The Development of Nursing

The development of nursing in South Africa in the late nineteenth century formed the professional and organisational backdrop against which British military nursing operated during the South African War. This page outlines the evolution of civilian, colonial, and military nursing structures relevant to the period, focusing on those developments that shaped the deployment, expectations, and experiences of nurses who later served with British forces. Wider political and military histories of the conflict are not repeated here.

Colonial and Imperial Nursing

Victorians saw the Empire, along with the export of professional, financial and commercial services, as one of their glories. In reality the Empire was a drain on Britain’s resources in terms of the cost of defence and administration, grants, and the cheap services offered to member states. As the nineteenth century progressed there was a move, not always successfully, to concentrate on the commercial aspects of Empire rather than territorial acquisitions.

This period also saw an outflow of professionals, including nurses, and this was a cause for concern. Many nurses travelling to work overseas would have been placed by the Colonial Nursing Association (CNA). All CNA applicants were white, British, single women. Applicants were accepted “based on assumptions about the nurse’s class, age, training, personal attributes, manner and characteristics”.

For these nursing sisters, life in the colonies could be isolated and lonely. They were white ‘ladies’ but had little in common with other colonial women and carried out work which made them less than ‘lady-like’ in status. They often had little support other than from the local ‘Association’, which reinforced Victorian values of the lady nurse of good character. There is evidence of nurses going to South Africa and, through marriage or favourable appointments, staying permanently.

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British Nurses as Agents of Empire

British nurses in the South African setting were enmeshed in imperialism by their role in dealing with indigenous populations and through their relationships with other colonial officers and families in a gendered medical hierarchy shaped by racially mediated discourses of sexual propriety. In this sense they may be understood as ‘Agents of Empire’. They helped to establish and reinforce British control over the bodies and cultures of colonised societies in South Africa, and it is noteworthy that many nurses were working in the Orange Free State and the Transvaal at the outbreak of the Boer War.

Some of the British nurses who travelled to work in South Africa would later appear in the prosopography, having cared for sick and wounded British soldiers during the war. Others remained permanently in South Africa, contributing to a steady influx of British-trained nurses before and after the conflict. Some of these nurses took leading roles in the development of nursing as a profession in South Africa, including the establishment of nurse training schemes discussed below.

Nursing in South Africa before the Boer War

The Cape Colony

In the Cape Colony, organised medical and nursing care began in the early nineteenth century, with the first civilian hospital opening in Cape Town in 1818. Standards of care and the organisation of nursing developed gradually. In 1874 the first two professionally trained nurses arrived from England to work at the hospital in Port Elizabeth. In the same year the first Anglican Sisterhoods arrived in South Africa.

These developments led to the establishment of local training schools and to the introduction of the first statutory nurse registration in the world in 1891. Nurse training in the Cape Colony expanded steadily in line with the growth of hospital provision. Alongside hospital nursing, district nursing developed, having been initiated in 1810 by Matilda Smith, a deaconess of the London Missionary Society.

Natal

In Natal, nursing was shaped by the legacy of ‘Folksnursing’ associated with the original Boer settlers. In 1857, with a grant from General White, Gray’s Hospital opened in Pietermaritzburg as part of the consolidation of British colonial control. It was largely staffed by untrained assistants, a pattern that persisted for many years.

Nursing care in Natal improved slowly up to the outbreak of the Boer War, centred on Gray’s Hospital and the Natal Government Hospital at Addington. Although there were intentions to establish nurse training, recruitment of white women proved difficult. Training eventually commenced, and in 1896 state registration was introduced. During the Boer War Gray’s Hospital served as a base hospital, and its sisters were deployed on the hospital ship Avoca.

Orange Free State and Transvaal

In the Orange Free State, Anglican Sisters of the Community of St Michael and All Angels established themselves in Bloemfontein in 1874, undertaking both hospital and district nursing. Most nursing care, however, continued to be provided through ‘Folksnursing’ within families and communities. Hospital provision expanded slowly, and while some hospitals employed Anglican Sisters, many relied on untrained assistants.

A similar situation existed in the Transvaal. Emergency hospitals were established in 1878 during malaria and typhoid epidemics, but patients were largely cared for by local women rather than trained nurses. During the Transvaal War, British military authorities requested assistance from the Community of St Michael and All Angels, leading to the establishment of emergency hospitals in Pretoria and at the Loretto Convent.

The gold rush of the 1880s brought trained nurses to the region, and Barberton became the first hospital in the Transvaal to train nurses.

Nurse Training and Professional Leadership

One of the most influential figures in South African nursing during this period was Sister Henrietta Stockdale of the Community of St Michael and All Angels. Following the diamond rush, she moved from Bloemfontein to Kimberley, where she played a central role in establishing nurse training.

“Although she had to start at the very bottom on her arrival at Kimberley, by dint of her personality, wisdom and foresight, she established herself as the authority on nursing and was soon consulted by doctors, hospital boards, Cecil Rhodes, the government and parliament in Cape Town.”

By 1890 nurses trained at Kimberley had gone on to establish training schools at Barberton (1887), Pretoria (1890), and Queenstown (1890). Although the output of trained nurses remained small, these initiatives significantly expanded the pool of trained nurses in South Africa.

In 1890 Sister Henrietta was registered with the British Nurses Association and corresponded with Mrs Bedford Fenwick, a leading advocate of state registration. Along with Sister Mary Agatha, she successfully lobbied the Colonial Government to introduce statutory nurse registration in 1891.

Religion, Race, and Gender in Colonial Nursing

One obstacle to the development of nurse training lay in the views of colonial officials, who regarded white women caring for African men as “repulsive and in violation of both racial and sexual taboos”. These concerns were not applied to religious sisters, allowing Sisterhoods to dominate nursing provision well into the late nineteenth century.

Roman Catholic Sisters of the Order of Assumption staffed Albany Hospital in Grahamstown from 1850, while Anglican Sisters provided nursing staff for the New Somerset Hospital in Cape Town from 1871. Sisters of the Community of St Michael and All Angels staffed the hospital at Kimberley. Many of these Sisters would later appear in the prosopography as providers of care to sick and wounded soldiers during the Boer War.

Military Nursing before the South African War

Military nursing developed in parallel with civilian nursing, and many reforms were reflected in the Army Nursing Service (ANS), which during this period remained small. The first nurses deployed to the Crimea had no prior military experience. Jane Shaw-Stewart, later Lady Superintendent of the Military Hospital at Woolwich, accompanied the second wave under Mary Stanley.

Florence Nightingale and her colleagues employed paid nurses but maintained a patronage-based hierarchy that caused tension. Many paid nurses were dismissed, having viewed themselves as professionally equal to the Sisters and Ladies who sought to retain authority.

Nurses’ activities were constrained by prevailing moral codes that limited physical contact with male patients. As a result, much hands-on care was provided by male orderlies drawn from regiments or trained within the hospital corps. Nightingale’s influence is therefore more accurately characterised as sanitary reform rather than nursing reform.

The ANS was established in 1881. In 1882 ANS Sisters were deployed to Gibraltar and Malta during the Egyptian campaign, and by 1889 Army Orders mandated their employment in all military hospitals with over 100 beds. By 1898 the ANS had expanded to 72 Sisters, although retention remained poor, with fewer than half completing three years’ service.

“At the heart of the Army Sister’s discontents in the nineteenth century was the ambivalence of their status within a combatant establishment.”

Definitions of Nurses and Nursing

During the period of the Boer War, the term ‘nurse’ encompassed a broad range of caregiving roles. It could refer to trained hospital nurses as well as to women caring for infants in domestic service.

War Office records and contemporary accounts indicate that nurses engaged by the military were generally trained in recognised nurse training schools and had experience as qualified nurses. Evidence also suggests that many civilian nurses working in South African hospitals were similarly trained. At the same time, some individuals provided nursing care without formal training, though all were recorded as nurses in official documents and appear in medal rolls.