Ask any nurse or nursing student “Who’s the mother of nursing?” and you’ll get a quick, confident answer—Florence Nightingale. Her achievements are well-known: nurse in the Crimean War, nursing administrator, researcher, statistician, political activist, consultant, author, and instructor. The improvements she made in nursing care and the resulting reduction in deaths among British soldiers in the Crimean War were legendary.
Supported by her research and statistics, along with the publicity they garnered in newspapers, Nightingale’s work led to the reform of military healthcare. Her 1860 book Notes on Nursing: What It Is and What It Is Not became an undisputed guide for nursing care. In England, 1,500 copies were sold in the first month after publication; the next year, two more editions were published in America. Three years later, in her book Notes on Hospitals (1863), Nightingale suggested ways to improve hospital construction and operation. She may well have started the evidence-based practice movement decades before that term was coined. Her dedication to nursing and leadership for nursing students are clear in Florence Nightingale to Her Nurses (1914), a compilation of her addresses to graduate nurses from 1872 to 1900 at the graduation ceremonies of the Nightingale School of St. Thomas’ Hospital in London. Through her many publications and her pioneer nursing school at this hospital, she disseminated her vast knowledge of nursing and health care throughout the world to her “children” (her nurses), earning her the title of the Mother of Nursing.
A father to pair with the mother
But “mother” is only half of the parental pair. Who’s the father of nursing? Few men have become famous in nursing. Can you name even one? While several influential and noteworthy male nurses of the modern era may come to mind, 19th-century history offers none. Nightingale birthed nursing around the late 1850s (Crimean War), early 1860s (American Civil War), and early 1870s (beginning of formal nursing schools in America). So to put things on an equal footing, the Father of Nursing should be more or less her contemporary.
Gender in health care
To find suitable candidates for the Father of Nursing, one must understand the history of gender in health care. In the 1860s, healthcare roles were sharply divided by gender. During the Civil War (1861 to 1865), most such roles related to the war. Diseases and wounds associated with war constituted most of the era’s health care, and nursing began to evolve as a profession during this period.
The nurse was the only healthcare role held by women. In each family, the mother or grandmother served as the nurse. Nuns (in religious hospitals) or prisoners (in community hospitals) served as nurses for those without family caregivers.
But while women filled the role of healthcare provider as untrained nurses in the home or community, they were in the minority in military settings. At the start of the Civil War, all military nurses were males. Slowly, females were allowed into nursing positions in the north at the beginning of the war; in the south, they had to wait a year. Military regulations allowed only one female nurse for every two male nurses in the hospital, and no female nurses at all on the battlefield or in frontline hospitals. At the time of the Civil War, Dorothea Dix’s endorsed nurses were all middle-aged females. Nearly all volunteer nurses during the Civil War were females (poet Walt Whitman was an exception), and most paid civilian nurses in the military were female. Even then, most nurses were men.
During the Civil War, men were ,i>detailed as nurses—meaning they were privates assigned to be nurses on a temporary basis for a week or a month to deliver nursing care in the hospital or on the battlefield. They had no training in nursing. They were pulled from the ranks and assigned to nursing just as another soldier might be assigned to kitchen duty (peeling potatoes and onions) or latrine duty (shoveling dirt over human excrement in outdoor sinks). Later in the war, when strong men couldn’t be spared from active duty, only invalid or convalescent soldiers were detailed as nurses.
Men also were employed as surgeons, assistant surgeons, and contract surgeons. Early in the war, especially in volunteer units, these positions were assigned or detailed based on community status. Later, written exams were instituted and review boards convened with interviews and oral exams. Women were excluded from these roles, with one exception—Dr. Mary Walker.
Role of the hospital steward
Besides nurses and surgeons, the other healthcare role for men was the hospital steward. While some men were assigned this position earlier in the war, for the most part military units were careful to select men who were pharmacy students, medical students, and civilian pharmacists as hospital stewards. They were chosen specifically. Permanently assigned to the position in the regiment or hospital, they stayed in that role until they were mustered out of the military or left to attend medical school.
The hospital steward’s description and responsibilities are found in The Hospital Steward’s Manual (1862). The steward was chosen from the ranks or from outside the unit in civilian life. He had to be age 18 to 35 and was appointed that title by the Secretary of War. He had to be either an enlisted soldier or a noncommissioned officer, and was promoted to a rank just above first sergeant.
Hospital stewards answered to the surgeon-in-charge. Once appointed, they stayed in that position for the duration of their enlistment terms. Unlike nurses, they weren’t detailed to the position on a temporary basis. The Manual states that the hospital steward “must have sufficient practical knowledge of pharmacy to enable him to take exclusive charge of the dispensary…acquainted with such points of minor surgery as the application of bandages and dressings…and the application of cups and leeches.”
The hospital steward served as pharmacist. During that period, the terms pharmacy and pharmacist were rarely used; the preferred terms were apothecary as the place or profession, and druggist or chemist as the person. Besides filling the role of pharmacist, hospital stewards performed minor surgery and applied bandages, dressings, leeches, and cups. Under the regulations of the period, female nurses generally were restricted from changing bandages or dressings or even from being present at those times.
Clearly, hospital stewards performed skills that today are considered nursing skills. They also assisted in administering medications, including anesthetics—skills that today also fall into the category of nursing skills.
The Manual also describes the hospital corps, which included attendants, male nurses, and cooks who were “under the orders of the Hospital Steward.” So in modern terms, the hospital steward would have been seen as the equivalent of the nursing administrator or vice president of nursing or of patient care within the hospital. The surgeon selected one nurse from the female nurse corps to be Directress of Female Nurses. She would directly supervise the female nurses and “co-operate with the steward, and strictly obey the orders of the medical officers.”
Moreover, the hospital steward had general supervision of the hospital, including “ventilation, lighting, and warming” and would see “that cooking is properly executed.” These are duties Florence Nightingale specifically had described 3 years earlier as nursing responsibilities.
Hospital stewards in the field
In my view, the hospital steward was as much a nurse as he was a pharmacist. But this is based only on what the military manuals say. Any student of history knows that what appears in print often differs from what happens in the field. So what was really happening in the field?
John Samuel Apperson was a hospital steward in the Army of Northern Virginia, the Stonewall Brigade. Before his appointment as hospital steward, Apperson had been an apprentice to an established civilian physician and had attended premedical lectures while preparing to enter the Medical College of Virginia. Thus, he was a skilled healthcare provider. In his diary, he describes bloodletting, setting bones, diagnosing simple cases, prescribing treatments and medications, compounding medicines, administering medications, assisting in surgery, and vaccinating for smallpox prevention. In the absence of a surgeon, he would often conduct sick call for the unit unassisted, and was known to ride into the neighboring countryside to make house calls on the ill. In his diary entries of October and November 1862, he wrote of his confusion regarding sounds he heard during auscultation and his weakness in performing percussion—assessment skills that even many established physicians avoided. On May 7, 1863, he wrote: “To-day, I performed my first important operation – took off a Yankee’s leg below the knee.”
John N. Henry, 49th New York regiment, U.S. Army, was a nurse who requested and was granted a promotion to hospital steward. He’d sought the promotion in an effort to increase his pay. In December 1861, he was detailed for hospital duty as a nurse. By January 1862, he was regarded as the best nurse in the regiment and by February, he complained that for 5 weeks he had done the work of both nurse and hospital steward. Henry’s numerous requests for a furlough to visit his family were denied; the denial, he believed, was because “any other person connected with the Hospital could leave better than I could, for not a half hour could – will – pass without I was wanted at the medical wagon to do what no one else could.” (Similar complaints are heard today, expressed in more modern language.) By 1865, Henry wrote of supervising nurses, being engaged in auscultation and percussion, and assisting in autopsies and embalming.
C. Marion Dodson, surgeon’s steward (the Navy’s shipboard equivalent of the hospital steward), served in the Union fleet during the blockade of southern Gulf Coast cities. He served aboard several ships in the fleet. While on board one ship, he noted in his diary that he only filled prescriptions and had nothing to do the rest of the day, but later assisted in amputating a finger by delivering chloroform anesthesia. On another ship, he was the sole healthcare provider and filled all roles of diagnosing and prescribing in the absence of a surgeon.
For the Father of Nursing, I nominate…..
…the hospital steward. A paternal figure, the hospital steward served during the 1860s just before the birth of nursing as a profession, functioning as both nurse and pharmacist. While not educated or licensed as a nurse, he was as skilled in these areas as other nurses of that time. He had the same duties and responsibilities as female nurses and was better educated and more dedicated than the detailed male nurses. As we can glean from the original diaries and letters of hospital stewards, they not only served as nurses but may have pioneered the role of advanced practice nurse. My vote is cast.
William T. Campbell is an assistant professor of nursing at Salisbury University in Salisbury, Maryland.
Earp CA. (ed.). Yellow Flag: The Civil War Journal of Surgeon’s Steward C. Marion Dodson. Baltimore: Maryland Historical Society; 2002. (Originally written 1864-65.)
Notes on Nursing: What it is and what it is not. New York: D. Appleton and Co.; 1860 (first American edition).
Nightingale F. Notes on Hospitals. London, England: Longman, Green, Longman, Roberts, and Green; 1863.
Nightingale F. Florence Nightingale to her nurses: A selection from Miss Nightingale’s addresses to probationers and nurses of the Nightingale School at St. Thomas’s Hospital. London, England: Macmillan; 1914.
Priest JM (ed.). Turn Them Out To Die Like a Mule: The Civil War Letters of Hospital Steward John N. Henry, 49th New York, 1861- 1865. Leesburg, Virginia: Gauley Mount Press, 1995.
Roper JH (ed.). Repairing the “March of Mars”: The Civil War Diaries of John Samuel Apperson, Hospital Steward of the Stonewall Brigade, 1861-1865. (Jason Clayman, Peter Gretz, and John Herbert Roper, transcribers). Macon, Georgia: Mercer University Press; 2001.
Woodward JJ. The Hospital Steward’s Manual: For the Instruction of Hospital Stewards, Ward-Masters, and Attendants, in Their Several Duties. Philadelphia: JB Lippincott; 1862.