Where it all began…

Here's the first of a four part post from Rebecca regarding the Visiting Nurse Association of Boston (i.e., the visiting nurse/home health) story...

I have a penchant for thoroughness, which in this case means I cannot resist summarizing for you the relevant points of Annie M. Brainard’s 1922 book, The Evolution of Public Health Nursing, in which she traces the roots of the organized visiting nursing profession in England and America from the early Christian movement of the 1st century through the mid-1880s. The points I found relevant are many and so I may have to cover them over a couple of postings as I roll out some of the history behind public nursing.

Having set out to understand the history of visiting nursing, I fear that if I omit recounting this early history we might miss some kernel of information which would help put the course of visiting nursing in perspective. I think that Brainard had a couple of motivations in writing this history in 1922. First, although she acknowledges that “human sympathy and love must have moved people to visit and care for the sick and suffering from the very beginning of time”, she wants to make the point that nursing is a profession, and that public health nursing is a distinct profession within nursing.

Second, she emphasizes that public health nursing is a very different enterprise from private duty nursing even though to the casual observer they appear to involve the same skills. Brainard wrote another book entitled The Organization of Public Health Nursing in which she contrasts the role of the public health nurse with that of the private duty nurse. She argues that the structure of the organization supporting the public health nurse is a crucial part of the success of the entire field of public health nursing. I am eager to read her second book soon as I have a feeling that many of her points will still be relevant today!

Early Roman Christian Society and the First Organized Efforts to Care of the Poor and Sick

Brainard identifies the deaconesses and deacons of the early Christian church as the first organized visiting group. In Greek, the word deacon means “servant” or “helper” and these early Christian devotees strove to serve in accordance with the teachings of Jesus, “I was sick, and you visited me: I was in prison, and you came to me.” (Matthew 25:36, American King James Version).

Deaconesses had a prominent role in serving the community up through the fifth century, when their office was diminished as the church became more established and opportunities for women were increasingly curtailed. Brainard cites from a history of early Christianity that the role of the deaconess was to “Minister to the infirm, to strangers and widows, to be a [mother] to orphans, to go about into the houses of the poor to see if there is anyone in need, sickness or any other adversity, [she] is to care for and give information to strangers; [she] is to wash the paralytic and infirm that they may have refreshment in their pains…[she] is also to visit inns to see if any poor or sick have entered or any dead are in them.”

The work of these early caregivers was steeped in charity and their actions were infused with the principles of self-sacrifice and of giving to those less fortunate. In accordance with their calling as servants of the church they would have shunned personal wealth, would have given away what they had, and when there was greater material need amongst the people, they would have applied to the church for support. Brainard sees in this system of deaconesses and deacons an organization very similar to what developed into the Public Health Nursing profession of her era. The work of the deaconesses was overseen by a central organization and large cities were divided into districts, with each district overseen by a deacon. The major difference between the two eras is that part of the deaconesses’ purpose was to spread the word of Christianity

The system of deaconesses broke down in the middle ages when the Councils of Orange in 441 and Orléans in 533 forbade the ordination of deaconesses. By this time, the popularity of the Christian church had spread far and wide. It had become a wealthy and powerful organization, and such had lost some of the purity of purpose possessed by the early followers of Christ. As we will see in the next post, women of the middle ages wanting to follow Christian teachings often sought other avenues for serving the poor and sick.