Cholera and Kulturkampf: Government Decision Making and the Impetus to Establish Nursing as a Secular Occupation in Prussia in the 1870s

Abstract

With regard to the history of nursing in Germany, the nineteenth century turned out to be a century of success for the denominational motherhouse organizations-both for Catholic orders and for Protestant deaconesses. Owing to the revival of Catholicism, Catholic orders in particular1 proliferated throughout Germany, and the provision of nursing services was an important part of their social work. However, in the 1870s, the fact that the expulsion of Catholic orders from Prussian territory during the Kulturkampf coincided with a cholera epidemic gave the idea of the secular training of both women and men in nursing-an otherwise negligible item on the list of governmental priorities-a prominent place on the political agenda. This article explores the reasons why the Prussian state, despite the political, social, and health crises that it was passing through, ultimately decided to do next to nothing-a decision that determined the future of nursing in Prussia for decades to come. Aspects of the Prussian Health System with Regard to Nursing In Prussia, nursing was not recognized as part of the health professions, such as medicine and midwifery. If the occupation of medical aide (Heilgehilfe), also known as medical servant (Heildiener), was given legal status in the 1850s, it was only in order to fit the requirements and the convenience of physicians. Medical aides were allowed to give medical assistance and carry out minor surgery delegated to them by a physician.2 There were no minimum requirements for entry into nursing practice and no state nursing examination. Medical aides were generally not formally qualified or educated; indeed, in the early nineteenth century many seem to have been illiterate.3 Unlike Catholic France and Spain, early modern Protestant Prussia was not even remotely a breeding ground for nursing orders. Since, at the Congress of Vienna, 1814-15, which shaped the political map of Europe at the end of the Napoleonic Wars, Prussia acquired the Rhineland and Westphalia-regions where the Catholic religion was dominant-Catholic affairs took on an unprecedented importance for the Prussian government. From the early nineteenth century onward, Catholic orders-spreading from France as well as growing in native German soil-took the opportunity to offer nursing services that state and local poor relief could not, or would not, provide. Nursing was part and parcel of their social work, and their nursing traditions ensured that knowledge and experience were handed on from the experienced nurse to the inexperienced. 4 In part, the nursing traditions were supplemented by physicians' lessons. The organization of orders in motherhouses served as a model for Theodor Fliedner (1800-64), who founded the Protestant deaconess movement in 1836. Animated alike by the misery of the population and by denominational competition, motherhouses of orders and deaconesses spread throughout Germany. The work of these nurses garnered them a fine reputation among the general population. Their devoted patient care, provided almost free of charge, made them an attractive proposition for treasurers in charge of town hospitals. 5 During the German Wars of Unification in 1863, 1864, and 1870/71, they contributed much to the care of the sick and the wounded soldiers. They served as a model for the Red Cross sisterhoods, which-in a German peculiarity-adopted the motherhouse system from their denominational counterparts. The significance of denominational nursing in Prussia is underlined by admittedly not very reliable statistics taken from the year 1876, when only females with some sort of nursing experience were counted. Of a total of 5,226 nurses, 3,409 were Catholic and 1,063 were deaconesses. A total of 327 came from other sisterhoods and associations, such as the Red Cross, and there were an additional 427 nurses of various backgrounds.6 Prompted by the tensions of the 1870s, the question arose as to whether a successful non-Catholic alternative to the Catholic orders could be established. …