In Nursing Civil Rights, Charissa J. Threat investigates the parallel battles against occupational segregation by African American women and white men in the U.S. Army.
As Threat reveals, both groups viewed their circumstances with the Army Nurse Corps as a civil rights matter. Each conducted separate integration campaigns to end the discrimination they suffered. Yet their stories defy the narrative that civil rights struggles inevitably arced toward social justice. Threat tells how progressive elements in the campaigns did indeed break down barriers in both military and civilian nursing. At the same time, she follows conservative threads to portray how some of the women who succeeded as agents of change became defenders of exclusionary practices when men sought military nursing careers. The ironic result was a struggle that simultaneously confronted and reaffirmed the social hierarchies that nurtured discrimination.
About the Author
Charissa J. Threat is an assistant professor of history at Spelman College.
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Nursing Civil Rights
Gender and Race in the Army Nurse Corps
By Charissa J. Threat
UNIVERSITY OF ILLINOIS PRESSCopyright © 2015 Board of Trustees of the University of Illinois
All rights reserved.
The Politics of Intimate Care
Gender, Race, and Nursing Work
The nascent reality of nurses as trained professionals found an audience amid the evolution of the medical profession during the 1850s in Europe and the United States. As the field of medicine became more sophisticated and developed—focusing on preventative care and not just healing—so, too, did ideas about patient care and who had the authority to provide and control that care. With "professionalization," medical authority became gendered. Society viewed men as having both the intellectual and physical capabilities necessary for the medical profession. In contrast, as the fairer sex, women were seen as fragile, weak, and lacking in the brain capacity necessary to successfully attend to medical emergencies. In addition, late-nineteenth-century Victorian notions of sexual propriety made such work unsuitable for women. The increasingly male-dominated medical profession strongly opposed women entering professionalized medicine, even as nurse leaders attempted to professionalize their occupation. In a 1904 address titled "The Nurse and the Medical Man" Dr. Casey Wood described the job differences between doctor and nurse as the "practice of medicine and the art of nursing" Doctors in the late nineteenth and early twentieth century agreed that the "success of the physician's treatment" went hand in hand with the help of a cooperative, loyal, and obedient nurse, but many doctors did not view nursing as a scientific profession, nor could they envision nursing as an autonomous profession. Exacerbating this viewpoint was the fact that until the 1870s, the hospital remained only a peripheral institution for the medical care of most individuals, a place most went to die, and nursing occurred primarily within the confines of domestic responsibility, as both duty and obligation provided by women for their families and neighbors. Therefore, as Dr. Wood's comments suggest, nursing performed outside of the home needed the careful and expert supervision of doctors to find success in the professional world.
By the turn of the twentieth century, nursing moved from an unpaid domestic obligation for "respected" ladies or paid labor employing undesirable women, to the paid occupation of respectable working women. As one of several "women's professions," nursing particularly attracted white, middle-and upper-class women, among whom the first training schools actively recruited. For these women, the opening of schools of nursing imbued nursing with a semi-professional status, one that provided nurses with "a type of public stature and power previously reserved for men." Nevertheless, nurses walked a fine line, one that meant reimagining nursing in a way that did not completely negate the domestic "art" vision many had of respectable vocations for women outside the home. Women began promoting this activity as both duty and responsibility to family and community, and late-nineteenth-century war and warfare provided the medium. Beginning with the Civil War, wartime exigencies allowed women to co-opt nursing as female work. Wartime relief work—exemplified most concisely with nurses—became the catalyst for change, particularly for white women. Military nursing, in particular, promoted the formalization of the nursing practice.
War and wartime experiences are entwined with the history and meaning of nursing in the United States. Here, what were understood as female obligation (caregiving) and male duty (soldiering) are juxtaposed with the reality of need. The history of the Army Nurse Corps (ANC) is rife with examples of how war complicates social, cultural, and economic beliefs and values that organized and informed American society. Just as military participation has historically defined citizenship and access to the rights that go along with it, military nursing also challenged notions of who had rights, the types of rights, and access to them through military service. A focus on the ANC and its nurses helps to illuminate the relationship between the military and civilian populace, revealing trends in nursing practices, debates about work, and concerns about war taking place in the larger civil society. In this sense, the transformation of nursing—from paid occupation in the late nineteenth century to autonomous profession within the medical field during the second half of the twentieth century—suggests not only that "gender informs work" but that work was transformed by "existing relationships of power and inequality" as well as changing social, economic, and cultural conditions.
War, Women, and Modern Nursing
In the fall of 1854, Florence Nightingale—an upper-class woman from an influential English family—lead a group of women nurses to the Crimean War front. The British assigned Nightingale the task of resolving the deplorable health and sanitary conditions that were crippling the British Army. Nightingale, who trained as a nurse against her family's wishes, challenged the popular images of nursing as uncouth work. Instead, she set out to "correct the evils in nursing," and starting in the mid-1840s trained and educated herself and others with this in mind. She believed that healthcare, in the form of sanitary knowledge rather than a medical degree, resulted in a healthier population. In many ways, Dr. Wood's comments about the "art of nursing" reinforced Nightingale's earlier vision of nursing. Further, Nightingale asserted that health encompassed not only diet but also cleanliness and environment; this was something that the medical profession was also beginning to recognize in the same period. The combination of all three prevented disease and ensured a quick recovery from ailment.
In late October 1854 Nightingale arrived in the Crimea to conditions that participants later described as the source of nearly three-quarters of the casualties suffered by the British. In the time between her arrival and the end of the Crimean War in early 1856, Nightingale's reorganization of British military hospitals throughout Crimea—including the institution of basic sanitary, dietary, and social services for soldiers—resulted in an astonishing overall drop in the mortality rate from 42 percent to 2.2 percent. Yet despite her success, particularly in advancing the idea that respectable women had a place within the medical profession, Nightingale and the nursing occupation faced large obstacles in the male-dominated medical community.
Most men, at least initially, resented Nightingale's meddling as an outsider and worried about the results of her intrusion. In what became a recurring theme into the twentieth century, female nurses—especially those who participated during military conflicts—had to contend with resentment from many male medical professionals, especially doctors, and anger over the possibility that women nurses would ultimately undermine military authority. Yet Nightingale's success during the Crimean War did champion nursing as a respectable female occupation, and her reforms became the foundation for the professionalization of nursing in both England and the United States. Nightingale's activities in the Crimean War enabled her to gain enough financial support to open the first nurse training schools for women in Britain, and although she warned women not to be involved in medical politics, she politicized and identified herself and women as the only authorities on nursing in the medical profession.
The experiences and work of Nightingale and her female nurses resonated with many in the United States. Adequate care for soldiers was a recurring concern for U.S. military officials with each successive conflict in American history since the Revolutionary War. Until the Civil War, however, the role of the nurse was unorganized, and nursing—especially military nursing—was a loosely defined occupation. Hospital and battlefield work was the domain of men. The role of the domestic caregiver, as nursing was traditionally understood, remained the purview of women. Throughout the Civil War, temporary volunteer or short-term staffing by men and women met all nursing needs in the military. This raised few questions, therefore, about either defining the profession of nursing or the parameters of nurse care. Nurses came from a multitude of backgrounds that included men, women, and minorities, as well as Catholic nuns and individuals from other religious orders, and until the late nineteenth century nurses were known by a variety of titles, including hospital stewards, nurse matrons, or surgeons' mates. Their duties included basic sanitary and domestic work such as housekeeping and ward keeping; they served as cooks or dieticians, and laundresses.
The evolution of nursing from volunteer obligation to paid work was a direct result of miscalculation in the first few months of the Civil War and the expectation of the conflict ending quickly. The unanticipated carnage during those first months of the war allowed for challenges to notions of gender- and class-appropriate behavior. Upper-class white women in the North, moved by a sense of patriotism and worry about loved ones, and working- and middle-class black and white women, realizing the possibilities of earning an income, joined military life among the Union Army through hospital and relief work. This work appropriated idealized constructions of women's morality and "natural" caretaking abilities and tested the restrictions or limitations of a woman's proper place. Women argued that their proper place was wherever their natural abilities were needed. The participation of women in nursing and hospital work during the Civil War also provided the foundation for co-opting nursing as a white, female, and middle-class occupation in the years following the war.
Two Civil War policies and structural changes directly influenced women's participation in wartime activities and furthered the evolution of nursing. First, in June 1861 the army commissioned the first superintendent of women nurses, Dorothea Dix. Already well known for her work with insane asylums, Dix had offered her services free of charge to organize military hospitals and supply female nurses during the first month of the war. Her services were accepted by the secretary of war (Union), and she became "responsible to select and assign women nurses ... in military hospitals, [where] they not be employed without her sanction and approval, except in cases of urgent need." In essence, Dix's commission as the first superintendent of an "army nurse corps" not only sanctioned women's presence in military hospitals but also defined the requirements of women who sought the title of "nurse" in public.
Under Dix's influence nurses were required to be "between the ages of thirty-five and fifty ... and [have a] 'matronly' appearance," while also displaying "good conduct, or superior education, and serious disposition." Dix's strict requirements reflected her belief that only middle- and upper-class women, educated and from good families, could serve in this capacity. The military and the white public concurred with Dix that only white women could meet the expectation of good conduct and respectability. While this was one avenue to gain official status with the medical department, women who did not fall into Dix's narrow parameters and wished to serve as nurses found other ways of doing so. Some women followed male loved ones, nursing with their regiments; other women joined relief organizations such as the United States Sanitary Commission (USSC) or were hired for domestic services and ultimately served as nurses. Therefore, the contingent of women serving as nurses comprised both white and black women, working- and middle-class women, and elite women as well.
The second change influencing women's participation in wartime activities—congressional passage of Public Order 38—granted women validation for their nursing service. Beginning in June 1861, the order provided some female nurses a wage of forty cents per day, or about twelve dollars a month for their labor. This was an enormous opportunity for women. For those who could take advantage of the chance to earn an income, the pay provided women a way to experience economic independence and therefore some measure of control over both their public and private lives. Not all women, however, wanted a wage, and some women, particularly elite women, volunteering for nursing service were careful to set themselves apart from women who received wages. Instead, they believed that their service as nurses was within the boundaries of their duty as respectable women; to receive a wage degraded that female obligation and those volunteers shouldering it.
By the end of the Civil War, nearly six thousand women served as nurses. Yet, however celebrated women's participation within the military was, the U.S. Army viewed their positions as a temporary addition made in time of crisis. At the end of the conflict, the U.S. military terminated the employment of female nurses. Nursing for the Medical Department of the United States Army reverted to the domain of male soldiers. Most of the women relief workers returned to their prewar activities, and many would not participate in the nascent nursing profession or work in the medical field in any capacity following the Civil War. For some, however, the foray into the wage-labor market as nurses was not over.
Men and the Early practice of Nursing
Men have had a long, if unacknowledged, history in nursing under the auspices of both religious and military orders. Men founded many of the early Christian hospitals and institutions for the sick and infirm in Europe. Strict sex segregation of care, however, meant that both men and women staffed these institutions. Monks and laymen took care of men in hospitals, while nuns and the traditional midwife cared for women in hospitals and homes. Men also organized groups dedicated to nursing that eventually became religious orders, which until the sixteenth century were overwhelmingly male dominated. As early as 1095, a father and son founded the Hospital Brothers of St. Anthony in southeastern France. The original members were laymen, but by the thirteenth century members had taken monastic vows. Other religious nursing orders included the Brotherhood of Santo Spirito, the Alexian Brothers, and the Brothers of the Happy Death. The existence of such orders reveals nursing as a much more diverse activity historically than is commonly known.
Religious orders were not the only institutions in which men focused on nursing as a function of their mission. Soldiering unarguably necessitated the need for nursing; consequently, beginning with the crusades of the eleventh century, military orders established branches to ensure the care of their soldiers. Members of these military orders frequently provided care and nursing for private citizens in their immediate surroundings as well. While these orders changed over time, and nursing became a priority in the missions for some but not all, it was nonetheless a duty performed by male soldiers. The histories of these military and religious nursing orders reveal the need to reevaluate the history of nursing. What accounted for the decline in men's participation and leadership in nursing to the point that the occupation became primarily associated with women's work, duty, and obligation?
Florence Nightingale's nursing reforms were certainly one factor in reconceptualizing the place of men in nursing. The number of men practicing nursing, however, was already on the decline by the time Nightingale pushed for nursing to become the domain of women inside and outside the home in the mid-nineteenth century. According to scholar Chad E. O'Lynn, three social changes contributed to the decline of men in nursing between the sixteenth and nineteenth centuries. The first was the decrease in monasteries and male military nursing orders and the increase of convents and female nursing orders during the Renaissance. Convents increased in scope and size as the number of women entering religious orders swelled. Women increasingly worked in hospitals and provided care for the sick as part of their religious life. Second, nursing became less organized and disciplined once the responsibility of nursing moved from religious to secular hospitals in the nineteenth century. Many scholars link this shift to the decline in the quality of nursing as oversight in the personnel who worked in secular hospitals was less organized. This change eventually gained infamy, as represented by Charles Dickens's literary character Sarah Gamp. Finally, the social effects of the Industrial Revolution contributed significantly to the decline of men in nursing. The growth of factories and heavy industry required physical labor that employers deemed appropriate only for men. These jobs attracted men, O'Lynn argues, because they paid better wages than any farm or menial job and required no formal education. The modest wages and unglamorous work of nursing held little appeal for men even during wartime and as part of military pursuits during the nineteenth century.
Excerpted from Nursing Civil Rights by Charissa J. Threat. Copyright © 2015 Board of Trustees of the University of Illinois. Excerpted by permission of UNIVERSITY OF ILLINOIS PRESS.
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Table of Contents
1 The Politics of Intimate Care: Gender, Race, and Nursing Work 10
2 "The Negro Nurse-A Citizen Fighting for Democracy": African Americans and the Army Nurse Corps 25
3 Nurse or Soldier? White Male Nurses and World War II 53
4 An American Challenge: Defense, Democracy, and Civil Rights after World War II 79
5 The Quality of a Person: Race and Gender Roles Re-Imagined? 107
Appendix A Facts about Negro Nurses and the War 133
Appendix B Male Nurse Population, 1943 135
Appendix C African American Nurse Population, 1940 137
Appendix D Male and African American Nurse Population, 1950 139
Selected Bibliography 185