INTRODUCTION

History is the study of the currents of human thoughts and actions as they weave
the pattern of our lives. Yesterday is the history of the today. Today is the history
of tomorrow. History is not just the story of dates, conquests, discoveries or
research. It is the events of yesterdays and todays, people who lived, who loved,
&died
Today, you are likely to be healthier, fitter, fatter and to live longer than at any
other time in human history. The medical surgical nursing history provides the
basis of understanding the nursing today. The nursing development is mainly
based on the history of development of medicine and surgery.
The formulation of clear and concise definitions of nursing also has been hindered
by the lack of an obvious distinction between nursing and medicine. The primary
differences between nursing and medicine are the purpose and goal of each
profession and the education needed to fulfill each role. Further, historically,
medicine was perceived as a profession for men and nursing as a profession for
women although that situation is much changed today. In general, medicine is
concerned with the diagnosis and treatment of disease. Nursing is concerned with
caring for the person from a holistic perspective in a variety of health related
situations

IMPORTANCE OF STUDY OF HISTORY OF NURSING

To understand and interpret the changes which have taken place in nursing
Since nursing is closely associated with medicine, it is necessary to
understand how medicine has developed from the belief in witch- craft and
superstition to a science

The study of the development of nursing will enable to understand some of

the development of nursing problems of the past and how they have been
solved

The study about those who have developed nursing to the present stage
will stimulate the present generation

 It helps to accept the share of responsibility for the future of nursing

By studying nursing history, nurses learn how the profession has advanced
From its beginnings
Learning from the role models of history nurses can increase their capacity
to make positive changes in the present & set goals for the future
By applying the lesson learned from history nurses will continue to be a
vital force in the health care system

HISTORY OF DEVELOPMENT OF MEDICINE

460BC; Birth of Hippocrates, Greek physician and founder of the first university,
considered the father of medicine. Hippocrates bases medicine on objective
observation and deductive reasoning, although he does accept
the
commonly held belief that disease results from an imbalance of the four
bodily humors [an idea that persists for centuries]
130 AD; Birth of Galen, considered by many to be the most important
contributor to medicine following Hippocrates. Born of Greek parents, Galen
resides primarily in Rome where he is physician to the gladiators and personal
physician to several emperors. He publishes some 500 treatises and is still
respected for his contributions to anatomy, physiology, and pharmacology
910 AD; Persian physician Rhazes is the first to identify smallpox, as distinguished
from measles, and to suggest blood as the cause of infectious disease. Rhazes also
noticed that the pupil of the eye gets smaller when exposed to light
1590; Dutch lens grinder Zacharius Jannssen invents the microscope
1628; William Harvey publishes An Anatomical Study of the Motion of the
Heart and of the Blood in animals, describing how blood is pumped
throughout the body by the heart , and then returns to the heart and
recirculates. The book is very controversial but becomes the basis for
modern research on the heart and blood vessels.

1656; Experimenting on dogs, English architect Sir. Christopher Wren is the first
to administer medications intravenously by means of an animal bladder
attached to a sharpened quill. Wren also experiments with canine blood
transfusions (although safe human blood transfusions only became feasible
after Karl Landsteiner develops the ABO blood-typing system in 1900).
1670; Anton van Leeuwenhoek refines the microscope and fashions nearly 500
models. Discovers blood cells and observes animal and plant tissues and
microorganisms. Anton van Leeuwenhoek's noticing bacteria in 1683
1747; James Lind, a Scottish naval surgeon, discovers that citrus fruits prevent
scurvy. He publishes his Treatise of the Scurvy in 1754, identifying the cure
for this common and dangerous disease of sailors, although it takes another
40 years before an official Admiralty order dictates the supply of lemon juice to
ships.
1796; Edward Jenner develops a method to protect people from smallpox by
exposing them to the cowpox virus. In his famous experiment, he rubs pus from a
dairymaid's cowpox postule into scratches on the arm of his gardener' s 8year-old son, and then exposes him to smallpox six weeks later (which he
does not develop). The process becomes known as vaccination from the Latin
vacca for cow. Vaccination with cowpox is made compulsory in Britain in 1853.
Jenner is sometimes called the founding father of immunology.
1800; Sir Humphry Davy announces the anesthetic properties of nitrous oxide,
although dentists do not begin using the gas as an anesthetic for almost 45
years.
1816; Ren Laennec invents the stethoscope.
1818; British obstetrician James Blundell performs the first successful transfusion
of human blood.
1842; American surgeon Crawford W. Long uses ether as a general anesthetic
during surgery but does not publish his results. Credit goes to dentist William
Morton.

1844; Dr. Horace Wells, American dentist, uses nitrous oxide as an anesthetic.
1846; Boston dentist Dr.William Morton demonstrates ether's anesthetic
properties during a tooth extraction.
1849; Elizabeth Blackwell is the first woman to receive a medical degree (from
Geneva Medical College in Geneva, New York).
1867; Joseph Lister publishes Antiseptic Principle of the Practice of Surgery, one
of the most important developments in medicine. Lister was convinced of the
need for cleanliness in the operating room, a revolutionary idea at the
time. He develops antiseptic surgical methods, using carbolic acid wounds and
surgical instruments. The immediate success of his methods leads to general
adoption. In one hospital that adopts his methods, deaths from infection
decrease from nearly 60% to just 4% to clean
1870; Louis Pasteur and Robert Koch establish the germ theory of disease.
According to germ theory, a specific disease is caused by a specific organism.
Before this discovery, most doctors believe diseases are caused by spontaneous
generation. In fact , doctors would perform autopsies on people who died
of infectious diseases and then care for living patients without washing their
hands, not realizing that they were therefore transmitting the disease.
1879; First vaccine for cholera
1880; French army surgeon Charles Louis Alphonse Laveran identified parasites
in the blood of a malaria patient
1881; First vaccine for anthrax
1882; First vaccine for rabies
1890; Emil Von Behring discovers antitoxins and uses them to develop tetanus
and diphtheria vaccines.
1895; German physicist Wilhelm Conrad Roentgen discovers x rays.
1896; First vaccine for typhoid fever.

1897; Ronald Ross, a British officer in the Indian Medical Service, demonstrates
that malaria parasites are transmitted via mosquitoes
1897; First vaccine for plague
1899; Felix Hoff man develops aspirin (acetyl salicylic acid). The juice from willow
tree bark had been used as early as 400 BC to relieve pain.19th century
scientists knew that it was the salicylic acid in the willow that made it work, but
it irritated the lining of the mouth and stomach. Hoffman synthesizes acetyl
salicylic acid, developing what is now the most widely used medicine in the world.
1901; Austrian-American Karl Landsteiner describes blood compatibility and
rejection (i. e. , what happens when a person receives a blood transfusion from
another human of either compatible or incompatible blood type), developing
the ABO system of blood typing. This system classifies the bloods of human
beings in to A, B, AB, and O groups. Landsteiner receives the 1930 Nobel Prize for
Physiology or Medicine for this discovery.
1906; Sir. Frederick Gowland Hopkins suggests the existence of vitamins and
concludes they are essential to health. Receives the 1929 Nobel Prize for
Physiology or Medicine
1907; First successful human blood transfusion using Landsteiner's ABO blood
typing technique
1913; Dr. Paul Dudley White becomes one of America's first cardiologists, a
doctor specializing in the heart and its functions, and a pioneer in use of the
electrocardiograph, exploring its potential as a diagnostic tool.
1921; Edward Mellanby discovers vitamin D and shows that its absence causes
rickets.
1922; Insulin first used to treat diabetes.
1923; First vaccine for diphtheria
1926; First vaccine for pertussis (whooping cough).

1927; First vaccine for tuberculosis.

1927; First vaccine for tetanus.
1928; Scottish bacteriologist Sir Alexander Fleming discovers penicillin. He shares
the 1945 Nobel Prize for Physiology or Medicine with Ernst Chain and Sir Howard
Florey
1935; First vaccine for yellow fever
1935; Dr. John. H. Gibbon Jr, successfully uses a heart-lung machine for
extracorporeal circulation of a cat (i. e. , all the heart and lung functions are
handled by the machine while surgery is performed). Dr. Gibbon uses this
method successfully on a human in 1953. I t is now commonly used in open heart
surgery.
1937; First vaccine for typhus
1937; Bernard Fantus starts the first blood bank at Cook County Hospital in
Chicago, using a 2% solution of sodium citrate to preserve the blood.
Refrigerated blood lasts ten days.
1943; Microbiologist Selman A. Waksman discovers the antibiotic streptomycin,
later used in the treatment of tuberculosis and other diseases.
1945; First vaccine for influenza
1952; Paul Zoll develops the first cardiac pacemaker to control irregular heartbeat
1953; James Watson and Francis Crick at Cambridge University describe the
structure of the DNA molecule. Maurice Wilkins and Rosalind Franklin at King's
College in London are also studying DNA
1954; Dr. Joseph E. Murray performs the first kidney transplant between identical
twins
1955; Jonas Salk develops the first polio.

1957; Dr. Willem Kolff and Dr. Tetsuzo Akutzu implant the first artificial heart in a
dog. The animal survives 90 minutes.
1962; First oral polio vaccine (as an alternative to the injected vaccine)
1964; First vaccine for measles
1967; First vaccine for mumps
1967; South African heart surgeon Dr. Christian Barnard performs the first
human heart transplant.
1970; First vaccine for rubella
1974; First vaccine for chicken pox
1977; First vaccine for pneumonia
1978; First test-tube baby is born in the U. K.
1978; First vaccine for meningitis
1980; W.H.O. (World Health Organization) announces smallpox is eradicated.
1981; First vaccine for hepatitis B
1982; Dr. William Devries implants the Jarvik-7 artificial heart into patient Barney
Clark. Clark lives 112 days.
1983; HIV, the virus that causes AIDS, is identified
1992; First vaccine for hepatitis A
1996; Dolly the sheep becomes the first mammal cloned from an adult cell (dies in
2003)
1998; First vaccine for Lyme disease
2007; Scientists discover how to use human skin cells to create embryonic
stem cells

History of development of surgery

The earliest surgeries in history were crude at best and likely to have been
performed out of desperation or ignorance. Surgery as we know it did not truly
begin until the late 1800s, and even then, infection was common and outcomes
were poor. Surgical procedures that are common place today, such as
appendectomies, were not common then. In fact, until 1885, a person with
appendicitis was expected to die of the infection that occurred once the appendix
ruptured.
Early techniques were rudimentary, or even barbaric by today's standards, as
anesthesia was not commonly used until the mid-to late 1800s. Today, surgery
takes a wide variety of forms and is often performed using minimally invasive
techniques. This has shortened recovery times, improved outcomes and
minimized complications for most patients

Notable Milestones in Surgical History

6,500 B.C - Skulls found in France show signs of a rudimentary surgery called
trepanation, which involves drilling a hole in the skull
1540 AD - English barbers and surgeons unite to form The Unite d BarberSurgeons Company. These barber-surgeons performed tooth extractions and
bloodletting. Physicians were considered an entirely different profession, treating
illness with medications.
1818 - First transfusion of human blood.
1842: Crawford W Long (America) used ether as an anesthetic while operating on
a neck tumor (but did not publish details of his operation).
1843 - First hysterectomy performed, in England
1845: Horace Wells (America) tried unsuccessfully to demonstrate that laughing
gas would allow him to extract a tooth painlessly.

1846: Dr. JC Warren (America) removed a tumor from the neck of Gilbert Abbott
using ether
1846: Robert Liston (Britain) removed a leg using ether - 'this Yankee dodge'
1847: James Simpson (Britain) discovered chloroform.
1847: Ignaz Semmelweiss (Hungary) cut the death rate in his maternity ward by
making the doctors wash their hands in calcium chloride solution before treating
their patients.
1854: Standards of hospital cleanliness and nursing care rose rapidly under the
influence of Florence Nightingale.
1865: Joseph Lister (Scotland) - basing his ideas on Pasteur's Germ Theory cut
the death rate among his patients from 46 to 15 percent by spraying instruments
and bandages with a 1-in -20 solution of carbolic acid.
1867 - British surgeon Joseph Lister publishes Antiseptic Principle in the Practice
of Surgery, extolling the virtues of cleanliness in surgery. The mortality rate for
surgical patients immediately falls.
1884: Carl Koller (Germany) discovered that cocaine is a local anesthetic.
1885 - First successful appendectomy performed, in Iowa.
1890s - Wide spread use of chemical agents to minimize germs. Carbolic acid was
put on incisions to minimize germs and decrease infection rates.
1890: Beginnings of aseptic surgery - surgeons started boiling their instruments to
sterilise them W S Halstead (America) started using rubber gloves when
operating -German surgeons started to use face masks.
1893 - First successful heart surgery performed, Provident Hospital, Chicago. The
surgery repaired the pericardium, the sac around the heart. Many do not consider
this to be the first successful "heart surgery" because the heart itself was not
operated on.

1895 - First X-ray performed, in Germany.

1896 - First successful heart surgery performed, in Germany. Surgeons repaired a
stab wound in the muscle of the right ventricle.
1901: Karl Landsteiner (Austria) - discovered blood groups. Transfusions had been
tried before but usually killed the patient because of clotting. Matching blood
groups stopped this happening
1905 - First successful cornea transplant
1913: Richard Lewisohn discovered that sodium citrate stopped blood clotting
during an operation
1917 - First documented plastic surgery performed, on a burned English sailor.
1922 - Insulin first used for treatment of diabetes, allowing diabetics to survive
after diagnosis
1928 Antibiotics discovered.
1930 - German man has the first sex change operation (to a female)
1937 - First blood bank opens, helping make more surgery possible by treating
bleeding during the procedure.
1940 - First metal hip replacement surgery performed.
1950s - First LASIK eye procedures performed, in Columbia.
1950 - First successful organ transplant. The kidney recipient rejected the organ
after eight months.
1952 - First successful heart surgery where the heart was stopped and restarted.
1953 - First successful surgery using a heart-lung bypass machine.
1954 - First successful living donor kidney transplant, the kidney was donated by
the recipient's twin brother. The recipient lived eight years after the procedure.

1966 - First successful pancreas transplant.

1967 - First successful liver transplant.
1967 - First heart transplant surgery performed, by South African Christian
Barnard. The heart recipient survived 18 days until succumbing to pneumonia.
1975 - First organ surgery performed using laparoscopic or minimally invasive
technique.
1978 - First "test tube baby born.
1982 - Jarvik-7 artificial heart used.
1984 - Baby Fae survives 21days after being transplanted with the heart of a
baboon.
1985 - First documented robotic surgery.
1999 First successful hand transplant (previous patients had rejected their
grafts).
2000 - da Vinci robotic surgical system wins U.S. Food and Drug Administration
approval. The system is now used in a wide variety of procedures, including
prostate surgeries and coronary artery bypass.
2007 - First natural orifice transluminal endoscopic surgery performed. This
technique uses a natural body opening, such as the mouth, to insert instruments
and minimize recovery times.
2010 - World's first full-face transplant performed, in Spain.

HISTORICAL EVENTS INFLUENCING THE EVOLUTION OF NURSING

Date

Event

1-500 BC Approximately

Nursing care primarily involves meeting the

hygiene and comfort needs of individuals and

families

Christians

weeding

on

close

association with an organized church primarily

provide care.
1817

General Nursing

1854-1860

Florence Nightingale opens a training School at

St. Thomas, Hospital in London and publishes
notes on Nursing: What it is and What it is not.

1872

Americas first trained Nurse, Linda Richards

graduate from new England Hospital for women
in Boston.

1873

Three Nursing school patterned after the

Nightingale plan develop in the United States:
Bellevue Training School. In 1874, the first
Nightingale Model School of Nursing in Canada
in St. Catherines, Ontario.

1899

International Council of Nurses is established.

1911

Founded INA

1940

World War-II results in another Nursing

shortage. Estcher Lucille Brown completes the
brown report on nursing education, advocating
that education for nursing for belongs in
colleges and universities, not in hospitals.

1946

Basic Bachelorette Degree-Delhi & Vellore

1960

MSc Nursing

1985

National Centre for Nursing Research is

established at the National Institute of health in
Bethesda, Mary Land.

DEVELOPMENT OF NURSING IN INDIA

The earliest records of Indian medicine are found in the sacred books
Vedas. They are divided in to four parts as: the Rig Veda, the Yajur-Veda, the
Sama-veda and the Atharva-veda. In the Rig-Veda, disease was regarded as the
result of divine wrath. The Adharva-veda contained innumerable incantations and
charms for the practice of magic, disease, injuries, sanity, health and fertility.
Supplemental Vedas were also developed. Among these, Ayur-veda (Ayur
means life and Veda means to know the knowledge by which life can be
prolonged or better understood) or science of life was given by Brahma. It
contains eight parts that dealt with subjects such as medicine, surgery and
childrens disease and stressed hygiene and preventation of illness.
Indian scholars studied anatomy and physiology. Methods of diagnosis
were carefully wacked out; a great number of remedies for disease were listed
with specific instructions for applying them. These medical scholars advocated
cleanliness in the treatment of wounds and message for muscular troubles. Two
outstanding men of this period were Sushruta and Charaka. Sushruta, known as
father of surgery in India and charaka of medicine on a high ethical basis.
About 1400 B.C Sushruta wrote a valuable book on medicine in which he
described many surgical operations including plastic surgery, Cataract,
amputations, brain tumors and caesarean etc. He enumerated and described 121

surgical instruments and advocated dissection. Antiseptic, Surgery, anesthesia,

antidotes for poisons and vaccination were practiced in India. Later years from
these two mens writings we know that medicine and surgery were advanced to a
high level and doctors and nurse were to be of high moral character. In India
hospitals were large and well equipped and nurses were usually men or old
women. In the writings of Chakra and Sushrutha an estimate was given for the
desirable qualification of physicians, nurses, drugs and patient.
Physician: through mastery of the scriptures, large experience, cleaverence and
purity (of mind and Body) are the principle qualities of the physician.
Nurse: Knowledge of the manner in which drugs should be prepared for
administration cleverness, devotness to the patient waked upon purity (both
mind & body) are the qualifications of the attending nurse.
MILITATRY NURSING
Military nursing was the earliest type of nursing in 1664 the East India
Company helped to start a hospital for soldiers at fort St. George, Madras. Later a
civilian hospital was built. They appointed a medical team to serve at both places
hospitals. In 1797 another hospital was built as lying in hospital and in 1864
through Miss. Nightingale, reforms were made at military and civil hospitals. In
1954, Government started a training school for midwives. In the beginning this
was only for British people in India but later it extended to Indians.
CIVILIAN HOSPITAL
Nursing in the military the hospital was poor quality carried by male
orderlies and the menial staff. In 1871 the government general Hospital Madras,

under look a plan to train nurses. Nurses were brought from England to be in
charge and the first 6 students were those who had previously received their
diploma in midwifery. Later this plan was changed to general nursing and
midwifery.
IN MUMBAI
Among the earliest hospitals is the Jamsetjee Jeejeebhoy group, the first of
which was opened in 1843.
Another hospital which had played an important part in the development
of modern nursing in India was the Pertanji Hormusji Cama Hospital for women
and children which was founded in 1883 but not opened until 1886.
In 1891, Bai Kashibai Ganapat, was the first Indian Nurse to come for
training.
Training was at first 2 years but become 3 years when the Bombay
presidency Nursing Association was established in 1890.
An outstanding graduate of the JJ group of Hospital is Miss. T.K. Andravala.
Miss Andranvala has worked very hard to raise the status of the nursing to the
interest of the INAI having held the office of president for two. Miss Andranvala
was on the world Health Organization its representatives.
Mission Hospitals
Mission Hospitals were first top begin the training of Indian as nurses.
Religious taboos and prejudice against nursing career had prevented parents form
sending their daughters to nursing course.

In 1907-1910 North India united board of examiners for Mission hospitals

was organized and set-up rules for admissions and standards of training and
conducted a public examination.
In 1909 the medical association granted the nursing diploma after examining
students by central nursing board for nursing training in south India.
NURSING EDUCATION
Nursing Education in India begin with brief period of 6 months rising to present
period of 3 years. The short period of 2-6 months were given with Nursing care of
sick and midwifery.
The basic programme for combined general nursing and midwifery developed
rapidly after 1871.
The leaders of Nursing in India realized that more and better qualified teachers
and ward supervisors were needed if standards were to be maintained and
Nursing was to an advance.
Hence, courses were setup in several palaces to give Indian nurses an opportunity
to prepare themselves for responsible position in hospital and school of Nursing.
Post certificate courses were first offered in Nursing Administration, Supervision
and teaching. These originated at the college of Nursing, New Delhi, the college of
Nursing CMC Hospital, Vellore and the Government General Hospital, Chennai.
The first 4 year Basic Bachelorette to Degree Programmes were established in
1946 at the college of Nursing in Delhi and Vellore.

In, 1963, the School of Nursing in Trivandrum instituted the first 2 year post
certificate Bachelor Degree Programme.
In recent years, as higher education for nurses has developed around the world,
courses in India have developed so that the nurse can specialize in almost any
subject and continue education through the level of the Masters degree to
Doctorate Degree. The first Masters Degree course, a two years Post graduate
programme, was begun in 1960 at the college of Nursing in Delhi.

TRENDS IN DEVELOPMENT OF NURSING EDUCATION

A profession is a dynamic integration of various faculties of knowledge. Since
nursing education is a professional education, it is dynamic by its own nature and
thereby giving rise to trends. The current trends in nursing educations are given
below.
Curriculum changes
Flexible curriculum designs are evolving to facilitate diversity of educational
opportunity and overcome barriers of distance and time. These curricula are
often competency based, focused on outcome and emphasize student
participation and responsibility for learning
Innovations in teaching and learning
In nursing education lot of innovations are taking place in the areas of teaching
and learning. Invariably, these innovations lead to intellectual development,
personal development and career development
Educational quality assurance
Educational quality assurance is a process for monitoring and evaluating efficiency
and effectiveness of educational provision and to institute remedial measures as
and when needed.

 More reliance on technology

Technology exerts greater influence on nursing education as a tool for teaching
and learning. Judicious use of educational psychology in the development and
practice of educational technology has increased its user friendly nature
considerably.
Emphasis on high-tech-high-touch approach
High-tech-high-touch approach in nursing care was devised to preserve the
human component of nursing care without undermining the advantages of
technological advancements in the field of patient care. Present day nursing
education is preparing the students to maintain the human element of nursing
while caring the patients with the help of sophisticated gadgets
Preparation of global nurses
Nursing education is all set to reap benefits created by globalization and
liberalization by way of preparing global nurses. Many institutions are preparing
students with a global perspective through providing learning experiences to
enrich students knowledge in English along with the attainment of other
objectives.
Transnational acceptance
Nursing educational programs in one nation is widely accepted by other nations.
In fact, this transitional acceptance is the main reason for the development of
nursing education in the countries like India
Ensuring a promising career
Unlike many other professional education programs, nursing education ensures a
promising career either in India or abroad. A study conducted by Johnson and
Johnson reveals that nursing education will maintain this status at least for the
coming twenty years.
Emergence of new specialties

In par with the development in the medical and allied fields, nursing education is
also offering new specialties to meet the needs of the community.
Increased opportunities for higher studies
Different from the past, many institutions are offering programs such as post
certificate BSc nursing, MSc nursing, M. Phil and Ph.D. An eligible candidate can
easily pursue higher education without much time lag.
Potential shortage of nursing educators
As a result of the exciting career opportunities in the service sector when
compared to the educational side, talented nurses are now opting a career in the
service side for better prospectus. This may lead to a shortage of nurse educators
in the near future. Since the presence of talented nurses in the service sector will
do a lot in uplifting the public image of our profession, it is not wise to prevent
this flow. Allowing the qualified nurses from service side to work in teaching
institutions on a part time basis will help to solve this problem to a certain extent.
Diminishing government role
Shortage of funds coupled with certain policy decision has prevented the
government from investing further in the field of nursing education. Now the
private sector is playing a dominant role for the development of nursing
education.
Uniformity and standardization
Various universities and nursing boards are conducting nursing programs in a
different manner. Even though efforts are on the way to bring about the much
needed uniformity and standardization, nothing significant has been achieved so
far.
Coping with the impact of globalization
As a result of the impact of globalization the status of nursing shifted from that of
a caring profession to a rewarding profession. Majority of students consider
nursing education only as a means of securing a rewarding career. Nursing

education sector is trying hard to cope with this worrisome impact of

globalization.
Enhanced student status
In the past, students joining for nursing educational programs were viewed as
student nurses rather than nursing students. Increased career opportunities
offered by the nursing as well as the tremendous increase in the number of
nursing institutions prompted society and other health care professions to
consider nursing students as nursing students.