“Who but Women Should Manage It?”: Convalescent Home Matrons and Medical Recuperation

Today we often hear reports about women’s invisible labor. Female family members do the lion’s share of housework and caregiving — not just for their own children, but for any household member. Given that such caregiving takes time, often drawing women away from wage-earning jobs, this care is likely one source of wage discrepancies between men and women. All of this is quite familiar, yet no less frustrating for its familiarity. But in light of the current conversation about women’s invisible caregiving roles, the history I focus on may be a refreshing surprise. In nineteenth-century Britain, philanthropic “convalescent homes” sought to extend the benefits of domestic caregiving (so often a middle-class luxury) to impoverished patients recently discharged from the hospital. In these homes, women’s domestic caregiving was not only visible but also celebrated as a necessary supplement to medical treatment. Precisely because of women’s supposed fitness for domestic labor, female campaigners  achieved increasingly public roles in managing philanthropic convalescent homes. While some affluent women volunteered their time, convalescent care also opened up new professional opportunities for women to work as paid matrons and nurses.

Starting in the late 1830s, British hospital administrators and physicians began to realize that something was missing from the treatment provided in large urban hospitals. These institutions largely served working-class and impoverished patients, many of whom seemed trapped in a cycle of repeated admittance, treatment, and discharge for the same ailments. In 1837, Dr. John Roberton argued that this cycle was not the result of intractable illnesses but rather the consequence of a systemic lack of after-care. Patients were discharged in a very weak condition, on the presumption that they could rest and recuperate at home under the supervision of a sympathetic female caregiver. Among the affluent, it was routine for women (either servants or family members) to oversee the process of recovery from all kinds of illnesses. It was commonly believed that an attentive domestic caregiver, even without special training, could greatly improve patients’ chances of recovery by managing their capricious appetites, monitoring their physical activity, and keeping their spirits up in times of boredom or frustration.

However, working-class households could not spare anyone to look after an ill family member full time, and very often working-class convalescents returned to work immediately to make up for wages lost to illness. All too soon, then, these sufferers relapsed and returned to the hospital. Roberton was particularly worried about the plight of postpartum working-class women, who were ill prepared to resume their work (not to mention their own domestic caregiving roles) while barely recuperated from childbirth. Roberton insisted, “It is hardly necessary to remark, that this sort of patient is in want of something besides medicine.”¹ What these patients needed, according to Roberton and many campaigners, was an extended period of domestic convalescent care. Without this caregiving, reasoned one hospital administrator, hospital medicine itself was “in one sense incomplete.”²

Women’s Work and Convalescent Care

While professional men wrote the earliest pleas for convalescent homes, the work of the homes themselves became increasingly associated with middle-class women. Medical authorities advised that convalescent patients should receive a sustained experience of domestic comfort and interpersonal sympathy, requirements which mapped onto the kind of domestic and emotional skills middle-class women (and those aspiring to this role) already cultivated. “Convalescent relief is emphatically women’s work,” declared a report from the Charity Organization Society in 1884.³ Most homes offered little in the way of medical treatment or even skilled nursing. Rather, they offered patients access to the kind of domestic comforts and caregiving that already supported the health of the well-to-do. The women running these homes supplied hearty meals, clean spaces, and diverting amusements, along with access to that all-important Victorian remedy: fresh country air. In fact, in support of the apparent psychological benefits of domestic care, the homes themselves were built to resemble personal dwellings, with familiar pieces of domestic architecture, such as gables and bay windows.

With characteristically basic amenities, convalescent care was a kind of vocation to which many women could aspire. While medical nursing at this time required special training (thanks to Florence Nightingale), convalescent care did not seem to require more than conventional domestic skills. In applying to the position of convalescent home matron, women were vetted based on their housekeeping skills rather than their nursing credentials.⁴ Additionally, affluent women could establish their own philanthropic convalescent homes on a small scale by renting out a cottage by the seaside, fundraising through their social network, and advertising available beds to doctors and hospitals. Historian Jenny Cronin reports that women sponsored a majority of convalescent homes founded in Scotland during the nineteenth century, perhaps because they were so often excluded from the management of voluntary hospitals.⁵ In making interpersonal caregiving an accessible social benefit, convalescent homes thus offered middle-class women professional outlets for their domestic skills.

Convalescent homes proved to be a widely popular intervention for charity-minded elites, middle-class matrons, and working-class patients.⁶ Over the course of the century, hundreds of these homes were founded across Britain. Many were run independently by affluent women, others were extensions of large urban hospitals, and a few even were founded by working-class friendly societies. Some of these institutions grew enormously, with scores of beds and hundreds of patients each year. The Prudhoe Convalescent Home, for example, had 165 beds.⁷ Yet, even in such grand institutions, women’s supposed domestic skills were central. As one writer reasoned, it was critical to the patients’ health that even the large convalescent institutions felt like homes: “Everything must be done to deprive it of that barracks character which is so soon acquired, and to make the tone of intercourse with the managers affectionary and familiar, rather than official.”⁸ This sympathetic, domestic atmosphere relied entirely on the women administrators. As this writer continued, “It is astonishing how much depends on the matron in all these institutions.”⁹

In 1895, the writer C.S. Bremner toured the grounds of the Parkwood Hospital Convalescent Home, reporting her amazement at the sheer size of the institution with “wings, blocks, gables, towers, turrets, spines, porches, [and] bay windows.”¹⁰ Most surprising of all, she found, was that two women, a matron and a head nurse, managed the entire institution. She asked the women if “you ladies think it is a strange thing that a great institution like Parkwood, containing 80 men and 40 women patients, should be entirely managed by women?”¹¹ She reported that the women were surprised by the question, retorting: “Who but women should manage it?” Because taking care of the sick was so integrated with Victorians’ ideas about proper femininity, ironically it could still be considered appropriate for women even when it led them to take leadership roles in large philanthropic institutions.¹²

Domestic Labor and the Caregiving Crisis Today

Today, many researchers say that we are facing a “caregiving crisis,” as children, the elderly, and people with various impairments urgently need practical assistance that is currently undervalued and undercompensated. I don’t mean to suggest that convalescent homes are the answer to our problems. Their history is far more fraught than I have space to address — from the ways that some philanthropic homes sought to pick out “deserving” cases to the fact that these institutions glamorized middle-class domesticity above all other arrangements of the home.¹³ Yet, even so, these institutions are a useful example to include when we discuss contemporary problems of women’s hidden caregiving. What would it take today to make the work of caregiving visible (and even better, compensated)? In what ways can hospitals better work with and support the domestic caregivers who have the daily care of their patients? And when individual health so often depends upon the care of another, how will our generation work to make interpersonal caregiving more widely accessible?

Hosanna Krienke

Hosanna Krienke is a Post-Doctoral Research Fellow for the “Diseases of Modern Life: Nineteenth-Century Perspectives” project, funded by the European Research Council and hosted by St. Anne’s College at the University of Oxford. She received her Ph.D. in English from Northwestern University and is currently writing a book: Convalescent Time: The Afterlife of Illness in the Nineteenth-Century Novel.

• Hosanna Krienke

  https://nursingclio.org/author/hosanna-krienke/

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