INTRODUCTION
Nursing is one of the oldest arts and is an essential modern occupation. It began with the need to provide care and comfort to those suffering from illness and injury. It has been, therefore, as long as there has been life. Evidences support that nurturing is essential to preserve life. Survival of human race is an intertwined with development of nursing. Knowledge of general history is necessary as a basis to understand and interpret the changes which have taken place in nursing. The roots of medicine and nursing are intertwining and found in mythology, ancient eastern and western cultures and religions.
Knowledge of the profession's history increases the nurse's awareness and promotes an understanding of the social and intellectual origins of the discipline. From its earliest history, the nursing was a form of community service to protect and preserve the family. Historically men and women held the role of nurse. In prehistoric period, women were responsible for gathering herbs, roots and plants that were used to heal the sick.
PREHISTORIC NURSING
Myths, songs and other findings of the archeologists throw light on prehistoric man's care for the sick. It was believed that ‘evil spirits cause illness within the body’. Body was ill-treated by starving, beating, administering nauseous substances, beating of drums, magic rites and ceremonies and by causing sudden fright to get rid of evil spirit. Doctor cum nurse was the magic man.
NURSING IN EARLY CIVILIZATIONS (ANCIENT TIMES)
In Egypt
Medicine was thought to be Devine in Origin. Temples took place of hospitals and doctor cum nurse was the priest. High ranking women who became priestesses in temples played role of nurses. Mothers and daughters nursed sick at home. Sacred books were strictly followed by priest physicians. Egypt made progress in medicine and nursing, Egypt made progress in medicine, surgery and nursing though it soon declined for no dissection was permitted.
In Greece
Medicine was closely connected with religion. Apollo, the Sun God, was their God of healing; Asclepius, the son of Apollo, was the Greek God of medicine. Hygeia, the daughter of Apollo, for magical cures for their illnesses. Temples were also places for the treatment of sick and priest physician was in charge of them. Personal cleanliness, exercise and the dietetics were emphasized. Hippocrates, in 100 BC, known as “Father of Scientific Medicine” separated medicine from religion for the first time.
In Rome
There was proper sanitation, drainage and sewage system. Roman noble women cared for the sick. With the invent of Christianity, deacons and deaconess performed duties of nurses.
In China
There was an advancement in medicine and surgery. They had good knowledge of internal organs and knew about blood circulation. They practiced dissections, vaccination and physiotherapy. The sick were prayed for in halls of healing. Importance was given to cleanliness and hygiene.
In India
3000 BC
Ayurvedic system stressed hygiene, sickness prevention, inoculation against smallpox, sanitation, good ventilation, and kitchen, construction of hospitals, medicinal plants cultivation and suitable building for animals.
700 BC to 600 BC
Nurse attended the patient, cool headed and pleasant in his demeanor, didn't speak ill of anybody, was strong and attentive to requirements of the sick and strictly followed instructions of physicians. According to Charakha Sanhita: There should be resourcefulness, devotedness, purity of mind and body. Attendants of sick should have good behavior and should be distinguished for purity and cleanliness of habits. Nursing treatments prescribed were baths, enema, emetics, vaginal and urethral infusions, venesection, gargles, massages, rubbing or pressing limbs, etc. Nurse assisted patient to walk or move about, to make clean beds. Nurse should be skilled in compounding drugs and ever willing to do her work.
226 BC to 250 BC
King Ashoka built monasteries and hospitals for both men and animals. Doctors and midwives were to be trustworthy and skillful. They had to wear clean clothes, cut short nails. Operations preceded by religious ceremonies and prayers. Nurses were usually men or old women. Women cared for sick members in the family. Nursing of patients seemed to have been devoted primarily to men, great deal of unrewarded work. Qualities expected of nursing attendants were good behavior, purity, kindness and skill. Ashoka made provision for the education and training of women for that purpose.
EARLY CHRISTIAN ERA (1 – 500 AD)
Religious beliefs played a major role in building attitude towards the sick and mode of caring for the sick and their sufferings. Christianity believed in rendering services of love to humanity without any reward. Women assisted clergy in the work of church.
Deaconess
Originated from Greek word ‘diakonia’ which means ‘to minister’ or ‘to serve’ in both the material and spiritual sense. Women who were mature, gave teaching and cared for the sick in homes. Marriage was not prohibited, and they could live at home. Duties included clerical work in church, teaching, helping women converts, teaching in missions and visiting the sick. They have been called the first visiting nurses.
Widows
They assisted deaconess in home visiting. Freedom from responsibilities at home was a necessity.
Virgins
They were younger women, assisted in caring for church vestments and in giving alms to poor. They lived in their own homes, and received no pay except when necessary. Order of virgins was created when church felt that virginity was essential to purity of life.
Later, widows and virgins merged into group of nuns, certain things were common:
- Wore usual dress of women, later dressed more uniformly.
- Lived in own houses and many received allotment from church.
- All members were enrolled for church service.
5Phoebe was the first deaconess, intelligent, educated who could care for the sick in their homes. She can be compared to a modern public health nurse.
Fabiola was the daughter of a great Roman Noble. She converted her palace into hospital, first Christian hospital in Rome, collected the poor and sick from streets and cared herself, in her palace.
Paula was the friend of Fabiola, devoted herself for the services of sick. She built hospital for strangers, pilgrims and travelers and for the sick, constructed monastery in Bethlehem.
Marcella was wealthy woman. She was able to lead a group of high-rank women and induced them in works of charity.
MEDIEVAL ERA (500 AD – 1500 AD)
The period between 500 AD and 1500 AD is generally known as “Middle ages”. The Roman Empire broke-up. The seat of the Roman government was shifted from Rome to Constantinople. The medical schools appeared in Roman times disappeared. The practice of medicine reverted back to primitive medicine dominated by superstition and dogma. Consequently, there was no progress in medicine or surgery. The Medieval period is, therefore, called the “Dark Ages of Medicine”.
‘Altruism’ taught that sincere love for God and a desire to be like him, would be the chief motive for one's selfless and sacrificial service to the mankind without hope of reward. It inspired men and women opened their homes to the sick who were called “Diakonia”.
- Monasticism: Monasteries became chief place for education, medicine and nursing. Monks and nuns worked as doctors and nurses. They were skilled in the use of home remedies. They got scientific knowledge in care of the sick from books in monasteries. Monasteries did ground work for the development of universities, gave medical and nursing care to travelers, poor and needy. Women found freedom to develop ideas and skills in monasteries. They became wealthier, gained more freedom and political power. Monasteries when criticized, made rules stricter and many lost interest in the work. Between 9th and10th century, monasteries declined.
- Military Nursing Orders: During the middle ages, a religious movement known as the Crusades, took place. There was mass movement of devoted people who left their homes under the leadership of soldiers and Knights to Jerusalem to rescue the tomb of Jesus Christ from the muslims. In order to render medical and nursing care to the sick and wounded, two military orders were formed:
- Order of knights of St John of Jerusalem
- Order of knights of St Lazarus
The nursing orders brought discipline and unquestioned obedience into nursing. They rendered excellent nursing service. The traditions of the order of St John live today in the St John Ambulance Corps. The order of St Lazarus specialized in the care of leprosy patients. In short, nursing was greatly enriched with and strengthened by these military orders. - Medicant and Secular Nursing Orders: Medicants were travelling monks. They gave-up their possessions and lived with the poor. They earned their livelihood by manual labor or begging. They were all inspired by the religious teachings of Jesus Christ. St Dominie and St Francis of Assisi were well-known monks, and each had large number of followers. The followers of these monks took vows of chastity and obedience. One of the activities was giving nursing care to the sick. They formed various religious and non-religious orders for providing nursing care.
MODERN ERA (1500 – 1850 AD)
Dark Ages in Nursing (1500 AD – 1850 AD)
- Renaissance (14th to 16th century): New ideas in art, architecture and literature developed. Reformation (1517): Revolt against feudalism and power of church over nonchurch matters.
- Industrial revolution: Change in manufacture of goods from production in homes to factories. Many left country to settle near factories. Children used to go to work for long hours to help family in earning livelihood.
- Unhealthy living conditions: People lived in crowded, unhygienic/unsanitary conditions. There were illness, poverty and suffering.
- 6Hospitals: Hospitals were needed more than ever. Hospitals were influenced by politics. Lay people who lacked religious motive, were hired to care for the patients. There was no isolation of patients. Doctor did most nursing duties like changing sheets, doing dressings and giving medicines. Servants did bathing, care of excreta.
- Nursing: It included mostly cleaning and scrubbing. Nurses were poorly-fed, over-worked and treated badly. Nurses lacked in skills and morals. Women of refinement and intelligence didn't take-up nursing.
Renowned Nursing Personalities of the Time were:
Saint Vincet De Paul (1576 – 1660 AD): Born in little village of Pony, France, went to Rome. He educated poor boys, brought food to hungry peasants and attended the sick, founded confraternity of charity for women (1617): Visiting Nurse Association. He exhorted wealthy women to seek God through works of charity, comfort of food and care in sickness to prisoners. He founded night shelters and workshops for idle beggars. Purposes were to reform the clergy, conduct missions among the poor people, body relief to the poor and sick while providing spiritual welfare. He was Founder of Daughters of Charity (1633AD):First organized group to make practice of nursing sick in their homes. Now it is called sisters of charity. Training period was 6 months to 1 year and consisted of:
- Exercise of prayer and spiritual life in order to teach poor.
- To attend to needs during illness.
- Dressings of sores of poor.
- Serving and cooking.
- Moral training for themselves.
Elizabeth Fry (1780 – 1845 AD): Famous for work among prisoners. Founder of institute of nursing sisters in 1840. Worked for sick poor. Became interested in terrible conditions—both physical and moral—that existed in prisons.
Florence Nightingale (1820 – 1910 AD): The era of modern nursing commences with the work of Florence Nightingale in the Crimean war. She was born on May 12, 1820. She belonged to a well-to-do family. She felt that God had called her to a mission of Mercy and nursing appeared as suitable for her calling. In 1851, she went to Kaiserwerth, Germany, for her early nursing training. After leaving Kaiserwerth, she continued to examine the facilities at hospital, reformatories and charitable institutions. In 1853, she became superintendent of the Hospital for invalid Gentlewomen in London. During the Crimean war, Nightingale volunteered to go to Suctari, Turkey, where she organized a nursing department and devoted her efforts to eliminating sanitation problems in the wards (Fig. 1.1).
Nightingale's work make her popular with the men. They called her “The Lady of the Lamp”, in recognition of her Turkish candle lantern, which she carried through the corridors packed with wounded soldiers. After returning back to England after war, she established a teaching institution for nurses at St Thomas Hospital and at King's College Hospital in London. Within a7 few years after its foundation, the Nightingale School began receiving requests for nurses to found new schools and hospitals worldwide and Nightingale's reputation as the founder of modern nursing was assured. During her career, Nightingale concentrated on army sanitation reform, army hospitals and sanitation in India and among the poorer classed in England. For her efforts, Nightingale received numerous honors, including the Order of Merit from King Edward VII, Germany's Cross of Merit and France's Secours Aux Blesses Militaries. She wrote between 15,000 and 20,000 letters to friends and distinguished acquaintances. Nightingale was regarded as pioneer in the graphic display of statistics and was elected as the fellow of the Royal Statistical Society in 1858. In 1874, an honorary membership in the American Statistical Association was bestowed on her. Her writings, Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army (1858), Notes on Hospitals (1858), Notes on Nursing (1859), Notes on the Sanitary States of the Army in India (1871), and Life or Death in India (1874), reflect her continuing concerns about these issues. She worked into her eighties gathering data about nursing and healthcare. She died in her sleep at the age of 90 on August 13, 1910 in London.
HISTORY OF NURSING IN INDIA
- 1664–Military Nursing was started by East India Company in St George Military Hospital in Madras.
- 1854–Govt. sanctioned training school for midwives.
- 1861–Public health nursing school was started.
- 1867–St. Stephens hospital at Delhi was first one to begin training of Indian girls as nurses.
- 1871–First School of nursing started in Govt. General Hospital, Madras with 6 months diploma midwives program.
- 1890-1900–Many schools under mission or govt. were started in various parts of India.
- 1897–Dr BC Roy did great work in raising the standards of nursing and that of male and female nurses.
- 1908–TNAI formed to uphold dignity and honor of nursing profession.
- 1918–Training schools were started for health visitors and dais at Delhi and Karachi.
- 1926–Madras state formed the first registration council to provide basic standards in education and training.
- 1946–First 4-year basic Bachelor Degree program was established at RAK College of Nursing in Delhi and CMC, Vellore.
- 1947–After independence, Community Development Programme and expansion of hospital service created a large demand for nurses, ANM, health visitors, midwives, nursing tutors and nursing administrators.
- 1949–INC was constituted.
- Miss Andrenwala was appointed as Nursing Advisor to Govt. of India.
- 1959–the first master's programme in nursing was started at RAK College of Nursing, New Delhi.
- 1963–School of Nursing in Trivandrum instituted the first 2 years post-certificate Bachelor Degree program.
- 1985–IGNOU, established.
- 1986–M Phil at RAK College of nursing, New Delhi, was started.
- 1991–The first doctoral programme in nursing was established in institute of nursing sciences, MV Shetty Memorial College, Mangalore.
- 1992–Postbasic programme started under IGNOU.
- 2002 onwards–Nursing education flourished in an unprecedented manner throughout India.
- 2005-06 INC started PhD programme (INC consortium) with the collaboration of Rajiv Gandhi University with 25 seats.
- 2010–BFUHS, Faridkot, started PhD programme.
BIBLIOGRAPHY
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