Fever Hospitals and Fever Nurses: A British Social History of Fever Nursing: A National Service (review)

For some years now, academic historians of medicine have viewed the history of nursing with concern as an important area of the discipline in need of professional treatment. This is not because nursing history does not exist, but rather because it is largely the province of amateur historians with a professional nursing background. Enthusiastic as it is, much of this history falls short of the analytical approach and critical historiographic engagement that give point and purpose to scholarly historical inquiry. Margaret Currie's well-intentioned Fever Hospitals and Fever Nurses falls into this category, her aim apparently being to explain and justify fever nursing to the wider profession, and to argue for its continuing relevance in the twenty-first century.

Currie's account of the fever hospitals themselves adds little to what is already known. She does not, for example, attempt any systematic inquiry such as might enable us to map the location and distribution of these institutions across the country. Historical interpretation can be confused: a table reproduced on p. 20 is said to show that by 1914 fever hospitals were "the largest single type of institution in England and Wales." The table does indeed show fever hospitals to be the most numerous type of institution, but with an average of 41 beds and a total of 31,149 beds in all, they ranked behind the general hospitals (53 and 31,329), the special hospitals (62 and 13,651), and the Poor Law infirmaries (134 and 90,001) in terms of size and significance. Outside of London, many fever hospitals were in fact very small, and as a facility they were never a match for the number of infectious cases occurring annually in England and Wales. Founded, funded, and independently operated by local authorities (except in London, where they were under the auspices of the Metropolitan Asylums Board), they never in any sense constituted a national service, and the services they provided were somewhat variable.

Currie's account of fever nursing is of greater originality and interest, drawing attention to the neglected issue of specialist nursing practice in relation to general nursing. It is something of an irony that fever nursing as a specialty only emerged around 1900, when the toll of fever cases was already falling. Much may be mined from Currie's chapters on the nursing aspects—her account of practices in the care of smallpox patients is fascinating—but the inclusion in the text of raw primary-source material in the form of nurse testimonies, and of several case-study nurse biographies, detracts from the strength and cohesiveness of the wider story. She makes much of the skill and dedication of these nurses, but the underlying themes are of exploitation, even of ghettoization, and reflect little credit on the leaders of the profession. Fever nurses began their careers in fever nursing at the age of seventeen. It was a dangerous and underappreciated occupation. The training did not qualify them to work in general nursing, and although the nursing authorities were concerned by this, they did little to remedy it. In this respect professional nursing and hospital practice differed from that of medicine, where even before the Medical Act Amendment Act of 1886 specialist doctors had, by and large, received the same basic training as general practitioners and developed their specialist skills after this initial training.

Interestingly, it was the medical specialists who took the lead in establishing fever nursing as a nursing specialty, being instrumental in the founding of the Fever Nurses Association in 1908. Frustratingly, the largely chronological structure of the book does not offer the opportunity for closer analysis of the professional relationships and professional tensions that seem to have surrounded this group of nurses, or their integration into the unhappy history of nurse registration, and the disputes that were an integral part of the development of this profession.