History of nursing

See also: Timeline of nursing history

Before the foundation of modern nursing, nuns and the military often provided nursing-like services.

The religious and military roots of modern nursing remain in evidence today in many countries, for example in the United Kingdom, senior female nurses are known as sisters. Nurses execute the "Orders" of other health care professionals in addition to being responsible for their own practice.

Ancient history

The first known Nurse, Phoebe, was mentioned in Romans 16:1. During the early years of the Christian Church, St. Paul sent a deaconess Phoebe to Rome as the first visiting nurse. She took care of both women and men.

In the 16th century, Protestant reformers shut down the monasteries and convents, allowing a few to continue in operation hundred municipal hospices. Those nuns who had been serving as nurses were given pensions or told to get married and stay home. in Catholic areas however the role of the nursing sister continued uninterrupted.

Early modern Europe

In the early modern period from 1600 to 1800, Protestant Europe had a few noticeable hospitals, but no regular system of nursing. The weakened public role of women left female practitioners restricted to assisting neighbors and family in an unpaid and unrecognized capacity.

In Catholic countries, orders of nuns provided nursing services in hospitals. Their operations continue to expand. For example in rural Brittany in France, the Daughters of the Holy Spirit, created in 1706, played a central role. New opportunity for nuns as charitable practitioners were created by devout nobles on their own estates. The nuns provided comprehensive care for the sick poor on their patrons' estates, acting not only as nurses, but took on expanded roles as physicians, surgeons, and apothecaries. During the French Revolution, most of the orders of nurses were shut down and there was no organized nursing care to replace them.

Modern nursing

Modern nursing began in the 19th century in Germany and Britain, and spread worldwide by 1900.

Deaconess

Main article: Deaconess

Phoebe, the nurse mentioned in the New Testament, was a deaconess. The role had virtually died out centuries before, but was revived in Germany in 1836 when Theodor Fliedner and his wife Friederike Münster opened the first deaconess motherhouse in Kaiserswerth on the Rhine. The diaconate was soon brought to England and Scandinavia, Kaiserswerth model. The women obligated themselves for 5 years of service, receiving room, board, uniforms, pocket money, and lifelong care. The uniform was the usual dress of the married woman. There were variations, such as an emphasis on preparing women for marriage through training in nursing, child care, social work and housework. In the Anglican Church, the diaconate was an auxiliary to the pastorate, and there were no mother houses. By 1890 there were over 5,000 deaconesses in Protestant Europe, chiefly Germany Scandinavia and England. In World War II, diaconates in war zones sustained heavy damage. As eastern Europe fell to communism, most diaconates were shut down, and 7000 deaconesses became refugees in West Germany. By 1957, in Germany there were 46,000 deaconesses and 10,000 associates. Other countries reported a total of 14,000 deaconesses, most of them Lutherans. In the United States and Canada 1550 women were counted, half of them in the Methodist Church.

Between 1880 and 1915, 62 training schools were opened in the United States. The lack of training had weakened Passavant's programs. However recruiting became increasingly difficult after 1910 as women preferred graduate nursing schools or the social work curriculum offered by state universities.

Nightingale and other pioneers

The Crimean War was a significant development in nursing history when English nurse Florence Nightingale laid the foundations of professional nursing with the principles summarised in the book Notes on Nursing.

Other important nurses in the development of the profession include:

• Mary Seacole, who also worked as a nurse in the Crimea
• Agnes Elizabeth Jones and Linda Richards, who established quality nursing schools in the USA and Japan; Linda Richards was officially America's first professionally trained nurse, graduating in 1873 from the New England Hospital for Women and Children in Boston
• Clarissa Harlowe "Clara" Barton, a pioneer American teacher, patent clerk, nurse, and humanitarian, and the founder of the American Red Cross.

British Empire

New Zealand was the first country to regulate nurses nationally, with adoption of the Nurses Registration Act on the 12 September 1901. It was here in New Zealand that Ellen Dougherty became the first registered nurse.

France

Professionalization of nursing in France came in the late 19th and early 20th century. In 1870 France's 1,500 hospitals were operated by 11,000 Catholic sisters; by 1911 there were 15,000 nuns representing over 200 religious orders. Government policy after 1900 was to secularize public institutions, and diminish the role the Catholic Church. The lay staff was enlarged from 14,000 1890 to 95,000 in 1911. This political goal came in conflict with the need to maintain better quality of medical care in antiquated facilities. Many doctors, while personally anti-clerical, realized their dependence on the Catholic sisters. Most lay nurses came from peasant or working class families and were poorly trained. Faced with the long hours and low pay, many soon married and left the field, while the Catholic sisters had renounced marriage and saw nursing as their God-given vocation. New government-operated nursing schools turned out nonreligous nurses who were slated for supervisory roles. During the World War, an outpouring of patriotic volunteers brought large numbers of untrained middle-class women into the military hospitals. They left when the war ended but the long-term effect was to heighten the prestige of nursing. In 1922 the government issued a national diploma for nursing.

United States

Nursing professionalized rapidly at the late 19th century as larger hospitals set up nursing schools which proved highly attractive to ambitious women from both middle-class and working-class backgrounds.

In the early 1900s, the autonomous, nursing-controlled, Nightingale era schools came to an end – schools became controlled by hospitals, and formal "book learning" was discouraged in favor of clinical experience. Hospitals used student nurses as cheap. The United States in late 1920s, the womens specialties in health care included 294,000 trained nurses, 150,000 untrained nurses, 47,000 midwives, and 550,000 other hospital workers (most of them women).

Professionalization in recent decades moved nursing degrees out of RN-oriented hospital schools and into community colleges and universities. Specialization has brought numerous journals to broaden the knowledge base of the profession.

Hospitals

The number of hospitals expanded dramatically from 149 in 1873, to 6300 in 1933, primarily because the public trusted hospitals more, and could afford more intensive and professional care. The number of hospitals reached 4400 in 1910, when they provided 420,000 beds.. They were operated by city, state and federal agencies, by churches, by stand-alone non-profits, and by for-profit enterprises run by a local doctoer All the major denominations built hospitals; the 541 Catholic ones (in 1915) were staffed primarily by unpaid nuns. The others sometimes had a small cadre of deaconesses as staff. Most larger hospitals operated a school of nursing, which provided training to young women, who in turn did much of the staffing on an unpaid basis. The number of active graduate nurses rose rapidly from 51,000 in 1910 to 375,000 in 1940 and 700,000 in 1970..

Church sponsored hospitals and nursing

Main article: deaconess

The Protestant churches reentered the health field, especially by setting up orders of women, called deaconesses who dedicated themselves to nursing services.

The modern deaconess movement began in Germany in 1836 when Theodor Fliedner and his wife opened the first deaconess motherhouse in Kaiserswerth on the Rhine. It became a model and within a half century were over 5,000 deaconesses in Europe. The Chursh of England named its first deaconess in 1862. The North London Deaconess Institution trained deaconesses for other dioceses and some served overseas.

William Passavant in 1849 brought the first four deaconesses to Pittsburgh, in the United States, after visiting Kaiserswerth. They worked at the Pittsburgh Infirmary (now Passavant Hospital).

The American Methodists – the largest Protestant denomination -- engaged in large scale missionary activity in Asia and elsewhere in the world, making medical services a priority as early as the 1850s. Methodists in America took note, and began opening their own charitable institutions such as orphanages and old people's homes after 1860. In the 1880s, Methodists began opening hospitals in the United States , which served people of all religious backgrounds beliefs. By 1895 13 hospitals were in operation in major cities. well

Lutherans in the U.S. in 1884 brought seven sisters from Germany to run the German hospital in Philadelphia. By 1963 the Lutheran Church in America had centers for deaconess work in Philadelphia, Baltimore, and Omaha.

Public health

See also: Public health § History

In the U.S., the role of public health nurse began in Los Angeles in 1898, by 1924 there were 12,000 public health nurses, half of them in the 100 largest cities. Their average annual salary in larger cities was $1390 In addition, there were thousands of nurses employed by private agencies handling similar work. Public health nurses supervised health issues in the public and parochial schools, to prenatal and infant care, handled communicable diseases and tuberculosis and dealt with an aerial diseases.

Canada

Canadian nursing dates all the way back to 1639 in Quebec with the Augustine nuns. These nuns were trying to open up a mission that cared for the spiritual and physical needs of patients. The establishment of this mission created the first nursing apprenticeship training in North America. In the nineteenth century there were some Catholic orders of nursing that were trying to spread their message across Canada. Most nurses were female and only had an occasional consultation with a physician. Towards the end of the nineteenth century hospital care and medical services had been improved and expanded. Much of this was due to Florence Nightingale who was training women in English Canada. In 1874 the first formal nursing training program was started at the General and Marine Hospital in St. Catharines in Ontario. Many programs popped up in hospitals across Canada after this one was established. Graduates and teachers from these programs began to fight for licensing legislation, nursing journals, university training for nurses, and for professional organizations for nurses.

The first instance of Canadian nurses and the military was in 1885 with the Northwest Rebellion. Some nurses came out to aid the wounded. In 1901 Canadian nurses were officially part of the Royal Canadian Army Medical Corps. Georgina Fane Pope and Margaret Clothilde Macdonald were the first nurses officially recognized as military nurses.

The Lethbridge Nursing Mission in Alberta, Canada, was a representative Canadian voluntary mission. It was founded, independent of the Victorian Order of Nurses, in 1909 by Jessie Turnbull Robinson. A former nurse, Robinson was elected as president of the Lethbridge Relief Society and began district nursing services aimed at poor women and children. The mission was governed by a volunteer board of women directors and began by raising money for its first year of service through charitable donations and payments from the Metropolitan Life Insurance Company. The mission also blended social work with nursing, becoming the dispenser of unemployment relief.

Richardson (1998) examines the social, political, economic, class, and professional factors that contributed to ideological and practical differences between leaders of the Alberta Association of Graduate Nurses (AAGN), established in 1916, and the United Farm Women of Alberta (UFWA), founded in 1915, regarding the promotion and acceptance of midwifery as a recognized subspecialty of registered nurses. Accusing the AAGN of ignoring the medical needs of rural Alberta women, the leaders of the UFWA worked to improve economic and living conditions of women farmers. Irene Parlby, the UFWA's first president, lobbied for the establishment of a provincial Department of Public Health, government-provided hospitals and doctors, and passage of a law to permit nurses to qualify as registered midwives. The AAGN leadership opposed midwife certification, arguing that nursing curricula left no room for midwife study, and thus nurses were not qualified to participate in home births. In 1919 the AAGN compromised with the UFWA, and they worked together for the passage of the Public Health Nurses Act that allowed nurses to serve as midwives in regions without doctors. Thus, Alberta's District Nursing Service, created in 1919 to coordinate the province's women's health resources, resulted chiefly from the organized, persistent political activism of UFWA members and only minimally from the actions of professional nursing groups clearly uninterested in rural Canadians' medical needs.

The Alberta District Nursing Service administered health care in the predominantly rural and impoverished areas of Alberta in the first half of the 20th century. Founded in 1919 to meet maternal and emergency medical needs by the United Farm Women (UFWA), the Nursing Service treated prairie settlers living in primitive areas lacking doctors and hospitals. Nurses provided prenatal care, worked as midwives, performed minor surgery, conducted medical inspections of schoolchildren, and sponsored immunization programs. The post-World War II discovery of large oil and gas reserves resulted in economic prosperity and the expansion of local medical services. The passage of provincial health and universal hospital insurance in 1957 precipitated the eventual phasing out of the obsolete District Nursing Service in 1976.

A Red Cross recruiting poster for nurses from World War I.

Nursing sisters at a Canadian military hospital in France voting in the Canadian federal election, 1917.

After World War II, the health care system expanded and was nationalized with medicare. Currently there are 260,000 nurses in Canada but they face the same difficulties as most countries, as technology advances and the aging population requires more nursing care.

Military nursing

Nightingale's revelation of the abysmal nursing care afforded soldiers in the Crimean War energizer reformers. Queen Victoria in 1860 ordered a hospital to be built to train Army nurses and surgeons, the Royal Victoria Hospital. The hospital opened in 1863 in Netley and admitted and cared for military patients. Beginning in 1866, nurses were formally appointed to Military General Hospitals. The Army Nursing Service (ANS) oversaw the work of the nurses starting in 1881. These military nurses were sent overseas beginning with the First Boer War (often called Zulu War) from 1879 to 1881. They were also dispatched to serve during the Egyptian Campaign in 1882 and the Sudan War of 1883 to 1884. During the Sudan War members of the Army Nursing Service nursed in hospital ships on the Nile as well as the Citadel in Cairo. Almost 2000 nurses served during the second Boer War, the Anglo-Boer War of 1899 to 1902, alongside nurses who were part of the colonial armies of Australia, Canada and New Zealand. They served in tented field hospitals. 23 Army Nursing sisters from Britain lost their lives from disease outbreaks.

During the Spanish-American War of 1898, medical conditions in the tropical war zone were dangerous, with yellow fever and malaria endemic. The United States government called for women to volunteer as nurses. Thousands did so, but few were professionally trained. Among the latter were 250 Catholic nurses, most of them from the Daughters of Charity of St. Vincent de Paul.

Nursing schools

Sporadic progress was made on several continents, where medical pioneers established formal nursing schools. But even as late as the 1870s, "women working in North American urban hospitals typically were untrained, working class, and accorded lowly status by both the medical profession they supported and society at large". Nursing had the same status in Great Britain and continental Europe before World War I.

Hospital nursing schools in the United States and Canada took the lead in applying Nightingale's model to their training programmers:

standards of classroom and on-the-job training had risen sharply in the 1880s and 1890s, and along with them the expectation of decorous and professional conduct

World War I

Britain

By the beginning of World War I, military nursing still had only a small role for women in Britain; 10,500 nurses enrolled in Queen Alexandra's Imperial Military Nursing Service (QAIMNS) and the Princess Mary's Royal Air Force Nursing Service. These services dated to 1902 and 1918, and enjoyed royal sponsorship. There also were Voluntary Aid Detachment (VAD) nurses who had been enrolled by the Red Cross. The ranks that were created for the new nursing services were Matron-in-Chief, Principal Matron, Sister and Staff Nurses. Women joined steadily throughout the War. At the end of 1914, there were 2,223 regular and reserve members of the QAIMNS and when the war ended there were 10,404 trained nurses in the QAIMNS.

Grace McDougall (1887-1963) was the energetic commandant of the First Aid Nursing Yeomanry (FANY), which had formed in 1907 as an auxiliary to the home guard in Britain. McDougall at one point was captured by the Germans but escaped. The British army wanted nothing to do with them so they drove ambulances and ran hospitals and casualty clearing stations for the Belgian and French armies.

Canada

When Canadian nurses volunteered to serve during World War I, they were made commissioned officers by the Royal Canadian Army before being sent overseas, a move that would grant them some authority in the ranks, so that enlisted patients and orderlies would have to comply with their direction. Canada was the first country in the world to grant women this privilege. At the beginning of the War, nurses were not dispatched to the casualty clearing stations near the front lines, where they would be exposed to shell fire. They were initially assigned to hospitals a safe distance away from the front lines. As the war continued, however, nurses were assigned to casualty clearing stations. They were exposed to shelling, and caring for soldiers with "shell shock" and casualties suffering the effects of new weapons such as poisonous gas, as Katherine Wilson-Sammie recollects in Lights Out! A Canadian Nursing Sister’s Tale. World War I was also the first war in which a clearly-marked hospital ship evacuating the wounded was targeted and sunk by an enemy submarine or torpedo boat, an act that had previously been considered unthinkable, but which happened repeatedly (see List of hospital ships sunk in World War I). Nurses were among the casualties.

Canadian women volunteering to serve overseas as nurses overwhelmed the army with applications. A total of 3,141 Canadian "nursing sisters" served in the Canadian Army Medical Corps and 2,504 of those served overseas in England, France and the Eastern Mediterranean at Gallipoli, Alexandria and Salonika. By the end of the First World War, 46 Canadian Nursing Sisters had died In addition to these nurses serving overseas with the military, others volunteered and paid their own way over with organizations such as the Canadian Red Cross, the Victorian Order of Nurses, and St. John Ambulance. The sacrifices made by these nurses during the War in fact gave a boost to the women's suffrage movement in many of the countries that fought in the war. The Canadian Army nursing sisters were among the first women in the world to win the right to vote in a federal election; the Military Voters Act of 1917 extended the vote to women in the service such as Nursing Sisters.

Australia

Sister Grace Wilson of the 3rd Australian General Hospital on Lemnos. She sailed from Sydney, New South Wales on board RMS Mooltan on 15 May 1915.

Australian nurses served in the war as part of the Australian General Hospital. Australia established two hospitals at Lemnos and Heliopolis Islands to support the Dardanelles campaign at Gallipoli. Nursing recruitment was sporadic, with some reserve nurses sent with the advance parties to set up the transport ship HMAS Gascoyne while others simply fronted to Barracks and were accepted, while still others were expected to pay for their passage in steerage. Australian nurses from this period became known as "grey ghosts" because of their drab uniforms with starched collar and cuffs.

During the course of the war, Australian nurses were granted their own administration rather than working under medical officers. Australian Nurses hold the record for the maximum number of triage cases processed by a casualty station in a twenty four hour period during the battle of Passchendale. Their work routinely included administering ether during haemostatic surgery and managing and training medical assistants (orderlies).

Some 560 Australian army nurses served in India during the war, where they had to overcome a debilitating climate, outbreaks of disease, insufficient numbers, overwork and hostile British Army officers.

Interwar

Surveys in the U.S. showed that nurses often got married a few years after graduation and quit work; other waited 5 to 10 years for marriage; careerists some never married. By the 1920s increasing numbers of married nurses continued to work. The high turnover meant that advanvcement could be rapid; the average age of a nursing supervisor in a hospital was only 26 years. Wages for private duty nurses were high in the 1920s -- $1300 a year when working full-time in patients' homes or at their private rooms in hospitals. This was more than double what a woman could earn as a teacher or in office work. Rates fell sharply when the Great Depression came in 1929, and continuous work was much harder to find.

World War II

Australia

centaur poster

In 1942, sixty five front line nurses from the General Hospital Division in British Singapore were ordered aboard the Vyner Brook and Empire Star for evacuation, rather than caring for wounded. The ships were strafed with machine gun fire by Japanese planes. Sisters Vera Torney and Margaret Anderson were awarded medals when they could find nothing else on the crowded deck and covered their patients with their own bodies. A version of this action was honoured in the film Paradise Road. The Vyner Brook was bombed and sank quickly in shallow water of the Sumatra Strait and all but twenty-one were lost at sea, presumed drowned. The remaining nurses swam ashore at Mentok, Sumatra. The twenty-one nurses and assorted British and Australian troops were marched into the sea and sprayed with machine gun fire. This killing became known as the Banka Island massacre. Sister Vivian Bullwinkel was the only survivor. She became Australia's premier nursing war hero when she nursed wounded British soldiers in the jungle for three weeks, despite her own flesh wound. She survived on the charity provided by Indonesian locals, but eventually hunger and the privations of hiding in mangrove swamp forced her to surrender. She remained imprisoned for the remainder of the war. The Empire Star fared better, sailing to Betawi (Dutch Batavia, now Jakarta ) Nurses were sent to help Dutch nurses at Buitenzorg (now Bogor ), but evacuated again after three days to Fremantle, when it became clear that the Japanese were preparing to invade Java.

At around the same time, another group of twelve nurses stationed at the Rabaul mission in New Guinea were captured along with missionaries by invading Japanese troops and interred at their camp for two years. They cared for a number of British, Australian and American wounded. Toward the end of the war, they were transferred to a concentration camp in Kyoto and imprisoned under freezing conditions and forced into hard labour.

Australian sisters

United States

As Campbell (1984) shows, the nursing profession was transformed by World War Two. Army and Navy nursing was highly attractive and a larger proportion of nurses volunteered for service higher than any other occupation in American society.

The public image of the nurses was highly favorable during the war, as the simplified by such Hollywood films as "Cry 'Havoc'" which made the selfless nurses heroes under enemy fire. Some nurses were captured by the Japanese, but in practice they were kept out of harm's way, with the great majority stationed on the home front. However, 77 were stationed in the jungles of the Pacific, where their uniform consisted of "khaki slacks, mud, shirts, mud, field shoes, mud, and fatigues." The medical services were large operations, with over 600,000 soldiers, and ten enlisted men for every nurse. Nearly all the doctors were men, with women doctors allowed only to examine the WAC.

Britain

During World War II, nurses belonged to Queen Alexandra's Imperial Military Nursing Service (QAIMNS), as they had during World War I, and as they remain today. (Nurses belonging to the QAIMNS are informally called "QA"s.) Members of the Army Nursing Service served in every overseas British military campaign during World War II, as well as at military hospitals in Britain. At the beginning of World War II, nurses held officer status with equivalent rank, but were not commissioned officers. In 1941, emergency commissions and a rank structure were created, conforming with the structure used in the rest of the British Army. Nurses were given rank badges and were now able to be promoted to ranks from Lieutenant through to Brigadier. Nurses were exposed to all dangers during the War, and some were captured and became prisoners of war.

Germany

Germany had a very large and well organized nursing service, with three main organizations, one for Catholics, one for Protestants, and the DRK (Red Cross). In 1934 the Nazis set up their own nursing unit, the Brown Nurses, absorbing one of the smaller groups, bringing it up to 40,000 members. It set up kindergartens, hoping to seize control of the minds of the younger Germans, in competition with the other nursing organizations. Civilian psychiatric nurses who were Nazi party members participated in the killings of invalids, although the process was shrouded in euphemisms and denials.

Military nursing was primarily handled by the DRK, which came under partial Nazi control. Front line medical services were provided by male medics and doctors. Red Cross nurses served widely within the military medical services, staffing the hospitals that perforce were close to the front lines and at risk of bombing attacks. Two dozen were awarded the highly prestigious Iron Cross for heroism under fire. They are among the 470,000 German women who served with the military.

Further reading

• Bullough, Vern L. and Bonnie Bullough. The Emergence of Modern Nursing (2nd ed. 1972)
• Dock, Lavinia Lloyd. A Short history of nursing from the earliest times to the present day (1920)full text online; abbreviated version of her four volume A History of Nursing [http://books.google.com/books?id=uiJtAAAAMAAJ vol 3 online
• Donahue, M. Patricia. Nursing, The Finest Art: An Illustrated History (3rd ed. 2010), includes over 400 illustrations; 416pp; excerpt and text search; full text online
• Fairman, Julie and Joan E. Lynaugh. Critical Care Nursing: A History (2000) excerpt and text search
• Snodgrass, Mary Ellen. Historical Encyclopedia of Nursing (2004), 354pp; from ancient times to the present

North America

• D'Antonio, Patricia. American Nursing: A History of Knowledge, Authority, and the Meaning of Work (2010), 272pp excerpt and text search
• Fairman, Julie and Joan E. Lynaugh. Critical Care Nursing: A History (2000) excerpt and text search
• Judd, Deborah. A History of American Nursing: Trends and Eras (2009) 272pp excerpt and text search
• Kalisch, Philip A., and Beatrice J. Kalisch. Advance of American Nursing (3rd ed 1995) ; 4th ed 2003 is titled, American Nursing: A History
• Kaufman, Martin, et al. Dictionary of American Nursing Biography (1988) 196 short biographies by scholars, with further reading for each
• Reverby, Susan M. Ordered to Care: The Dilemma of American Nursing, 1850–1945 (1987) excerpt and text search
• Sarnecky, Mary T. A history of the U.S. Army Nurse Corps (1999)

Britain

• Abel-Smith, B. The Hospitals 1800-1948: A Study in Social Administration in England and Wales (1964) London: Heinemann.
• Allan, P. and Jolley, M. Nursing, Midwifery and Health Visiting since 1900 (1982) London: Faber.
• Baly, M. (1986) Florence Nightingale and the Nursing Legacy, (1986) London: Croom Helm.
• Baly, M. A History of the Queen’s Institute: 100 Years 1887-1987 (1987) London: Croom Helm
• Bendall, E. and Raybould, E. A History of the General Nursing Council for England and Wales 1919-1969 (1969) London: H.K. Lewis.
• Cowell, B. and Wainwright, D. Behind the Blue Door: The History of the Royal College of Midwives 1881-1981 (1981) London: Bailliere Tindall.
• Davis, C., ed. Rewriting Nursing History (1980) London: Croom Helm.
• Dingwall, Robert, Anne Marie Rafferty, Charles Webster, eds. An Introduction to the Social History of Nursing (1988) online
• Dingwall, R. and Mclntosh, J., eds. Readings in the Sociology of Nursing (1978) Edinburgh: Churchill Livingstone.
• Maggs, C. ed. Nursing History: The State of the Art (1986) London: Croom Helm.
• Santos, E.V. and Stainbrook, E. "A History of Psychiatric Nursing in the 19th Century," Journal of the History of Medicine (1949) 4#1 pp 48-74.
• Scull, A. Museums of Madness: The Social Organisation of Insanity in 19th Century England (1979) London: Allen Lane.
• Smith, F.B. The Peoples Health 1830-1910 (1979) London: Croom Helm.
• Smith, F.B. Florence Nightingale: Reputation and Power (1982) London: Croom Helm.
• Summers, A. "Pride and Prejudice: Ladies and Nurses in the Crimean War", History Workshop (1983) 16:33-56. extract
• Summers, A. Angels and Citizens: British Women as Military Nurses 1854-1914 (1988) London: Routledge & Kegan Paul.
• Webster, C. "Nursing and the Crisis of the Early National Health Service," Bulletin of the History of Nursing Group (1985) 7:4-12.
• White, R. ed. Political Issues in Nursing: Past, Present and Future (1985) Chichester: John Wiley and Sons.