The medieval origins of healthcare assistants

I was lucky enough to be asked to speak at the launch of the Royal College of Nursing’s (RCN) new exhibition about nursing healthcare support workers, called Shining A Light . If you are in London, head over to Cavendish Square and visit it. There are lots of fascinating artefacts *. At the launch I spoke about the history of support workers. This almost always starts with nursing aides who worked alongside nurses in the Crimean War. ?Indeed in the section of my recent book about this workforce’s history that is exactly where I started, however the history goes back a lot longer than that. In fact for as long as there have been people who might be regarded as healthcare professional there have been support workers.

?Formal healthcare roles like physicians, apothecaries and surgeons started to emerge in the thirteenth century. They were 'formal' in the sense that they sought to define their roles, set rules and sought to protect what they did. Professions like surgeons were almost always men, who saw themselves as being at the top of the medieval medical hierarchy. They are though only part of the story. Although you would not know it from the records, there was a much bigger workforce caring for people, one that was predominantly female that provided a wide range of care in places such as religious orders, hospitals, in homes and on the streets. These informal carers performed a wide range of support tasks from feeding to personal care, to helping with walking, to saying prayers, singing hymns and emotional wellbeing. They also performed more direct interventions.

In her excellent 2021 article Sara Ritchey provides the following example (quoted in full)-

Sometime in the 1220s a young woman named Ida was walking the city streets of Leuven in Belgium when she was called into the home of a dying man. The sick man was so certain of his imminent death that he had already summoned a priest to administer last rites. Entering his home and having learned something of his affliction – its duration, symptoms, and the source of his pain – Ida fixed her eye upon the pestiferous tumour that vexed him. She promptly drained the tumour of its puss and – lo! – the man reported immediate results. The swelling and pain had diminished with Ida’s assistance. He made a full recovery.

Interestingly Ritchey describes women who provided care such as Ida as ‘unseen’. This notion of being invisible, captured in the RCN’s exhibition title, still characterises how support staff are perceived. A 2020 book about support workers edited by Mike Saks has the sub title The Invisible Providers of Healthcare. Historically the reason for this invisibility was gender. More recently, I have argued in the British Journal of Healthcare Assistants , it is about class. The RCN’s exhibition is a sign that support workers are now, at long last, moving into the limelight.

*The image at the top of this article is from the RCN exhibition. It dates from 1955 and sets out the tasks that nursing aides were expected to perform.