History of nursing from Zsuzsanna Kossuth to Ilona Andrássy

In the 19th century, the history of patient care underwent a huge change, one of the main drivers of which was the improvement of the state of military nursing. Florence Nightingale was one of the most important implementers of these reforms. In Hungary, Zsuzsanna Kossuth is considered the founder of the nursing profession. The fate of the two women is similar: they were contemporaries and the storms of history deployed their commitment to nursing. Their mission remains an important pillar of the profession even today.


The need to care for the sick is as old as humanity, and for a long time it was not considered a separate profession, but was carried out by priests or healers. We can already speak of the philanthropic vocation of nurses in the context of nurse monks and deaconesses. The Order of Malta, the Hospitaller Order, the Sisters of St. Elizabeth and the Sisters of St. Vincent are famous nursing orders. In our country, at the turn of the 18th and 19th centuries, monastic and secular nursing began to separate. Joseph II's health measures supported the healing activities of monks, but also emphasised the professional training of both monastic and secular nurses. The health system required an increasing number of nurses to be involved in patient care, exacerbated by the outbreak of the Hungarian Independence War, which resulted in a severe shortage of nurses.

The first Hungarian head-nurse

Zsuzsanna Kossuth, a prominent figure in the history of nursing - undeservedly known only in Hungary - was born in Sátoraljaújhely in 1817. She was 15 years younger than her brother Lajos Kossuth, with whom she had a close connection; her brother called her “my twin soul”.

orvosok_801686.jpgIn 1848-49, the reform of the army's medical care became urgent, because outdated customs were still in practice, for example, in the field hospitals, the wounded were nursed by the war invalids. Ignác Stáhly and later Ferenc Flór started to reorganise the military health service. The first thing was to train military hospital nurses, but they did not want to call away from the battlefield the men who were fit for troop service, especially surgical students. To solve the problem, Kossuth came up with an unusual proposal: to involve volunteers, mainly women, in the care of patients in the hinterland. Zsuzsanna Kossuth, with her experience as a nurse during the cholera epidemic, was then appointed by her brother to the post of 'head-nurse in all field hospitals'.

Many women volunteers came forward to serve under the leadership of the head-nurse. She was responsible for proposing the establishment of new field hospitals. Thus, together with chief physician Ignác Barna, she enabled 70 military hospitals to be set up with equipment and nurses. She paid attention to the mental state of the wounded, and attached great importance to ethical patient care, also looking after Austrian and Russian prisoners of war. After the Independence War, she was forced to flee with her family, but the Austrians dragged her back to Pest, where she was tried and acquitted based on the testimony of the Austrian officers she had nursed. She immigrated to Brussels and then to USA, where she died at the age of 37.

The "lantern" in military nursing

voroskereszt_mozgo_korhaz_228084.jpgThe 19th century saw a huge development in nursing science, and Florence Nightingale's role is inescapable in it. Nightingale was born in Florence in 1820, the daughter of an English noble family - she was named after the city. Her interests turned early to science and mathematics and she read a lot. It was during her readings that she first encountered the cholera epidemic, which awakened in her a strong need to help and care for the sick and the fallen. Her parents were not happy about her ambitions, because at that time there was no public respect for those who dealt with the sick. Nightingale graduated from a nursing school in secret.


After working at a hospital in London, she served in a military hospital during the Crimean War of 1853. Here, seeing the alarming state of health care, she started reorganising patient care and establishing proper hygiene. As a result, the mortality rate among wounded soldiers in her hospital fell from 42% to 2%. She recorded data and established statistical correlations, thus proving the effectiveness of her methods to the doubters - of whom there were plenty, especially among authoritarian doctors who underestimated hygiene. Florence Nightingale became known as the "lady with the lantern", as she walked among the wounded at night with a lantern in her hand. She considered great importance to the training of nurses, including ethical training, and her book Notes on Nursing is the fundamental work of the profession.

The Red Cross

goszthonyi_maria_675160.jpgJean Henri Dunant, the founder of the International Red Cross, recognised the importance of nurse education early, and the aid organisation took up the cause of nurses' education, organised congresses and last but not least, established the equality of women in the profession - the recognition of which had been a major source of conflict. In 1864, Dunant drafted the first Geneva Convention, the basic thesis of which was impartiality in the care of the war-wounded. The Habsburg Monarchy accepted the convention in 1866, but after the Compromise, problems arose in the operation of the aid organisation in the Kingdom of Hungary.

The idea of an independent Hungarian Red Cross was raised in 1878, when the invasion of Bosnia and Herzegovina exposed the shortcomings of military health care. A year later, the National Women's Aid Society was established in full compliance with the requirements of the International Red Cross and the Geneva Convention, but at that time, it had not yet been admitted to the relief organisation. Frigyes Korányi and Viktor Fleschacker, the doctors who organised the training of nurses of the association, paved successful membership and as a result the Hungarian Red Cross was founded in 1881.

salzburg_207015.jpgThe newly formed organisation took great care to provide formal nursing training. By 1885, courses were held at the Nursing Institute of the Erzsébet Hospital of Red Cross, which was the methodological centre. By the turn of the century, nearly five hundred red-cross nurses had graduated, enriching the health care system in Hungary. All the hospitals accepted the certificates of the graduates, but the Red Cross tried to keep the nurses in its fleet. For example by offering them a pension, which was not yet provided by the state hospitals at the time. The need to clarify the pension issue gave rise to the first nurses' advocacy organisation, the Hungarian Nurses' Association.


However, with the outbreak of the First World War, it was high time for a reform of nursing education and it should have been necessary for the state to take on the burden. In the 1920s, a progress was made in this area: nursing training was introduced in all medical universities with the establishment of the Nurse and Health Visitor Training Institute. Soon afterwards, the Institute became the methodological centre for standardised nursing training under state supervision - complemented by the Red Cross and other medical associations and nursing monks.

Countess in a field hospital

andrassy_ilona_esterhazy_pal_212239.jpgDuring the First World War, a number of aristocratic women took up nursing posts with the Red Cross, including Archduchess Augusta, Queen (and Empress) Elisabeth and the granddaughter of Franz Joseph I. of Austria. Countess Ilona Andrássy, who followed her husband, Count Pál Esterházy, to the battlefield in Galicia, was a heroic nurse, who had already completed a nursing course, and owing to her husband, she could work illegally as a medical orderly. She lost her husband in the war and escaped from her grief into the bloody world of the Red Cross field hospital, where, in addition to caring for the wounded, she had to struggle with the threat of close combat, deranged soldiers and sometimes the leadership. After serving in the field, she married Count József Cziráky, and in a twist of fate, she had to worry about her sons in World War II, one of whom was killed in a battle similarly to her first husband. In her old age, after Count Cziráky’s death, she followed her children to Canada, where she died at the age of 81.



Translated by Zita Aknai


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