The Politics of Intimate Care

Gender, Race, and Nursing Work

The nascent reality of nurses as trained professionals found an audience amid the evolution of the medical profession during the 1850s in Europe and the United States. As the field of medicine became more sophisticated and developed—focusing on preventative care and not just healing—so, too, did ideas about patient care and who had the authority to provide and control that care. With "professionalization," medical authority became gendered. Society viewed men as having both the intellectual and physical capabilities necessary for the medical profession. In contrast, as the fairer sex, women were seen as fragile, weak, and lacking in the brain capacity necessary to successfully attend to medical emergencies. In addition, late-nineteenth-century Victorian notions of sexual propriety made such work unsuitable for women. The increasingly male-dominated medical profession strongly opposed women entering professionalized medicine, even as nurse leaders attempted to professionalize their occupation. In a 1904 address titled "The Nurse and the Medical Man" Dr. Casey Wood described the job differences between doctor and nurse as the "practice of medicine and the art of nursing" Doctors in the late nineteenth and early twentieth century agreed that the "success of the physician's treatment" went hand in hand with the help of a cooperative, loyal, and obedient nurse, but many doctors did not view nursing as a scientific profession, nor could they envision nursing as an autonomous profession. Exacerbating this viewpoint was the fact that until the 1870s, the hospital remained only a peripheral institution for the medical care of most individuals, a place most went to die, and nursing occurred primarily within the confines of domestic responsibility, as both duty and obligation provided by women for their families and neighbors. Therefore, as Dr. Wood's comments suggest, nursing performed outside of the home needed the careful and expert supervision of doctors to find success in the professional world.

By the turn of the twentieth century, nursing moved from an unpaid domestic obligation for "respected" ladies or paid labor employing undesirable women, to the paid occupation of respectable working women. As one of several "women's professions," nursing particularly attracted white, middle-and upper-class women, among whom the first training schools actively recruited. For these women, the opening of schools of nursing imbued nursing with a semi-professional status, one that provided nurses with "a type of public stature and power previously reserved for men." Nevertheless, nurses walked a fine line, one that meant reimagining nursing in a way that did not completely negate the domestic "art" vision many had of respectable vocations for women outside the home. Women began promoting this activity as both duty and responsibility to family and community, and late-nineteenth-century war and warfare provided the medium. Beginning with the Civil War, wartime exigencies allowed women to co-opt nursing as female work. Wartime relief work—exemplified most concisely with nurses—became the catalyst for change, particularly for white women. Military nursing, in particular, promoted the formalization of the nursing practice.

War and wartime experiences are entwined with the history and meaning of nursing in the United States. Here, what were understood as female obligation (caregiving) and male duty (soldiering) are juxtaposed with the reality of need. The history of the Army Nurse Corps (ANC) is rife with examples of how war complicates social, cultural, and economic beliefs and values that organized and informed American society. Just as military participation has historically defined citizenship and access to the rights that go along with it, military nursing also challenged notions of who had rights, the types of rights, and access to them through military service. A focus on the ANC and its nurses helps to illuminate the relationship between the military and civilian populace, revealing trends in nursing practices, debates about work, and concerns about war taking place in the larger civil society. In this sense, the transformation of nursing—from paid occupation in the late nineteenth century to autonomous profession within the medical field during the second half of the twentieth century—suggests not only that "gender informs work" but that work was transformed by "existing relationships of power and inequality" as well as changing social, economic, and cultural conditions.

War, Women, and Modern Nursing

In the fall of 1854, Florence Nightingale—an upper-class woman from an influential English family—lead a group of women nurses to the Crimean War front. The British assigned Nightingale the task of resolving the deplorable health and sanitary conditions that were crippling the British Army. Nightingale, who trained as a nurse against her family's wishes, challenged the popular images of nursing as uncouth work. Instead, she set out to "correct the evils in nursing," and starting in the mid-1840s trained and educated herself and others with this in mind. She believed that healthcare, in the form of sanitary knowledge rather than a medical degree, resulted in a healthier population. In many ways, Dr. Wood's comments about the "art of nursing" reinforced Nightingale's earlier vision of nursing. Further, Nightingale asserted that health encompassed not only diet but also cleanliness and environment; this was something that the medical profession was also beginning to recognize in the same period. The combination of all three prevented disease and ensured a quick recovery from ailment.

In late October 1854 Nightingale arrived in the Crimea to conditions that participants later described as the source of nearly three-quarters of the casualties suffered by the British. In the time between her arrival and the end of the Crimean War in early 1856, Nightingale's reorganization of British military hospitals throughout Crimea—including the institution of basic sanitary, dietary, and social services for soldiers—resulted in an astonishing overall drop in the mortality rate from 42 percent to 2.2 percent. Yet despite her success, particularly in advancing the idea that respectable women had a place within the medical profession, Nightingale and the nursing occupation faced large obstacles in the male-dominated medical...