Collaboration and Conflict in International Nursing, 1920–39

Abstract

After the devastation brought about by World War I and the accompanying collapse of the political order in many countries in Europe, there was a general desire to create a new and more humane social order. Supranational institutions like the League of Nations, the International Labor Organization, and the Court of International Justice were set up to encourage international collaboration and the sharing of scientific knowledge. The League of Red Cross Societies was formed to address the problems of refugees, starvation, and disease in much of Europe, but it needed nurses who were trained in public health to lead the work. In the absence of nurses with appropriate training, the league decided to organize an international course in London for nurses who would be able to direct its public health work in Europe. This article analyzes how the organization of these international courses in public health for nurses involved the Red Cross movement, the College of Nursing in Britain, the University of London, the International Council of Nurses, the Rockefeller Foundation, and the leaders of nursing in North America. At one level the story is about the international students themselves, the hundreds of nurses from all over the world who came to London to take the courses. The shared experience of each year group led to the founding of the Old Internationals, the alumnae association, which became an international network and survived the disruptions of World War II. At another level, the story is about the role of nurses in the development of public health services at a time when the field was expanding rapidly. The public health field had no boundaries, and there was no consensus about the best method of training nurses or others for the work. Within nursing, the debate was around whether the training should be completely separate from existing nursing courses, with the emphasis on preventive rather than curative medicine. This debate took place against the background of the competing ideologies of the North Americans and the British about nurse education in general. The tension between these two powerful cultures was also about their vision of nursing. The British believed that traditional hospital-based apprenticeship training was important to inculcate the spirit of service essential in a good nurse, while the Americans believed that nurses needed a modern college-based education if nursing was to hold its own as a profession in the modern world. Ultimately the fate of the international courses was decided by the outcome of this struggle for international hegemony between the American and the British nursing leaders.1 Setting Up the International Courses At the conclusion of the war, many parts of Europe were experiencing severe starvation, disease, and poverty. Eastern Europe was the hardest hit, with millions of refugees who were homeless and dying of hunger; typhus and smallpox were endemic in Russia, Poland, and Czechoslovakia; and the Balkan states were threatened with plague from Turkey. The American Red Cross had been active in many of these countries during the war, and its chairman, Henry Davison, wanted it to continue to deal with the postwar problems in these countries. Davison, a New York banker, believed that the Red Cross needed an injection of American enthusiasm and money. In 1919 he proposed setting up a League of Red Cross Societies as a permanent international agency, based in Geneva, which would employ professional experts in all fields of public health and act as a humanitarian counterpart to the League of Nations. He wanted to move quickly while governments and conditions were still fluid after the war, believing that waiting to organize a full congress of the world's national Red Cross societies would mean losing the opportunity for a new approach. The International Committee of the Red Cross, based in Geneva since the founding of the Red Cross in 1863, was in no hurry to change the traditional role of the Red Cross and resisted the tactics of the Americans. …