Page 9, 14th April 1967

14th April 1967
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Page 9, 14th April 1967 — When 8 patients to a bed was quite normal
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When 8 patients to a bed was quite normal

By KAY BERNARD

CHRIST gave a new look ‘--.• to the role of the nurse. That is not to say that preChristian civilisations completely neglected their sick; there is evidence that hospitals existed in ancient Egypt. Greece, China and India but the sick poor, often synonymous with slaves, tended to receive treatment

only in proportion to their value as an investment.

For the early Christians, care of the sick was an obligation. It is difficult to determine how far this was on an organised scale. Christians were a persecuted minority and, no doubt. had to work surreptitiously. Certainly, there were deacons and deaconesses (St. Paul speaks of one, Phebe), who assisted at baptisms but there is no doubt that they also nursed.

However. by the 4th century, these social duties were taken over by 'free-lance' women workers. In Rome. St. Jerome gathered about him a community of such women. One. Fahiola founded the first hospital in Rome. St. Jerome, describing her work in what has been called 'the first literary document in the history of nursing' shows that she was surprisingly practical. 'She was the first person to found a hospital into which she might gather sufferers out of the streets and where she might nurse the unfortunate victims of sickness and want.'

It was probably not devoted exclusively to the care of the sick as it was then the custom

to congregate all recipients of charity—the ailing, the aged, the orphans, the destitute—together. This 'blanket' care continued right through the Middle Ages. 'Iospitaliawas more closely associated with 'hospitality' than medicine.

Until comparatively recently, nursing was solely a church responsibility. The Council of Padua in 850 decreed that Bishops should control the hospitals, which were mushrooming all over the C'hristian world. These hospitals gradually became influenced by a new trend in church life— monasticism.

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Segregation of the sick from other sufferers did not occur until about the 12th century, when a contemporary account of the hospital attached to the Pantokrator monastery in Constantinople reveals a degree of refinement that was sadly lacking in later centuries.

It held 60 beds-10 surgical, 8 for acute and eye cases, 12 for women, 20 for less severe cases, 5 for emergencies and 5 for fractures. There was a good patient/doctor ratio and ample 'attendants' but although mention is made of training doctors there is nothing to indicate that the nurses received any tuition.

Medieval hospitals were ecclesiastical, not medical establishments. The nursing was simple, for care rather than cure. for relief of the body, when possible but primarily for the refreshment of the soul.

At this period nursing orders, formed especially to care for the sick, rose to prominence. They fell roughly into two categories—the military orders, like the Knights Hospitallers of St. John of Jerusalem. a direct result of the Crusades and the religious orders. such as the Augustinian Sisters of the Hotel-Dieu in Paris, one of the oldest purely nursing orders.

The role of the military orders was significant. They were invested with a certain glamour, attracted the flower of the knighthood. thus raising the prestige of nursing. They were rich and could equip and conduct their hospitals lavishly and their rigorous discipline left is reflection on nursing etiquette.

Some of the new religious orders departed from convention by rejecting a rigid enclosure. which would hamper Renaissance did not extend to nursing and the nuns became no better trained as a consequence.

But, in England, the Reformation certainly left its mark. The dissolution of the monasteries by Henry VIII left England, alone of all European countries. without a hospital service. In an atempt to fill the gap and stem the ensuing tide of misery, hospitals, for the first time were taken over by civil authorities.

In 1547, the City of London petitioned Edward VI for permission to control the largest institutions — St. Bartholemew's, St. Thomas's Bridewell and Bethlehem. ushering in the era of lay nursing and, incidentally. three centuries of disrepute. for there was one fundamental ingredient missing—there were no real nurses.

They were recruited from the lowest rank of servant, illiterate, drunken, (described during the Great Plague as 'dirty unwholesome. ugly hags). and ill-paid.

One of the first attempts to liberate nursing from the shackles of ignorance and corruption was the revival of the ancient Order of Deaconesses by Pastor Theodor Fliedner at Kaiserwerth, Germany. In 1836 he started an institute for the sick. installing Gertrude Reichardt as the first deaconess.

Elizabeth Fry attempted a similar project in England with her Institute of Nursing Sisters, which sought to provide nurses of a quality superior to the usual hirelings. They had little of what might now be termed training, going daily for a few months to Guy's Hospital, where they must have learnt precious little from the uneducated ward nurses. Still, they were respectable. devoted women and that in itself was a step forward.

The seeds of modern nursing were being scattered. Before long they were to flower under the guidance of a remarkable woman Florence Nightingale. like so many people who have shaped the course of history, she fitted uniquely the hour and the need.

their work. Chief among them was the Third Order of St. Francis, whose nurses included many outstanding men and women, St. Elizabeth of Hungary, St. Louis, St. Isabel of Portugal, etc., and the Order of the Holy Ghost which has always been associated with nursing in large hospitals, at one time controlling 900.

That life for nurses and

patients was pretty bleak in these hospitals is shown by a 13th century description of the Hotel-Dieu in Paris. It was administered by the clergy but the Sisters. who were responsible for all household management, were under the supervision of a maitresse—a system later adopted by Florence Nightingale.

They spent their lives in the wards, leaving the hospital only to do visiting nursing, in an incessant round of toil, broken only by religious offices and two meals a day. They were hard-pressed to cope with the volue of patients since it was the custom. (a practice which endured long after the Middle Ages), to put up to eight patients in a bed! This unremitting routine was selfdefeating. precluding intellectual pursuits and the improvement of technique. But it must he remembered that they were working within the limits and resources of their age.

To the 16th century belong two great movements — the Renaissance and the Reformation. Unhappily the surge of enlightenment diffused by the




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