick Chamberlain, sister-in-law of the great English politician. She was in a Canadian nurse’s uniform, and had a white cape with lace. … [S]he has grey hair and a very haughty expression of countenance. … I should imagine she would probably write a book about it all. She looks that sort of woman.124 Perhaps further reluctance to criticise upper-class women, or the absence of open criticism, is due in part to the fact that the Australian nurses were benefiting from the patronage of several of them in Australia, for example Lady Brown and Janet, Lady Clarke. Administrative Challenge Another area where upper-class women were threatening to usurp control was in hospital administration. This claim was harder to deny as many civilian hospitals still held to the practice of shorter period of training for ‘lady nurses’ to take up managerial roles. ‘Several of the best known London hospitals accepted a certain number of so called “lady nurses” who paid down a sum of money’, noted Fletcher. ‘After a few months experience it was not unusual for these “lady nurses” to be appointed to administrative posts in other hospitals.’125 The Nursing Record and Hospital World as a professional journal contested the suitability of society ladies taking up positions of authority, both in England (particularly in regard to the selection of nursing staff) and in the hospitals in South Africa. The objection of the journal and of nurses in South Africa was not that these women were involved in the war effort, rather that some were specifically challenging the position of the trained nurse as a clinical and administrative practitioner. ‘They [lady amateurs] get in everyone’s way, and have no intention of working. Their idea is to take posts of authority and “boss” the trained nurses.’126 The Nursing Record and Hospital World noted how, on the hospital ship Maine, it was reported that ‘Lady Randolph Churchill superintended all the arrangements … and personally directed the berthing. Lady Randolph was here, there and everywhere, flitting about amongst the invalids, like a “ministering angel”.’127 The nursing journal commented with some irony, ‘[W]e hope this does not indicate the very able, thoroughly trained Superintendent of Nursing, Miss Hibbard, is incapacitated for duty by ill-health.’128 Many upper-class women were accustomed to running large, complex households and, perhaps more pragmatically, were serving on hospital committees or providing (or their families were providing) financial backing to fund hospitals in South Africa.129 Although The Nursing Record and Hospital World rejected outright the idea of lay women assisting the nurses in South Africa, even it conceded that ‘practical women with a knowledge of domestic management’ could supervise the linen stocks and domestic department, in army hospitals.130 The Threat to the Image of Nurses The nurses were well aware of the ‘plague of amateur nurses’ with references to them in diaries and letters. E. J. Wood wrote of Lady Roberts, ‘She has made herself rather obnoxious with her interference in hospital affairs. … (One of the plague).’131 In her writings, Sister X clearly differentiates between those who were helpful and those who were less so. ‘We do not find the ladies at all in the way; but then there are a very nice lot round here all anxious to do what they can to help but not interfere, which makes the distinction [italics in the original].’132 The protestations by The Nursing Record and Hospital World about society ladies working as ‘amateur’ nurses and about the suitable qualifications of the nurses or the committees who chose them, appears a little excessive, but they need to be placed into context. The journal and its adherents were aiming to advance nursing. First, it worked to uphold the gains of the past, of the first generation of modern nursing: it presented nursing as a middle-/upper-class philanthropic and feminine occupation, implying certain personal characteristics—devotion, cleanliness, obedience, integrity and an absence of any sexual agenda, especially between nurse and patient. Secondly, the journal also wanted to propel nursing into the future, developing it as a professional career, rather than an occupation. The intrusion into modern nursing by society women was inherently more threatening than the ‘Sarah Gamps’ that modern nurses had replaced because ‘society’ women were articulate, had influential families and friends and could use money as a means of gaining entry into the sphere of military hospitals in South Africa. (Most society ‘nurses’ were interested only in ‘nursing’ in South Africa in association with the war effort rather than being involved with nursing in the civilian sphere either in South Africa or in England.) This threat at a clinical level and, perhaps less so, at an administrative level (which was more complex due to the nature of the private funding of hospitals in South Africa by wealthy families) could be tackled by constructing nursing as a closed profession—based on a specific set of knowledge and skills gained over three years training and certification. It could also be used as a means of furthering their legitimacy to function and operate with some authority within the military hospital. Public support by respected civilian medical doctors for trained nurses and their opposition against ‘society’ nurses was an additional important factor. Another facet of this threat was that at the commencement of the war the army nursing sphere was not particularly secure. However, the war acted as a catalyst to propel military nursing into the twentieth century. The actions of the ‘society’ women actually highlight not only how far nursing had progressed from feminine benevolence, but also how valuable trained nurses could be to the military medical sphere. They were becoming essential to successful patient outcomes in both surgical and medical treatment in military hospitals. In addition, by having nurses attached to or connected to the army, rather than being freelance, the military authorities had considerable more control over them when operating within the military and within a war zone. Something to Say ‘Amateur’ nurses became the butt of many jokes in both the military and civilian public life.133 But despite this, some of them also brought articulate and valid testament to the poor conditions that the wounded were often subjected to and had the means, financially and socially, to be effective patient advocates. Letters and witness accounts printed in the public sphere challenged the glowing accounts of how the wounded were treated and called for better conditions. Lady de Crespigny, writing in the Essex Herald, an article reprinted in the Australian press, recalled a train journey where ‘the wounded had no one in charge of them to assist them … and no food for their journey’.134 Throughout the journey, Lady de Crespigny tried to obtain food and comforts for the wounded with mixed results. As previously noted, she also wrote about the ‘red tape’ that delayed much needed goods reaching the hospitals. Similarly, The Times featured an extract of a letter, written by a ‘lady’ at Thaba Nabu (near Bloemfontein), I found the poor men who had been wounded and brought in the day before had not had their wounds dressed. Sick and wounded alike were lying with the sore and tired bodies on the hard floor. … I was angry at all the lies and pictures they put into the papers about the splendid way the wounded are being nursed. … I do think the whole A.M.C should be kicked.135 On her return to England, the ubiquitous Mrs Richard Chamberlain, in a reflection of her own upper-class status, wrote to Lord Roberts and urged women with loved ones in South Africa to lobby their own members with regard to the state of military hospitals.136 She also gave evidence to the South African Hospitals Commission. The account in the Daily Mail, and reprinted in The Adelaide Observer, pilloried her appearance at the examination, commenting that although she was ‘a sadly trying witness, she made a charming picture’.137 Despite this, however, Mrs Chamberlain did make some pertinent and stinging observations that were probably very reflective of the medical military environment. Of the questioning of the commission she commented, ‘you are doing … what everyone did in South Africa, trying to make things as awkward as you can. You are behaving not as if you were judges, but as if you were the counsel for the defence of the army doctors.’138 Conclusion Nurses successfully contested the position of primary carers in the army hospitals because they were able to deliver a high standard of nursing care and often brought ‘order out of chaos’. This came about because of their skills, ethics, knowledge base and lengthy training. While many of the amateur, society ladies who came to ‘nurse’ the wounded were educated and articulate, they did not possess the required knowledge and expertise. Their ineptitude as clinical practitioners not only brought derision, but highlighted the gap between trained nurses and amateurs. It should also be remembered that many of the trained nurses who went to South Africa were very often the elite, most highly skilled and experienced and as such would arguably have been able to offer the highest quality of nursing possible. Although female nurses still had to face prejudices from within the upper echelons of the army sphere, they had strong and increasingly vocal advocates in the many doctors imported into the army from civilian hospitals. These doctors knew the advantages that good nursing care could offer their patients. However, the nurses needed both the orderlies and the benevolent upper-class women in order to provide the best possible care to their patients. Orderlies supplied many of the ancillary services essential to the provision of good care practices. Benevolent ladies became auxiliary carers and support workers for the nurses. The role of ‘carer to the carer’ was also of paramount importance in enabling nurses to continue in their work. Articulate and assertive, many upper-class ladies became effective patient advocates demanding better care and conditions for injured and sick army personnel. The army hospital would never be the same again. Acknowledgements In writing this paper I wish to thank the following: Professor Barbara Caine for her knowledge and patience in supervising my thesis; Dr Pauline Payne for her generosity in time and advice; and Kim Dell, research assistant (Bachelor of Health Science Program). 1 Sister Mansfield, ‘Ladysmith after the Siege’, The Queenslander, 21 July 1900, 128. 2 This article is largely taken from my PhD Thesis, ‘“… So give three cheers for our sisters”, the role and status of Australian nurses in the second Anglo-Boer war, 1899–1902’ (unpublished, Monash University, Melbourne, 2010). 3 On the RAMC, see Kieron Spiers, Queen Alexandra’s Royal Army Nursing Corps, <http://britisharmynurses.com/index.php/nursesandnursing/nursing>, accessed January 2017. 4 Adams ‘“… So Give Three Cheers for our Sisters”’, 74–83. 5 Charlotte Serle, The History of the Development of Nursing in South Africa, 1652–1960 (Cape Town, Struick, 1965) 203. 6 Adams, ‘“… So give three cheers”’, 35. 7 Ann Summers, Angels and Citizens—British Women as Military Nurses 1854–1914 (London: Routledge & Keegan Paul 1988), 102–4. 8 Unknown British Nurse cited in Summers, Angels and Citizens, 101. 9 Jane Lempriere, cited in Adams, ‘“… So give three cheers”’, 37. 10 On Florence Suttaby, see Keiron Spires, cited in Charlotte Dale’s thesis ‘Raising Professional Confidence: The Influence of the Anglo-Boer War (1899–1902) on the Development and Recognition of Nursing as a Profession’ (University of Manchester, 2013), 97. On Laura Woolcott, see Adams, ‘“… So give three cheers”’, 35–7. 11 ‘The Nursing Sisters—Life in a Hospital Camp’, The Adelaide Observer, 2 June 1900,7–9. See also Dale, ‘Raising Professional Confidence’, 95. 12 Dale, ‘Raising Professional Confidence’, 110. 13 Ellen Gould, ‘Report by Miss E J Gould, New South Wales assistance asked in connection with the collection of the historical material for Australian Army Nursing Service, AIF’, Canberra, Australian War Memorial, AWM41 [172], 1933, 1. (The ANS nurses were attached to RAMC—Royal Army Medical Corps). 14 Adams, ‘“… So give three cheers for our sisters”’, 103 and Dale, ‘Raising professional Confidence’, 113. 15 Serle, The History of the Development of Nursing in South Africa, 187. 16 J. C. de Villiers, ‘The Medical Aspect of the Anglo-Boer War, 1899–1902 part II’, Military History Journal, 1984, 2; See also Serle, The History of the Development of Nursing in South Africa, 187;Georgina Fane Pope, ‘Nursing in South Africa during the Boer War, 1899–1900’, The American Journal of Nursing, 1902, 3, 10–14, at 12. 17 S. A. Watt, ‘The Anglo-Boer War: The Medical Arrangements and Implications Thereof during the British Occupation of Bloemfontein: March–August 1900’, The South African Military History Society Journal, 1992, 9; Martha Bidmead, ‘Our Nurses at the Front—An Interesting Diary’, The Adelaide Observer, 9 June 1900, 7–8; ‘Report by Miss J Gould Australian War Memorial’, AWM41 [172], 1933, 1. 18 Sister Rawson, ‘The Victorian Nurses—Letter from the Sister in Charge’, The Argus, 25 June 1900, 5; Stephen Pagaard, ‘Disease and the British Army in South Africa, 1899–1900’, Military Affairs, 1986, 50, 71–76, at 72. 19 Lady De Crespigny, quoted in ‘The Military Hospital Scandals’, The Adelaide Observer, 13 October 1900, 42; See also Sr Peter in Anna Rogers, While You’re Away, New Zealand Nurses at War 1899–1948 (Auckland: Auckland University Press, 2003), 22–3. 20 I. G. P. Humphries, quoted in ‘The Military Hospital Scandals’, 42. 22 See Summers, Angels and Citizens, 99. 23 Summers, Angels and Citizens, 99. 24 Sister X, The Tragedy and Comedy of War Hospitals (London: John Murray, 1906), 6. 25 Adams, ‘“… So Give Three Cheers”’, 67–9. 26 Christopher Maggs, The Origins of General Nursing (London: Croom Helm, 1983),13. See also Dale, ‘Raising Professional Confidence’, 26. 27 Mrs Bedford Fenwick, ‘Editorial’, Nursing Record and Hospital World, 16 December 1899, 486. 28 See for example Mary Nicolay, in Adams, ‘“… So give three cheers”’, 160. 29 Adams, ‘“… So give three cheers”’, 39. 30 Summers, Angels and Citizens, 103. 31 For the early buildings of army hospitals, see Juliet Piggott, Queen Alexandra’s Royal Army Nursing Corps (London: Leo Cooper Ltd, 1990), 16. 32 Serle, The History of the Development of Nursing in South Africa, 185. 33 Summers, Angels and Citizens, 104. 34 Gertrude Fletcher, Some Memories and Extracts from the Life of a Nurse (private publication, 1949, nfd), 91. 35 Although, according to Burdett-Coutts, ‘the chief ward master … supports the nurses by his authority’, this was not always the case (Mr Burdett-Coutts MP, ‘Our Wars and Wounded. VII’, The Times, 29 June 1900, 14; See also Sister X, The Tragedy and Comedy of War Hospitals, ch. 1. 36 Sister X, The Tragedy and Comedy of War Hospitals, 20. 37 Burdett-Coutts, ‘Our Wars and Wounded. VII’; See also Sister X, The Tragedy and Comedy of War Hospitals, 23. 38 For example, Fletcher, Some Memories and Extracts from the Life of a Nurse, 87; Boer War—Manuscript note book containing continuous dated extracts from letters written by an army nursing sister serving in South Africa 1900–1901 (London: Wellcome Trust Centre) (most probably E. J. Wood), 13. 39 For example, Fletcher, Some Memories and Extracts from the Life of a Nurse, 86f and Martha Bidmead, ‘The Nursing Sisters—Life in a Hospital Camp’ The Adelaide Observer, 2 June 1900, 7. 40 Sister X, The Tragedy and Comedy of War Hospitals, 26 and 127; Dr Conan Doyle in ‘Mr. Burdett-Coutts’s [sic] charges’, The Times, 6 July 1900, 7; ‘JA’, ‘Some experiences of a Victorian nurse in South Africa’, Una, 1903, 1, 31–3, at 32; Dr A. E. Morrison in ‘Mr. Burdett-Coutts’s [sic] charges’, 8; ‘Medical Services of the Australian Contingent’, The Adelaide Observer, 28 April 1900, 11. 41 Boer War—Manuscript note book containing continuous dated extracts from letters, 59. 42 Bidmead, ‘The Nursing Sisters’, 7–9. 43 Conan Doyle in ‘Mr. Burdett-Coutts’s [sic] charges’, 8. 44 Fletcher, Some Memories and Extracts from the Life of a Nurse, 91. See also Sister X, The Tragedy and Comedy of War Hospitals, 32. 45 Sioban Nelson, ‘From Salvation to Civics: Service to the Sick in Nursing Discourse’, Social Science and Medicine, 2001, 53, 1217–18. 46 Alison Bashford, Purity and Pollution (Basingstoke: Macmillan, 1998), 65. 47 Anne Marie Rafferty, ‘The Seduction of History and the Nursing Diaspora’, Health and History, 2005, 7, 3. 48 Maggs, The Origins of General Nursing, 13. 49 ‘Marshburgh’, in Broad Arrow, the Naval and Military Gazette, cited in The Nursing Record and Hospital World, 24 December 1898, 513. 50 Sister X, The Tragedy and Comedy of War Hospitals, 18. 51 Sister X, The Tragedy and Comedy of War Hospitals, 26–7. 52 Fletcher, Some Memories and Extracts from the Life of a Nurse, 91–2. 53 Surgeon-General, ‘Nursing the Sick and Wounded—Letters to the Editor’, The Times, 25 January 1900, 12. 54 ‘JA’, ‘Some Experiences of a Victorian Nurse in South Africa’, 32. See also Sister X, The Tragedy and Comedy of War Hospitals, 26. 55 ‘Marshburgh’, in Broad Arrow, the Naval and Military Gazette, 513. 56 Letter from Miss Hancock, Army Medical History Museum, Ashvale, 18 May 1900, see also Sister X, The Tragedy and Comedy of War Hospitals, 26. 57 E. C. Lawrence, A Nurse’s Life in War and Peace (London: Smith, Elder & Co, 1912), 162–3. 58 Sister X, The Tragedy and Comedy of War Hospitals, 123. 59 Peter, in Rogers, While You’re Away, 22. 60 Bidmead, ‘The Nursing Sisters’, See also Sister X, The Tragedy and Comedy of War Hospitals, 119. 61 Sister X, The Tragedy and Comedy of War Hospitals, 23, 79 and 122. 62 ‘A Colonial Volunteer’s Experiences’ in ‘Army Nursing Notes’, The Nursing Record and Hospital World, 28 July 1900, 74. 63 ‘The Military Hospital Scandals’, The Adelaide Observer, 13 October 1900, 43. 64 ‘A Colonial Volunteer’s Experiences’, 74. 65 Anne Marie Rafferty, ‘The Seduction of History and the Nursing Diaspora’, 1–2. 66 Sister X, The Tragedy and Comedy of War Hospitals, 26. See also Fletcher, Some Memories and Extracts from the Life of a Nurse, 91, Boer War—Manuscript note book containing continuous dated extracts from letters, 59; and Lance-Corporal Phil. Alexander, ‘Life in Hospital’, The Adelaide Observer, 15 September 1900, 41. 67 ‘Mr Burdett-Coutts Charges’, 8, See also, for example, ‘A Colonial Volunteer’s Experiences’, 44. 68 The Nursing Record and Hospital World, 1 September 1900, 175. 69 A Canadian soldier, ‘Mr Burdett-Coutts charges’, 48 and ‘A Colonial Volunteer’s Experiences’, 44. 70 Burdett-Coutts, ‘Our War and our Wounded’; Sister X, The Tragedy and Comedy of War Hospitals, 23. 71 Lord Wolseley, ‘Army Nursing Notes’, The Nursing Record and Hospital World, 15 September 1900, 209. 72 Burdett-Coutts, ‘Our Wars and our Wounded’, 14. 73 Ibid.; ‘The Governor on Nursing’, The Adelaide Observer, 28 July 1900, 16. 74 Ibid. 75 Burdett-Coutts, ‘Our Wars and our Wounded’, 14. 76 W. T. Reay (Maj), Australians in War with the Australian Regiment from Melbourne to Bloemfontein (Melbourne: A H Massina & Co, 1900), 63. 77 ‘A Glimpse of War’ The Advertiser, 4 January 1900, 5. 78 See for example, ‘Our Nurses in Africa’, The Adelaide Observer, 19 January 1901, 41, Boer War—Manuscript note book containing continuous dated extracts from letters, 20, 22; ‘The Governor on Nursing’. 79 Sergeant Legge, quoted in Rogers, While You’re Away, 29. 80 See Adams ‘“… So give three cheers”’, ch. 7. 81 Bidmead, ‘The Nursing Sisters’. 82 Ibid. 83 Boer War—Manuscript note book containing continuous dated extracts from letters, 27. 84 Sister X, The Tragedy and Comedy of War Hospitals, 62–3; Bidmead, ‘The Nursing Sisters’. 85 Boer War—Manuscript note book containing continuous dated extracts from letters, 27. 86 Ibid. 87 Fletcher, Some Memories and Extracts from the Life of a Nurse, 91. 88 S. A. Watt, ‘Deelfontein (A hospital in the Karoo during the Anglo-Boer War, a cemetery today)’, Military History Journal, 7, 1. 89 Beatrice Huston, ‘Hospital Work in South Africa, a Letter from Nurse Huston’, The Queenslander, 1 September 1900, 498. 90 Maud Rolleston, Yeoman Service; Being the Diary of the Wife of an Imperial Yeomanry Officer During the Boer War (London: Smith, Elder, 1901), 101–2. 91 Huston, ‘Hospital Work in South Africa’. 92 See for instance, Beatrice Huston, ‘With the wounded at Rondobosch’, The Queenslander, 16 June 1900, 1138. 93 Rolleston, Yeoman Service, 54–5. 94 Rolleston, Yeoman Service, 135, 154f. 95 Sister X, The Tragedy and Comedy of War Hospitals, 94. 96 ‘A Plague of Amateur Nurses’, The Adelaide Observer, 5 May 1900, 5. 97 Frederick Treves, ‘To the Editor of The Times’, The Times, 2 May 1900, 8. 98 ‘Nurses in South Africa’, British Medical Journal, 3 February 1900, 280–3. 99 Karel Schoeman (ed.), Witnesses to War (Cape Town: Human and Rousseau, 1998), 73. 100 Captain Jones in Schoeman (ed.), Witnesses to War, 73–4. 101 ‘Professional Review’, The Nursing Record and Hospital World, 9 June 1900, 461. 102 Extract of letter from unnamed army nurse, The Nursing Record and Hospital World, 19 May 1900, 9. 103 ‘A Lady War Correspondent’, The Advertiser, 20 February 1900, 4. 104 Ibid. 105 Fane Pope, ‘Nursing in South Africa during the Boer War’, 10. 106 ‘Army Nursing Notes’. The Nursing Record and Hospital Times, 18 November 1899, 410; see also, ‘Army Nursing Notes’, The Nursing Record and Hospital World, 31 March 1900, 251, concerning Lady Ormonde who was going to South Africa to see family and was ‘anxious to do a little nursing on her own account’. 107 ‘The Governor on Nursing’. 108 Extract from letter, author unnamed, ‘Army Nursing Notes’, The Nursing Record and Hospital World, 19 May 1900, 399. 109 Ibid., See also, ‘An Officer’s Wife’, ‘Fine Lady Nurses’, and ‘Letters to the Editor’, The Nursing Record and Hospital World, 10 February 1900, 123. 110 Ibid. 111 On contemporary advances in procedures, see Emonoel Lee, To the Bitter End, Photographic History of the Boer War 1899–1902 (Harmondsworth: Penguin, 1985), 68. 112 Maggs, The Origins of General Nursing, 13. 113 Boer War—Manuscript notebook containing continuous dated extracts from letters, 9–14 November 1900, 46–7. 114 Ibid. 115 Fletcher, Some Memories and Extracts from the Life of a Nurse, 86ff. 116 ‘JA’ ‘Some experiences of a Victorian nurse in South Africa’, 31. See also Sister X, The Tragedy and Comedy of War Hospitals, 63. 117 ‘Army Nursing Notes’ The Nursing Record and Hospital World, 28 July 1900, 73. 118 ‘Army Nursing Notes’, The Nursing Record and Hospital World, 12 May 1900, 376. 119 Ibid. 120 ‘An Officer’s Wife’ and ‘Fine Lady Nurses’, 123. 121 Report from Fletcher Robinson, in the Express in the Nursing Record and Hospital World, 5 May 1900, 356. 122 ‘An Officer’s Wife’, 123. 123 Bidmead, ‘Our Nurses at the Front’, 8 and ‘Army Nursing Notes’, The Nursing Record and Hospital World, 31 March 1900, 252. 124 Martha Bidmead, ‘The Nursing Sisters’, The Adelaide Observer, 2 June 1890, 7. 125 Fletcher, Some Memories and Extracts from the Life of a Nurse, x. 126 Extract from letter of unnamed army nurse (9 August 1900). 127 The Nursing Record and Hospital World, 10 February 1900, 114. 128 Ibid. 129 An example would be Lady Chesham, in S. A. Watt, ‘The Anglo-Boer War: The Medical Arrangements and Implications thereof’, 1, 4. 130 ‘The Domestic Department’, The Nursing Record and Hospital World, 10 February 1900, 116. 131 Boer War—Manuscript notebook containing continuous dated extracts from letters, 17. 132 Sister X, The Tragedy and Comedy of War Hospitals, 21. 133 See for example, ‘The Army Hospital, a Talkative Woman’, The Adelaide Observer, 29 December 1900, 7; ‘The Plague of Women’, The Nursing Record and Hospital World, 12 May 1900, 387. 134 Lady De Crespigny, ‘The Military Hospital Scandals’, The Adelaide Observer, 13 October 1900, 42. 135 ‘Mr Burdett-Coutts’s charges’, The Times, 4 July 1900, 9. 136 ‘Army Nursing Notes’, The Nursing Record and Hospital World, 2 June 1900, 437. 137 ‘The Army Hospital, a Talkative Woman’, 7. 138 Ibid. © The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine.

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Social History of MedicineOxford University Press

Published: Jun 7, 2017

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