One now forgotten but once commonplace occupation readily seen on censuses is that of the monthly nurse, also found as confinement nurse or as SMS (subsidiary medical services). There were a great many of them, over 22,000 in 1901, yet today few people know that they existed.

Monthly nurses looked after mothers after childbirth, in theory for a month, but they could equally be engaged for a few days or several months depending on what was required of them. Unlike midwives, they were not expected to have medical knowledge. Their services were mostly used by the better off, in which case they usually lived in, sleeping by the cot and bringing in the baby to the mother for breast feeding. But lower-class women sometimes employed their services too, although generally paying for daily visits for a week or so.

Wealthier mothers might hire nurses for their ‘lying-in period’, a phrase that would have once required no explanation. Nineteenth century families were large and women spent a great deal of time being pregnant, so it is understandable that they tended to have a lying-in period of bed rest after childbirth, which could be for as little as five days or for as long as two months. However, it was not a time of seclusion; new mothers frequently received visitors in their beds.

Queen Victoria employed a monthly nurse, Mrs Lilly, who attended at the births of her nine children. Mrs Lilly was in the news in 1840 when she alerted palace staff to an intruder who climbed over the wall. Her funeral in 1882 was recorded in the Court Circular, which noted “she was greatly respected and esteemed” by the Queen. We also learn that: “Four years ago, Mrs Lilly came to see Her Majesty and several members of the Royal Family at Buckingham Palace, being in her 88th year.” In 1846 Mrs Lilly was present at the birth of Princess Helena, who went on to become a founding member of the Red Cross, president of the British Nurses’ Association and an advocate of the registration of nurses (a cause opposed by Florence Nightingale).

Monthly nurses had to carry out messy and often unpleasant tasks, not only in connection with childbirth but also in connection with death as they were also hired to lay out the dead. Sometimes their two tasks coincided due to the high level of infant mortality.

They flourished at a time when nurses were untrained and nursing was not considered a profession. They could be almost any age, ranging from late teens to late seventies. Up until the later 19th century they were usually uneducated – and were sometimes dishonest. An article in the Derry Journal in 1905 read: “At Exeter today a monthly nurse named Phillips was remanded on a charge of numerous thefts. It was alleged she was in the habit of purloining articles from the houses where she was employed.” The police found her house packed with stolen goods.

Attempts were repeatedly made to place the profession on a more respectable footing. There was at least one manual for midwives and monthly nurses, written by Fleetwood Churchill MD as advertised in the Dublin Medical Press in 1867. In 1876 there was a charity appeal in the Morning Post by the Council of St John’s House for the Training of Nurses seeking funds to help set up an institution for “training a body of qualified monthly nurses”.

By the late 1800s there was some training and certification although it was hardly reliable and rogue organisations issued dubious certificates for a fee. This is hardly surprising in context; the registration and recognition of trained midwives did not take place until the 1902 Midwives Act. The dangers of this type of unqualified nursing were, however, increasingly well recognised. We read in a 1912 Whitby Gazette: “There are cases on record of puerperal disease which have been directly traced to the ulcerated leg of an old and rather careless woman in attendance.”

We know from the 1861 census that the artist Richard John Pollentine and his wife Mary employed three live-in servants at their house in Claremont Square in Kentish Town; two 15-year-old servant girls and a 41-year-old monthly nurse named Ann Whisson. Ann was employed by the family to look after Mary and her new daughter Minnie who had been born a month earlier. There were thousands of monthly nurses like Ann in London alone, and although many of them had a poor reputation Ann’s subsequent employment suggests she was quite well regarded.

Ann Whisson (c1821-1897) came from Holme-next-the-Sea near Hunstanton, Norfolk. She appears in the 1871 census (where she is noted as a widow) as a servant for a doctor in Watford, and in 1891 as a servant for a vicar in Newark. These seem like desirable and comfortably off employers (they both kept other servants), and indeed Ann did not seem to be poor, as probate records show her leaving £82 16s 9d.

The poor opinion that many had of monthly nurses is evident from a piece in the Edinburgh Evening News in 1875: “Ever since the days of Mrs Gamp… these necessary visitors to many households have been the subject of much well-placed distrust.” They may be “wholly unworthy of the confidence placed in them, and both by ignorance, incapacity and untrustworthiness, frequently entail lifelong miseries on the helpless mother and the still more helpless child”.

The Mrs Gamp referred to was the fictional Sarah Gamp, the sloppy and somewhat drunken monthly nurse portrayed in Charles Dickens’ Martin Chuzzlewit (1843). She was based on a real nurse described to Dickens by a friend. Some quotes from the novel give an indication of her character.

• “She went to a lying-in or a laying-out with equal zest and relish.”
• “She wore a very rusty black gown, rather the worse for snuff, and a shawl and bonnet to correspond.”
• “The face of Mrs Gamp – the nose in particular – was very red and swollen, and it was difficult to enjoy her society without being conscious of a smell of spirits.”

There were many court cases regarding disputes between families and the monthly nurses they hired. In Lloyd’s Weekly in 1883 a woman was charged with striking her monthly nurse, but she alleged that the nurse had used foul language, drunk four pints of beer the day before the birth, and “emptied a slop-pail over her”. The judge was unable to decide between the parties and dismissed the case.

Nineteenth and early 20th century newspapers were full of advertisements by monthly nurses seeking work, such as ‘Monthly nurse; holds a certificate from the lying-in hospital’, ‘Monthly nurse, references from medical profession’, and ‘Monthly nurse of 15 years’ experience desirous of engagement; has first class references and has just left a lady in the neighbourhood’. Sometimes it is institutions that placed the advertisement, like: ‘For trained medical, surgical and monthly nurses, apply to sister in charge, Nurses Home, York’ and ‘Trained surgical, medical and monthly nurses can be obtained on application to the Superintendent, Hull Nursing Institution’. No doubt many families felt that nurses hired in this way were better qualified and more trustworthy.

A monthly nurse’s work was hardly secure, going from one short-term engagement to another, and nurses inevitably sought work to coincide with their disengagement as some of their small ads make clear. Thus we find ‘Respectable and experienced monthly nurse will disengage almost immediately’ and ‘Monthly nurse will be disengaged after February; good references, local and otherwise’.

It cannot have been the most lucrative of occupations and advertisements frequently stressed ‘terms moderate’, although at least board and lodging were generally included. Still, the better the client the better the pay; in an Exeter & Plymouth Gazette of 1889 we learn of one nurse who claimed only to hire herself out to gentry. She charged 10s per month.

Useful sources and records

• ElizabethWalne.co.uk: Elizabeth Walne, Your Local History
• London Metropolitan Archives: Register of midwives and monthly nurses 1886-1892
• http://thefamilyrecorder.blogspot.co.uk
• The National Archives for 1878-1936 records about Harriett Simpson Cater Simpson held by the Royal College of Midwives Archives.