History of Nursing TK Indrani
Chapter Notes

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Historical Developments in NursingOne

  • History of Ancient Period
  • Early Christian Era—feudalism
  • Medicine and Nursing 500-1500 AD
  • Middle Ages
  • Woman of Renaissance and Development of Nursing
  • Changing pattern of nursing
  • Image of the nurse
  • Current status of nursing
  • History of Nursing India
Definition of History: Continuous record of important public events, past events, and study of these is called history.
Nursing has come to mean many different things to many people today.
Most people still think of nursing as only caring for the sick or assisting the doctor in care and treatment of patients. But it is more than that.
Definition: Nursing is the process of recognising, understanding and meeting the health needs of any person or society and is based upon a constantly changing body of scientific knowledge.2
Definition of Health: The WHO definition health is a state of physical, mental and social well being and not merely the absence of disease of informity.
History shows that nursing always developed more rapidly in a society where women were given greater freedom and that it is also closely related to development in the medical science.
Nursing in Prehistoric Period
Prehistoric main interest was in the mysteries of life, birth, disease and death.
His life was simple. He lived close to nature and soon associated spiritual values to natural objects.
Prehistoric man believed that a thing in nature like tree or river had a spirit or soul. Such a religion is known as Animism.
The things in nature became friends or jobs according to main ability to control them. Water and trees were friends, while storms and poisonous plants were enemies.
This leads to a form of worship. They thanked friendly things for their help and tried to make peace with the unfriendly.
Diseases appeared to be associated with sorcery, magic, breaking a tatoo and bodily invasion by a spirit.
To get rid of these evil spirits dwelling in the body, the body had to be made unpleasant for them. Thus starving, beating and nauseous medicines were used. Loud noises, magic, trites and ceremonies and sudden fright were also tried.
If the evil spirit was thought to live in a special part of the body, holes were made to allow it to escape.
In the excavated graves of prehistoric man skulls with holes made by Trepanation have been found (Trepanation—cutting a circular hole with saw have been found).
The ‘medicine man’ was one who paid close attention to signs and symptoms and he knew what to do in some 3conditions. He attracted attention by wearing strange costumes, using magic words and queer procedures.
As his influence increased he took up the role of priest—Pretending to understand and control the forces of health and disease. In this role he was known as the ‘Priest-physician’. His word was law.
Magic: While magic was used to attract good or helpful spirits. While black magic was used to drive away evil spirits or to bring harm to ones enemies.
From the primitive man's belief in evil spirits they soon come to think that disease was caused by their failure to please the gods or by their sins.
This idea still exists, even among highly civilized intelligent people.
Role of the Nurse in the Care of the Sick
From the time of the first mother down to the present time. We find women protecting and caring for their children, aged and the sick members of the family.
Nursing evolved as an initiative response to the desire to keep healthy as well as to provide comfort to the sick.
This was reflected in the caring, comforting nourishing, cleansing aspects to the patient.
Knowledges of these simple skills were passed down from generation to generation. Tenderness, concord, love and hope were expressed in the simple remedies. Thus, empirical practices in nursing evolved.
Empirical means based or acting or observation and experiment. Not on theory.
The art of healing began thousands of years ago. With the 4primitive man trying to provide relief in sickness and suffering motivated by feelings of sympathy and kindness.
The causes of diseases he thought were the anger of gods invasion of the body by evil spirits and bad influences of stars and planets.
The medicine he practised consisted in pleasing gods by prayers, rituals and sacrifices, driving out evil spirits from the human body by noise or violence and using charms and amulets to protect himself against them.
Medicine was intermingled with superstition, religion, magic and witch craft. The practices of primitive medicine are still practised in many parts of ths over civilized world today.
In the most primitive setting, the nurturing efforts and independent role of the nurse in response to survival needs were directed toward keeping people healthy as well as comforting the sick resulting in empirical practice.
  1. A New Textbook for Nurses in India by The Board of Nursing Education Nurses League—Christian Medical Association of India (South India Branch) Ed 1991. Printed at Rajan and Co, Printers 1,  Goomes Street, Madras - 600 001. 
Ancient Culture and Practices of Health Care
Ancient cultures are:
  1. The Sumerians
  2. The Babylonians (New Iraq)
  3. The Persians (New Iran)
  4. The Ancient Egypt
  5. The Ancient Hebrews
  6. The Ancient Americans
  7. Incas5
  8. Ancient India
  9. The Ancient Chinese
  10. Ancient Japan
  11. The Ancient Greek
  12. The Ancient Romans
  13. The Irish Cults
They lived 5,000 years ago. They workshipped evil spirits as gods and built temples to them. The medicine man became priest physician who stayed in the temple.
They had a well-developed system of writing. During this Sumerian Period, medicine changed from witchcraft to craft (Technique as hot applications). Sumerians wrote the prescription on day tablet.
They believed, illness was caused by sun and anger by god. Temples became centre for medical care. They brought the sick and obtained advices, diagnosis and treatment of diseases. Their treatment consisted of giving better concoctions, in order to drive away the evil spirits from the rich persons. The team approach was used to treat the sick persons.
  1. Physician directed the treatment
  2. Nurse carried out the case
  3. The pharmacies prepared the medicine
  4. Along with this spiritual care was also given.
So, the Babylonians believed that sin was the causes by anger of god.
Persians were a group of Iranian tribes. Their religion at the time was Zoaras Tronums founder of this was “Prophet Zoraster”.6
The Parsees in India are discendants of the Persians. They believed in “evil spirit theory of disease”. Their holy book is called Avesta. This describes ceremonial rules of laws for birth and death.
After a persons death body was fastened to the roof of a special high tower called “Tower of silence”. The birds picked the flesh, bones, dropped to the pit below the tower.
The Health Care
Three types of practitioner came out of their medical centres:
  1. Those who heal with the knife
  2. Those heal with herbs
  3. Those with holy words
The oldest medical record we have come from Egypt. They date back to 1600 BC. The records were written on “Papyrus Paper”. One of the best known of this was brought in 1974, by Dr Ebers of Germany. It is known as “Ebers Papyrus”.
Egyptian thought medicine was though to be divine origin.
One of the outstanding priest physician was “IMHOTEP” means who came up in peace. He was well-liked by people, because of his kindly personality and his success in healing the sick. Temples were centre of healing process.
The Egyptians believed in life after death. They developed an art of “Embalming and bandaging” (dead body to preserve it). Such as Embal body was known as “Mummy”. From these preserved body, the disease that existed at their time and the treatment has been gained.
Women in Egypt of high rank become priestesses in the temple. Some of them assisted the priestesss in casing for sick mother and daughter nursed the sick in their homes.
Egyptians—prohibited dissection of the dead body.7
The best source book of the history of Hebrews, is the Old Testament of a Bible. Many rules and regulations in regard to social and religious customs, healthy, sanitary practices are compiled into, what is called the Mosaic code. This code presents, a systematic organised method of practice of disease. It includes principles of personal hygiene to rest, sleep, cleanliness, hours of works and special rules for women. Principles of public hygiene and sanitation regarding food, disposal waste of excrete and garbage, isolation, quarantine disinfection and reporting of communicable disease.
Isolation keeping some diseased person separately, quarantine supporting the disease will be disappeared, we have tendencies to spread to others. So, they are kept separately, and reporting of communicable disease.
The high priest was “priest physician” and health inspector. Houses of hospitality, forerunner of inns, hotel and hospital. They practised excellent hospitality, visiting and caring for the sick was religious duty. A nurses role includes a midwifery.
Before Columbus discovered America, a highly developed culture fluorished there. There were many different groups but much is known about Mayas, Eucas, AZTECS.
The priest was the medical advisor and pharmacists. They practised sweatbath. The AZTECS were war like group ruling central America. They also practised sweatbath and human sacrifice to cure diseases.
Incas empire was located in Peru in America. They were skilled engineer at supervision bridges. They practised “Trephin ring” (Making hole in the skull to cure disease) and applied cramial bandage skills.8
They also believed diseases were caused by anger of God. Disease gift to the God were in the forms of “Effigy”.
The Incas also practised “sand painting” to cure the disease.
Sand painting, applied to the sense of right. Prayerful singing to the sense of hearing the sweet smelling herbs, to the sense of small, and the herbs to be eaten to the sense of taste, faith on the part of the patients. In addition to their technique, they also practised “Hydrotherapy” (bringing down the temp down) in to the healing ceremony.
The chinese doctors used systematic methods of diagnosis like our modern doctor, the Chinese doctor's slogan was look, listen, ask and feel.
Among the Chinese doctor “Sen lung was known as father of medicine in China and an authority of an internal medicine. The Chinese doctors practised “vaccination” as earlier 1000 BC. They used “sea weed” to cause thyroid conditions and chaul moogra oil for curing leprosy. As earlier as 13,000 AD physiotherapy was also used, as part of treatment. They recognised disease such as “Syphilis and Gonorrhoea”.
They also had halls, near to temple where the sick prayed for healing hygiene was important, bathing and wearing cloths were advised and practised. Tea drinking was an ancient precautions in China, against intestinal infections. The chinese believed when disease due to the evil spirits in the patients. Thus nursing was impossible and this faith also prevented the progress of medical progress.
Japanese, copied Chinese system of medicine. They developed the art of Acupuncture. Today, it is a highly specialised branch of medicine, practised all over the world.9
The earliest records of Indian medicine is found in the sacred book of Veda especially “Aur-VED”. “Sushruta” was known as the Father of Surgery in India. He lived about, 1400 BC.
Wrote on internal medicine from these two persons writings, surgery had advanced to a high level, doctors and attendants (nurses) must be people of high moral characters, hospitals were well-equipped and larged.
King—Emperor Ashoka
He was the first person to improve the medical care in India.
King Ashoka, built monasteries and houses for travellers and hospitals for both men and animals.
Prevention of disease became the first important thing. Hygenic practices were adopted, i.e. people must wear clean clothes, should keep their nails cut and short. The women after delivery should live in rooms, which are clean and well ventilated. The nurses were usually men or old women.
By 1000 AD superstitions and magic replaced by modern medicine. Medicine remainded in the hands of the priest physicians. Dissection was forbidden. All this things let to a decline in medicine.
The early Greeks believed in medicine of divine origin and was represented by many God, e.g. Apollo, the sun God, the God of health and medicine. Asklepios, the God of healing, Hygenia, the Goddess of health. Temples were built for these gods. People come here, not only to worship the God, but 10also to get treatment for illness or disease. Incubation was practised during illness.
Medical treatments included special diets, massage, bath, “Inunciation” (rubbing medicine on skin).
The uncleaned patients like delivered lady and dying patients were not allowed to come in the temple or remain throughout. In 1070 AD special buildings were erected for their patients. They were regarded as the first “Europeon hospitals”.
Hippocrates was known as Father of Medicine. He was born about 460 BC. He spent much time absorbing symptoms and thus was able to teach, that evil spirits did not cause disease. But it was due to nan's dis-obedience to the laws of nature.
Prevention of diseases, dependend upon obedient to the natures law and this was the begining of scientific medicine. Hippocrate developed, ways of doing physical examinations and of taking histories. He stressed fresh-air cleanliness, good diet for health. He gave instructions about hot applications, poulitices cold sponging for fever.
Fluid for kidney diseases and mouth washes. He stressed loyalty to one's profession and responsibility for those depending on us. This is expressed in “Hippocratic OATH” used in medical schools today.
The Caduces
Insignia of medical profession is one of the gifts from Greeks, i.e. symbol is associated with “AESCULA PEUS” of Greek mythology.
The “The CADUCEUS” is one of the gifts from Greek. It is composed of the staff intewined with serpents. This staff indicates the traveller, the intertwined serpents signify Rejuvenated, knowledge and wisdom. The Epics (tip) of the 11staff, are two wings of mercury (God of Greek) for speed, with which a physician should act.
Romans copied much from Greeks (system of medicine). Many physicians were Greek slave, who did not believe in Roman superstition. The early hospitals in Roman were built for soldiers and slaves, old women and men of good character did the nursing. In the ruins of Poempeis.
Many instruments, similar to our modern surgical, scapel, forceps speculum were found.
Many of these, Irish people were migrated of non Europe and brought with them the richness of art, music and literature. They practised moist, heat in treatment, believed attending to the peace of mind and patients.
  1. A New Textbook for Nurses in India by The Board of Nursing Education Nurses League—Christian Medical Association of India, South India Branch (Ed) 1991. Printed at Rajan and Co, Printers 1,  Goomes Street, Chennai. 
Changed from witchcraft to craft
Wrote the prescriptions on day tablet
Team approach was used to treat the sick persons
Holy book of Parsees
Tower of silence
Outstanding Priest physician of Egypt
Developed art of Emblaming and bandaging
Embral body was known as
Many rules and regulations in regard to social and religious customs, health and sanitary practices are complied into what is called the mosaic code
Trephining and applied cranial bandage
Sand Painting
Ancient America
Look, listen, ask and feel
Chinese doctor
Father of Medicine in China
Sen Lung
Which country practised 1000 BC
The chinese doctors practised (vaccination) as earlier as 1000 BC
Father of Surgery in India
Father of Internal Medicine in India
The first person who improved the
Medical Care in India
Which country first practised incubation during illness
Ancient Greek
Father of Medicine (Greek)
Developed ways of doing physical examinations and of taking histories
The Iusignia of the medical profession is one of the gifts from the Greeks
They practised moist heat
Irish cult
Acupuncture practised
Write short notes on:
  1. Caduceus
  2. Emperor Asoka
  3. Hippocrate
1 AD to 500 AD
1 AD to 500 AD Pre-christian times was influenced by various religious beliefs they accepted diseases as punishment.
Jesus Christ brought a new aspects that of Altruism (thoughtful interest in others).
Christianity tought that kindly service to humanity, without any hope or reward. Followers of Jesus Christ took upon themselves the care of sick and poor.
From early Christian Era, we have a continuous record of history of Nursing.
The church thought equality in men and women—assisted the clergy in the work of church. In the time, three were orders of women developed.
  1. Deconesses (Those who are doing religious teachings)
  2. A second order of widows
  3. The virgin
  1. Deconesses did teachings and preachings and cared for their sick in their homes.
  2. A second order of widows also assisted—deconesses with home visiting.
  3. The virgin are the younger women, assisted in caring for the Church Testaments and giving out alms to poor.
One of the outstanding early deconesses was Phoebe.14
Phoebe is known as the forerunner of modern public health nurse.
The deconesses order, disappeared after 4th century. Widows and virgins interested in religious works went to monasteries as nuns.
Early Christian Hospitals
Early Deacons and Deconnesses practised hospitality. They opened their homes to the poor, sick and any one in need. Private homes, which did these type of hospitality is known as DIA KONIA.
As time went on Jesus was prosecuted. Many who were poor, sick turn to the Bishop of the Church for help.
The Bishop home was too small to meet the demands of hospitality. So additional rooms and shelter were added. This was called xenodochia. In this all types of relief work was carried out, e.g. hospitals for the sick those with leprosy, home for strangers and orphans, aged and the travellers.
The Roman Matrons
In Rome, women of high rank, had much freedom. As Christians they become interested, in works of charity and nursing. Some of the wealthy women formed a organised group used their wealth to found monastries and hospitals. The well known among them was Marcella, Fabiola, Paula.
She was the leader of this group. She had palace in best part of the Rome. She turned it into a Monastry. This was the first monastry in Rome.15
Under the influence of Marcella, Fabiola become a Christian.
She made a public confession of her sins and gave her wealth and energies for the care of the sick and poor.
She turned her home into the first free Christian Hospital in Rome. She gathered the sicks from the streets and devoted her life to giving them nursing care.
Paula was a friend of Fabiola. She was wealthy and very intelligent.
When her husband died she entered Marcella's monastery and there she became a Christian. About 385 AD. She and her daughter, Eustochia, went to Palestine and settled in Bethlehem. Here she built hospices (place of shelter for travellers) and hospitals for the sick. She and her staff did the nursing. She established a monastery in Bethlehem and gathered a group of devoted women. After her death, in 404 AD her work was carried on by her daughter.
During the life time of these famous woman many changes were taking place. A new religion had been introduced and the Roman Empire was beginning to weaken. Marcella had introduced a new type of organization—the Monastery under which men and women found self expression and work out side their homes. These monasteries became heavens for many who lost their homes when the empire was destroyed by the Barbarians.
Early Middle Age is a dark age in the history of nursing. This era began with the fall of the mighty Roman Empire.16
Barbonic tribes invaded Rome in 476 AD and brought about the final disorganization of society.
During, this time, the Roman armies were disbanded. Roads and bridges were destroyed. “Roter hands” crowded the high-ways, making travel unsafe. People's homes were destroyed or taken over by the Barbarians turning many homeless.
Roman authorities shifted the capital from Rome to Constantinople. Due to this change in the capital, many of the aristocracy left for constantinople.
Many of those who have to remain, turned to the Monastries for help and protection.
According to the self needs of the time. Three protective units developed:
  1. The Monasticism
  2. The Feudalism
  3. The Guilds
Monasticism means life, rules, conditions of monasteries.
Monasteries where priests or nuns lived. The monasteries increased in size and facilities and new rules were set up to meet the needs of changing society.
As time went on, many of the monks and nuns proved themselves to be exceptionally good organizers and administrators.
One outstanding monk was St. Benedict of Nursia. He encouraged all his neighbours whether Pagan or barbarians, to become Christians and to work together in hormony. He also built a monastery on a rocky mountain top between Rome and Naples called Monte casino. Monte casino grew to become one of the most efficient mediaeval monasteries. Here the Benedictine rule was developed to meet their needs. In addition to custo mary monastic vows of poverty, chastity and obedience vow of life long service was made. Men and 17women were allowed to live purposeful lives devoted to the kind of work they enjoyed. Men and women from all ranks and social classes were admitted to the Benedictine order. It became one of the most active organisations for social work.
Throughout the Middle Age the monasteries became the chief place for education, medicine and nursing. They gave medical and nursing care to travellers, poor and needy.
As the monasteries became wealthier they gained more freedom and political power. When they were critized they made their rules stricter. Many lost interest in the work when their freedom was restricted. As a result between the 9th and 10th centuries the monasteries went into decline.
Feudalism and Chivalry
Following the fall of Rome, much of the agricultural land was controlled by a class of gentlemen farmers. The homeless turned to these landlords for protection. Thus, an ancient system known as feudalism, but modified by Christian ideals came into existence along with monasticism.
In feudalism the king owned all the land. He gave portions of the land to his favourite subjects who were barons, earls or knights. These grants of land were known as a fief or feud in Europe and a manor in England.
The Baron divided his land among many serfs who worked on the land in return for food, shelter and a form of protection. Since, there was no standing army the landlord might call on the serfs to leave the land and serve in his army when necessary. The serf had very little freedom. If the land was sold he became the serf of the new owner. Petty quarrels among the knight took place and kept the serfs from the land. This resulted in famine and disease.18
The training of the knight, which become known as “chivalry” stressed service to others, protection and defence of the weak. Every true knight came to believe that service to God came before service to his earthly lord, chivalry was the accepted code for living a good life.
This was the first organization of workmen and tradesmen who were not attached to monastic or feudal groups. Divided into three categories these guilds protected the worker, the products and the public.
In the guilds apprenticeship method of learning a skill was stressed higher standards of work encouraged, unethical practices were checked and social insurances including sickness insurances were followed.
This guild apprenticeship method have been followed in nursing and medical teaching for many years. Also the guild was the fore runner of the modern labour unions and professional organisations.
Special Care of Mentally Ill
The first organised plan for the care of mentally ill and retarted children was found in Greece, Belgium. St Dymphma had been made the Patron saint of mentally ill people.
Medieval Hospitals
There were three famous medievel hospitals built out side monastry walls which are still in existence.
  1. Hotel—Dieu of fyons in France.
  2. The Hostel Dieu of Paris
  3. The Saints Spirito Hospital of the Holy Ghost in Rome.19
Islamic and Arabic Medicine
A new religion arose among the nomadic people of the Arabian Reninsula. Mohammad the founder of Islam, was born in Mecca in 570 AD said he was called by Allah, to preach a new religion. Each convert was called a Mosleum or one who submits this religion spread fast and they conquered lands.
While so doing they learnt many things from other cultures and about medicine from the Greeks.
Islam did not allow surgery and dissection and so medicine did not progress. Mosleum women were absent in the care of the sick and were kept under ‘Purdha’.
As the early Middle Ages ended in spite of poverty, confusions and political unrest the church had grown. Christianity had spread, hospitals and institutions have risen. Islam and Arabic medicines contributed a lot to the development of medicine and nursing.
Nursing at last had developed roots, purpose, direction and leadership.