TRACKING THE TRACES: TOWARDS THE RECOVERY OF PRE-NINETEENTH-CENTURY PRACTICE

Examining nursing practice prior to the development of the modern hospital and scientific medicine provides significant challenges to the historian. This editorial is a cheat — I bring problems and no answers. I wish to pose the methodological and conceptual dilemma of how to write a history of nursing prior to the nineteenth century. My assumption all along (and of course this may be flawed) is that there is such a thing as the history of nursing — that nursing, like salt, or sex or medicine, can be the object of such a singular historicisation. But the further we look back, the greater the methodological quandaries grow. If we begin with religious history, with the early saints such as Fabiola, we face a significant layer of interpretative challenge. Although care of the sick was part of the response to the religious imperative to attend to God's poor, charity towards the hospital and the sick poor (serving five of the six corporal deeds of mercy by which early and medieval Christians considered they were to be judged) occurred within a context of enormous poverty and the highly circumscribed allocation of such charity. Those who were chosen to benefit from the charitable imperatives of the well resourced and/or pious were relatively few indeed and in many instances should be understood as symbolic (no welfare system then!) and possessing some connections — or at the least, extremely good fortune. In other words, admission to a medieval hospital often involved formal patronage — the 50 poor who would be fed each Friday during Lent and would have their feet washed by the abbot on Good Friday were unlikely to have been randomly chosen. A further quandary for nursing historians is that shared by historians of women and work: how does one disentangle the domestic work from other skills? Does one need to? Certainly in attempting to trace something like clinical practice and knowledge it seems important to do so, but in truth the domains of domestic and nursing skill rapidly lose delineation on examination — diet, assistance with hygiene and mobility involve certain skills above standard domestic attention when dealing with the sick. But what are those skills? Contemporary nursing finds this hard to articulate; how much harder is it for the historian? Both the domains of religious duty and domestic work add incredible levels of complexity to the historian's task. Hospital historians (of any period) rely on documentation, and the charter, records of endowments, benefactors, investigations and scandals are what shine forth. If one takes for example the medieval hospital, if there is a documentary record, one typically finds a history of piety, poverty and politics. Little light, however, falls on the daily work — weaving the linen for garments and bedding, the onerous laundry duties, preparation of food, and the apothecary duties. When we find the occasional ‘medical’ activities — bloodletting, lancing boils, surgeon/dentist activities, or perhaps an amputation — we seize on these as recognisable traces of ‘clinical work’. Yet how much of a distortion are we committing by noting these activities above the others? In addition to this complexity of domestic work and religious observance comes a further, charitable layer. By charitable I am referring here to the fact that working nurses (if not saintly) were understood to be the object of charity. In the hospital the nurse was an inmate and a worker — receiving more than providing care as the infirmary increased. The medieval hospital by and large was a hybrid institution that cared for its nurses along with its inmates and indeed the distinction between them is fluid. If one looks away from institutional history there are further challenges. Servants and household members attended the sick. I have always side-stepped that problem by agreeing with Charles Rosenberg and looking at the care of the sick stranger as something quite different to domestic responsibilities. Nonetheless, it is hard to believe the practices were all that different — recovery was wisely boosted by rest, warmth, cleanliness, and restorative diet and fluids, whether the sick were kin or strangers, whether location was infirmary or home. Meanwhile religious succour provided what we would today think of as psychosocial support (usually of the getting ready to meet one's maker variety!). Despite these challenges, and the list here is only a beginning, it is this very complexity that makes nursing history so interesting and, I would argue, so important. Nursing is interstitial work: it cuts across the fabric of our social relations — gender, family obligations, religious observances, social values and forces of community cohesion. What makes a society committed to the care of its sick and vulnerable? How is that care performed and by whom? These are questions no less important now than a 1000 years ago.

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