This chapter outlines how diabetes re-emerged as a concern of central government during the late 1970s, setting the scene for the move of managed care from clinical settings to policy arenas. It does so by examining the tribulations of efforts to secure Department for Health and Social Security funding for retinopathy screening and photocoagulation treatment trials between 1977 and 1985. The trials were by no means the biggest intervention that central government made into diabetes care during the 1970s and 1980s. Examining their history, however, reveals the ways in which post-war policy networks developed in relation to diabetes, and the shifting ways in which they framed diabetes to garner government attention in a period of considerable economic and political change. Crucially, underpinning debates about the trials were new concepts of risk management, disease prevention, and standard-setting that became central to policy discussions of diabetes care and managed medicine at the end of the century.
This chapter analyses shifting dynamics within medical missionary work in Nigeria, from support for British colonialism to humanitarianism. It explores Irish Catholic missionaries as nurses, midwives and physicians from c.1937-1970, to the end of the Nigerian Civil War in 1970. It uses unpublished documents to disentangle, although not disconnect, modern missionary work from colonialism. Using gender as a category of analysis it focuses on women’s work during the Nigerian civil war compared to men’s activities, and how the media focused on one but not the other. By giving voice to the “silenced” in history it argues that there was a significant Nigerian presence in relief work during the war, differing from most research which focuses only on the work of whites. Significantly, in the 1960s and 1970s, Catholic mission hospitals became sites for shifts in the understanding of mission during periods of violence and upheaval. As Catholic women renegotiated their place in an emerging decolonised world, complex relationships developed among Irish sisters, Nigerian nuns, priests, Nigerian chiefs and international peacekeepers. Whereas in the 1930s and 1940s, Catholic sisters saw Africa as a fertile ground for converts, over time the Catholic mission tradition liberalised to promote humanitarianism.
Colonial Caring covers over a century of colonial nursing by nurses from a wide range of countries including: Denmark, Britain, USA, Holland and Italy; with the colonised countries including South Africa, Australia, New Zealand, Ethiopia, Nigeria, India, Indonesia (Dutch East Indies) and the Danish West Indies. It presents unique perspectives from which to interrogate colonialism and post-colonialism including aspects of race, cultural difference and implications of warfare and politics upon nursing. Viewing nursing’s development under colonial and post-colonial rule reveals different faces of a profession that superficially may appear to be consistent and coherent, yet in reality is constantly reinventing itself. Considering such areas as transnational relationships, class, gender, race and politics, this book aims to present current work in progress within the field, to better understand the complex entanglements in nursing’s development as it was imagined and practised in local imperial, colonial and post-colonial contexts. Taking a chronologically-based structure, early chapters examine nursing in situations of conflict in the post-Crimean period from the Indian Rebellion to the Anglo-Boer War. Recruitment, professionalisation of nursing and of military nursing in particular, are therefore considered before moving deeper into the twentieth century reflecting upon later periods of colonialism in which religion and humanitarianism become more central. Drawing from a wide range of sources from official documents to diaries, memoirs and oral sources, and using a variety of methodologies including qualitative and quantitative approaches, the book represents ground-breaking work.
From 1900 Dutch nurses arrived in the East Indies, but their numbers were wholly insufficient to meet the colony’s increased demand for competent nursing staff. Therefore European physicians started training native women as nurses. Initial endeavours were disappointing with problems closely connected to the position young women occupied in native society. Young women from poor families were uneducated, whilst those from middle and upper classes often considered it culturally improper to live outside their parents’ home at marriageable age. The poor reputation of governmental hospitals made them only appropriate as work places for lower-class women and women with dubious reputations. European nurses taught and supervised nursing and provided role models. After qualifying, nurses could spend a further two years studying midwifery which combined hospital and community experience. The nurses and midwives were deployed as intermediaries to spread the ideology of western care among the native population, who nevertheless continued to have an aversion to western medicine. The (student) midwives were distrusted because of their youth and unmarried status. Native women variously rejected or embraced such advice or accommodated it selectively. In the main they remained loyal to the indigenous healers, the dukun bayi.
Disease, conflict and nursing in the British Empire, 1880–1914
Transnational developments in biomedicine and technology together with broader social changes, not only reshaped disease prevention and healthcare policy, but facilitated mass migrations of people, creating new pathways for spreading disease, simultaneously helping form various conduits, including nursing, for the “new” medical knowledge required to combat this spread. Additionally, this period (1900-1914) was characterised by global crises, which provide important contexts for reappraising the history of nursing at local, national and transnational levels, while creating an important lens through which to study the changing profession. The geographical focus of this chapter is on three port cities: Cape Town, Melbourne and Hong Kong, selected as representing different types of colonial administration, and colonial histories, which naturally affected the implementation of healthcare systems. Traditional approaches to nursing’s history are enclavist in arguing that nursing practice, education and policy was established and solidified in the metropole before being exported to the colonies by British nurses. Consequently, professional nursing developed independently in each of the colonial outposts. The chapter argues that nursing practice is equally constituted on the peripheries of Empire, so that complex networks of nursing ideas existed within the British Empire, fuelled and expanded by mass migration of nurses.
Contextualising colonial and post-colonial nursing
Helen Sweet and Sue Hawkins
The introduction provides an overview of the book’s focus, structure and remit, outlining commonalities as well as differences between the experiences of colonial nurses discussed in the book. Drawing from their experience in researching and writing gender and racial social histories and in colonial and post-colonial nursing history respectively, the editors tease out emerging themes placing them within a clear chronological and historiographical framework. They examine how this field has developed in the history of medicine and identify questions which current research still leaves unanswered, but for which nursing’s history is uniquely placed. The chapters in this book reveal the presence (or absence) of underlying racial and cultural tensions between nurses and their patients, nurses and professional colleagues or their indigenous counterparts; and the editors question whether past histories have not been grossly oversimplified by projecting images of imperial collaboration/cooperation onto all forms of colonial nursing, by all countries, across a long timespan. We evaluate the difficulties of discussing and analysing the impact of colonial nursing from the indigenous population’s viewpoint to present balanced analyses, and explore different experiences of colonial/ post-colonial nursing over more than a century whilst considering the impact of peacetime or conflict on nurses and nursing.
The Indian Rebellion (1857) occupies a central position in the mythology of late nineteenth-century British history. The shock throughout British colonial society was expressed through a medium synonymous with the British experience in India, namely diaries or journals. Differing to accounts from other conflicts of the period, the prolonged and localised nature of fighting at Lucknow and Cawnpore meant that chroniclers represented a cross-section of gender, class and professional status in colonial society, including a range of medical practitioners but also women of various social ranks who had volunteered for medical service. Drawing on printed and manuscript sources from c.1857-c.1900, this chapter argues that the Indian Mutiny diary functions as both a vital record of women’s voices in the history of British colonial experience and a unique example of a nineteenth-century practitioner narrative told from a female perspective. The chapter largely focuses on journals published by participants of the Siege of Lucknow, and will explore the way in which a range of women eyewitnesses acting as nurses were able to participate in the defence of British interests in a time of national emergency thereby contributing to the culture of imperial myth-making that surrounds the Indian Rebellion.
Nursing and medical records in the Imperial War in Ethiopia (1935–36)
Anna La Torre, Giancarlo Celeri Bellotti and Cecilia Sironi
The Ethiopian war (also known as the ‘Abyssinian War’) refers to the war waged by Italy during Mussolini's regime against the Empire of Ethiopia in 1935. It led to the proclamation of the AOI (Italian Oriental Africa) in 1936. Through analysis of primary and secondary sources the chapter explores how the Italian Army health care service was organised during the war, and the status of nursing in the Italian Army. From original reports, it was discovered that the male military nurse corps provided the majority of nursing care on the battlefield, in hospitals and clinics and in ambulances and radiological laboratories. Only 384 female Italian Red Cross volunteers participated in the war. They were called “Lady” nurses or Sisters because they belonged to the Italian nobility and to the upper class. These female nurses were joined by 200 missionary nuns of different religious orders. At the end of 1941, during the Second World War, the British Army freed Ethiopia. With reference to the data examined, the outcomes show that, in spite of what the official reports said, the real protagonists of nursing were male nurses.
At the commencement of the Second Anglo-Boer War the small cohort of nurses available for service in South Africa were insufficient to meet the demands inherent with the exigencies of modern warfare and ever-increasing numbers of sick and wounded. Around 1,400 civilian nurses from across the Empire served in varying capacities during the South African campaign, yet there was no defined overall control of those lay women and trained nurses who offered their services. From 1891 Nurse Registration in the Cape had been established in law, yet there was no demarcation over the role and responsibilities of British nurses serving in South Africa. Concerns were raised that some nurses were motivated for wartime service owing to a search for adventure in the colonies. Yet there were a number of motivators, including those of a humanitarian nature, combined with a patriotic sense of duty. This chapter will examine how accusations that nurses were ‘frivolling’ in South Africa, raised concerns over control and organization of nurses in future military campaigns and had an impact on discussions over levels of authority female nurses might be allowed in the new Queen Alexandra’s Imperial Military Nursing Service, established at the close of war in 1902.