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Medicine transformed: on access to healthcare
Medicine transformed: on access to healthcare

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5.5 Nurses, district nurses and midwives

While access to GPs and outpatient services was growing, access to nursing care was expanding in some sectors and declining in others. The numbers of trained professional nurses who were employed in wealthy households to care for seriously ill family members fell in the first decades of the twentieth century. These nurses stayed in the patient's home, carrying out the doctor's instructions, monitoring the patient's condition and providing general care – making beds, bathing the patient, giving medicines and keeping the sickroom in good order. The role of the private nurse was not an easy one: she had an ambiguous social position – above domestic servants but below family members. The ideal private nurse, according to one textbook, should possess ‘average intelligence’ but ‘more than the average amount of tact’ (Wightman, 1912, p. 10). Private nursing slowly died out after 1918, at the same time as did the live-in domestic servant. By this time, few households had enough room to accommodate a live-in nurse, and patients wealthy enough to afford a private nurse could get the same services in a nursing home (discussed in Section 6).

At the same time, poor patients were enjoying increasing provision of nursing care. The late nineteenth century saw the creation of new charities to provide the sick poor with nursing care in the home. Some of these organisations were secular, but a substantial proportion were religious, with care provided by orders of nursing sisters. These nurses paid short visits to their patients, caring for the sick, giving advice and sometimes helping with housework. From these fragmented charities, a coordinated district nursing service developed in Britain, which remained part of the voluntary sector until the 1950s. The backbone of the service was the Queen Victoria Jubilee Institute for Nursing the Poor in their Own Homes founded in 1889. In 1896, it had 539 nurses across the country: by 1914, there were over 2,000 Queen's Nurses. Existing nursing charities became affiliated to the institute, which provided six-month training courses for ‘village nurses’ who worked in rural areas (Dingwall et al., 1988, pp. 173–97).

In response to public demand, district nurses increasingly took on midwifery work, especially in rural areas. The demand for their services was in part driven by the increasing regulation of midwifery, and a reduction in the number of women working as midwives. From the early twentieth century, midwives attended the majority of births. Most were paid directly by their clients, and, as with other medical services, the better-off were able to afford practitioners who were better trained. Respectable working-class women would save up to employ a trained midwife to deliver their babies. The poorest women employed untrained midwives, often called handywomen, who charged lower fees and stayed on after the birth to help look after the household (Llewelyn Davies, [1915] 1978). However, in the early twentieth century, these untrained midwives were gradually pushed out of practice by the registration of midwives and new regulations on training (Dingwall et al., 1988, pp. 145–72; Loudon, 1992, pp. 172–92, 206–33).