[Pictures of Nursing: theZwerdling Postcard Collection]

[Jeffrey S. Reznick, Ph.D.] Before we proceed, I'd like to mention

that our next History of Medicine Lecture will be held on Wednesday,

October 8th here in Lister Hill Auditorium. In recognition of Hispanic Heritage Month,

our own Michael North, who's head of NLM's Rare books and early manuscript section,

will be speaking on early Latin American medicine in the NLM's collections.

As I mentioned, this is a very special occasion as we celebrate the opening of our newest exhibition,

Pictures of Nursing, this Zwerdling postcard collection at the National Library of Medicine.

This project encompasses a special display open here at the NLM until next August,

a future traveling banner exhibition, a rich online presence with education resources,

and a digital gallery highlighting 585 postcards from NLM Zwerdling collection

of postcards about nurses and nursing. Before I introduce our speaker,

I'd like to acknowledge the presence of a few individuals in the audience

this afternoon. Doctor and Mrs. Lindbergh, welcome. Thank you for making time in your schedules.

Also would like to welcome Lieutenant Colonel retired Judy Harger and

Lieutenant Colonel retired Donna Owen. Welcome. Thank you very much for making

time in your schedules. Tours of Pictures of Nursing will follow this lecture,

as will a modest reception in the main lobby of the library. This is in the adjacent building.

For those of you who aren't familiar with our facility, everyone is welcome.

And if you're not familiar with our facility, please look for our colleagues from

the division who will will direct you accordingly through the hallways. One additional note please.

We ask that you not eat or drink here in the auditorium due to the very

sensitive equipment in front of you. Thanks very much. And when we do enter the question

and answer period after our lecture, we ask please that you use the microphones in front of you.

The button will indicate the microphone being on or off. When it's on,

the little red light will appear. So our speaker for today, Doctor Julia Hallam,

who studied at the universities of Glasgow and Manchester before receiving

her doctorate from Kings College, the University of London. Currently she teaches in the

Department of Communication and Media at the University of Liverpool, a place that by definition has

to be cooler and less humid than where we are today. [laughter]

[Julia Hallam:] That's absolutely true, right?

Doctor Hallam's research interests focus on issues of cultural representation and identity and film,

television and popular culture, with a particular emphasis in recent

years on issues of film and place, she has led three arts and Humanities Research Council funded

city and film related projects, and she's contributed to the development

of the history detectives gallery at the New Museum of Liverpool. Based on this work,

she's published widely as an author, co-author,editor and a co-editor of many books,

and among these is her monograph entitled Nursing The Image, Media,

Culture and Professional Identity, published by Rutledge. Doctor Hallam is also a

contributor to several journals, from the Journal of British Cinema

and Television to the European Journal of Cultural Studies and the Journal

of Organizational Change Management. Most recently, she has co-editor of a book

entitled Toward Spatial Humanities, Historical GIS, and Spatial History, which is.

Published by University of Indiana Press just this year, Doctor Hallam is the guest curator

for the wonderful exhibition that we are celebrating today, which is itself largely based on

Doctor Hallam's work on professional identity and popular culture. Please join me in thanking Doctor Hallam

for working with us here at the National Library of Medicine and for welcoming her here today

to offer us her presentation, Pictures of Nursing : the Zwerdling Postcard Collection,

and introduction to the collection. Thank you very much. Pleasure.

[applause]

[Dr. Hallam:] Hello everyone, a very warm welcome. Thank you for coming to this opening

celebration of an exhibition of postcards of images of nurses collected by Michael Zwerdling over

many years of effort and acquired by the National Library of Medicine,

where they're going to be available for you to explore for many years to come.

Today, I want to explore with you some of the delights in insights this exhibition has to offer us.

With a particular focus on popular culture and the ways in which, what I call 

"the popular imagination" has visualized nursing and nurses from ancient times.

Reflecting the breadth of images and the collection and the ways in which particular historical

events such as epidemics, wars and important milestones in nursing's professional history.

Are commemorated and celebrated in popular art.

Before I do that though, I want to thank those who have made this

wonderful collection available for us. Michael Zwerdling , of course,

whose vision created it initially. But from my perspective,

it is Patricia Tuohy and her team in the National Library of Medicine who

invited me to create the exhibition, and her colleagues Dan [?] and Jiwon Kim

will offer particular support during our long distance curatorial activities.

All of this curating activity has been done online and through e-mail,

and I've had a great experience, the first I've ever worked so extensively

electronically with this team from the National Library of Medicine. So I do hope that you're very

proud of the people that work here and the kind of work they're doing for the history of medicine.

I would also like to thank everyone who's contributed to creating the resource, translators,

educators and last but not least, of course the designers who've

realised our vision in creating an exhibition which shows off the

postcards often deemed unimportant. Ephemeral art objects at their very best. During the talk,

I will be referring to postcards from the exhibitions throughout,

alongside some additional material to illustrate particular ideas.

I'm not attributing academic references to particular ideas as I go along, 

but if anyone would like further information on the research underlying the paper,

please use the website and check out the bibliography under educational resources.

And feel free to get in touch and ask me any questions that may come to you after this talk.

And I've put my email there on the slide,

so please, please do feel free to contact me. If you have any questions.

Just going to go live online now and use the exhibition digital

display just to start us off so you can see what exactly is on offer.

[screen navigation]

I'm just going to scroll it down a bit so we get it central right.

OK, so you can see how we've organized the

exhibition around a set of particular themes. I'm going to now scroll it,

which I think is a great feature of the digital galleries.

So it's going to scroll so you get a sense of these images as I'm talking. The postcard, of course,

is a very fleeting art form, and one that in the age of electronic communication,

e-mail, Twitter, selfies, Flicker and Instagram looks ever more anachronistic.

Who amongst us still sends postcards? Anyone that can't see you now,

I can see a couple of hands. So I'm cheered by that and I still like to send a postcard.

But for much of the 20th century, the postcard actually enabled a form

of personal communication that kept people in touch with each other.

It was quick and easy to say hello without having to write a full length letter.

In the US, this funding of postcards can be traced back to 1841,

but it's not until the 1870s that pictures were used. And it was another 20 years before

a private companies were allowed to print images on the postcards. Thus,

it is the late 19th century that sees a huge rise in the popularity

of sending postcards, with what is often termed the Golden Age of Postcards

lasting until the 1920s. The collection consists of cards

from the 1980s through to the 2000s,

covering over a century of art images and of photographs of

nurses in almost equal measure. Graphic images with nurses and nursing

were produced commercially for a range of purposes to advertise commercial

products and give them healthy credentials. You can see a couple here as we're scrolling along,

not one there at the moment, but advertising commercial products,

certainly you can see when we move to the digital gallery that we've sectioned off, in fact,

let's do that. The ways in which you can explore the exhibition.

So if you go into browse and the digital gallery.

And then search refine by topic.

It gives you first of all showing the

images from advertising and you can see some of the range of images that were used

to advertise particular goods and services, most of them of course, health related.

So the nurse is a symbol of health, good health. And this dates back to

nurses in ancient times, and I'll say a bit more about that in a minute.

In selecting the cards then I've wanted to communicate a history of nursing.

That placed it in the context of rapid changes in society and gave

birth to modern professional nursing and the gendering of the profession

in these early years as female. I want foreground the influence of 19th

century white middle class Christian women. The ways in which they took their

vocational mission to many corners of the world and the effects of this image

of modern nursing had on men and on non European women and men in terms of

their professional status and identity. Today I want to take the opportunity to

embellish the stories on the banners with a little more historical detail.

Our time is limited and I've had to be selective and talk about nursing in general,

giving too little attention to particular areas of nursing such

as public health nursing, private duty nursing, and particular groups within nursing

such as African-American and male nurses who have often pioneered,

changes in the profession. Please forgive me, I hope you will all be inspired to use

the collection to explore all these areas in more depth using the gallery

to browse and explore the images.

I want to turn now to my own involvement in this process.

My perspective on nursing is unavoidably coloured by my own identity as a white

British woman from an aspirational working class background who trained

as a nurse as a teenager in the early

1970s at Liverpool Royal Infirmary. The training school at the Infirmary

was the first provincial training school in the United Kingdom.

It was founded in 1865, two years after St. Thomas' School in London,

by one of Florence Nightingale's first pupils, Agnes Jones. As you can see,

Agnes Jones in fact died of typhus at the age of 35,

demonstrating just how difficult and dangerous it was to become a nurse.

In the 19th century. Our training as nurses was very traditional.

We worked long hours on these wards and these wards were actually built

in the 1890s as a replacement for

the old infirmary and in part were built as a testament to Agnes Jones

and her work in establishing the School of Nursing in Liverpool.

This was female medical ward in my day,

which is only 1972 believe it or not.

It's not not back in 1911 and I'm not a wonder of medical science.

It's in 1911, so in 1972 and we lived in an all female nurses home.

We were discouraged from marriage until we qualified and studying was undertaken

in annual study blocks on the wards. The rest of the time we trained

in practices and procedures under the watchful eyes of the sister tutor,

sister tutors were the name given

to our educational supervisors. If you look carefully at the images here,

you'll notice the work nurses are wearing particular kind of hat and you look at their uniforms,

well, I thought it would amuse you just to see me in the early 1970s.

The only difference in the uniform is it's got shorter sleeves and shorter hems.

Other than that, we were still wearing basically the same uniform that nurses

were wearing many years previously. And of course, we were very proud of our uniform.

The history of nursing in nursing schools at this time

was a history focused on Florence Nightingale and her inspirational,

vocational approach to nursing.

But 1970s Britain was in many

ways in turmoil. And part of the turmoil was being

caused by a strike within the NHS by nurses and nurses were striking

for better pay and conditions, and we were thrown into the turmoil of nursing politics,

debates about vocationalism versus professionalism and influence by

second wave feminist campaigns for equal rights and status in society.

We began to question the gendered nature of nursing. As a profession,

there was one man in my training group and our own lowly position

in the healthcare hierarchy. Years later, armed with an undergraduate

degree and offered a PhD bursary to study for my doctorate,

and I wrote my thesis on image identity and nursing. And it's this book, in fact,

which led me here today because it was this book that Patty found and

used as the basis for her invitation. So thank you "book" because "book"

you brought me here today. And this book's available is ecopy, I should say.

If anybody wants to look at it or get hold of it, it is available in ecopy from Routledge.

You don't have to actually buy it anymore.

OK, today then, we know that the nexus of social class,

race and gender formations that structure our everyday lives affect

the life chances of every one of us, which is what calls sociologists call

our cultural and educational capital. For women and men becoming nurses at

the beginning of the last century, the structuring forces of

inequality in society were far more extreme than they are today. In Britain, for example,

only men with property rights and money could vote, a situation that was addressed here

by the 15th amendment of 1870, although I think again, it only affected some

members of the community, and in both countries women were denied

voting rights and becoming increasingly vocal in their demand for representation.

So nursing then is very much caught up with this period of change

at the turn of the 19th century and the beginning of the 29th.

And if we just look at some of the achievements of nurses during that

period and what we might think of as

the first phase of professionalization.

Mrs. Bedford Fenwick in Britain was advocating the registration of

trained nurses and legislation that would enshrine nursing's professional

status in law.  Activities more adhered

by the Association of Nursing [?]

formed in 1897 and the Association of Superintendents of Training Schools

for Nurses and at that time Nurses of the United States and Canada,

founded in 1893. And I've given you some key names

of people that were involved in finding these organizations. In the 40 years since the opening

of the first sorry in the 1st 40 years since the opening of the first

Nightingale training school in London, modern nursing had made remarkable

progress worldwide. By the 1900s, nurses were being formally admitted

to the armed forces in Britain and the US and playing an important

role in the Red Cross. And there are some very interesting images

of military nurses in the collection. And I'm pretty sure that these are the earliest ones.

Led by pioneering women such as Florence Nightingale,

Dorothea Dix and Jane Delano,

the idea of nursing as a professional vocation captivated the imaginations

of young women not only in Britain but around the world.  Prior to

Knightingales intervention, most nursing care being undertaken by members

of religious orders such as the Alexian Brothers, yes a group,

a male nursing order founded in the low countries in the 13th century.

So we actually have a much more established history of male nurses than we do of female nurses.

The Sisters of Charity, the other religious order known to look

after the poor and give them nursing care. The first trace I could find

of that was around 1600.

There's a commemorative window to the Sisters of Charity at this particular

church in Gettysburg because, like other nursing orders,

they served both sides in the Civil War.

Male nurses, of course, were found undertaking duties in prisons,

asylums and the armed forces, but little is known about their early history.

Ancient Mediterranean classical texts talk of

care attendance without reference to gender, although the goddess Hygeia,

daughter of Asclepius, the Doctor of Medicine, is often regarded as a mythological

forerunner of the female nurse. Because of her associations with physical and

mental health and the prevention of disease. There's some very interesting collection

of slides of Hygeia in the collection, and some of these she holds the serpent.

This one here she's heard holding a serpent,

and this particular card is for a hygiene

convention in Vienna around 1900. The second card I think is a

little bit more ambiguous. Some people interpret this as a lamp,

and we can see here it looks slightly like a

magic lamp and actually could be rubbing it.

But perhaps this is the serpent and certainly this nurse combined this.

I'm calling her a nurse and I'm calling her a nurse, actually, partly because she's wearing wings.

She's presented to us as a ministering Angel as well as Hygeia.

And the card is actually to support a campaign against tuberculosis,

for which this particular cross becomes

the symbol of the tuberculosis campaigns.

Tuberculosis was rife in cities across all

all industrial cities around the world. It was a major this is one of the kind of

first World Health Organization problems where there was some coordination around

the world to try and tackle tuberculosis.

By the 19th century, many Protestant orders had founded hospitals to care for the sick,

such as the influential Lutheran Deaconess Institute at Kaiser Worth in Germany,

where Nightingale and other notable 19th century nurses such as Dorothea

Dix spent time in training. Although Nightingale is remembered for today

for her contributions to nurse training, it was, as I'm sure everybody here knows,

her journey to the Crimea, in 1854, and her attempts to reform the

care of the injured and improve the sanitary conditions in the British

Army which made her famous in her day. Nightingale was a prolific letter

writer and I've just been looking at a couple of letters held here

in the collection where she wrote letters constantly, the equivalent of an email lobbyist

I think today.  She lobbied members of Parliament in Britain about the appalling sanitary

conditions in the British Army and used the power of the press to get public support behind her.

It was a Times' journalist who first refers to her as her as the lady with the lamp,

which is of course the other common name given to Florence Nightingale.

In an article about the Crimean War, an image which captivated Victorian middle

class readers and led to Nightingale establishing a training school for

nurses funded by public subscription. She really raised an enormous

amount of money for the her day. And this next image, I think, is interesting.

We can see part of the way in which she's envisaged as looking like Hygeia,

rather than looking like the more traditional of the nurse that we're accompanied, accustomed to.

And it's accompanied by a poem from Longfellow, which has become a famous

poem about the joy of service.

Let's fated in her day than Nightingale, but no less indefatigable in her work to improve the lot

of soldiers fighting in the American Civil War. Clara Barton

improved Army supply trains and coordinated volunteers to nurse wounded.

But perhaps Clara Barton's greatest gift to the American public was her

efforts to fund the American Red Cross, which she achieved in 1881.

The International Red Cross had a major influence on attitudes

towards soldiers injured in battle, so I'm sure many of you here know.

Inspired by Henry Dunant, a businessman, horrified at the human cost of war that he

witnessed at the Battle of Solferino in 1859, a committee was set up in Geneva,

Switzerland, that led to the creationof the Red Cross in 1863.

Dunant advocated a network of national relief organizations staffed by trained

volunteers that were provide neutral and impartial help to those affected

in times of war.  From the outset influential nurses such as Nightingale

were instrumental in lobbying for support for the Red Cross. The training of volunteer nurses

was fundamental to its success, and this cause was avidly taken up by wives and daughters around

the royal houses of Europe. And I've just selected just a couple

of the many images of European royalty dressed as nurses at this time. Worse, I think,

more research in terms of their effect on the Red Cross and the development of the Red Cross.

I was particularly interested in this one. This is the Czarina of Russia. This one here,

according to the postcard with her, the princesses, Tatiana and it is Tatiana,

not Titatio on the postcard. This postcard has actually misspelled her name.

And Olga.  And these three women worked serving the Red Cross, serving soldiers in war,

and one of their relatives actually gave up all her possessions and

entered cloisters to serve as a nurse. Of course, they all lost their heads just

a couple of years later as part of the Russian Revolution. So some very interesting

research materials here. I was also particularly interested in the Japans

involvement in the Red Cross at this time. The Red Cross in Japan was supported

initially by a count of one of the Japanese provinces who founded a relief organization in 1877,

and Japan became four members of

the Red Cross ten years later.

The idea of nursing as a spiritual patriotic duty had a great resonance

in Japan and led to the introduction

of western medicine and arguably the modernization of Japanese society.  And again,

there's some work now being done in this area, but it's a area that's rich, I think,

for further research and exploration. By the end of the 19th century,

modern nursing had become a worldwide movement, and nurses formed the First

International Association of Health Professions in the world.

the International Council of Nurses, in 1899.

So I think these were huge achievements and I think just

looking at what was achieved in that really short period of 40 years

by women who were determined to create change

in society is really quite inspiring.

OK. So I'm going to move on now to look at what underlies my approach to

this exhibition and I want to talk about the idea of nursing and it's

inspirational force at this time because without that inspirational force,

so much could not have been done.

You've probably, I think, come across something called The Cult of

True Womanhood in 19th century society. And at the core of The Cult of True

Womanhood, as it became known, is an image of femininity based on a

white middle class idea of respectability,

which had a huge impact on the way women of

that era thought about nurses and nursing. This, of course,

is an idealized notion of femininity. And it germinated in the nexus of social circumstances,

social relations, and social practices that accompanied

changing roles of women in the rapidly industrializing societies

of the US and Europe in particular. Industrialization created a new class

of wealthy women who were eager to aspire to the condition of ladies,

a mode of behavior and appearance designed to show off their financial status.

And define them as better and

more respectable than those of a lesser economic means and less

educational and social capital. 19th century popular culture was awash

with conduct books and magazines. They were like the celebrity journals of the day, if you like.

Instead of looking at "Hello,"  "People", or "Cosmo", or whatever your favorite

woman's magazine is, these conduct books were everywhere.

And ideas around the kind of poetry inspired by ideas about

womanhood were published. This poem from Coventry Patmore at the

"The Angel in the House," was published in 1854, and it's actually extremely long.

It's a short book, so I'm certainly not recommending

you read it unless you have a fascination for the language in

which it's worship of a particular kind of femininity is put,

but I've put it there so you can have a look and get the flavour of it. As you see,

the housewife here is envisaged as passive, meek, charming, graceful,

sympathetic, self sacrificing,

pious and above all morally and spiritually pure.

She was expected to be a devoted companion and submissive and obedient to her husband.

I think we all like the early bit, we're maybe not quite so keen these days on the later bit.

Queen Victoria of England in both a public and private life was

regarded as a model of this idea, adding to its popularity.  In the US

this image of white female middle class respectability was known as

the Cult of True Womanhood and was promoted in magazines and books. And one of the most famous ones

and my understanding of American popular culture is this one called

Godey's Magazine and Lady's Book, which was published for a long period

1830 to 1878 by somebody called

Louis A. Godey in Philadelphia.

Of course, this ethos of devotion to

home and family life was enshrined in ideas about woman's service to society.

Middle class evangelical Christian women were encouraged to extend the domestic

virtues of physical and moral cleanliness from the home into the public sphere

by volunteering to care for the sick in their own homes and offering their

services as nurses in charitable hospitals and institutions.

This work becomes known as "Women's Mission."  Nightingale's ideas

were therefore part of what the British cultural critic Raymond Williams

refers to as a structure of feeling in society at the time.

Today what we might think of as a "zeitgeist." It was a particular idea and people

really latched onto it and Nightingale exploited this feeling in her

entrepreneurial and fund raising activities. But this new image of modern nursing

also made visible of binary opposite an image of unreformed private duty nursing

and an image of the private duty nurse

as a drunken woman of slack morals.

A drunken lower class woman we should add. Sairey Gamp,

characterized by Charles Dickens in his serial Martin Chuzzlewit, is perhaps the best known,

and this is from an addition of not the cereal, but the novel published rival

later on in 1867, which I think gives us a wonderful picture of Sairey Gamp, here she is here, see.

These images appeared in various forms all

across 19th century British society. Cartoons, Toby Jugs and it's an image that

represents a fear of disease, contagion and a fear of the knowledge of

the physical work associated with nursing. In the collection we can see this

image was also applied to young women. Particularly young lower class women.

And this is the kind of cartoon image that would have circulated not only on

postcards but in magazines, newspapers, magazines like Punch in the UK.

In contrast, the idea of the nurse as a ministering angel emerges from

the cultural and social milieu of the cult of true womanhood. Nightingale's

pupils such as Agnes Jones,

who founded School of Nursing at Liverpool.

Oh, we've missed a slide, sorry. Trained nurses,

but also taught Christian morals and values to her pupils and patience.

By the end of the 19th century, the image of the nurse  the Ministering Angel is found across all manner

of popular art and entertainment, including stories, images and paintings,

poems as we've seen, and drawings. Angels become particularly associated

with nursing on the battlefields. Accomplished complex nexus of imagery.

That combines Christian symbolism and secular protection and martyrdom,

apparent in many images of army and Red Cross nurses attending the wounded on

the battlefields of the First World War. I've just selected 3 images

here which we haven't gone into depth with on the exhibition, but The Angel of Mons arises from

a British fable about nurses, sorry about angels on the

battlefields in France and angels were seen to appear to dying

soldiers and this term becomes attributed to the nurses that

are caring for the soldiers. The second card.

Mary Somers, the Angel of Antwerp. She suffered bayonet injuries as a

consequence of helping British soldiers to escape during the occupation of Belgium,

and these were severe injuries. She was really severely injured. Edith Cavell, perhaps will be

known to some of you. Edith Cavell, British nurse serving in Belgium, was killed by the Germans for

aiding Allied soldiers and buried with full military honours by the British state when that was later

on when they managed to find her body and rebury her on British soil.

I think this is a wonderful image of Edith Cavell. An angel, a martyr.

Queen Victoria was a patron of the British

Red Cross and related through intermarriage to royal families throughout Europe.

The ties between nationalism, the state figurehead of a woman, nursing,

and the image of a mother are aptly summarized in this quotation

from Princess Maria from Romania, who, like many female Royals,

served in the Red Cross in wartime. And I'm actually going to read this one.

Many a dying soldier whispered to me with his last breath that it was for

me he was fighting.  For was I not his home, his mother, his belief, his hope?

So perhaps these sentiments underline

the many images of the Red Cross as a

mother that we find in their collection.

In fact, the Red Cross in its promotional postcards often

announces itself as the world's greatest mother. So the image of the mother,

along with the ministering Angel, becomes one of the most common images

around in these early 19th century,

early 20th century images of nursing on the postcards.

So images then of feminine duty,

self sacrifice and the notion of a spiritual vocational mission

are harnessed to serve colonial expansion by all Western powers at

this time.  Before the First World War and arguably what caused the

First World War was the race to colonize territories in Africa,

and this led to the militarization of European societies.

Along with this militarization, Christian missionaries were sent to all parts of the world,

the missionaries combining teaching of the gospel with the founding of schools, hospitals,

and the training of nursing. This is 2 images, one of a European group of Belgian

instructors with students at a school in what is now known as the

Democratic Republic of the Congo, and the other of a group from what is

what's actually called the SPCK Foundation, a British Missionary Society whose

full name there is The Society for the Propagation of the Gospel in Foreign Parts

It's a bit of a mouthful, to say,

and this mission was very active in

China and a number of missions led in China.

The feminine ideal also had implications for the relationship between medicine and nursing.

19th century ideas of femininity permitted women to be active in the public sphere.

In areas designated as women's work. The hospital mirrored the organization of the home,

with the head nurse or matron looking after the housekeeping and ensuring that

patients were often treated as children --often treated as children,

were kept fed clean and nursed in a hygienic environment.

The idea of nursing as a white, middle class feminine idea had implications though for those who

could no fault of their own meet it. Although in theory anyone could be a nurse,

in practice if we look at the images of women in need across all countries

at this time in the collection,

it becomes very clear that actually it's

primarily white women that can be nurses. As medicine develops as a profession,

nurses are regarded as a potential threat to the autonomy of medicine.

Letters in the American Journal of Medicine, sorry, the Journal of the American Medical Association,

favorable and supportive of nursing in 1900 show a marked change in attitude towards nursing

by the 1920s. Doctors become keen to curb the role of the nurse,

not least because the cost of a private duty nurse was proving

very expensive for patients and eating into the doctor's fees.

Nurses were regarded at best as doctors helpers and doctors were keen to ensure

that the nursing field of operation was strictly restricted to non medical tutors.

This relationship of subordination to what was predominantly

at this time male medical power, was reinforced by social conditioning

and mirrored the views of society more generally. 

In children's books, games, stories and photographs,

the message is constantly reinforced.

In children's games, boys play doctors

or soldiers and girls play nurses. The message is repeated in popular

entertainment aimed at young people.

Female stars of stage and screen play

nurses while men are courageous soldiers

or handsome doctors.  In films, plays, career books for girls, and romance novels

of the first half of the 20th century. The idea about nursing is communicated

across all these entertainment forms is that

it's a role for well educated white girls.

I want to move on now then to the 1940s.

By the 1940s, the heroic work of

nurses and World War Two has created

a new awareness about nursing work in

a society sorry, I've slipped out of.

I think from my slides there, we're doing well to that point.

[organizing slide show]

I've got a slide that's not translated,

unfortunately, to the slide show,

which is another slide of military nursing.

Sorry about that flip, which hasn't transferred. We had some problems with the PowerPoint,

so I do apologize for this. But by 1940s, the heroic work of nurses

killed in World War Two has created a new awareness about nursing in society

and begins to change attitudes amongst the American public and the ways in

which nursing is valued as a profession. And these changes happened in both the UK and Britain,

and of course reinforced ideas of nurses of angels in the

UK the foundation of the National Health Service was founded primarily

on the provision of nursing labour. Our nurses are still the main employees

in the British National Health Service.

In the US, nurses win their battles for commissioned officers status.

In the US Army Nurse Corps, amid post war struggles for

equality within the profession itself. As we move into the 1960s,

television has become the most important source of information

and entertainment about nursing, and postcards are already declining in use.

Programs such as Doctor Kildare in the US and Emergency Ward 10

in Britain perpetuate romantic, sexy stereotypes about nursing. By the 1980s,

nurses began to lobby for better and more informed representation, with some results.

In the UK, a male nurse becomes a principal advisor on the BBC Drama Casualty and

a male nurse plays the leading role. Recruitment and male nurses in the UK rose dramatically,

over 10% within the first month of the program being broadcast.

So the power of the media should never be underestimated when it comes

to thinking about how it alters our perception of our public selves.

By the 1990s, nurses have made substantial inroads into

changing public perceptions of their image. Although the postcard is no longer

a major player it continues to play a role in recruitment campaigns.

And also in certain kinds of health campaigns.

Postcard stamps tend to be used along with postcards to commemorate the work of nurses.

We've got a number in the collection, but I've just included the most recent one here.

This is a British post office Millennium Tribute to the NHS to the nurses of the NHS,

which you'll find at the bottom of the slide. Other cards on the slide show that

the image of nursing has changed considerably in the last 30 years.

Nurses are no longer regarded just as angels and handmaidens

today recruitment images and many other images in popular culture.

I think [?] had a bit of a role here. Shows men and women of all classes

and races working together as equal

members of the health care team. Thank you for your attention.

I hope you've enjoyed the presentation and that I've encouraged you to

explore this very rich collection. And I'd like to open the floor to questions.

So perhaps we could have some lights and I can see people's faces. It's very odd speaking to you all

in the dark. I'm used to seeing people when I speak to them.

So thank you. Well, thank you.

[applause]

[silence]

[?]

[Ken Koyle:] Thank you Dr. Hallam. I really enjoyed your presentation

[Julia Hallam:] Could we add that volume a bit?  [Ken Koyle:] Patrick, have you got OK, there we go. So thank you,

enjoyed the presentation very much. My question is about the the transition of the,

the perceptions of nursing you mentioned that with the kind of the the the advent of television.

The image of the wholesome handmaiden uh kind of devolved

into in some cases comedic or less

wholesome perceptions of nursing. Was that just crass commercialism

or was there something, something in of a deeper social nature

do you think that was driving that that change and then the the subsequent change where

the nursing profession gained more respectability in more recent years?

[Julia Hallam:] I think a lot of it has been crass commercialization actually, particularly in relation to

some of the films about nursing. If we look at the 1930s, for example,

we can see there's a whole rash of films that are very complementary about nursing.

And as we move into the period after the Second World War, these continue with our censorship

relaxes in general and we enter a more permissive society in the 1960s.

The images certainly get racier on the innuendo that

we see on cards from an earlier period becomes more explicit,

and I think that goes along with a

general shift in society as a whole towards a greater sexualized image.

Sexualization of women's image, which certainly becomes more apparent

in British and American societies in the 50s with the start of Playboy

and these kind of pinup magazines. Marilyn Monroe Classic pinup

before she becomes a film star, but never, to my knowledge, a nurse.

But of course many of these people are continue. This is not an image that's gone away.

I was looking at an image the other day. I don't know if people here have heard of Kate Moss,

the supermodel, but if you look online and put Kate Moss

and Richard Prince into your Google.

You'll find an image of Kate Moss dressed as a sexy nurse against

a background of a Richard Prince painting from I think the 1980s,

where Richard Prince took images from the fronts of novels and created

this collection of paintings based on

images of nurses from what were at the time, medical romance books, those sort of things.

Another huge influence in popular culture along with the kind of

Doctor Kildare effect was this whole image in romance stories of nurses

marrying doctors and they were again, it was always their gendered

relationship and this pattern, I think continues pretty

much until the 1980s. It was very prevalent in the UK,

certainly when I was nursing in the 70s. So yeah, I think crass commercialization

and it's another thing that nurses have had to work very hard and I

think to some degree being quite successful at beginning to combat and

challenge by presenting alternative voices,

making sure they have nurses on to staff TV shows, to advise on medical

serials and medical programmes. Our nurses, I think have become much more proactive in making

sure their voice gets out there. But they, you know,

they need to take that tip I think from their their nursing forbearers

back in 1900 at the kind of power of the media and what you can do

if you get the media on your side. Sorry, that was a bit lengthy.

[laughter]

[Audience member:] Thank you for coming all the way across town to NIH for this talk.

You mentioned that the use of postcards has been declining and understandably with

the electronic media that is that the case. But in the past has it been mainly campaigns

such as in public health awareness? Sorry, I can't quite hear you.

For the use of postcards in the past, I guess the use has been tied to

campaigns of some sort of nature, yeah.

Has there been any recent sort of movement

or a sort of a revitalization or has

that just been following the use of just transitioning to electronic medium,

the use of a postcard with nursing as a focus? Has that just kind of is that

continuing to be so?

[Julia Hallam:] I think others here who've been involved in more recent campaigns

would know more about that than I do. But I do think there's much more

emphasis today on the medical team so that they're much less likely to

focus on a particular individual. And of course,

the changes in uniform where in a lot of general publicity people would just

wear scrubs and they they're a medical, medical personnel, I think is much more a term

that you're likely to see. In those sort of campaign images, a bit like the one I showed

of the British NHS, you wouldn't really know around the that trolley who's who. But you know,

some of them are nurses and some of them are going to be doctors and some

of them are going to be perhaps other professional members of the team as well.

Does that, yeah, yeah.

[Audience member:] I was interested in your comment about the NHS and the role of nurses

in the NHS and I was wondering if you could expand on that a little.

[Julia Hallam:] And the NHS, when it was formed in the post war period in Britain,

was primarily formed because a group of young doctors,

junior doctors as we call them in the UK, were in favour of a system. They were all quite liberal

rather than left wing.  And the NHS was of course a liberal manifesto.

It was never a socialist manifesto. It was brought in by a liberal, it was imagined

initially by a liberal government and it was brought in by the

labor government and so that the junior doctors supported this. But there was quite a battle about

the roles in the NHS and who would do what and who would be what.

And the NHS did agree in the end to employ doctors.

But of course doctors are not the biggest employment group within the NHS.

There was a huge staff in municipal and charitable hospitals across the

UK that were already, as it were, in place who just became absorbed into the NHS.

But in the reality, looking back at history, for a lot of people working in

the hospitals and in the kind of associated district nursing services, those sorts of things,

very little actually changed apart from the fact that they discovered

that health was an unending need and so they employed more and more nurses.

Because they're cheaper than doctors to try and meet this need. And the role of the nurse then

expanded in Britain under the NHS in a way that perhaps it hasn't done in other countries,

but I wouldn't like to be too generalised on that. Does that give you sufficient?

[Audience member:] It's very helpful just a follow on questions. So do you have nurse practitioners as

well as registered nurses in the UK?

--Yeah.  -- And I just to. Expand a little bit,

the focus on health and the outcomes with the NHS seem to be better than

most other countries and so I'm curious about your thoughts of the

role of nurses in those outcomes?

[Julia Hallam:] Nurses within the NHS today perform a

whole range of expert nurse functions

or nurse practitioner functions which

some of which are diagnostic so you can, but if you are that kind of person

you're what's called an expert nurse and other nurses are practitioners in their own right.

We have teams and nurses now attached to general practice,

and those practice nurses actually give and monitor,

give injections to a whole range of minor medical activities.

And nurses have been responsible as well for NHS Direct. But maybe we could talk a

bit more about that later. I know the director had a

question he wanted to ask me so,

but we could talk at the reception.

[low audio] [Donald Lindberg:] Quiet and very trivial.

I heard in the UK, did the early airplane people claim that some of the folks on

the airplane were nurses? [?]. Passengers?

[Julia Hallam:] Umm, now you've got me trivial, but I'm not absolutely sure.

I know that many of the people that are on early airlines,

there was a lot of overlap in the role and those of us that aspired

to be nurses sometimes also thought we could easily be air hostesses.

And so there was a a good chance, and I'm talking 70s before air traffic was popular

to the extent it is today.  Though, you had a much better chance of becoming an air hostess if you

had a nursing qualification. That was absolutely true. And and so some of us had that little notion,

ohh, when we qualify, you know, we'll become Flyers. So you're not wrong.

But it wasn't a specific requirement. It wasn't one of those kind of spelt out requirements,

but it was definitely something that helped you get the job at a time when

the job was much scarcer than today. [Donald Lindberg:] Advertising. [low audio level]

[Milton Corn, MD:] As this evolution occurred in the one you're described here today,

what were the major changes in the education and training of nurses period? [low audio]

[Julia Hallam:] I think the major changes again, I'm going to have to talk from a UK perspective here because I'm

not totally familiar with the US context.

I don't think the major changes

came in until it was decided

probably about 1990. I'm not, don't quote me on the dates here

because I'm not 100% sure and I haven't looked at this for a while,

but the major change would be the introduction of a more college based

education and that happened I think. No, I'm wrong. It would have been in the probably early 80s.

I think I was one of the last groups of people to go through a

nursing education that was primarily based in practice and based on the wards and not in a college.

And then after that nursing degree started to become popular and my sister, for example,

did a combined practice nursing degree and spent two years training in a hospital,

two years with the university. Doing a degree.

But these were not integrated courses. Integrated college courses tended

to focus more more time in college,

less time on the wards and then slowly we move towards something called

Project 2000.  And Project 2000 aimed

to have nursing education become

completely university based and and now we've just entered that phase I think,

where nursing for the first time is a completely university based

profession so you won't be able to practice as a nurse from about

now unless you have a degree. But again my dates on that are not not 100% secure.

Sorry, I'm going to connect you. I can't quite.

[Audience member:] [low audio] Yeah, I do. As a comparison

[Lieutenant Colonel retired Judy Harger:] Yeah, I do. As a comparison

between the UK and US, I first went to nursing school at the University of San Francisco.

Now mind you, it was a Mercy Hospital nurse based program.

Diploma program. They started their

program for the baccalaureate in 1958. So when I got there into 1960,

you had the entire diploma program from the nursing aspect, from the Mercy Nuns,

and then they dumped the Jesuit university education on top of it.

So we were in the hospital like 5:30 in the morning doing the Mercy nun,

end of the diploma, and we were in school all the rest of the week.

And then I ended up in 1964, so a bit ahead of you, in that.

OK, I'm I'm an old nurse.

I'll go back to my OK. But it sounds like it was a bit earlier in the university system for the US.

[Julia Hallam:] I think the Diploma program preceded

the degree program and was taken up by certain universities across the UK.

But it wasn't everywhere. And again it was only those privileged

kind of universities, probably like kings, that had nursing traditions.

Edinburgh, I think was another one, Manchester, another one that actually began

that program and it was quite slow I think to develop and catch on and

again it was seen as something that you wouldn't really do or know about.

It wasn't pushed from school to my knowledge or given that kind of,

but whereas in the US it was quite different. I think it was introduced much earlier

and there was an expectation and it was introduced as a science subject

rather than a social science subject, which again is a big difference between

the way it was introduced into universities I think.

[LTC (Ret) Judy Harger:] We were talking about the cultural,

cultural view of nursing. Just as an aside on that, there were 200 nurses at the University

of San Francisco in a male school, which was male at the time. Entirely male. --Yeah.

--So it where did the dating center come straight down to the nursing program

where we lived in nurses residence halls. You know, it was, it was quite interesting and fits a

lot of what you were saying about the UK and the perspective of nursing and, you know,

that's where the best girls were kind of thing.

[laughter]

[Dr. Reznick:] Doctor Hallam, thank you very, very much.

On behalf of the NLM, we really appreciate all that you've done, especially your curation

of our great exhibition. I'd like to invite all of you to join

us for a modest reception in the main lobby. Look for our colleague Jeremy

Withnell and just outside the doors here and he'll guide you.

If you're not familiar with the building, doctor Helen, thank you very much.

Thank you everybody for coming.

[applause]