By David Cantor, PhD (Instituto de Desarrollo Económico y Social (IDES), Buenos Aires)



Introduction

In the early decades of the twentieth century, American nursing leaders came to see the motion picture as a quintessentially modern instrument of education, training, and recruitment. In their view, movies were a powerful tool to transform public opinion about nursing, to instruct new recruits in the mysteries of nursing practice, and to keep the qualified nurse abreast of new developments in the field. The result was that many hundreds of films were produced by nurses, hospitals, health departments, and nursing schools that aimed to recruit men and women into the profession, to teach nurses about the ideas and techniques of their field, and to educate the public about the role of the nurse in health care.

This essay discusses a selection of rare historical nursing movies, originally chosen by Anne Marie Rafferty, Rosemary Cresswell and David Cantor for a series of film shows screened in the late 2000s.[*] It includes educational, newsreel, and training movies aimed at a variety of audiences, and produced from the 1940s to the 1970s by an assortment of private, philanthropic, professional, and governmental organizations. Together, they illustrate the varied uses of the nursing educational film in the mid-to-late twentieth century; the complex cinematic representations of nurses and nursing during this period; and the roles of sexuality, gender, and surveillance in these movies.  I conclude with some observations on the different narratives deployed in these films, and on the use of fear within nursing films.

The Army Nurse

A close up of a woman's face in a surgical mask.DATE: 1945
LENGTH: 15 min
DIRECTOR: Unidentified
PRODUCER/PUBLISHER: Army Pictorial Service Signal Corps, U.S. War Office
CATEGORY: Educational & Instructional, Sound, Black & White

Released in the closing months of World War II, this film explores the work of the Army nurse in part from the perspective of a wounded soldier (and includes a cameo by the actor Gary Cooper). Intended to be shown to a variety of audiences—including servicemen, nurses, and potential recruits to nursing—it has a reassuring message about the skill and effectiveness of the Army nursing service. It also comforts its audiences with a story about the therapeutic uses of femininity.

The film opens with a soldier wounded in action. Coming out of delirium, the first person he sees is a female Army nurse, who smiles at him and gives him a conspiratorial, welcoming wink. This therapeutic wink is the start of his road to recovery and provides a cue for the narrator to talk about the uses of femininity in the healing process. He explains to his audience that women mean safety, comfort, and home to the wounded man: the nurse’s touch and her voice instill hope. Within each nurse is the tenderness of all women, he claims, that which is found in mother, sister, and friend—roles that dampen any suggestion of sexual invitation in the nurse’s wink or touch. Here is a feminized version of medical surveillance: the welcoming, comforting, caring surveillance of women who watch and monitor wounded men throughout their treatment.

Two other narratives in the film are related to this theme of the therapeutic uses of femininity. The first is a story of how Army nurses adjust to the masculine world of Army life. The film shows how female nurses undergo four weeks of grueling basic training, and how, once in the field, they share the same life as the GI: Army clothes, Army beds, and Army rations. But the movie also shows how they adapt Army paraphernalia and life to their own purposes, as when, for example, they turn Army helmets into instruments for cooking, washing, and self-beautification. The film portrays these women as dedicated nurses, willing to sacrifice themselves to the war effort. It also sets out a place for a caring, tender, watchful femininity amid the pain of war, and within military and medical organizations dominated by men. As the narrator puts it, the Army nurse “lives roughly, and works gently.”

The second story focuses on how nurses help to define the roles of their male surgical colleagues and patients. Thus, the movie defines the male surgeon, in part, in relation to the female Army nurse: Where the surgeon’s technical skill saves a man’s life, the Army nurse’s loving care helps him to live. She “completes” the surgeon, much as wives were said to “complete” their husbands. She also helps her patients decide on the sort of men they want to be. Inspired by the prospect of an Army nurse’s care, the narrator asks the wounded soldier (and the film’s audience): “Which man will you be? The one who gets hurt and dies, or the one who gets hurt and lives?”

Evening Care

Title screen: Part 2 Evening Care.DATE: 1943
LENGTH: 7 min
DIRECTOR: Unidentified
PRODUCER/PUBLISHER: U.S. Army, adapted from a film by the Chicago Film Laboratory for U.S. Navy
CATEGORY: Educational & Instructional, Sound, Black & White

This short companion piece to Morning Care (1943) focuses on how Navy corpsmen care for sick and injured sailors as they get ready for the night. The intended audience is more limited than that of The Army Nurse. This ‘restricted’ picture is a Navy training film, originally aimed at Navy corpsmen, but adapted by the Army.

The movie opens at sea, where a US Navy ship is preparing for the evening. In the sickroom the patients are restless after a long day of inactivity. The first part of the movie explores how corpsmen relieve the tension in the sickroom and ensure that the men, relax, rest, and sleep better: they wash their patients, provide them with backrubs, change their dressings, and give them their medications. The second part of the movie explores the transfer from day-watch to night-watch, how the night-watch corpsmen prepare for lights-out at 21:00 hours, and how, after lights-out, the night-watch check their patients hourly, paying particular attention to the very ill.

In this film, the relationship between the corpsman and his patients is very different to that between the nurse and her patient in The Army Nurse. The corpsman does not provide the inviting, therapeutic wink we see in the other picture, nor does he provide the combination of safety, comfort, and home that the female Army nurse gives the wounded man. Yet there are elements of intimacy and comfort in his ministrations. For example, at one point in the movie a corpsman gives a backrub to a semi-naked man, after which he casually gives his patient some “homework”: a copy of Esquire magazine (founded 1933), popular among wartime servicemen for its pinups. The patient whistles his appreciation at an indistinct image we only briefly glimpse, and the corpsman adds his approval: “not bad,” he comments. In this all-male world, women are no longer the mothers, sisters, or friends we saw in The Army Nurse: they are sexual objects.

The collusion of corpsman and patient in their appreciation of the Esquire image highlights anxieties over both sexuality and the body in the 1940s.  On the one hand, it allowed the filmmakers to downplay the possibility of a homoerotic reading of the movie. According to the narrator, the backrub stimulates circulation, relaxes tired muscles, relieves fatigue and allows the corpsman to check for bed sores—nothing more. On the other hand, this collusion must also be set against contemporary concerns that the female body might harm public morals. The film was released the same year that the U.S. Postmaster General brought charges of obscenity against Esquire for printing allegedly harmful material that was not fulfilling a public service or need—in this case, an airbrushed image of a blonde, voluptuous, scantily-clad woman. Thus, the sexualized female body both threatened to corrupt its male audiences and served to protect against what the authorities regarded as the dangers of homosexuality.

Girls in White

Women in white nursing uniforms sit in a classroom.DATE: 1948
LENGTH: 16 min
DIRECTOR: Harry W. Smith
PRODUCER/PUBLISHER: RKO Pathe
CATEGORY: Educational & Instructional, Sound, Black & White

If The Army Nurse and Evening Care were products of the Federal Government’s wartime interest in movies as tools of health education, Girls in White was a product of an older tradition of commercial newsreel cinema. Produced as part of RKO’s This Is America series (1942-1951), which was modeled on the March of Time, the movie would have been shown to a mixed audience of cinemagoers.

Like other movies in the RKO series, Girls in White uses dramatic reenactment to tell its story. The film opens with an account of the post-World War II shortage of nursing staff; a preamble to a story of nurse training, exemplified by ‘Betty Burns’, one of the 43,000 ‘girls’ who enter nursing school that year. The film follows Betty from her first day at nursing school through her training in chemistry, anatomy, microbiology, nutrition, diet therapy, and pharmacy. We then see her progress from the lab and the lecture hall to the hospital ward, operating theater, and outpatient clinic. Eventually Betty finds her true vocation—pediatric nursing. Others in her cohort become office nurses, public health nurses, and Army nurses.

This movie builds on some of the representations of femininity in The Army Nurse. While there is no therapeutic wink of the sort presented in the earlier movie, this film—like The Army Nurse—emphasizes the skills, knowledge, and professional demeanor that nurse training inculcates in recruits. During her training we see Betty become a cog in a well-run medical machine, a helpmeet to the doctor, anticipating ‘his’ needs, and those of ‘his’ patients. This vision of Betty as a skilled, selfless carer is contrasted with another image of her as self-admiring, self-centered, and fun-loving woman. For example, at one point in the movie Betty goes on a date: Only then, the male narrator tells us, can Betty indulge in the luxury of making someone wait, only then can she play a commanding role—albeit only for a short time. At the end of the evening, Betty chastely kisses her partner on the steps of the nurse’s home, before she returns to duty, and abandons herself to the demands of patients and physicians.

This then is a movie about repressing some aspects of femininity as imagined in the late 1940s. Attitudes that might be acceptable in courtship—such as the ‘luxury’ of keeping men waiting—are discarded within the walls of the hospital. Betty’s femininity is remade during her training to service (male) doctors and patients—she becomes a nurse first and a woman second, as the narrator in The Army Nurse puts it. The only time as a nurse that she admires herself is after the capping ceremony when Betty is awarded the distinctive hospital nurses’ cap. “Men may not understand the cap; women will,” the narrator tells us, as Betty watches herself approvingly in the mirror. The self-admiring woman we see preparing for her date has become a nurse preparing for a career.

Unsuspected

A woman in a nursing uniform sits smiling with an old man and a boy.DATE: 1951
LENGTH: 17 min
DIRECTOR: Charles F. Schwep
PRODUCER/PUBLISHER: Trident Films Inc. for the National Tuberculosis Association
CATEGORY: Educational & Instructional, Sound, Black & White

A near-accident opens this story of the role of the public-health nurse in identifying an unsuspected case of tuberculosis, and of how her actions mobilize public-health services to protect the community against TB.

After almost hitting Johnny Walsh with her automobile, public-health nurse Linda Thorpe is introduced to the child by a local storekeeper. Linda recognizes Johnny as a newcomer to the area, and, after hearing that his mother is pregnant, takes the opportunity to meet the family. During the visit, Linda persuades Johnny’s mother, Mary, to see a physician for a prenatal check-up. When Mary goes for the checkup, a chest x-ray reveals she has an unsuspected case of tuberculosis.

Like other TB education movies of the period, Unsuspected highlights the importance of routine x-ray screening to the identification the disease. According to the National Tuberculosis Association, early tuberculosis often exhibited no symptoms. The result was that people were often unaware of the disease until it was well advanced, which reduced the chance of successful treatment and increased the possibility that they might infect others. In the Association’s view, the only person who could identify the disease was a recognized physician. It, therefore, encouraged the public to go for a regular checkup, including a chest x-ray, and urged that those identified with TB be isolated in a hospital, where they might receive complete rest, good food, and the care of skilled physicians and nurses. Mary’s case confirms the value of such a procedure. In this film, Mary gives birth to a healthy baby boy and returns home after her successful rest cure. The movie ends with Linda Thorpe leaving the Walsh’s family reunion on her continuing mission to protect the public health.

Like The Army Nurse, Unsuspected is a story of surveillance by women. However, unlike the earlier movie, this is not a story of surveillance of the sick and wounded but of the seemingly healthy. In this film disease lurks in the population, unsuspected by physicians and the public. Linda personifies the community’s efforts to police this hidden danger, and to negotiate the tricky boundary between protecting the public and caring for the individual. She also illuminates the importance of children to the solution of this problem. Linda infiltrates the family through their children, and it is Mary’s desire to protect her children from her disease that allows the film to make her hospitalization a matter of individual choice rather than coercion. In the child-centered culture of the postwar baby boom years, this film presents children as a route to public-health surveillance and a reason for individuals to submit to medical authority.

Nurse-Patient Interaction

A young man in a hospital bed with breathin tubes.DATE: 1976
LENGTH: 14 min
DIRECTOR: Barnett Addis
PRODUCER/PUBLISHER: Barnett Addis, Neuropsychiatric Institute, UCLA Center for the Health Sciences
CATEGORY: Educational & Instructional, Sound, Color

In the 1960s and 1970s, the psychologist Norman Kagan created an educational model known as Interpersonal Process Recall (IPR), a training method used to develop interpersonal skills and self-awareness. Commonly used to train nurses and counselors, Kagan’s method employed videotape recording and playback to allow trainees to reflect on how they interacted and so to encourage their awareness of the relation between intentions and behavior. In practice, this involved the trainee being videotaped attending to a patient or client, after which the trainee was asked, upon viewing the video, to stop the tape and comment on the interaction. The aim was to use the incidents captured on video to enable trainees to explore their own affective responses to a wide range of interpersonal challenges.

The movie presented here adopts a different—albeit related—method of encouraging nurse trainees to reflect on their responses to how patients and co- workers present themselves, verbally, physically, and emotionally. Based on Kagan’s affect-stimulus technique, the camera takes the perspective of a trainee nurse who is presented with a series of different people who speak directly to the camera. Thus, the viewer is put into the situation of the trainee nurse and is invited to respond to and reflect upon the different, sometimes difficult, interpersonal situations he or she encounters. The film would have been shown as part of a broader training program in which the training group—having been told to imagine themselves as the nurse to whom the person on screen is talking—was asked to consider and discuss their affective and verbal responses to these situations.

The people the viewer encounters are a mix of patients and co-workers. Sometimes they praise the viewer; sometimes they question his or her competence or emotional maturity. Some proposition the viewer, some are confrontational, some vulnerable, some passive aggressive. They all provide puzzles of motive and meaning. Patients may be inarticulate or articulate. Their words may say the opposite of what they seem to mean. Some are resentful, others vulnerable looking for empathy, others patronizing, and others looking for a date. There is tragedy in some of their stories, appeals for support, attempts to come to terms with illness, to understand how it has changed their lives. Kagan told instructors to use vignettes such as these sparingly so as to adequately explore trainee reactions to them. He also encouraged instructors to cut and splice films to suit their purposes: student responses to a film might be videotaped and used in IPR sessions. Film/videotape was thus used to dramatize difficult interpersonal situations, to elicit viewers’ responses to these situations, and to record these responses for further discussion.

Conclusion

Nurse-Patient Interaction is very different to the earlier films in this collection.  The first four are all stories of transition or transformation, unfolding processes with a resolution internal to the film. In The Army Nurse, the nurses morph from women to army nurses, and help wounded service men transition towards recovery, some to return to the U.S., others back to the front.  In Evening Care, the corpsmen help sickroom patients transition from the day-time activities to the quiet of night, calming their patients, monitoring the very sick. In Girls in White, Betty transforms from woman to nurse, as do her co-trainees, as they prepare for their chosen careers.  And in Unsuspected, Johnny’s near accident helps Linda Thorpe persuade Johnny Walsh’s mother to go into a sanatorium, where she is transformed from a public health threat to a non-threat and from ill-health to health.  Mary Walsh’s story is a restoration narrative, a story of her recovery from tuberculosis to health, as well as a conversion narrative, since Mary (unaware of her illness) has to be persuaded that she is a danger to her family and that she must follow medical recommendations.

By contrast, the narrative trajectory in Nurse-Patient Interaction is open-ended. Each short, even abrupt sequence breaks off without resolution, and none give clues as to the outcome, no solutions to the issues raised by the sequence, no conclusion. In some of the sequences, there are hints of the surveillance delineated in the other films. Through the camera, the viewer/nurse trainee observes patients and listens to them, but unlike the earlier films the consequences of this surveillance are not portrayed, nor are the patients the obedient grateful figures of the other films. Nor it seems are the nurses simple helpmates to their white-coated male colleagues. They are subject to angry tirades from two, or praise that may be something more. The professional roles of the nurse, so clearly outlined in the earlier films, are tested by patients and colleagues alike. Without a conclusion within the film, the viewer is asked to complete the story, perhaps under surveillance by another camera or instructor, after which iteration their reactions would be reviewed.

Finally, Nurse-Patient Interaction makes a very different use of fear to the others.  While there is fear in the other films­—the fears of wounded patients, the fears that Mary Walsh’s illness might affect her family, and perhaps the fears of failure among the nurse trainees—they are all contained within a reassuring narrative in which these fears are eased (for the patients) by the professionalism of the nurses and doctors who offer reassurance and the hope of recovery, and (for the nurse trainees) the inspirational conclusions of each movie.  Nurse-Patient interaction, however, made one sort of fear—interpersonal fear—central to its educational method. The assumption behind this film is that fears—such as giving and receiving affection or expressing and receiving hostility—limit the ability of nurses to work effectively with colleagues and patients alike. The film sequences (and the videotape recall component) aimed to help trainees experience and accept these fears, and by extension gain skills necessary to respond to these and other difficult inter-personal situations they might encounter in their professional life. If the earlier films in this collection scripted all interpersonal behavior, and portrayed the outcome of this behavior within the movie, Nurse-Patient Interaction only scripted one part of the interaction, avoiding an outcome within the film to focus on the unscripted responses of the nurse trainees, some off-camera, others recorded for later discussion.

David Cantor is an investigador (researcher) at the Instituto de Desarrollo Económico y Social (IDES), Buenos Aires Argentina and an adjunct professor in the School of Public Health at the University of Maryland, College Park. His scholarly work focuses on the history of medicine in the twentieth century, most recently the histories of cancer, stress and medical film. He was for several years affiliated with the National Library of Medicine and also worked in the Office of History, National Institutes of Health. His publications include Reinventing Hippocrates (2002); Cancer in the Twentieth Century (2008); Meat, Medicine and Human Health in the Twentieth Century (2010), co-edited with Christian Bonah and Matthias Dörries; Stress, Shock, and Adaptation in the Twentieth Century (2014), co-edited with Edmund Ramsden; and Health Education Films in the Twentieth Century (2018), co-edited with Christian Bonah and Anja Laukötter. He is series coeditor of Social Histories of Medicine published by Manchester University Press.

Notes

[*] This essay is based on notes that author David Cantor wrote to accompany a series of talks and film presentations titled Screening the Nurse. The films for this series—and discussed here—were chosen and reviewed by David Cantor and Anne Marie Rafferty with the assistance of Rosemary B. Cresswell. David Cantor and Anne Marie Rafferty co-presented screenings of the films at King’s College, London, September 1, 2008; The American Association for the History of Nursing Conference, Philadelphia, Pennsylvania, 25th–28th September 2008; and (with Rosemary B. Cresswell) the European Association for the History of Medicine and Health Biannual Conference, Heidelberg University, Heidelberg, Germany, 3rd-6th September 2009.


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