Negotiating nursing explores how the Queen Alexandra's Imperial Military Nursing Service (Q.A.s) salvaged men within the sensitive gender negotiations of what should and could constitute nursing work and where that work could occur. The book argues that the Q.A.s, an entirely female force during the Second World War, were essential to recovering men physically, emotionally and spiritually from the battlefield and for the war, despite concerns about their presence on the frontline. The book maps the developments in nurses’ work as the Q.A.s created a legitimate space for themselves in war zones and established nurses’ position as the expert at the bedside. Using a range of personal testimony the book demonstrates how the exigencies of war demanded nurses alter the methods of nursing practice and the professional boundaries in which they had traditionally worked, in order to care for their soldier-patients in the challenging environments of a war zone. Although they may have transformed practice, their position in war was highly gendered and it was gender in the post-war era that prevented their considerable skills from being transferred to the new welfare state, as the women of Britain were returned to the home and hearth. The aftermath of war may therefore have augured professional disappointment for some nursing sisters, yet their contribution to nursing knowledge and practice was, and remains, significant.
The chapter examines the changes to the dominion of nursing work on active service overseas. The chapter first explores the extensions to the nursing role, most particularly the care of wounds and burns. This is followed by a discussion of the expansion of nursing duties into those that had hitherto been the domain of medicine. These roles include the commencement and management of blood transfusions, surgical work and anaesthesia. Finally the chapter considers ‘new work’, the most critical of which was the administration and use of penicillin. The constantly shifting requirements of war nursing prevented Army nurses from remaining in a professional comfort zone of accepted roles and regimes. The experience of living with uncertainty may have caused anxieties for some, but the active participation in new treatment modalities suggests that nurses who went to war were keen to move beyond the normal boundaries of nursing practice and many relished the opportunity to do so. The chapter argues that the developments in practice and the increased confidence nursing sisters displayed with this new work altered their working relationships with medical officers from one of deference to one of collegiality, enabling more productive decisions for their soldier-patients’ care.
Military success in war was contingent on men sustaining a determination to fight. Persuading men to continue fighting or returning them to combat after illness or injury depended on maintaining their morale. The use of female nurses in upholding this resolve was integral to the war effort. The chapter explores the value of the presence of women in hospital wards and in social environments on active service overseas. It considers the occasional antipathy of military authorities and male colleagues to the location of female nurses in war zones. However, it is argued through the provision of expert clinical care, domestic acumen and the use of their ‘female-selves’, nurses were able to salvage men in readiness to return to battle. Nursing sisters thus created a space for themselves in frontline duties. However, the chapter argues, this was not without its difficulties. As single, white women in far-flung places, this position situated nurses in a liminal place between the respectable European colonial wife and the ‘biohazardous’ local women. The chapter acknowledges these difficulties, but also demonstrates how the nurses negotiated their way through these contradictions to their advantage and for those in their care.
The chapter considers the civilian world into which the Q.A.s returned at the end of the war and explores the options they faced. It begins with the immediate aftermath of war and the opportunities for interesting and worthwhile work that would only exacerbate the nursing sisters’ difficulties on demobilisation. This is followed by a consideration of the return to Britain and the options open for professional practice. The chapter argues that for some the option of interesting work remained, either in the colonial service or the military. However the main professional opening for returning nurses was the crisis ridden civilian hospital system that wanted and recruited cheap, malleable workers; this was not an attractive choice for demobbed nursing sisters. The chapter argues that despite nursing being a female dominated profession, the ideology that encouraged women to return to the home in the aftermath of war had significant ramifications for demobilised nurses. The social structure precluded married women from working outside the home and funds for postgraduate training available to returning male doctors were not offered to nurses. As the chapter maintains, most nursing sisters married, leaving the profession without their considerable talents and new ways of practicing.
The chapter maps the nursing practices on active service overseas that recovered men including, body care, feeding work, the management of pain and support for the dying. These four areas of nursing practice are commonly associated with nursing work, yet, as the chapter argues, in war zones, they demanded complex gendered negotiations. Comfort care placed the single female nurse too close to the naked male body and feeding work was allied to mothering, rather than professional practice. In the absence of sufficient medical officers in a war zone, pain relief demanded the development of scientific skills of diagnosis and prescription. The chapter examines how the nurses managed these contradictions to develop an understanding of the critical role of fundamental nursing care and create a space for themselves as experts by the bedside.
In this chapter, the records for New Jersey are mined for details about the relationship between lunacy investigation law and other forms of care and treatment of the insane. The focus here is on how these forms of care intersected with the civil law. The detailed witnesses’ accounts of the New Jersey documents also allow for an analysis of the complex array of treatment, care and management strategies, including the services of professionalising orthodox medical practitioners and the psychiatric services of fledgling lunatic asylums, on the one hand, and the myriad responses that were grounded in the conventions of popular culture, on the other hand. The detail in the New Jersey testimonials also allows for an analysis of the symptoms and causes of madness as understood by the relatives and neighbours of those who were put on trial.
This chapter begins with a broader consideration of how lunacy law fitted into more general assessments of the role of law in the exercise of imperial power. Eighteenth-century legal experts made connections between the states of non compos mentis among Europeans and the ‘natural’ states of unreason found among many groups of people ‘discovered’ in the ‘new’ world through exploration. These experts concluded that indigenous people without any concept of property or property ownership (as defined by English legal tradition) were in need of guardianship just like white colonists who had lost their reason. More practically, this body of civil law was placed into the hands of colonial rulers by English authorities as a mechanism for dealing with propertied colonists who were considered mentally incapable of managing their property. In colonial New Jersey, the law of lunacy investigation was a very successful legal transplant, taking root in ways that could not have been anticipated by those who had shaped the law in England. In New Jersey, the law applied to a much broader socio-economic group and served as a formidable regulatory, managerial and caring mechanism for madness.
This chapter evaluates the ways in which lunacy investigation law powerfully shaped the management and care of the mad in England. The focus is on the period 1700–1820. During this period, lunacy investigation law stood out as the most important among many formal responses to madness in two respects. First, the law of lunacy investigation viewed the wellbeing of the person and property of the lunatic as a priority. This point was reiterated and acted upon constantly by Lord Chancellors in lunacy trials throughout the period under study. Second, the possibility of recovery of those found to be non compos mentis was built into the structure of lunacy investigation law. In their verdicts and recommendations about guardianship arrangements and about the financial arrangements for maintenance, Lord Chancellors thus paid considerable attention to the manner of caring for the insane. Their long deliberations about the nature of madness and its proper form of management further contributed to this influence. The development of this outlook from the experiences of the chancery court was also shaped in part by the families of the insane who initiated court proceedings in the first place, often as part of a struggle over property.
The conclusion reiterates the main themes of the book, emphasising what is significant about the book in terms of both historiography and methodology. This study helps us to ‘get out’ of the asylum in our investigation of the history of madness – not because the asylum was unimportant but, rather, because the asylum’s long shadow becomes shorter, and more geographically specific, when one is able to uncover pre-asylum understandings of and responses to madness that continued to thrive long after the asylum’s introduction. This study also helps to establish the importance of civil law in the response to madness over a considerable period of time in a transatlantic context. The conclusion also draws attention to the continuing relevance of the relationship between civil law and the consideration of mental capacity and guardianship as evidenced by the United Nations’ recent declarations about the rights of people of unsound mind.
The survival of a continuous run of documents relating to lunacy investigation law in New Jersey allows for a closer analysis of the dynamics of family members seeking redress by lunacy trial, as well as a more in-depth consideration of how concepts of madness and mental health were affected by the development of lunacy investigation law. In New Jersey, the legal process itself had direct effects on conceptualisations of madness. Moreover, a host of popular understandings of madness can be gleaned from the testimonials of the lunacy trials. These popular views about madness were partially shaped by the encounter with lunacy investigation law, but were also clearly part of much older traditional beliefs and practices. In New Jersey, the legal records demonstrate the primacy of this law in negotiating responses to madness well into the nineteenth century. The accounts of relatives and neighbours of the insane offer the historian a rare window onto practices around madness that did not necessarily form part of formal medical or institutional responses. These records also show how informal traditions of understanding and caring for the mad intersected with both legal and, later, institutional responses to madness.