Discipline of Nursing. Michel Nadot
we do not find the word “history” in the 1996 Bachelor of Science in Nursing program of the Faculty of Nursing at the Université de Montréal. It is assumed here that the course title “Introduction to the Discipline of Nursing” plays this role [COH 02].
In the history of the nursing profession, we know Florence Nightingale, but we often ignore the name of the woman who inspired Florence Nightingale to found a nursing school in Great Britain. It is around a religious problem resulting from a conflict of values between Valérie de Gasparin-Boissier and Florence Nightingale that training began in Europe. Why does one of these women take center stage and not the other? And of course, the history of the nursing discipline has nothing to do with the history of medicine or religion. There is often a tendency, not only in the media, for example, but also within the profession, to confuse disciplines and the places where knowledge is produced.
Why always position oneself as an “auxiliary profession” or present oneself as “para something”? Legislation on the profession does not explain everything. Just because women care workers from the servant and working classes were unable to access education in the 18th Century does not mean that the specificity and complexity of their task should be ignored today, especially if we interpret it from a biomedical paradigm that only very partially reflects actual practice.
Caring in ancient societies and in popular circles also means taking into account the environmental conditions and those of the habitat or domestic uses of the time. But, as Ehrenreich and English point out in connection with the witch hunt (empirical healers at the service of the peasant population), “domestic work is much more than cleaning the house. It is about physically, emotionally, sexually serving those who bring in the wages, keeping them ready for work day in and day out”. In the devaluation of women’s social role, “witch hunts have served the sexual division of labor and the control of men over women, their bodies and their labor” [EHR 15]. To understand also how care was instituted in pre-industrial society, it must be kept in mind that most secular healthcare professionals in institutional settings at the end of the 18th Century came from rural or domestic settings and school was not yet compulsory. There has to be a start to everything!
The history of nursing knowledge has little to do with the history of religion or the history of medicine. Rather, it would be the history of the organization of collective households, of the way they are run and how they function that is at issue. This history is simply concomitant with the history of hospitals (that of the house, the household, the Domus, the hospital). These hospital establishments are then the first spaces of speech devoted to hospitality. They are the first spaces for “discursive events” [FOU 69] to take institutional care of it or for the specialization of hospital domestic work.
1 1 The school was closed in 1995.
2 2 The Ancien Régime in France was its political and social system from the Late Middle Ages until the French Revolution of 1789, which led to the abolition of hereditary monarchy and the feudal system of nobility.
3 3 Collière seems to be speaking here more to history teachers in nursing schools than to the nurses themselves. In fact, most of the instructors of yesteryear (now educators) who taught the history of the profession in nursing schools and institutes in France, for example, were not, in general, researchers in history.
4 4 We sometimes speak of inter-trade or inter-professionality.
2
The Hospital as a Place to Talk
It is at the time when the hospital was built and organized that the traditions of language of the care discipline began to emerge and thus find their singularity. Symbols of the central power of the urban bourgeoisie in the legal sense, some of these hospital buildings underwent successive major architectural changes or were rebuilt (more beautiful and larger than before)1. In this particular space and time, of prime importance in determining the place of emergence of what would later become the nursing discipline and its knowledge, stood a language of a welcoming nature, a form of life support and protection of human beings similar to that held by an ordinary housewife or mother looking after the home, her spouse, children, parents and other relatives.
NOTE.– Here, it is important to distinguish between the different places of care and not to mix everything together. We can have a space in which a religious language is shaped by the values of the hierarchy of the Church, sacred or doctrinal texts (practical charity of the Church, alms, hospitality, works of mercy, etc.). These religious spaces were first created in Catholic regions and then in Protestant regions. There are also public secular spaces whose organization and functioning sometimes differ from those of the Hôtel-Dieu (the French municipal or communal hospital, often dependent on the bourgeois fiefdom) built by the patricians of a city.
2.1. The origin of the hospital
Rather, the public hospital was an institution of reception and assistance to life that provided a practical economic and material benefit to those who worked there. At the same time, by offering hospitality to the poor, the hospital could in return expect from them work in the service of the prosperity of the hospital’s land holdings. The era of feudalism based on land ownership and serfdom was not far off the mark: the bourgeoisie made its appearance. Thus, at the hôpital de Fribourg (Freiburg hospital), founded between 1248 and 1252, the hospital keeper “was assisted in his task by his wife (Magistra), who took care of the housekeeping and directed the female staff of the establishment. The hospital, governed by a layman, was also served by servants and not by religious men or women. This secular and bourgeois character allows us to classify the hospital as a communal or municipal hospital” [NIQ 21]. In comparison, the hôpital de Genève (Geneva hospital) welcomed 135 patients in 1600 [LES 85]. It was establishments of this kind, small (4–12 beds) or large (100–150 beds) that were favored to evoke the emergence of lay nursing knowledge. However, even though only one category of institutions was chosen, it is clear that these institutions could sometimes differ in their management, organization and staffing. “The differences between institutions, even within the same city, are as great as their commonalities. Within the major trends that are shaping the overall hospital landscape in French-speaking Switzerland, for example, each establishment also adopts its own rhythm, depending on local determinations” [DON 03]. We can extend this observation to all the countries concerned by the founding of hospitals. Hospitals therefore present different characteristics in terms of the quality of their services.
The adventure of the so-called “nursing” care began in a fairly limited field of hospital action. At the beginning, the story was mundane and there was nothing medicalized2. We owned land or bought a piece of land, if possible close to a river and along communication routes, we began by building, buying or receiving an ordinary house devoted to hospitality in order to welcome passers-by, the poor3 who were often isolated or without social ties, orphans, the elderly or any wandering person in need of help to live their daily life and we regulated the collective life. A hospital was born! There were “maisons” (houses) or “ménages” (households) according to ancient texts.
The terms “maison” or “ménage” often appeared in the documents (status, job descriptions, accounts, reports) that were created once the house was in operation. There was a need to hire (household) staff to operate it and to offer hospitality. The term “ménage” had a special status. The word was often used “as a separate entity with a defined position within the communal structures that were being established and becoming more complex” [ROD 05].
2.2.