lessons from the archive – episode 3

Caring for the sick has been a feature of Christianity ever since its inception. [1] Jesus told the parable of the Good Samaritan to show that his disciples should care selflessly for those in need, whoever they were. [2] Communities have always looked after their own, but Jesus’ unique contribution was to spur his followers on to care for those who suffered outside their own family and community.Countless examples can be given of how Christian women and men through the centuries have cared for the sick and vulnerable – abandoned babies, destitute orphans, and plague victims. Many monasteries and convents had a particular ministry of caring for the sick; some of these evolved into dedicated hospitals, such as St Thomas’s in London during the twelfth century. [3] Indeed, the very word ‘hospital’ derives from the ‘hospitality’ that was offered to the poor and sick in these Christian institutions. [4]

Much of this caring activity could be described as ‘nursing’. And yet the modern profession of nursing emerged much more recently, in the nineteenth century. Prior to this, nursing was simply personal care for the sick, sometimes done with skill and compassion, sometimes not. Often it was done by family and friends or by paid carers of varying skill. In early Victorian England, stereotypes of poorly trained nurses were well known, such as the infamous Sarah Gamp in Charles Dickens’ novel Martin Chuzzlewit, who was ‘dissolute, sloppy and generally drunk‘. [5]

early nursing reforms

Medical knowledge was advancing rapidly in the nineteenth century, and hospitals were becoming more important. In London, in addition to the great mediaeval hospitals of St Bartholomew’s and St Thomas’s, a number of newer hospitals had been founded in the early eighteenth century – the Westminster, the London, Guy’s, and St George’s were all founded within a couple of decades.

As hospitals grew and doctors had more therapeutic options, they needed more highly skilled assistants to carry out treatments and observations methodically. The role of the nurse became more developed, and the need for a professional class of nurses became obvious.

Initially, little training was given or thought necessary. Nurses were usually lower-class women, eg domestic servants. Sisters and Matrons were often recruited separately, from higher-class women, with little idea of the lower-class nurses being promoted to these more senior roles.

What training there was often came directly from the doctors, who were obviously interested in ensuring that the nurses working with them could follow their directions between ward rounds.

Many of the poor and sick were cared for in workhouses, where the situation was particularly bad. There, nursing was often done simply by those inmates who were relatively able-bodied but who usually had little or no training. Very few workhouses had paid nurses. [6]

As the nursing profession developed, one of the most famous names is, of course, Florence Nightingale. She was motivated by Christian compassion in her work, but she was by no means the only one, and there are a number of examples of Christians who greatly influenced the movement’s early direction. In the rest of this article, we shall see several such examples.

Elizabeth Fry

Elizabeth Fry was born into a wealthy Quaker family in Norfolk in 1780. She was motivated by her Christian faith to make a difference in society, and in 1813 she first visited Newgate prison in London. She was horrified by the conditions she found, especially for female prisoners, and she spent many years effecting prison and penal reforms. [7] She also campaigned tirelessly for reform in other areas, such as welfare, homelessness and the abolition of slavery.

However, later in life, at age 60, she finally found time to do something she had been meaning to do for years. Whilst chiefly engaged in prison and penal reform for most of her life, she had long wished to do something for the standard of nursing care. In 1827 she had written:

‘During the last ten years much attention has been successfully bestowed by women on the female inmates of our prisons…But a similar care is evidently required for our hospitals, our lunatic asylums, and our workhouses.’ [8]

Three years earlier, in 1824, she had hosted a young German pastor, Theodor Fliedner, who came to see her prison reform work. He went home inspired to set up a similar prison ministry and, later on, nursing work (see below).

In 1840, Elizabeth Fry could finally do something herself about nursing training in England. Along with her sister-in-law, Elizabeth Gurney, they set up the Institution for Nursing Sisters, linked with Guy’s and the London Hospitals. [9] An Annual Report stated its purpose as:

to provide experienced, conscientious and Christian Nurses for the sick, and also to raise the standard of this useful and important occupation, so as to engage the attention and enlist the services of many who may be desirous of devoting their time to the glory of God, and to the mitigation of human suffering. [10]

The same report interestingly notes the kind attentions of Dr Hodgkin (the fellow Quaker and friend of medical mission that we met in our previous article), [11] who cared for the nursing sisters when they themselves were ill; it also lists one ‘Miss F Nightingale’ as one of the Institute’s donors!

Kaiserswerth

Pastor Theodor Fliedner, mentioned above, was a young pastor in Kaiserswerth, near Düsseldorf in Germany. Needing funds for his community, he travelled in Holland and England, meeting Moravians in Holland and learning how they had revived the ancient Christian ministry of deaconess. [12] Going on to London, he met Elizabeth Fry in 1824 and was inspired by her work amongst prisoners. He returned and set about reforming prisons and supporting both current and former prisoners in his local area.

He went on to develop other projects, such as education. Then in 1836, he and his wife Friederike set up the Kaiserswerth Deaconesses’ Institute, training young Christian women to care for the sick poor of the area. Deaconesses had been a vital part of the Church’s social outreach in the early centuries of Christianity, but this role had gradually died out until revived by the Moravians and then further by Pastor Fliedner. His Institute gained fame far and wide, setting up daughter institutions in many cities, including the German Hospital in London, [13] which opened in 1845 to care for poor German immigrants in London.

Florence Nightingale visited the German Hospital twice and the Kaiserswerth centre twice before finally enrolling for training at the Deaconesses’ Institute in 1851.

Florence Nightingale

Florence was born into a wealthy family in 1820. Aged 16, she experienced a call from God that prompted her to devote her life to the service of others, which in her case also involved rejecting marriage. Although her own faith was not exactly orthodox evangelical, it was clearly a huge motivator for her work. [14]

As mentioned above, Florence was greatly influenced by her contact with the Kaiserswerth Deaconesses’ Institute, and financially supported Elizabeth Fry’s Institute for Nursing Sisters. But of course, she is best known for work amongst wounded soldiers at Scutari Hospital in Istanbul during the Crimean War. In 1854, Florence took a team of 38 volunteer nurses (including some from Fry’s Institute) and 15 Catholic nuns to Scutari. Through their hard work and diligent attention to basic issues such as hygiene, sanitation and nutrition, Florence and her team were able to reduce the death rate significantly.

During her time there, her influence was also felt by Dr George Saunders, a Christian military surgeon who would be one of the founders of both the Medical Prayer Union (1874) and the Medical Missionary Association (1878). In his autobiography, Reminiscences, he tells of being invalided back from Crimea to Scutari with a fever in 1855:

When I came to Scutari, I found that the hospital there had now every appearance of comfort, and was unsurpassed by any other, civil or military. For this improved state of things all the praise was due to the noble and indefatigable efforts of Miss Nightingale, who fortunately had carte blanche to do whatever she thought necessary for the comfort and well-being of the sick and wounded. [15]

On returning to London after the war, she used her new-found fame and influence, and the funds this had attracted, to open the Nightingale Training School for Nurses at St Thomas’s Hospital in 1860 (then based at London Bridge next to Guy’s Hospital, before its move to Lambeth). She was also responsible for hospital redesign to improve infection control – the ‘Nightingale Ward’ layouts common in many hospitals from the period, including St Thomas’s. [16]

Call the Midwife

The kindly exploits of the fictional nuns of St Raymond Nonnatus in Poplar, East London, are well known to many of us through the TV series Call the Midwife. However, the true story behind this is no less inspiring.

Dr Robert Todd was an energetic and talented London physician who was influential in the launching of King’s College Hospital in 1840. [17] He gave his name to Todd’s Paralysis (paralysis following a seizure). Furthermore, as a keen Christian, he introduced reforms for the medical students at King’s to provide better academic, social and pastoral support, becoming the first Dean of the medical school at King’s.

Seeing the need to improve standards of nursing in the London hospitals, Dr Todd worked with his friend, Charles Blomfield, the Bishop of London, to establish St John’s House in 1848. This was an Anglican nursing order based on similar principles to those of the Kaiserswerth Deaconesses. [18] It became highly successful in producing quality nurses and was influential on Florence Nightingale as she prepared to set up her own nursing school. The Superintendent of St John’s House, Mary Jones, was a close friend of Nightingale’s, and Florence formulated her new school in many ways as a secular version of St John’s House. [19]

The Sisters of St John’s have gone through turbulent times over the years, including their time in Poplar, immortalised in Jennifer Worth’s memoir Call the Midwife. [20] The small community lives on today in the West Midlands, though without its original nursing function. [21]

Mildmay Mission Hospital

The Rev William Pennefather was appointed Vicar of Christ Church, Barnet, in 1852. Filled with passion and energy, he engaged in evangelism, overseas mission, and social action, such as working with orphans and developing interdenominational Bible conferences that were the forerunners of the Keswick Conventions. [22] His wife Catherine was no less a force to be reckoned with,¬¬ and at their second conference in 1857, the Association of Female Workers was formed, with Catherine as President. They began to build up Deaconess ministry in and beyond their parish. A few years later, they moved to St Jude’s, Mildmay Park, in North London, where the growing network of ministries continued.

The Deaconess ministry was yet again inspired by what had begun in Kaiserswerth and it developed over several years, gaining the approval of Florence Nightingale, who wrote to Rev Pennefather:

I hail with the greatest satisfaction every attempt to train in practical activity all female missionaries, whether for home or foreign service, whether rich or poor. I am sure that whatever you do will be blessed in this thing. [23]

Then in 1866, things took a historic turn when a cholera epidemic ripped through the slums of East London. Mildmay Deaconesses were sent to Bethnal Green, where they set to work caring for the poor and sick. [24] Growing rapidly, the Deaconesses added a nursing home and a cottage hospital to their ministry.

At this point, the Mildmay work connects with the Edinburgh Medical Missionary Society (EMMS), which played such a vital role in the birth of medical mission and which featured strongly in our previous article. [25] In 1869, Dr Burns Thomson of the EMMS gave a stirring speech on medical missions at the annual Mildmay Park Conference. [26] This greatly impressed the Pennefathers, who subsequently visited Edinburgh and were inspired to launch the Bethnal Green Medical Mission in 1874 to further develop the work of Mildmay. Its first superintendent, Dr Dixon, was a graduate of the EMMS training school. [27]

The medical work grew rapidly, and in 1877, the Mildmay Mission Hospital opened its doors. Within a few years, in 1883, it was recognised as a nurse training institution. [28] Down the years, many Christian nurses – including my own mother – have been trained at Mildmay and sent out around the UK and the world. Dr Burns Thomson also retired to Mildmay on leaving Edinburgh and spent his final years providing pastoral support to the Deaconesses and the aged Mrs Pennefather. [29]

Through many changes and adaptations, the Mildmay Mission Hospital is still going strong today – it survived the dawning of the NHS in 1948 when many smaller hospitals were forced to close. Later, it focussed on specialist HIV care and is now reinventing itself yet again for the challenges of the twenty-first century with a new step-down service for homeless patients. [30]

what can we learn from the early nursing profession?

Looking back at the amazing Christian role models who played an important part in the development of nursing in the UK, several lessons stand out:

• As in previous articles, there were numerous links and connections between some of the early pioneers. We should never underestimate the power of putting people with similar good ideas together – creative inspiration and the Holy Spirit often take over!
• Sometimes ‘old’ ideas can be revived and adapted to new situations in amazing ways. The renewal of the Deaconess movement is an excellent example.
• These early pioneers often saw their Christian faith as foundational to raising standards and maintaining the unity of those they inspired – excellent evidence that life-changing faith can (and should) make us better professionals.
• Difficult and challenging times can inspire us to do incredible things and show creativity and leadership we never knew we had. Both Florence Nightingale’s experience in Crimea and Elizabeth Fry’s in Newgate prison inspired them. Modern nursing faces many challenges – what might the Lord enable his disciples to do in the midst of them?
• Mission, evangelism, and wider social reform went hand in hand with most of these early movements. Christian nurses and other healthcarers can have incredible effects beyond their purely professional achievements.