"To help a million sick, you must kill a few nurses": nurses' occupational health, 1890-1914.

Abstract. Although nursing is recognized today as a serious occupational health risk, nursing historians have neglected the theme of occupational health and individual nurses' experience of illness. This article uses the local history of three case study institutions to set nurses' health in a national context of political, social, and cultural issues, and suggests a relationship between nurses' health and the professionalization of nursing. The institutions approached the problem differently for good reasons, but the failure to adopt a coherent and consistent policy worked to the detriment of nurses' health. However, the conclusion that occupational health was somehow neglected by contemporary actors was, nevertheless, erroneous and facilitated omission of the subject from historical studies concentrating on professional projects and the wider politics of nursing. This article shows that occupational health issues were inexorably connected to these nursing debates and cannot be understood without reference to professional projects. In 1890, probationer nurse Ellen Yatman told the Select Committee of the House of Lords on the Metropolitan Hospitals that nursing caused her ill health.1 During her 18 months of training at The London Hospital, Yatman complained that she, like "most of the nurses," constantly suffered from "overwork" and "overtiredness." The causes of her fatigue, she believed, included an 83-hour working week and the onerous, menial cleaning duties that took up most of her working day. She also protested that a shortage of trained staff placed inexperienced nurses in positions of overwhelming responsibility and that overcrowded wards were inadequately staffed.2 Yatman's short-lived nursing career came to an end when she contracted "blood poisoning from sewer gas," a smell she believed emanated from the sink basins in her ward but which affected most parts of the hospital. This article examines attitudes toward nurses' health at three case study hospitals and suggests a relationship between nurses' health and the professionalization of nursing.3 Nursing was drawn into the political spotlight at the end of the 19th century. The campaign for nurse registration began in 1887, prompting doctors and nurse leaders to redefine nurses' work and place in the hospital hierarchy: commentators often supported their arguments for and against change with reference to nurses' health. It was used as a barometer to measure the extent to which change was possible within the existing power structures of 19th-century hospitals. As we will see, supporters and opponents of registration had very different ideas about the organization of nursing. This article examines how these ideas not only shaped national nurse organizations' strategies but also affected individual nurse's experience of illness. Three case studies were chosen to assess whether and why nurses' experience varied between hospitals. I will focus first on The London Hospital, a large, metropolitan, voluntary teaching hospital whose matron, Eva Luckes, was important as registration's leading opponent. The London Hospital is then contrasted with the South Devon and East Cornwall (SDEC) Hospital, a much smaller provincial, voluntary hospital, whose matron, Harriet Hopkins, supported nurse registration, and the Cornwall Lunatic Asylum, a rural mental asylum whose matrons expressed no interest in the politics of nursing. I can thus compare the practice of nurses' health care between an asylum and a voluntary hospital and between a large and small voluntary hospital. I focus on the matron's role in relation to the practice of occupational health care. The matron's role has been the subject of historical debate. Stuart Wildman and Alistair Hewison suggest that, contrary to previous analyses of nursing history that presumed matrons had independent control over nursing departments by the late 19th century, doctors and lay committees retained significant power. …