International Journal of Caring Sciences September-December 2015 Volume 8 | Issue 3| Page 791

Special Article

Nursing and Caring: An Historical Overview from Ancient Greek

Tradition to Modern Times

Dimitrios Theofanidis, RN, MSc, PhD

Clinical Lecturer, Nursing Department, Technological Educational Institute of Thessaloniki, Greece
Despina Sapountzi-Krepia, BSc, MSc, PhD, RN, RHV
Professor and Head of the Department of Nursing, Frederick University, Nicosia, Cyprus
Correspondence: Dr Theofanidis Dimitrios, Alexandrer Technological Educational Institute of Thessaloniki,
Sindos, 54100, Thessaloniki, Greece E-mail:[email protected]

Abstract
Introduction: Nursing as a humanistic profession is closely related to the core of caring which embraces the
human essence in both illness and good health. This position paper examines the fundamental humanistic
elements of caring and nursing particularly from a Greek perspective.
Aim: to discuss critically the implications of care delivery mainly in Greece by looking at the deeper ‘roots’ of
these notions, within their historical and geographical contexts.
Method: a historical literature search was undertaken in a ‘time series snapshots’ methodology whereby key
events and historical contexts were critically appraised with regard to the evolution of nursing as an art and
science. Both international and national library databases were used.
Results-Discussion: Just like modern medicine, nursing also uses the Hippocratic Medical heritage as its base
and therefore Hippocrates could be seen as a ‘ shared forefather’ for health care professionals. It is often argued
that in his early writings he described in detail what is now the nursing profession as he did not mention 'nurses'
but referred to doctor assistants! Nursing has now become an independent scientific discipline with discrete
evidence based knowledge but certainly the care side still has powerful historic, cultural and traditional roots.
Conclusions drawn from a review of the literature show that historically the roots of Nursing and Caring in
Greece have a triple dimension. a) Caring care was provided within the family mainly by members, slaves and
servants. b) Wartime nursing care was provided by private citizens but also by nobles who possessed the art of
healing and caring. c) Organised nursing care was provided in many hospitals in the early Byzantine Empire.
Hostels and Nursing Homes were run by monks and laity, voluntary men and women initially as a token of
Christian love and later on payment.
Key words: nursing, caring, ancient Greece, Rome, history.

Introduction Aim
There is an inherent difficulty in writing the The aim, of this position paper is to discuss
history of nursing in the area of Greece because critically the implications of care delivery in the
of the social context in which it has been Greece by closely reviewing the deeper ‘roots’
practiced. Literature on this topic is scarce and and pillars of nursing steming from ancient
diverse and further attempts to clarify this subject Greek caring practices, its core mission and
are needed in order to comprehend the current values and the evolution of nursing within its
state of health care affairs. historical and geographical contexts.

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Method Lachman (2012) defines care as

For this paper’s needs, a historical literature “…a commitment to attending to and becoming
search was undertaken in a time series sequence enthusiastically involved in the patient’s needs”.
whereby key events and historical contexts were In these lines Morse et al., (1990) argue that: “If
critically appraised with regard to the evolution caring is to be retained as the "essence" of
of nursing as an art and science for this specific nursing, and if research in this area is to
geographical area. Key words used included: advance, then the various perspectives of caring
nursing, caring, ancient Greece, Rome and must be clarified, the strengths and the
history in both Pubmed and Greek databases. limitations of these conceptualizations examined,
and the applicability of caring as a concept and
Results-Discussion
theory to the practice of nursing identified.”
Providing nursing care in ancient Greece, a
In a philosophical analysis of the concept of
practice that could be argued continued until the
'care', Marieskind (1998) stressed that the
mid 20th century, was mainly the work of women
caregivers’ incentives should be to remove or
of every household. For this reason, the exercise
alleviate pain and discomfort of those they look
of nursing activities in the ancient world could
after. The empathetic adoption of this attitude
only be accessed through the social position of
when caring comes when the caregiver develops
women throughout these periods.
the ability to imagine experientially the plight of
In general, the dominant ideology at the time was others that is those who receive the care as if he
that women should not have to deal with were in his place.
common matters or practice a profession. Under
Maclean and Theisen (2012) put care within an
these conditions the social space where women
ethical framework, stressing that the provision of
could exercise nursing was confined to the site of
care is associated with a sense of morality and
the house which, however, was dominated by the
duty which are innate in many women, while one
ancient Greek proverbial philosophy: ‘τα εν οίκω
could also consider care to be directly related to
μη εν δήμω’, which loosely translates to: ‘house
technical aspects, educational preparedness, good
matters are not for the public eye’ or in today’s
interpersonal and communication skills and a
idiomatic phrase: ‘don't wash your dirty linen in
moral sense towards the person who receives the
public’. The outcome of this social framework is
care.
that only limited and indirect references can be
found in ancient texts concerning the exercise of Women and care delivery: the beginning of
nursing in ancient Greece and the Balkan area Nursing?
making it difficult to research and study
Women's involvement in health issues is an
(Sapountzi-Krepia, 2001).
ancient tradition in human cultures. Some
The notion of ‘nursing’ is closely related to the evidence for this activity can be found in early
essence of ‘caring’ as the philosophy which historical texts. Undoubtedly there are even older
underpins the theory and practice of Nursing unrecorded traditions but their roots are lost in
Science embraces the core human essence in the mists of time.
both illness and good health. As Donahue (1985)
A large part of this historical heritage was lost as
points out, ‘to care for’ is not a phenomenon
social changes confined woman to the ‘loft’,
exclusive to nursing but it appears in various
ousting women from exercising therapeutic
forms across all human constructs and
interventions and the introduction of laws
civilizations throughout time.
prohibiting women from formal education

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(Maclean 1974, Sapountzi-Krepia 1999, nursing were obscured for many centuries,
Sapountzi-Krepia 2013). healers, both women and men, practiced a
mixture of what are now called Nursing and
The word ‘nurse’ evolved from the Latin word
Medicine (Sapountzi-Krepia 2013).
‘nutrire’ which means to nourish. The
‘nourishing’ aspect of nursing prevailed The relevance of womanhood and its expression
throughout centuries with the roots of nursing to what is now called ‘care’ regarding the Greek
and medicine intertwined in ancient eastern and cultural heritage, can be traced back to the
western cultures and religions. Still, it should be ancient Greek pantheon.
noted that even in the previous century, in much
Nursing in ancient Greece
of the Balkans women were solely responsible
for housekeeping and raising children. Evidence on the involvement of women with
Limitations of their social role included not health issues can be found in Homeric works.
working outside the house and yet nursing was Helen of Sparta learned the secrets of herbs via
perceived as a ‘female job’. In Turkish, the term an apprenticeship in Egypt with Polydama, a
‘nurse’ means ‘sister’ i.e. hemşire kardeş renowned therapist and Queen of Egypt.
(Bahçecik & Alpar 2009). Similarly, the Greek According to Fernie (2006), borage was the
equivalent to ‘nurse’ is ‘αδερφή’ which again famous nepenthe (medicine for sorrow, literally
means ‘sister’. an anti-depressant) of Homer which Polydamas
sent to Helen for a token:
Thus, provision of nursing care was considered
throughout the centuries as an internal affair of "…of such rare virtue that when taken steep'd in
families and especially of women (Sapountzi- wine, if wife and children, and mother, brother
Krepia & Krepia 2005). In the long course as and sister, and all thy dearest friends should die
caregivers, women have sought and discovered before thy face, thou could'st not grieve, or shed
the healing properties of herbs and other a tear for them…"
substances, which in the course of time spread by In Homer’s Iliad, Agamedes, daughter of King
word of mouth, from one generation to the next Aegeus, was claimed to know all the medicines
(Laskaris, 2008). A report on the ancient on earth, and Hecamede, daughter of Arsinous,
knowledge from 3rd century BC regarding king of Tenedos, was credited for treating the
human milk dictates its use for treating burns wounded during the Trojan War (Morford et al.,
alongside ear and eye infections, now proven to 2011).
be effective due to its immunological and
antimicrobial properties as described by Vorbach Ancient Greeks worshiped Apollo the Sun God
et al. (2006). as the God of healing, while Asclepius, the son
of Apollo, was the Greek God of medicine.
Nevertheless, nursing care provision is less often Apollo’s daughter Hygiea was the goddess of
mentioned in historical texts although medical, health and was credited for magical cures. In
religious and literary texts contain evidence of that era, much emphasis was given to personal
the contribution of women in treatment and care. cleanliness (hence the term hygiene), exercise
The true and complete story of the contribution and ortho-nutrition dietetics (Sapountzi-Krepia,
of women in health is sadly lost and even 2004).
challenged in the writings of medical texts of
literary women therapists especially when men In some of the Hippocratic texts evidence can be
were given credit for these writings (Achtenberg, traced for the role of women as exclusively
1990). As the boundaries of medicine and providing therapy to other women, referred to
"Omphalētómos - Ομφαλοτόμος" (Umbilical

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cord cutting) and "latreousa - Ιατρέουσα" reference to hospitals for inpatient soldiers
(doctor-like tasks). Achterberg (1990) reports (Lanara, 1977; Messolora, 1959).
that according to Pliny (AD 50) Queen Artemisia
Roman period
of Ephesus could cure many diseases and
gynecological conditions using special herbs. The Roman civilization is well known for
advances in public health. Ancient Rome had
The foundations of Greek Nursing can also be
infrastructures like sophisticated sanitation,
found in the sanitariums (Αναρρωτήρια) of
including sewage systems, drainage and public
ancient Greece where some form of organized
baths. During the early years of the spread of
nursing was provided. Sanitariums pre-existed
Christianity, many women and monks provided
Asclepieia (Ασκληπιεία) which flourished in
care for patients, primarily the elderly and the
ancient Greece providing health care in a more
needy. The women were called ‘Deaconesses’.
structured form. It is reported that within their
These women were considered the predecessors
organizational structure there was a class known
of nursing because they used to tend to patients,
as 'zakoron- ζακόρων’ or ‘nakoron - νακόρων’
the poor in their homes, prisoners and others by
who cared for patients their duties being a
providing care for them. In this respect, the
mixture of servant and nurse (Risse, 1999;
Deaconess Order may be regarded as the first
Lanara, 1993).
‘visiting nurse’ effort, since in apostolic times
King (1998) argues that in ancient Greece and they cared for the sick poor in their homes as
Rome there were special nurse- nannies who well as in hospitals. In the year 400 there were
looked after children. In ancient Greece nursing forty deaconesses serving as parish nurses in
care was the duty of women of the house, free or Constantinople (Blainey, (2011).
slaves. Historians have therefore concluded that
Phoebe, a disciple of the Apostle Paul, was the
nursing was the duty of Greek women and was first-mentioned deaconess, alongside with
considered at the time to be of little interest to Thekla, Nikareto and Theodosia. Phoebe in
the advancement of medical science (Basford & particular is regarded sometimes today as the
Slevin, 2003). It should be noted that the verb first district nurse. Phoebe noted by her status as
‘to treat’ (Θεραπεύω) in ancient Greek is to cure, a deacon and ‘Prostatis’ one who should be
hence the noun ‘Therapainis - Θεραπαινίς’ (the esteemed highly because of her philanthropic
work was trusted by Paul to deliver his letter to
maid or servant who provided care). Similarly, the Romans as his emissary to the church in
Thucydides (4th century BC) states that at the Rome (Osiek, 2005).
time of the plague in ancient Athens, patient care
A series of Roman women of high rank gave
was provided by the women of the family, slaves
their wealth to charity and organized nursing
and their friends (Tountas, 2012).
groups also funding monasteries and hospitals.
Xenophon (5th-4th century BC) in his These important Roman matrons mainly of
‘Economics’ mentions an Athenian citizen patrician family heavily influenced nursing by
named ‘Isomacho’ who in instructing his young turning their immense energy and wealth to
wife, said that within her house duties she was founding hospitals and raising the standards of
also to take care and supervise patients of slaves nursing. These hospitals also practiced surgery as
(Sapountzi-Krepia & Krepia 2005). The same well as nursing (Ellis & Hartley, 2012).
author in his “Ascent Cyrus” says that in wartime
In the early 4th century A.D. Fabiola, a Roman
there were outdoor military hospitals where
lady, erected a house for the care of the sick. She
nursing for the wounded was provided, while
founded the first public hospital and later a
Plutarch in his biography of Solon also makes
hospice for strangers.

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At the time, hospitals were mentioned as an hygiene. Quarantine was adopted as a means to
established work and were spoken of with arrest the spread of such epidemics. Late in the
enthusiasm. Following her death, Fabiola was 12th and 13th centuries nursing became
canonised. differentiated from medicine and surgery as
medicine went into a period of advancement
Paula, another Roman noble, founded in
while nursing remained limited to basic caring
Jerusalem a hospital and a religious community
duties (Sweet, 2007).
for women. Paula was a typical nurse of this
period. She was an educated woman, and one Throughout Europe at the time, monks and nuns
historian goes so far as to pronounce her ‘the first were dedicated to the alleviation of human
trained nurse’ being one of the first who suffering working as ‘doctors and nurses’.
systematically trained nurses.
Although much of the ancient therapeutic
Marcella, another wealthy Roman, converted her wisdoms had been undermined through
luxurious home into a monastery. Her work deliberate destruction, they were skilled in the
mainly included praying and charitable tasks and use of home remedies. Their scientific
was well renowned as an authority in biblical knowledge in the care of the sick came from the
readings. She taught nursing as an art, rather than books saved within certain monasteries, which in
a service (Cilliers & Retief., 2002). turn provided pre-foundations behind the
development of universities (Silverman, 2002).
Women therapists continued this tradition
actively, mainly towards women patients, up to In the later middle ages, many social problems
medieval times. Therefore it can be argued that arose with further disintegration of the protective
the spread of Christianity was a major milestone units like monasteries, guilds and feudalism
in the history of Nursing (Sapountzi-Krepia, resulting in the redistribution of the population.
1999).
Overall, the Dark Ages were haunted by
Early middle ages superstition, mysticism, persecution of free
thinkers and religious oppression. The
Women therapists of all social classes were
therapeutic use of talismans and incantations for
conveyors of knowledge of the medicinal
treating the sick predominated. Nursing declined
properties of herbs and ‘drug’ preparation. They
in these dark times yet in the Balkan areas where
actively continued these traditions and applied
the late Byzantine period prevailed the art of
knowledge in the care of sick women throughout
caring was preserved and continued to evolve.
the medieval period (Sapountzi-Krepia, 1999;
Achterberg, 1990). Byzantine period
Until the thirteenth century A.D., despite the In Byzantium there were nursing homes for
already established persecutions, women the elderlies, leprosarium, asylums for
continued to work either as therapists or as immediate post-natal care named
caregivers. During the C13th A.D. it is estimated “λεχωκομεία”, nurseries, orphanages and
that in Europe approximately 200,000 nuns and
hostels that were the hospitals of that era.
commoners, provided organized care services
under the auspices of the church (Nutting & These institutions employed paid staff and
Dock, 1907). volunteers (nuns, monks and commoners) in
In northern Europe the medieval period brought order to provide care (Miller, 1997; Abel-
plague and pestilence as people held an Smith, 1982).
indifferent attitude towards sanitation and

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During the beginning of the 4th century in the Following the end of the Byzantine era, regarded
early Byzantine era, the first hospital-type hostels by many scholars as the zenith of humanitarian
began to operate as integral parts of the generosity and kindness to the underprivileged,
monasteries and by the 11th century, the the rest of Europe was moving out the dark ages
renowned Pantocrator Xenon (hospital) into the renaissance and later on to establishing
Monastery was founded by the emperor John I the scientific foundations for nursing and care.
Komnenos.
Renaissance period
This was an exceptional example of a forerunner
During the Renaissance era, the first hospitals for
of today’s modern hospitals as it had five wards
poor patients began to be established in Europe
for inpatients, including a surgical ward,
undertaken by nuns and monks. Yet, despite the
women's ward, and an outpatient clinic. There
involvement of monks with care provision, the
were provisions for proper heating, lighting and
original roots of organized care and the nursing
bed linen, as well as bathing facilities and
profession itself, being a caring profession, can
latrines. Care was supplied by a large and
be traced back to the servants of the houses, such
specialised staff of physicians, medical assistants
as the slaves of ancient Greece and Rome (Abel-
and orderlies (Miller, 1997).
Smith, 1982; Delougery, 1977).
The hospital’s daily operation is known in detail
Gradually in the Renaissance Western World,
due to the survival of its founding charter,
hospitals were being established by
‘Typikon’ which even dictates the pocket money
municipalities and voluntary non-profit
allowed to patients.
organizations. The staff who worked and
The term "nurse" first appeared in ‘Typikon’ provided care to the sick in these hospitals were
suggesting salaried officials of the hostel who poor illiterate women with their experience being
were responsible for its operation. Their powers only the upbringing of children and care of sick
were similar to the authority of today’s hospital relatives (Abel-Smith, 1982).
directors. There is evidence in later texts that the
Ottoman period
term ‘nurse’ was synonymous with doctor,
although the ‘Typikon’ leaves unanswered The Ottoman period that followed, although
questions about the origin of the term (Kourkouta holds an abundance of war-time and conflict
& Lanara, 1996). related nursing activities. Some historical
references rescued refer to the actions of women
Other health care workers mentioned in the
during the siege of Thessaloniki by Ottoman
‘Typikon’ are ‘Ypourgisses’, female aids to
troops in the 15th AD century (Dal & Kitis,
doctors and ‘Ministers’ who provided a mixture
2008). Generally, in crises, many government
of nursing services with servant orientated tasks.
and official buildings would be turned into
Their main duties were: psychological support makeshift hospitals where basic care services
for the patients, routine care, comfort, cleaning were provided despite insufficient facilities to
and feeding, administration of medicines meet this challenge.
according to a doctor's instructions. Supervision
Later, women from the nobility in Istanbul,
in the absence of physicians was another task.
participated voluntarily in the provision of
Duties also included enemas, cuppings and
healthcare services as they had been greatly
bloodletting, which were the main therapeutic
influenced by the achievements of Florence
means at the time together with placing patients
Nightingale, who had demonstrated that good
on the operating table and surgical assistance
nursing care achieved a reduction of wound-
(Kourkouta, 1998).

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related death rates from 42% to 2%. She had also science and profession were recognized through
demonstrated the therapeutic value of an the honour of Order of Merit in 1907 (Retief &
affectionate and warm attitude toward patients Cilliers., 2005).
(Bayik et al., 2002). This is a point not to be
The revival of scientific enquiry and learning in
overlooked in today’s technological nursing age.
Europe during the 19th and 20th centuries
Throughout the period of Ottoman rule, the affected nursing whereby the mid 1800's nursing
Orthodox Christian monasteries were considered became an organized practice. In the early
as asylums, due to the special privileges 1900's, nursing education was received primarily
appointed to them. Therefore, these became the from hospitals rather than colleges or
safest havens for the care of patients and injured universities. New nursing students were
fighters. responsible for tasks similar to that of maids –
dusting, scrubbing and doing dishes. These
In Athens during this era (16th century), a well
students typically worked 10 to 12 hour shifts,
respected nun Philothei (1522 to 1589) known
seven days a week, for a period of two to three
for her philanthropic activities and nursing care
years. Later responsibilities included sterilization
provision to patients founded a convent. She later
of equipment such as needles and bandages and
inspired the founding of a monastery, hospital,
cleaning operating rooms. After graduating, most
nursing home, orphanage and seminary for
worked in patient homes as private-duty nurses
women covering the needs of the Athenian
and were paid amounts comparable to today’s
population at the time and was recognized as a
minimum wage. Their duties included bathing,
saint by the Orthodox Church for her
administration of medications and enemas, and
humanitarian deeds (Botseas, 2010).
tending to wounds and sores (Cook, 2004;
The dawn of modern nursing McCarthy-Haslam., 1998).
From the mid 18th century, Europe saw the dawn During this time period, hospitals evolved from
of nursing. Florence Nightingale, the lady with facilities for the extremely poor and death-bound
the lamp during the Crimean war in 1854, is the to institutions for general health treatment and
symbolic figure of modern nursing, known for childbirth. At the dawn of World War II, nurses
her devotion to serve the poor and sick and to were removed from their familiar hospital
environment and placed at the bedsides of
raise the status of the nursing profession.
wounded soldiers, responsible for treatment
She became aware of the inadequate care being decisions for the first time. To ensure adequate
provided in hospitals, when she accompanied her nursing staff for the duration of the war, the
Cadet Nurse Corps program was initiated in 1943
mother on visits to the ill. What Nightingale saw
to subsidize education for nursing students who
in the hospitals intrigued her and made her want agreed to work in the understaffed areas until the
to become more involved. She decided to attend war’s end. Well over 100,000 nurses received
the nurse training program at Kaisersworth, training through this program over the next three
Germany in 1850. Nightingale and a dedicated years. The nursing profession gained much
group of 38 untrained nurses went to the British recognition and support from civilians during
hospitals at Scutari in Turkey were she found this time, at long last realized as a tremendous
asset to medical care (Winkelstein, 2009).
inadequate equipment and facilities. Her fist task
was to organize and clean the hospital and Despite the nursing and medical, scientific
provide improved care to the wounded soldiers. evolution and remarkable achievements of the
In 1860, she founded the first British training last century, pockets of traditional healing and
school for nurses at St. Thomas Hospital, caring flourished in the Balkans. Kerewsky-
London, 1860. Her services to the nursing Halpern (1985) in her long-term anthropological

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fieldwork in the Balkans describes the ritualistic Yet, the concept of care in Greece today for
healing roles of elder women in these largely example is somewhat compromised with very
patriarchal societies for the larger part of the last limited services for follow-up assistance in the
century, and can be found even to date. Folk home due to years of financial austerity affecting
pharmacology is perceived as being extraneous various branches of nursing and inadequate
to the eventual cure which rests heavily on trust concern about the health of patients once outside
and touch as foundations of a healing and caring the hospital setting (Kentikelenis et al., 2014).
process. ‘Patients’ in this sense are essentially
Conclusions
participants who have deep trust in the healer-
Bajalica and faith in her words and touch which The history of nursing care can be traced back to
is the cornerstone of her treatment. The nursing the beginning of human kind. For as long as
ministrations of disinfection, application of balm there has been human life and interactions, there
and protective bandaging (the biomedical has been a constant need for care and comfort to
aspects) are viewed as coincidental to this fellow humans inflicted by injury or suffering
healing process. Therefore, the fundamental from illness. The very roots of humankind
efficacy of this elaborate healing ritual resides in required women to breastfeed and nurture the
culture elements embedded in a people's offspring preserving life and ensuring survival of
collective knowledge. the human race.

In rural Greece, in much of the previous century, In this sense, nursing evolved from instinctive
customs, traditional preventive techniques, basic preservation acts to knowledge of how to
religious beliefs and superstitions were involved care. In this respect, nursing has been called the
in health, sickness and prevention perceptions oldest of the arts and the youngest of the
and behaviours. These views and customs were professions.
accepted by the local communities and hence Despite the glorious - and to an extent, glorified -
gave psychological support to ill members. past and great achievements in this geographical
Along these lines, a young woman about to give area, the contemporary Balkan Peninsula has
birth, was convinced that a hand shaped dried been suffering from poverty and austerity.
herb was that of The Virgin and thus would help Recent financial hardships, predominatly in
her during child birth (Tsiou, 2001). Greece today, put at risk the essence of care
By the late 1970s nurses realized that they should which can be often undermined where there is
study and discover the deeper humanitarian roots poor social or community nursing services and
of their profession, which make the foundation of other health care resources.
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