‘Naval Hospital, Haslar, near Portsmouth: view from right. Coloured aquatint with etching by J. Wells, 1799, after J. Hall.’ by J. Revd. Hall. Credit: Wellcome Collection. CC BY
Note from Stephanie: Hello everyone and welcome to the second of our 3-part series, based on a panel presentation given this past spring at the Canadian Historical Association annual conference in Regina, SK! You can read the first paper of the series here. Today’s essay comes to us from Erin Spinney, who will be discussing how the Digital Humanities help tell the stories of nurses who served in eigtheenth-century British naval hospitals. This year’s CHA was the first time I really had an opportunity to learn about Erin’s work, and it is truly fascinating and immersing research. Enjoy!
In the last quarter of the eighteenth century, Plymouth Naval Hospital employed over a thousand different women as nurses. Some like Honor Palmer, spent more than fifteen years of their lives, nursing in the service of the state. These women were part of the everyday fabric of the naval institutions and provided crucial medical care, ensured the cleanliness of hospital wards, and helped to enable a healthy healing environment through ventilation. Unfortunately, these women have been largely forgotten in nursing and medical history, or when they do enter into historical narratives, it is often to contrast the ‘superior’ practices of post-Nightingale nursing in the late-nineteenth century. For instance, American nursing leaders Lavinia Dock and Adelaide Nutting described the seventeenth to the mid-nineteenth century nursing as “the darkest known period in the history of nursing,” when nursing had “sank to an indescribable level of degredation.” (1) This description, intended to bolster the professionalization efforts of the new Nightingale nurses, would continue to frame the historiographical depictions of pre-Nightingale nurses throughout the twentieth century until the present day. (2)
Digital Connections
Such longstanding historiographical narratives disguise the diversity of care roles in eighteenth-century naval hospitals. I believe that one reason for this is the difficulty of accessing nurses’ individual lives. Bringing the stories of these women to light is no easy task when nurses’ voices remain depressingly hidden, only available through state documents, medical officers, and hospital administrators. Digital humanities and pay-list prosopography have enabled a greater understanding of how the number of nurses responded to epidemics and battle casualties, while a core nursing staff with upwards of ten years of experience remained relatively stable. Nurses have been silent yet omnipresent entities; new methodologies and a re-examination of source material allow their stories to come to light.
Prosopography, also known as collective biography, allows for the study of the common characteristics of a particular group, in this case nurses. Specifically, I created a database of over 1400 nurses employed at Plymouth Naval Hospital from 1777-1800 using pay list ledgers. (3) Naval pay lists indicate start and end dates for employment, sick leave, and other biographical information, of all individuals employed at the hospital. Using Structured Query Language (SQL) queries I analysed the careers of specific nurses, periods of paid and unpaid leave from service — including sick days — for the entire nursing staff, and the effect of increases and decreases in staffing levels as the hospital responded to military needs. I merged conceptions of nursing practice found in regulations and medical treatises with case studies on individual nurses. (4) This approach allowed me to dispel common perceptions of eighteenth-century nurses as drunkards, to highlight the long-term employment of nurses, and to illustrate how nurses were valued or remunerated for specific skills.
Importance of Nurses to the State
Figure 1: Number of nurses at Plymouth July 1777-October 1788
Figure 2: Number of nurses at Plymouth November 1788-December 1799
These two graphs show the fluctuation of the number of nurses per month at Plymouth Naval Hospital from July 1777 to December 1799. There is a sharp reduction following the end of the American Revolutionary War in 1783 and a reduction in British Naval operations. To save money, naval officials were particularly concerned with maintaining the smallest hospital, dockyard, and supply expenses possible. (5) When the French Revolutionary War started in 1793, there was a corresponding jump in the number of nurses: from a peacetime footing of 27 in February 1793 to 75 the following month. (6) Similarly, the aftermath of major naval battles like the Glorious First of June in 1794 also resulted in jumps in nursing numbers. As the number of patients in the hospital increased, so too did the number of nurses to care for them. When Governor Creyke was appointed in July 1795, hiring practices should have reflected the 1:10 ratio of previous instructions. However, the ratio of nurses to patients from the available reports between 1795 and 1799, and 1804, show that actual ratios of nurses to patients fluctuated between 1:4 and 1:9. (7) The fewer patients each nurse was required to care for would also, in theory, mean a better quality of care to the sick and injured, helping return them to their ships and the British war effort faster.
Retention of nurses could have been due to a multitude of factors: the skill they possessed, a belief that patient numbers would increase again, or the request of physicians and surgeons. For example, Dr. Geach requested that an additional nurse be employed in the 55th Ward in October 1795. This request had seemingly been approved by Creyke as he notes in his Private Minutes and Memoranda book: “Sent to the Steward to know why an additional Nurse had not been employed in the 55th Ward when Dr. Geach had represented her services were required.” (8) Following the Steward’s reiteration of “the standing regulations of the Hospital no more than one nurse is allowed to 10 patients,” Creyke directed that a nurse be taken from another ward in order to fulfil Geach’s request. (9) Furthermore, each of the 1804 Reports carry the phrase “The Extra Nurses kept by desire of the Physicians & Surgeons,” as rationale to the Sick and Hurt Board for the pay of nurses in addition to the regulated ratio. (10) This connection is also seen when nursing numbers responded to increases and decreases in the number of patients.
Although the number of nurses and other hospital staff was principally tied to the number of patients in the hospital and the needs of the Navy, other factors including stealing, drunkenness, misconduct, malpractice and disobeying orders could result in nurses’ discharge and the need to find a replacement. Letters to the Sick and Hurt Board indicate that intoxication was the primary concern of naval hospital management towards nurses. (11) For example, a report from Deal in 1780 proclaimed that “the Hospital Nurses have been frequently drunk & that they have made it a common practice to carry Spiritious Liquors into the Hospital which the Serjeants have taken from them.” (12)
Discharges and Discipline
Unfortunately, it is impossible to determine how many nurses were discharged or docked pay for drunkenness using pay lists alone, since they do not contain the reason for the pay lost or discharge. Yet, matching the information found in the pay lists with Creyke’s journals reveals not only how many nurses he reported as either drunk or accused of bringing liquor into the hospital, but also makes it possible to infer why certain nurses were discharged for their offences while others were simply docked their pay. Length of a nurse’s previous employment in the hospital and times of increased patient numbers were more likely to mean a decision to dock pay rather than discharge the nurse.
Discharges for drunkenness commonly occurred during a time of staff reduction, suggesting that if these women were liable to be drunkards early in their service it was only after the needs of the hospital and State had diminished that it was deemed necessary to discharge them. Sarah Ravencroft, for example, was discharged for “repeated drunkenness,” on December 24, 1798. (13) She had been working at the hospital for more than a year since December 2, 1797, without her pay being checked. (14) Yet, by December 15, 1798 the number of patients in the hospital had fallen below 570 for the first time since November 17th. (15)
Figure 3: Sarah Ravencroft’s nursing career at Plymouth Naval Hospital, 1797-1798.
Without digital methodologies it would be extremely difficult, if not impossible to contextualise the work of individual nurses, like Ravencroft, through their mentions in letter books, and Crekye’s journal. It would also be impossible to determine whether the types of discharges for drunkenness and improper behaviour discussed above represented the norm rather than the exception. Prosopography instead gives us a picture of the whole nursing workforce and highlights the connections between nurses, the navy, and the interests of the state in both peace and war.
Erin Spinney completed her PhD, “Naval and Military Nursing in the British Empire c. 1763-1820,” at the University of Saskatchewan in April 2018. She is currently an Associated Medical Services Postdoctoral Fellow at the Wellcome Unit for the History of Medicine, University of Oxford. Her postdoc project integrates Napoleonic Era Royal Navy hospital ships into a study of naval medicine as a system of care, through HGIS mapping.
Notes:
(1) Lavinia Dock and Adelaide Nutting, A History of Nursing: The Evolution of Nursing Systems from the Earliest Times to the Foundation of the First English and American Training Schools for Nurses, Volume I (New York and London: G. P. Putnam’s Sons, 1907), 499.
(2) Abel-Smith; Bullough and Bullough, The Emergence of Modern Nursing; Christopher J. Maggs, The Origins of General Nursing (London & Canberra: Croom Helm, 1983); Josephine A. Dolan, Goodnow’s History of Nursing, Eleventh Edition (Philadelphia and London: W. B. Saunders Company, 1963); M. Patricia Donahue, Nursing The Finest Art: An Illustrated History, Third Edition (Toronto: Elsevier Press, 2010).
(3) “Plymouth: pay lists, 1777-1779,” The National Archives UK (TNA), ADM 102/683; “Plymouth: pay lists, 1780-1781,” TNA, ADM 102/684; “Plymouth: pay lists, 1782-1784,” TNA, ADM 102/685; “Plymouth: pay lists, 1784-1788,” TNA, ADM 102/686; “Plymouth: pay lists, 1789-1794,” TNA, ADM 102/687; “Plymouth: pay lists 1794-1797,” TNA, ADM 102/688; “Plymouth: pay lists 1798-1799,” TNA, ADM 102/689.
(4) Sue Hawkins, Nursing and Women’s Labour in the Nineteenth Century: The quest for independence (London and New York: Routledge, 2010), 9-10.
(5) Letter, “Charles Middleton to Admiralty,” 1791, draft, NMM, “Letters from Charles Middleton to the Admiralty Office,” MID/2/54.
(6) “Plymouth: pay lists, 1789-1794,” TNA, ADM 102/687.
(7) NMM, TRN/3; “Return of Officers at Sick Quarters, and Men received in, or discharged from the Royal Hospital, at Plymouth between 6th of January and the 13th of January 1804” and “Return of Officers at Sick Quarters, and Men received in, or discharged from the Royal Hospital, at Plymouth between 13th of January and the 20th of January 1804,” and “Return of Officers at Sick Quarters, and Men received in, or discharged from the Royal Hospital, at Plymouth between 20th of January and the 27th of January 1804,” and “Return of Officers at Sick Quarters, and Men received in, or discharged from the Royal Hospital, at Plymouth between the 7th and 16th of March 1804,” and “Return of Officers at Sick Quarters, and Men received in, or discharged from the Royal Hospital at Plymouth between the 23d of March and the 30th of March 1804” ADM 1/3534.
(10) “Return of Officers at Sick Quarters, and Men received in, or discharged from the Royal Hospital, at Plymouth between 6th of January and the 13th of January 1804,” TNA, ADM 1/3534.
(11) Instructions for Royal Naval Hospitals at Haslar & Plymouth, 204; “Remarks made on an Examination of the Royal Hosptial at Haslar,” 17 June 1794, NMM, ADM/E/45; “Sick and Hurt to Richard Creyke,” 14 August 1795, NMM, ADM/E/45; “William Yeo to Sick and Hurt,” 28 March 1799, TNA, ADM 1/3533.
(12) “Proceedings of a Regimental Court of Enquiry held by order of Major Travis Marsh as Deal 20th Feb. 1780,” enclosed in “Admiralty to Commissioners for Sick and Hurt,” 10 March 1780, NMM, ADM/E/42.
(13) NMM, TRN/3, 163; TNA, ADM 102/689.
Thanks for joining us for the second installment of our CHA panel series! We hope you enjoyed it. If you did, please consider sharing it on the social media platform of your choice! And don’t forget to check back on Sunday for our regular Canadian History Roundup. See you then!
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