Abstract. A major controversy in French medicine at the turn of the 20th century was how to improve the training and education of hospital nurses. In 1899 the new government agency responsible for health and social services, the Conseil Supérieur de l'Assistance, encouraged setting up new nursing schools and imposing a curriculum to be followed by all. The Conseil discussion concerning these steps was very heated. Some councilors demanded the dismissal of all the religious nursing orders as a first step toward improving nursing services. Others favored efforts to educate all the nurses possible, be they religious or lay, leaving it to the municipalities to decide on the internal organization of their hospitals. To examine the issues faced by both choices, the article analyzes two cases of hospitals that went on to adopt each of the different orientations discussed: Le Havre, which set up a nursing school and kept its nuns, and Valence, which sent off its religious congregation and tried to set up a nursing school.
At the turn of the 20th century, hospitals in France were at the cutting edge of a major debate over how to improve the education and training of their nurses. A corollary of this debate was the relative merit of the care provided to patients by religious nursing orders compared to that by the newer lay nurses. This debate fitted into a larger national discussion revolving around two poles. The first was the long-term effort by French medicine to improve the quality of health care in the hospitals of the country. Beginning with the Paris clinic movement in the late 18th and early 19th centuries and continuing with the aseptic discoveries of Louis Pasteur after 1878, doctors and surgeons tried to reform hospital practices and operations to improve the treatment and care given to patients.1
The second national debate over hospital organization was an essentially political one in which partisans and opponents of the new Third Republic confronted each other. Created in 1870, in the aftermath of the Franco Prussian War and the fall of the Second Empire, the government of the Third Republic unleashed a wave of pent-up anticlericalism. Its supporters saw the Roman Catholic Church as the source of opposition to the new government, menacing both the state and the French nation. A determined cohort of politicians, elected in the republican victories in 1876 and 1879, took it upon themselves to begin dismantling church "privileges": school programs were secularized, normal schools were set up to laicize the teaching profession, religious congregations were expelled, divorce was recognized, and the presence of religious orders in French hospitals came under close scrutiny.2
The first part of this article examines these cleavages as they emerged in 1898 and 1899 during a national debate over how to reform the training and performance of the nursing staff, referred to as "secondary hospital personnel." The two camps clearly staked out their positions on the question. One favored better education and training for all nurses, both religious and lay, while the other made laicization of hospital services and the nursing profession a priority to any reform effort. The second part of the article examines local implementation of the eventual recommendations. It considers the hospitals of Le Havre in Normandy in northwestern France and Valence on the opposite side of the country, in the southeast along the Rhône valley in the Département of the Drôme. The strategies adopted by the two towns to improve their nursing services are typical of the divergent approaches of the camps in the national debate.
The Conseil Supérieur de l'Assistance and the Napias Report
The Conseil Supérieur de l'Assistance was founded in 1888 by the French government to oversee distribution of social and health services to the population. The minutes of its meetings allow us to follow the positions taken by the councilors in the debate over how far to go in laicizing nursing. …