Medical Jobs

World Health Day 2020

The Role of Nurses and Midwives in History

I wrote this article to celebrate the 70th World Health Day, which stands under the motto “Support nurses and midwives”, with you.

Today nurses and midwives make up more than half of the health workforce. They treat patients, work on their recovery and support them in palliative care – shortly they accompany us from birth to death.

But how was their job in the past? Well, it is pretty much the same today: Nurses and midwives did and do a great job but compared to doctors they are less appreciated.

I can proof that with a little experiment: Think about one famous scientist, inventor or doctor? I´m sure you managed to come up with a few names. Now, can you name a single famous nurse or midwife? To be honest, I could not before I wrote this article. That is a real pity as many contributed to medicine:

Nurses healed and cared for patients throughout history, treated wounded soldiers and became icons for caregiving. Midwives accompanied women through a very private and emotional event, birth; attendant the care of the newborns; treated women after giving birth. Furthermore, the witnessed the birth of royals.
So nurses and midwives played an essential role within society.


Till the 19th century nursing was religiously motivated and carried out mostly by nuns.

The first recorded Christian nurse was Phoebe and the first Muslime nurse was Rufaidah bint Sa’ad (early 7th century) -also known as Rufaida Al-Aslamia- a contemporary of Muhammad.

In medieval Europe monks and nuns ran hospitals, with some being directly attached to the monasteries. The Protestant reform in early modern Europe lead to the closing of many convents and hospitals. The nuns were sent home, often against there will.

Modern nursing began in the 19th century: One pioneer is Florence Nightingale, also referred to as “Angel of Mercy”, with her book “Notes on Nursing”: From her learnings in the Crimean War (1853-1856) she founded her training school at St. Thoma´s Hospital in London in 1860. The trained nureses were called “Nightingales” and with them her idea spread globally.

In 1901 New Zealand was the first to regulate nurses nationally with the so-called “Nurses Registration Act”.

It was especially WWI and WWII that drove the importance of and appreciation for nurses.

Serving in War

From the 19th century on nurses served in wars: They volunteered for the military and NGOs like the Red Cross. Their job was not safe: Some were wounded in action and even killed, which is a war crime considering the Geneva Conventions. For their service some were awarded, even with military metals.

US civil war (1861-1865)

Many women volunteered in the US Civil War to treat wounded soldiers. But two of them became particularly famous:

Dorothea Dix (1802 – 1887) was a teacher and ran a private school before the war but during the US Civil War she volunteered as a nurse for the Union Army, where she managed 6,000 women, who cared to wounded soldiers in Army hospitals. After the war she advocated for better treatment and care for patients with mental illnesses.

Clarissa Barton (1821-1912), a relative of Dix and a teacher like her, get the nickname “Angel of Battlefield” and was inspired to found the American Red Cross in 1881.

It is interesting that Mary Todd Lincoln (1818 – 1882), better known as First Lady, volunteered in Union hospitals as nurse too.

World War I

Grace McDougall (1887 – 1963) was a British officer of the First Aid Nursing Yeomanry (FANY). She was awarded British, French and Belgian medals: She and her crew of 11 nurses brought the wounded to a British war hospital. As Ghent was taken by the Germans and the British left, she stayed to care for the wounded, was captured by the Germans and managed to escape.

Edith Cavell (1865 – 1915) another British nurse was not that lucky: She helped Allied soldiers, was captured, put on trial and executed at the age of 49.

Helen Fairchild (1885 – 1918) descripted the life of combat nurses during WWI in letters to her family. During her service she was heavily exposed to mustard gas.

Vietnamese War (1955-1975)

Sharon Ann Lane (1943 – 1969) volunteered during the Vietnamese War. She was killed on-duty and so became an icon for heroism of nurses during war. Her death supported the public outcry to end the war, in which 7 other US military nurses died on-duty.

Midwives -it´s (almost entirely) a women´s world

Midwifery is one of the oldest and typically female jobs: Early records can be found in the Old Testament of the Bible and the so-called “Westcar Papyrus” (1700 BC).

One of the first midwives is Agondice (4th century BC): Born into a wealthy Athenian family, she dressed as a man to work as physician and she just revealed herself to gain the trust of her pregnant patients. Her existence is doubted by some classical scholars.

Agondice: The “first” midwive in history (4th century BC)

Till modern times midwifery was mostly a part-time occupation, which was done by women who had given birth themselves: Midwives were mainly called for help in complicate birth situations, otherwise older female family members did their job.

During the Middle Age European midwives have sworn an oath to live according to Christian ideology and they were allowed to do emergency baptism. If a child with a disability was born, they needed to report it.

The “Malleus Maleficarum” (“Hammer of Witches”) was written by the Catholic Henricus Institoris and published in 1486. Its description of midwives is not flattering at all:

“No one does more harm to the Catholic Faith than midwives. For when they do not kill children, then as if for some other purpose, they take them out of the room and, raising them up in the air, offer them to the devils.”

“Malleus Maleficarum” on midwives

This description lead to the execution of many midwives across Europe and in the US.

Witnessing the birth of kings and queens

The French midwife Louise Bourgeois (1563–1636), was chosen as midwife by the French queen Marie de’ Medici because Bourgeois had gained an excellent reputation as midwife at the Royal Court. Bourgeois assisted 6th royal births and was highly paid for her services: 500 livres for each boy, 300 livres for each girl plus a considerable pension. This is a very generous payment considering that the average income of midwives was 50 livres.

Better treated by a midwife than a physician

Even though in modern times physicians claimed that midwives were unscientific, it was preferable to get support by a midwife than a physician. But why? In 1847 Ignaz Philipp Semmelweis (1818 –1865) found out that women who were treated by physicians were about three times more likely to die from childbed fever than those treated by midwives. That was due the fact that many physicians did not wash their hands before treating women giving birth and so unknowingly infected them with bacteria.
Furthermore, till the 19th century physicians had little to no education in how to deliver babies and midwives were far more experienced and skilled in doing so.

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