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Excerpt
The campaign to reform nursing, which began in the mid-nineteenth century, was less an attempt to redefine nursing work than to reform the nurse's character and "skills" through reconstruction of the class basis of the occupation. Moral rather than technical attributes of nurses were singled out for criticism. The attack upon Sarah Gamp and her contemporaries can be seen as an extension of the wider campaign to reform working class morals. To understand why Mrs. Gamp, Dicken's comic creation of 1844, and her co-workers provided such a convenient and powerful symbol for reform, one has to understand something of her success and the nature of the threat that she and her counterparts allegedly posed to reformers.2
What medical men objected to was the independence and unsupervised nature of much of the work of the domiciliary nurse.3 Malpractice was publicized as especially common among those who, "with the usual temerity of ignorance, presume to oppose their own opinions to those of the physician."4 At a time when therapeutic authority depended more on "placebos" than clinical efficacy, Mrs. Gamp and her like posed a considerable threat to medical authority. Not only did she have a clientele of her own, which by-passed medical referral systems, but she also held strong views on remedies and treatment. When combined with a potential to provide a comprehensive range of services that included "watching," basic nursing care, laying out the dead, and attending lying-in women, the domiciliary nurse was a veritable general practitioner.
Hospital training of nurses was identified as a solution to the neglect and obstinate opposition to physicians' orders—traits supposedly common in the "old-style" nurse. Moreover, it provided an antidote to incompetence:"We should no longer hear of doses of medicines being given hazardous to life; or of patients poisoned by topical applications administered as internal medicines."5 Textbooks on nursing written by doctors exhorted nurses to follow medical instructions without deviation. The ability to read such literature presupposed literacy—a common stipulation of a nurse's qualifications.
While doctors may have taken particular exception to nurses' resistance to their authority, their complaints can also be understood as a smokescreen for their clinical failure. Sarah Gamp's appeal to polemicists may have been her conversion into a scapegoat for doctors' clinical frustrations as well as her defenselessness in print.
Doctors could assert their claims to superiority over nurses since they could exploit moral, social, educational, and gender differences at the same time. "Regular" practitioners of medicine were under pressure for space in the health care market from "irregular" male medical practitioners during the middle of the nineteenth century. If they could not differentiate themselves clearly from quacks on the basis of the efficacy of the remedies they offered, then educational qualifications provided an alternative form of legitimization. Appeals to "enlightenment" values associated with a liberal university education were asserted by regular practitioners as the benchmark of their professionalism.
