Men an invisible force in nursing history

The role of males in the profession has been understated but significant, writes Thomas Harding

Men played a significant role in caring for the sick in colonial Australia but their contribution has received little attention.

What emerges from the fleeting references to men in a wide range of historical documents is that substantial numbers were employed in nursing roles throughout Australia in the 19th century. The relative invisibility of men in nursing history is not unique to Australia; world-wide it is difficult to find well-documented records of men’s provision of nursing care.

The earliest documented trace of men in nursing emerges in India in the third century BC. The Emperor Asoka built hospitals that employed doctors and nurses. The nurses were male.

Although Western health care has long called Hippocrates of Cos (460-370BC) the father of medicine for establishing a rational basis for medicine, perhaps he should also be called the father of nursing. Hippocrates’ writings demonstrate that men were trained to carry out any treatment or therapy ordered by the physician.

The role of men in nursing in the Western world becomes easier to distinguish in the Common Era. Two influences have played a pre-eminent role in the evolution of modern nursing and men’s involvement in the care of the ill: Christianity and warfare. Arguably, the most famous association of nursing and warfare lies in the figure of Florence Nightingale. Before she went to the Crimea, male orderlies nursed the British soldiers. The orderlies had no training, except through experience and by working closely with surgeons.

In the American Civil War, the confederate army designated 30 men per regiment to care for the wounded. The title of nurse was only awarded to the women organised by Dorothea Dix, who was superintendent of the female nurses in the Union Army. As well as those employed by the armies to care for the fallen, there were groups of male volunteers on both sides who also served as nurses.

The most famous of these was the poet Walt Whitman. One of his most famous poems from this period is “The Wound Dresser”, which 150 years later still resonates.

Nursing in colonial NSW

There is evidence that nursing care in colonial hospitals was provided by a mix of both males and females, mainly without formal training until the late 19th century. For example, a history of the Parramatta Hospital (1790-1818) reveals that “the sick of the day were cared for by incompetents, for the most part drunken men and in some cases drunken women” (The Graduate Nurses’ Association of the Parramatta Hospital, 1979). The title “nurse” became associated almost exclusively with women, whereas men delivering similar or identical care were variously titled wards men, stewards, orderlies, porters and attendants and so on.

Often the work they undertook was circumscribed, such as the provision of care to groups of male patients that might have offended the sensibilities of a woman, for example, those with venereal disease or delirium tremens.

The Nightingale era

The modern era of nursing arguably emerged in the late 19th century after the reforms of Florence Nightingale. A number of authors have described the significance of Nightingale’s philosophies to the profession of nursing becoming associated with women and the apparent disappearance of men from the role.

In the NSW context, Sir Henry Parkes, the colonial secretary, was concerned about the appalling conditions at the Sydney Infirmary and requested Florence Nightingale to send qualified nurses to remedy the situation.

In 1868, Lucy Osburn and five other Nightingale-trained nurses arrived in the colony. As part of her reorganisation, male nurses were “abolished except in the male lock and stricture wards”. It is not surprising that a Nightingale-trained hospital matron such as Lucy Osburn would not value men. Nightingale’s vision of nurses was decidedly female. “Every woman, or at least almost every woman, in England has, at one time or another of her life, charge of the personal health of somebody, whether child or invalid - in other words, every woman is a nurse,” the reformer said in 1859.

The Nightingale model became ascendant in Australia and established nursing as a predominantly female profession. The movement of men out of nursing ought to be placed within the context of the dominant gender ideology of the late 19th century Victorian era.

Although there were no legislative barriers to men becoming nurses, an all-female nursing workforce became the norm in metropolitan areas. This, however, was not the reality for all hospitals, particularly in rural areas.

Entry into schools of nursing was dependent on gaining the approval of the matron and it would appear that in metropolitan Sydney, at least, this was difficult to obtain. For example, at the Royal Prince Alfred Hospital in 1950, despite a shortage of nursing tutors, the application of two qualified tutor sisters – a married couple from England – was rejected because the board was not prepared to employ a man.

The first male nurse was not employed there until 1966, when Lance Waddington was appointed. It was a further three years before a man was accepted for general training at the Royal Prince Alfred Hospital and it was not until the 1970s that men were accepted for training at St Vincent’s Hospital (1972) or Manly Hospitals (1975).

It is interesting to compare this with the example of Lismore Base Hospital, where the first male nurse, Charles Burgess, graduated in 1951. Throughout the 1960s and 1970s, a handful of men followed in his path.

Given that nursing had become stereotyped as women’s work, it might seem counterintuitive that men were more readily accepted as nurses in rural areas. It is possible, however, that in small towns in rural NSW, the man applying for work (and his entire family) knew the matron personally.

He might have even been born in the hospital to which he was applying. Personal relationship and local knowledge would therefore play a factor in the matron’s decision, whereas in the cities these personal connections were less likely.

Although men have had a long association with nursing it has been poorly documented, thus rendering men almost invisible in the history of the profession.

Thomas Harding is a professional officer with the NSW Nurses and Midwives’ Association and an associate professor at the Australian Catholic University.