By the mid-nineteenth century there was official recognition of the fact that the organisation and provision of care for the mentally ill in Scotland was inadequate.  Indeed, many “lunatic paupers” - as they were called at that time - were detained in dismal and harsh conditions, often accommodated in the over-crowded lunatic wards of the parish poorhouses.  Clearly, reform was necessary.

The Royal Commission on Lunacy was set up in 1855 to investigate matters:  the Parliamentary report presented in 1857 proposed a number of radical recommendations, most of which were written into the Lunacy (Scotland) Act of 1857.  This, together with specific amendments enacted in 1862 and 1866, formed the basis of Lunacy Law in Scotland over the next fifty years.

The newly formed General Board of Commissioners in Lunacy for Scotland was entrusted with overall national responsibility for the administration of the new legislation, designed to promote more positive and enlightened attitudes towards the humane care and welfare of the mentally ill.  The legislation redefined ‘lunacy’ and provided a legal framework for the detention, safe custody and discharge of patients.  Moreover, it was made possible for patients to be admitted to asylums as ‘voluntary boarders’.

Over the course of the second half of the nineteenth century, with rapid industrial and urban development, there was a marked increase in population;  in Scotland from 3,062,294 in 1861 to 4,025,647 in 1891;  and in Lanarkshire, including Glasgow, from 631,566 in 1861 to 1,046,040 in 1891.  As the number of lunatic poor dependent on relief increased, the financial pressures on the local Parochial Boards (Parish Councils after 1894), who had the responsibility of providing appropriate patient care and maintenance, became extreme.  Indeed, over the period, the proportion of the population requiring aid almost doubled.  To ease the burden, aid was authorised in the form of a parliamentary grant - with strict Treasury conditions - towards the maintenance costs of dependent patients. 

In 1885, it was decided that part of the Medical Relief Grant for Scotland could be used to encourage the employment of trained nurses in the parish poorhouses.  Prior to this time, although reform had been proposed by some progressive and radical thinking individuals in the medical profession, most of the nursing in the Scottish Poorhouses was done by pauper attendants, untrained inmates “selected for nursing by the matron, and all the pay they received was some beer and occasionally a half-crown a week”.  It was argued by those in charge of the poorhouses that such pauper nurses could be more easily managed than trained nurses.

As money was to be made available specifically for nursing expertise, nurses could be recruited from a broader spectrum of the population.  Indeed, nursing itself became a sought after occupation for some women.

The Local Parochial Boards, with responsibility for health care provision, offered to pay half of the salary of each trained nurse employed, plus three shillings per week for rations, lodging and uniform - an inducement for the introduction of trained sick nursing in the wards, infirmaries and poorhouses of Scotland.  However, no allowance was made at this time to cover the actual costs of training ‘probationer nurses’; such expense had to be met out of the general nursing budget of each poorhouse.

The 1885 regulations stated, “Where the average daily number of sick amounts to twenty there should be one trained nurse, up to a total average of sixty patients.  Where the average daily numbers exceeded sixty, a trained head nurse or lady superintendent was to be appointed”.  Moreover, the regulations specified that, “A trained sick nurse should have been not less than two years in a public hospital, being a training school for nurses, and maintaining a resident Physician or House Surgeon, and she must not be under 22 years of age nor over 65 when first registered”.

Initially, the system of registration was on a voluntary basis, being left to the individual nurse, who had to apply “in her own handwriting” to the Board, and present her Certificate signed by the matron of the training hospital to show that she had completed “two years training in the medical, surgical and midwives’ wards, and that she has passed a satisfactory examination and has given satisfaction in her hard work”.

During the early years, most of the nurses registered under the provisions of the Relief Grant gained their certificates from Glasgow Parish Council’s hospitals, where a nurse training scheme had been in operation for some time.  Generally, however, Poor Law officials preferred to train their own nurses, arguing that, “the Poor Law nurse needed to learn more tact, patience and psychology in order to deal with her patients”.

The regulations made provision to keep the Register up-to-date and deal with disciplinary matters.  Interpretation of the regulations was the responsibility of the medical inspector who made the final decision regarding the registration of suitably qualified candidates:  General Trained Nurses (R.G.N.).

Between 1885 and 1905, 773 names were added to the Register, 219 of whom were employed as nurses in the Poor Law service in 1905, at an approximate salary of £35 per annum.  Originally, seven Poor Law hospitals in Scotland participated in the scheme of nurse training:- five in Glasgow, one in Dundee and another in Aberdeen.

In 1904, recommendations were made by the Departmental Committee on Medical Relief in Scotland to the Local Government Board in order to promote recruitment, to standardise training and examination for probationer nurses.  As a result, the three year training programe was introduced in 1907:  probationers of good character, health and general education, aged between 20 and 35, could be accepted for training; as a concession, those training to be fever nurses could start at 18 years.

The final examinations, taken at special centres, included an oral test, which could only be taken if the written papers had come up to an approved standard.  Great importance was placed on the practical test, whereby the nurse “must obtain from the Matron a pass mark independent of other marks which she obtains from the doctors”.

Further to satisfactory completion of the training programme, the nurse was awarded a Certificate by the Board, she had to re-register each year in order to remain on the Board’s Register of Trained Sick Nurses.  After 1912, an official badge, to be worn with the uniform, was introduced.

Under the formal Registration of Nurses Act (1919), a General Nursing Council was instituted.  In Scotland, a separate, but of equal professional standing and status, General Nursing Council was set up.  This measure had been vigorously advocated since 1909, when Lord Inverclyde, as President of the Association for the Promotion of the Registration of Nurses in Scotland, argued that the education and training of Scottish nurses would deteriorate from inclusion in an English scheme of registration and training.  Emphasis was placed on the “important position which Scottish hospitals have taken in the training and equipment of nurses in the past”.  This marked the beginning of state registration for nurses:  by 1925 the first state examinations had been held, and the first nurses admitted to the register by examination.  

political history  The Founding of Hartwood Hospital
early progress   Hartwood Village   Hartwood