The Pre-History of Nursing: An alternative view

Posted by zoeturner - Monday, 20 Jan 2025

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This January, we publish Alannah Tomkin’s Nursing the English from plague to Peterloo, 1660-1820, a new addition to our Nursing History and Humanities series, the only book series devoted exclusively to nursing pursuits in the world. Tomkin’s monograph explores the negative stereotypes around women who worked as sick nurses in this period and contrasts them with the lived experience of both domestic and institutional nursing staff. It also integrates nursing by men into the broader history of care as a constant, if little-recognised, presence. In this blog, the author introduces the ideas behind her book, and the true beginnings of the history of nursing.


My first exposure to the history of nursing was the Ladybird book Florence Nightingale, from the ‘Adventure from History’ series. Like many primary-school children before and since, I was beguiled by Nightingale’s dedication to her cause. The only depiction of an earlier nurse in the Ladybird book comes as an illustration on page nine: an older woman with a red nose and coarse clothing looks on with some resentment as Nightingale demonstrates what a nurse should be. Relatively little academic research has seriously challenged the stereotype of the unreformed nurse as poor, tipsy, and occupationally inadequate.

My book Nursing the English from plague to Peterloo looks again at this figure of the pre-Nightingale nurse and examines the origins of her denigration. I argue that the women and men who worked before Nightingale’s elevation of nursing into a vocation suffered a number of serious social disadvantages.  Women tended to be poorer and older than their patients, and they required payment in exchange for their care. This meant that they were viewed with a suspicion that said more about patient fears of vulnerability (and about assumptions around appropriate feminine behaviour) than they did about women’s actual carelessness or self-interest while at work.  Furthermore, nurses’ responsibility for the excesses of illness such as bodily fluids and excretions meant that they were tainted by association with ‘dirty’ work. Consequently, female nurses were socially marginal on several counts. Yet they were also required to be authoritative in terms of maintaining doctors’ regimes for treatment and/or contradicting patients’ (or their families’) preferences for managing care. Women found it challenging to meet these multiple and often conflicting expectations.

Male nurses were arguably in an even more difficult position. The men who were paid to care for other men found it difficult to access normative pathways to masculine identity. This did not mean that all men failed to be kind, but it did encourage some men to conduct themselves in abusive ways.

Nursing the English considers paid and unpaid nursing by women and men in the period between the final outbreak of plague in England and the first calls for nursing reform in the early nineteenth century.  It draws on literary and institutional sources to consider the history of nursing from the point of view of the nurses themselves. Digitisation of genealogical materials like burial registers enables an historical view of the place of care work in their life stories. Putting these resources together provides a series of vivid accounts of nurses, and nursing, in patients’ homes, in hospitals, and in specialised settings like the Royal Chelsea Hospital, asylums for people thought to be insane, or during wartime.

The biography of Ann Fawdray demonstrates the detail that can be retrieved about even the poorest of women, and in the process reshapes our understanding of nurses’ life experiences.  Ann was probably born around 1702 to 1704 and in 1727 married goldsmith John Fawdray.  Her husband’s prosperity was evidenced by his ability to pay rent of thirty pounds a year but widowhood in the 1740s signalled impoverishment for Ann. She eventually sought work at St Bartholomew’s Hospital, and in 1756 was appointed as the nurse of Magdalen ward (for female patients). She performed well enough: so well, in fact, that she secured promotion to be a Sister, the woman in charge of Queen’s ward (for male patients), less than two years later. How her career as a nurse ended is not recorded by the volumes surviving in the Barts archives. What we do know is that she left the hospital, and her poverty deepened. She died in the workhouse at St Martin in the Fields in 1768. In other words, we can infer that Ann had enjoyed a measure of prosperity in her early life, but widowhood and associated financial pressure propelled her into the ‘dirty’ work of nursing and ultimately into parish poor relief. 

Finding out more about the individual women and men who nursed in the decades before 1820 provides depth to the history of the pre-Nightingale nurse and allows us to appreciate the difficulties facing carers across their lives as well as in their careers. The book concludes that the need for nurse training, when it was first perceived, can be reinterpreted as an urgent need for nurses to find ways to express their authority. 


Alannah Tomkins is a Professor of Social History at Keele University and is a series editor of MUP’s Nursing History and Humanities series.

The Nursing History series is now taking proposals. Read more about the series here. To submit a proposal, please complete the proposal form and return to [email protected].

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