This paper examines some of the changes which occurred as men entered nursing in the late twentieth century. Nursing is unique in that during the late nineteenth century it became an almost completely 'feminised' occupation, following what Theweleit calls a 'new female assault' on medical and caring work. Before this, women did little more than midwifery (1). During the late twentieth century men have increasingly found their way back into nursing. In this paper we shall contextualise the experiences of two of the men who pioneered this influx. This shift in gender ratios in nursing has proceeded in tandem with a variety of other tensions concerning nursing and gender, and the training and education which was deemed to be appropriate. Nursing represents a sign of the times, within which dramas concerning the nature of medical knowledge, and indeed the nature of men and women themselves, are performed in particularly graphic detail.

For this reason, the experiences of men in an occupation that is predominantly female are worthy of investigation. Examining the motivation and experience of men in nursing challenges traditional concepts of 'nursing' and 'masculinity'. Moreover, it illuminates the shifts between different ideologies of nursing. Let us begin by placing the mid-twentieth century experience of men in nursing in some historical context. Much modern nursing can be dated to Florence Nightingale, who promoted the idea that to be a 'good nurse' was also to be a 'good woman' (2). Klaus Theweleit describes this ideal vision of the female nurse as the 'white nurse' (3), a pure 'caring mother figure, who transcends sensuousness' (4).

Florence Nightingale was a strong advocate for both women and nursing, and considered traits such as nurturance, gentleness, empathy, compassion, tenderness and unselfishness to be essentially feminine and essentially nurse-like. Not surprisingly, in the present, this position has been increasingly challenged by those who argue that these attributes exist also in men, and might not necessarily be found in all female nurses! (5).

Nightingale herself believed that men's 'hard and horny' hands were not fitted 'to touch, bathe, and dress wounded limbs, however gentle their hearts may be' (6). Her opposition to men in nursing caused her to denounce male asylum nurses especially, because she considered their duties more akin to those of prison warders than to nurses in general hospitals. Her hostility, allied to that of her fellow-campaigner, Mrs. Bedford Fenwick, was partly responsible for the increasing divergence in training, philosophy and sex ratios between psychiatric and general nursing during the late nineteenth and early twentieth centuries.

Following Nightingale’s experiences at Scutari, she devoted forty years of her life to the development of nurse education, hospital design and sanitary reform (7). Carpenter has pointed out there 'are different ways of being a nurse' (8) as a brief study of the history of caring suggests. Before Nightingale began the formal education of nurses at St. Thomas's Hospital in 1860, 'nursing' encompassed a far broader range of activities, and involved a much wider variety of people.

In one of the few existing reviews of men in nursing, Wright and Hearn (9) suggest that the earliest nurses were men. There are references in Hippocratic writings to male slaves performing therapeutic activities with clients in their work as bath attendants. These slaves were trained by doctors to assist with and undertake treatments (10). Care in the public sphere in Ancient Greece was predominantly provided by men, whereas in the home, the sick were cared for by women (11). Later, the Romans were one of the first cultures to practice battlefield medicine in mobile tent hospitals (12) and these skills were later applied to civilian patients.

In the Middle Ages in Europe, health care was largely provided by the various religious orders. Indeed, a major manifestation of the Christian beliefs of these monks and nuns was the care they provided for the sick and outcast (13). It is partly through these religious movements that nursing became feminised as the middle ages progressed (14).

Rubin (15), in an analysis of medieval monasticism, is suspicious of the 'masculinity' of the monks because they had 'renounced' their heterosexual role. Yet Barber (16) notes that 'the charge of homosexuality was an obvious accusation to direct against an all-male celibate Order' and considers it irrelevant to the nursing work which the monks undertook. There are nevertheless intriguing parallels between these questions of sexuality and the recent role of gay men in caring for those suffering from HIV and AIDS (17). It is in this sphere, especially, that men's nurturant activities can be exercised without incurring suspicions.

A comparable climate of suspicion explains why, during the middle ages and Renaissance, care was increasingly relocated into religious institutions. These were the only places where mediaeval women could practice healing arts without the risk of being accused of witchcraft. At this time also we can see a profound ambivalence to knowledge in women, whose alignment with witchcraft meant that their knowledge and care-giving was regarded with suspicion by theologians and inquisitors (18). Indeed, as the middle ages led into the Renaissance, the reformation and the counter reformation, the climate for women became more hazardous as religious authorities rooted out such cases with increasing zeal (19).

The purpose of this argument, then, is to show that the feminised nature of nursing emerged through historical struggle and was never ‘naturally feminine’. The ideological hard labour of Nightingale served to bridge the gap between women serving in the workplace as nurses and the Victorian concern that well-bred women should remain in the home developing ladylike behaviour (20). Nursing then was about bringing the private sphere of nurturance into the public domain of the hospital (21).

A further strand of history which helps to explain the way in which nursing became increasingly a woman's sphere is the shift which took place in masculinity through the nineteenth century. Early in the nineteenth century men had a more physically intimate attitude to friendship and caring than is the case nowadays (22). As the nineteenth century wore on, masculinity was re-worked so as to emphasise the qualities we see in it today. There were the beginnings of a studied avoidance of sensitivity, nurturance and emotion. A particularly prominent sign of the times can be seen in the writings of Thomas Carlyle. As Clarke (23) describes, the young Carlyle was especially disgusted with the idleness, foppishness, slovenliness and self indulgence displayed by the poet Coleridge. Equally, he was revolted by his friend Edward Irving nursing and playing with his baby. Carlyle's writings then, valorised a form of masculinity which had no time for idleness, affection or chatter. A man, if he was to be a worthy example of his sex, should be silent, steadfast and have little to do with women and children.

The reformulation of masculinity and femininity which was taking place more generally in 19th century society set the stage for the likes of Nightingale and Carlyle to be heard by a wider audience. In Nightingale's case, her friends in government such as Sidney Herbert and Lord Stanley enabled her ideas to become policies. By being directly asked to go to the Crimea to care for soldiers by Sidney Herbert in his role as War Minister, she was in a powerful position to assert her vision of the female nurse.

There are particularly interesting implications here for scientific knowledge, gender and the nature of care. Knowledge was increasingly being defined away from the human contexts where care took place. Education for nurses was planned so as to originate in university medical schools, colleges, or within training courses. This kind of knowledge involved a one way path of transmission from the academy to the ward. The autonomous features of working life unique to nursing on the other hand were to do with the high moral character which was to be developed in nurses. Nurses needed to be scientifically trained so that they could become the skilled servants of medicine, rather than autonomous scientific minds in their own right.

Before Nightingale's expedition to the Crimea, British soldiers were mainly nursed by male orderlies. They had no training, except through experience and by working closely with surgeons (24). It was thus during the late nineteenth and twentieth centuries that a shift took place in the Armed Forces, the Religious Orders and the Hospitals so that caring became predominantly women's work. Indeed, 'nursing was lauded as a domestic art that fulfilled the calling of true womanhood’ (25).

Meanwhile, as the late nineteenth century developed, medicine itself was reforming as a discipline that originated not in the surgeon's craft but in the laboratory. The engine house of scientific medicine was increasingly seen as residing in the newly-developing sciences of bacteriology, neurology and biochemistry. It is significant in this regard that Nightingale herself never believed in germs. Thus, because of its rudimentary intellectual and scientific content, the Nightingale formulation of nursing could coexist quite comfortably with Victorian beliefs that education was bad for women and harmed their reproductive organs.

It is particularly important, from our point of view, that echoes of this vision of nursing can be found in the reminiscences of nurses and ex-nurses who undertook training at mid-century, and it is this issue which brings us on to the importance of oral history.

The oral history of nursing has been the subject of a growing interest in the 1990s (26). In this paper, we shall explore the accounts of men who worked as nurses between World War II and the 1970s which can still be heard at first hand, within which the residues of Nightingale's teachings can still be detected. This study takes its place among a number of similar efforts in the history of nursing, which often partake of a 'bottom up' historiography, where researchers try to suspend their desire to impose values on the material, rather in the manner of early participant observers (27). Whatever concept of history the researchers have, in nursing scholarship there is considerable excitement at life histories (28) and their ability to enliven history in a most compelling way.

The strength of oral history lies in the access it affords to people's accounts of their lived experiences, in a way which allows them to be recorded and preserved. Not only this, but within nursing the people involved in providing the histories are often themselves aware of the contribution their activities have made to the changing history of the profession. Nursing's ongoing concern for its history has been linked with the profession's search for an identity (29). Therefore nurses are often to be found collaborating to record one another's histories, where nurse-historians interview their older colleagues.

Oral history has gained increasing respect for the opportunity it provides to locate the feelings, attitudes and ways of life - which have been hidden from traditional written histories - within the broader framework of legislative, professional and social changes. Indeed, the accounts of 'ordinary people' who worked in the Health Service are richer than the formal accounts from officials, who often promulgate an 'official' version of events. In any case, through oral history we can show how these everyday reminiscences are intelligible through their being intertwined with the warp and weft of social change. The experience of a man becoming a nurse is nowadays relatively mundane. But in an era when this was unusual, these experiences, however mundane, would be uniquely significant.

Because of its focus on reminiscences of the fine detail of social life, oral history is perhaps the post-modern discipline par excellence. It resolutely avoids grand theory and enables, via participants' everyday narratives, ‘to explore the gaps, ambiguities and implicit power relations in the social and health contexts’ (30).

In order to examine the experiences of men in nursing during the middle part of this century, this paper focuses on the personal accunts of two nurses who were interviewed about their careers between the 1940s and 1970s. One had spent most of his working life in a General Hospital while the other had worked mainly in a psychiatric hospital. These two informants were interviewed as part of a larger project on the history of nursing in the Midlands and have been selected because their accounts appeared to be emblematic of the changing spirit of the times in post war nursing.

The interviews were semi-structured but the respondents were free to recall whatever events they chose and to describe them as they saw fit. The interviews were organised around a number of themes which were of interest to the researchers including the reasons why they entered nursing, their expereience as students and the social relationships which they remembered exisiting between them and their colleagues at work in their early careers. In addition, as researhcers we were interrsted in what had made the job worthwhile to them and why they had maintained their commitment to the career over several decades and how it changed as they gained in experience, seniority and influence. At the same time, it was emphasised to them that it was their experiences in nursing that were of interest and that they were free to develop their own agenda in the discussion. In general nursing at the time they trained, men were very much a novelty, so in the interviews and the subsequent interpretation we were especially attentive to what it felt like to be a man in a predominantly female occupation.

In presenting the ‘data’, in addition to their historical narratives, we will be particularly attentive to the recollections of social organisation, the training, the wards' organisation, even the way they wore their uniforms. Partly, this is because these elements featured prominently in the reminiscences, but also because it is in these ceremonies that the residua of nineteenth century can be detected. In addition, we shall attempt to discern how the transformation of their roles over time reflects a broader change in nursing from a system which was hierarchical, regimented and which embodied military lines of organisation to one which has become increasingly patient-centred.

'I was the only man in a group of a thirty who commenced their PTS [Preliminary Training School] in 1942 in a very prestigious hospital in the West Midlands'. This vignette is based on experience at a time when there were very few male nurses in training in the West Midlands although untrained male orderlies were being employed in some hospitals to fulfil a variety of roles from that of porter to nursing auxiliary. The Matron at the respondent's hospital was one of the few in the country who accepted male students and exercised no discrimination. She had also shown a progressive attitude towards nurse education, considering it essential if nurses were to be valued for their unique contribution to patient care rather than merely for being servants to the medical profession and to the routines of the hospital. The Sister Tutor had, on the other hand, been clearly uneasy in the respondent's presence; she addressed him as 'Mr.', a title usually reserved for surgeons. Matron addressed everyone, regardless of gender as 'Nurse'.

The fact that the respondent was one man amongst thirty female students did not bother him; he came from a large family which included four sisters and his brothers had girl friends whom he knew well. He had spent two years with the Red Cross prior to entering nursing and had considerable experience of dealing with casualties and of the emergency treatment of serious injuries. He was about two years older than the rest of the students and had no difficulty in getting on with them. Most of the lectures, he recalled, were given by doctors who were treated with extreme deference. The Sister Tutor would always introduce the Doctor in the same way - explaining that he was a very busy man and that the students should, therefore, be very grateful to him for coming to talk to them. She would then sit at the back of room during his lecture, taking notes and requesting him not to erase anything he wrote on the blackboard. 'I never recall a female doctor coming to talk to us, although there were female doctors working in the hospital at the time', commented the respondent. The respondent found the lectures to be generally very good. As the doctor left the room, all the students would stand. 'We had no idea that doctors were being paid to lecture to us,' he remarked. 'We all thought they were doing it free in order to improve the collaboration between nursing and medical staff!' After the lecture, the Sister Tutor would go through the words written on the board to make sure the students had understood them and would ask questions based on the notes she had herself taken during the lecture.

This vignette encapsulates several important themes. Nightingale's nurse education emphasised medical lectures, but training also focused on high moral character, duties and responsibilities rather than skills (31). Notice how the trainees were formalising the appropriate deferential demeanour of nurses (women) towards doctors (men). Notice also how the teaching is organised as if they would be barely able to understand the technical aspects of the talk, which required reinforcement and elaboration later. The ceremonies with which their education is delivered, in other words, consolidate their status. This also recollects the separation between nurses sphere of nurturance and moral character in relation to the medical knowledge which originated in male dominated contexts. In this way also we can see how the generic form of nurse education recollected Nightingale's programme. This parallels Bakhtin's writings about the way the form of social systems contains sclerotic deposits of what has gone before (32).

The most important event of the first week in Preliminary Training School was the day the uniforms arrived. A seamstress came to ensure that they fitted correctly. 'There were about six full-length mirrors for the female students to view themselves. However, I was given a white coat several sizes too big and was told that it would shrink after three or four washes!' It was frequently impressed upon the female nurses that they had the smartest uniforms in the country and that they should be proud of them.

The centrality of uniforms to nurses has been noted by other writers (33) who have examined how nurses police one another’s uniform wearing and ensure that it is up to scratch. Street sees this regulation of one another's uniforms as an oppressive practice which is in part self-inflicted by the nursing profession. However, here we can see a rather different angle. The uniform makes new forms of identity possible - in this case pride. The informant here is almost left out as there is little for him in this ceremonial form. The tendency of uniform-wearing to facilitate new identities has also been noted by scholars of military matters (34). There were other aspects of life as a trainee nurse which sidelined our informant. The Sister in charge of the Nurses' Home informed all the female nurses about the rules and regulations, the procedures for requesting leave and late passes, the times of meals and the importance of rest. 'I got the impression,' commented the respondent, 'that the welfare of the female nurses was the prime concern of the senior nursing staff and that males were thought to be able to fend for themselves.' Thus, rather than simply being restrictive, the rules also contributed to the identity and well-being of nurses.

On the wards, the new student accustomed himself to the rigid hierarchy, with the Ward Sister at the top. Reprimands came solely from her; praise solely from the junior staff nurses. Routines ordered the day: the 'back' round, the TPR round, the BP round, the teeth collection round at night and the medicine round. This informant knew why he was welcomed on the wards: 'I was popular to work with when it came to doing 'back rounds' and blanket baths because I was good at lifting patients.' He had three allocations to orthopaedic wards during his training, not because of any special interest he had in orthopaedics, but because he was strong and could lift immobile patients on his own. However, he had not found his position as a male nurse difficult. 'The patients accepted me and I never once experienced any discrimination'. Yet took far longer to achieve the rank of Charge Nurse than his fellow-students had to become Sisters.

In the mid 1950s, he and a nurse who had started training in the same set as himself decided to get married. To do so, the respondent had to request permission from Matron: 'She showed little interest in me but was very concerned about my wife to be. Had I enough money to keep her? Was there somewhere for her to live? Were we thinking of starting a family?' After the wedding, they lived outside the hospital and their strong attachment to the institution weakened. This reflects a broader historical process too. In the late twentieth century nurses are less likely to live 'over the shop' where their trade is practised. This loosening institutional attachment reflects also a lessening interest within nursing in routine and hierarchy and a greater interest in the nature of nursing practice.

'I applied for mental nursing once I was demobbed after the War'. This respondent had made the decision to take up nursing based on gossip he had heard during his time in the ranks that to seek work in the police, the prison service or the mental hospitals was a good career move after being in the army. Ex-service men and women were highly regarded in these services for which they would be considered already trained. The respondent freely admitted that he had not gone into psychiatric nursing primarily to care for sick people. 'What I most relished when I started were the company of ex-soldiers and the sporting facilities...Working with patients was boring, but once I could escape to the sportsfield, I was in my element.' He had been thrilled to find the facilities for playing sport were much better at the hospital than he could have expected elsewhere.

The respondent noted that many of the staff at the mental hospital were indeed ex-military and much of the culture of the hospital was overtly militaristic with a strong emphasis on uniforms and the correct wearing of them. Ex-soldiers were valued for their strength and fitness, making them well able to control difficult patients. Staff without a service background often disliked the hospital's regimentation during the 1950s and 1960s. Those favouring regimentation sometimes despised patients, thinking them 'to lack spine.' Talk amongst male staff often centred on tales of the War, violence and aggression. Male nurses were frequently trying to work through their own difficult and distressing experiences as soldiers whilst carrying out their duties on the wards. They tended to dismiss depressed patients as malingerers especially if they had never seen active service, and attention was given to those who were good company and good workers.

This distinction recollects a dilemma that had existed in military circles for forty years previous to this informant's experiences. Concerns over shell shock, cowardice and malingering had bedevilled psychiatry in the first World War. The patients, like disorientated soldiers in the trenches, had somehow suffered the loss of some important masculine feature. The concern that shell-shocked soldiers had lost courage or suffered from 'funk' (35) finds its echoes in the 1950s where these ex-military personnel found a lack of 'spine' in their patients. In either case, the objects of this militaristic gaze, be they malingering soldiers or patients had been disenfranchised from the company of men and had to be disposed of within the framework of military discipline or behind the shield of hospital routines.

Controlling patients in order to maintain a pristine establishment was the major task of the nursing staff and one to which ex-soldiers were well suited. 'Floors were polished twice a day and patients were forbidden to walk on them before a visit from the Superintendent or the Chief Male Nurse. The appearance of the ward was far more important than the comfort of patients. Staff were complimented on their clean and orderly wards, not on how compassionate they were to patients.' There was occasional violence when patients were restrained or secluded. Nursing staff might be guilty of using too much force, but were rarely held to account for what they did or said to patients as medical staff always accepted their account of incidents even when contradicted by the patients.

Although the atmosphere in the male wards was generally one of staff dominance and patient subservience, the respondent noted instances where friendships flourished between nurses and patients. Some staff would offer patients extra tobacco and help them write letters to their families and friends. As more nurses without a service background came onto the wards the atmosphere began to change. In the 1960s, talking to patients and providing companionship became an expected part of nursing. These new nurses were no longer satisfied with a controlling and supervisory role; they wished to be involved in therapy and treatment. The respondent noted how his own attitudes had changed: 'Towards the end of the 1960s, I attained the position of Charge Nurse and became convinced that the majority of patients in the hospital in which I worked led miserable, unhappy lives.' He had become interested in occupational therapy and sought to improve patients' lives, campaigning for them to receive payment for their work in the Occupational Therapy Department, even if this was only sufficient for them to buy cigarettes and sweets. He encouraged patients to get away from the hospital at week-ends and to cultivate enjoyable hobbies.

These two nurses' accounts of their working lives offer some interesting insights into nursing history. Both men came into nursing after previous experience of large organisations: the general nurse had worked with the Red Cross, and the psychiatric nurse had served with the armed forces. It seemed a natural progression to move from these organisations into nursing, which offered an institutionalised life with strict routines and codes of practice with which they could feel at ease. The uniform offered them a security which they valued; it represented a regimented way of life and signalled where they and others fitted into a particular hierarchy. Their accounts suggest that they were welcome recruits because of their strength as males, rather than for their personalities. They were able to fit in because they were doers who got on with the job and derived security from the structured organisation rather than reflecting on their position. Neither perceived his work as being in any way women's work. The general hospital nurse was not worried by being one man amongst many women and did not rebel when treated differently from his female colleagues. Perhaps both nurses flourished precisely because, at the time, they did not reflect on their position within nursing or the type of work in which they were employed.

There is a danger of romanticising the reminiscences of these men. Whilst they have detailed, complex recollections of their working lives, they never intended to be gender pioneers. Nevertheless, their reasons for becoming nurses, however mundane, differed from those which are found nowadays. Modern male nurses cite the desire to care for others, job security and empowerment as a professional (40). Moreover we do not see, in the early careers of either of our informants, the rapid drift into managerial positions common with contemporary men in nursing (41). This highlights how the pattern of men in nursing is a highly differentiated picture where patterns of employment shift with the passage of time and the influx of more men into the profession.

As men have found their way into nursing so too the training curriculum has become more academic and educational. Equally, there has always been concern that education is not necessarily good for nursing. As Young put it, ‘The aim of nursing education should be to produce a good nurse, not necessarily a well educated young woman.’ (42) Indeed, in the present, a number of increasingly strong voices are demanding a return to nurse training which is vocational rather than academic, and based on 'competencies' (43).

Thus we can point again to the long history of ambivalence about the education and training of nurses. Perhaps one clue about the role of training in nursing is given by our two informants. A great deal of what it means to be a nurse is transmitted via the experience of doing the job - the ceremonies of trying on uniforms, taking blood pressure and blanket bathing patients. This process is remarkably sensitive to shifts in social attitudes. In studies of some occupations, researchers have drawn attention to a cynical, reactionary 'canteen culture' which resists innovation. This is suggested in our second informant's reminiscences of the post war culture of psychiatric nursing. Conversely, our informants show that far from being a sclerotised mass of tradition, the local cultures of their hospitals enabled them to recognise a shift in the ethos of care as patients became more central to the organisation of hospital routines. They developed awareness of patients' needs, and their security in the hospital's organisational structure was superseded by an appreciation of their relationship with patients. For these men, the caring aspect of nursing grew in importance, as their original motives for entering the profession transmuted into something Florence Nightingale might have approved of, even if she might still have reservations about their gender.