R e v i e w

Being a male nurse in Portugal

during Salazars dictatorship
(194070)
Helena da Silva
Universite du Havre, Le Havre, France
Accepted for publication 15 February 2012
DOI: 10.1111/j.1440-1800.2012.00597.x
DA SILVA H. Nursing Inquiry 2013; 20: 176185
Being a male nurse in Portugal during Salazars dictatorship (194070)
In several western countries, nursing was clearly seen as an occupation for women. With the creation of the rst nursing schools,
the gendering of the profession was accelerated. Male nurses contribution to the development of the profession was limited in
comparison with womens. However, the situation was slightly different in Portugal. This article aims at demonstrating a specic
example of the gendering of the nursing profession, by simply copying the western model considered the most developed
without questioning the consequences or even whether it was adapted to the country that had a different nursing tradition.
Because the consequences of this gendering are still felt nowadays, this article opens a reection on how complex it is to follow
a foreign nursing model and on the issues associated with such a copy. Qualitative and quantitative analysis of several historical
documents and interviews with several retired nurses contributed to an understanding of how men became nurses and how they
worked in Portugal, despite gender discrimination, between 1940 and 1970. With different nursing training and job opportuni-
ties, Portuguese male nurses still managed to contribute, even beyond that of female nurses, to the improvement of the nursing
profession.
Key words: gender, history, nurse education, nursing practice, professional issues.
Nursing in Portugal has been a mixed-gendered activity, and
this characteristic did not change with the foundation of the
rst nursing schools at the end of the nineteenth century.
These rst Portuguese nursing schools were mixed-gendered
institutions in which the presence of male nursing students
was highduring several decades. After receiving their diploma,
these male nurses worked in the Portuguese hospitals where
they were in charge of male patients wards until the nursing
staff became mostly female inthe mid-twentiethcentury.
This change took place during a dictatorship. When the
Portuguese state began to feel the inuence of international
nursing models, it declared that nursing should only be for
women, excluding men from this profession and therefore
from several nursing schools. As a result, numerous changes
occurred in the training of male nursing students and in
their future career. In spite of the prejudice against male
nurses, they were present in larger numbers and were more
active than female nurses at the Portuguese nursing trade
unions, where they tried to improve the nursing profession
and the working conditions of its professionals.
Bearing in mind the advantages and disadvantages of
oral history, we have carried out a series of interviews with
eight retired nursing professionals (ve women and three
men, born between 1919 and 1938, who studied nursing
between 1946 and 1959).
1
The gathered information was
Correspondence: Helena da Silva, Universite du Havre, 25 rue Philippe Lebon,
BP 420, 76057 Le Havre Cedex, France.
E-mail: <helena.rfdasilva@yahoo.com>
1
Interviews with Ana, Antonio, Aurora, Em lia, Joao, Joaquim, Rosa, Teresa (cti-
tious names), 2008.
2012 John Wiley & Sons Ltd
Nursing Inquiry 2013; 20(2):176185
used in this research to corroborate written sources and to
create a more vivid image of the context and the difculties
felt by male nurses during their studies and working life.
We have also taken into account different documents
such as registration data from the nursing schools archives
and several articles published in nursing journals consider-
ing their interests, despite the controls imposed by the dicta-
torial regime and the censorship that marked Portugal
during this period (194070). The censorship committees
did not allow the authors to express their opinions freely,
especially against the dictatorial regime and its regulations,
setting a limitation on research that can be done today.
CREATION OF NURSING SCHOOLS IN
PORTUGAL AND MALE NURSING STUDENTS
In the second half of the nineteenth century, nursing staff
working in the three main Portuguese hospitals (Coimbra,
Lisbon and Oporto) had no scientic preparation and were
secular and of both sexes. In Portugal, male nursing staff
would be responsible for all the necessary care in the male
wards, while female nursing staff would only be working in
the female wards. This division remained throughout Portu-
gal over the rst half of the twentieth century, contrary to
the situation in other European countries.
2
This helps
explaining why there was no male discrimination in the
access to the nursing schools.
This untrained nursing staff was secular as a result of the
Portuguese political context during the nineteenth century,
marked by a set of liberal and anticlerical reforms, with the
aim of making schools and hospitals secular. Thus, several
religious orders that had lost their lands and possessions,
such as the Brothers of St. John of God and the Sisters of
Charity, left Portugal. The members of some religious com-
munities returned illegally to Portugal during periods of less
radical anticlericalism. However, these religious orders were
kept away from the main hospitals and worked in their own
institutions or in small-sized hospitals (Silva 2010, 7285).
Meanwhile, in the three Portuguese main hospitals, phy-
sicians and members of the administrations were greatly dis-
appointed by the services of the secular employees, who
were unprepared and uneducated. The advances in anat-
omy, physiology and bacteriology enabled physicians to
develop their diagnostic abilities. As a consequence, hospi-
tals became therapeutic spaces (Foucault et al. 1995, 47).
3
Therefore, the medical staff demanded more responsibilities
from nursing assistants. The simple domestic functions of
the nursing staff were no longer sufcient to correctly serve
the physicians or to collaborate in performing new scientic
therapies (Silva 2007b, 74952). Several physicians debated
on how to solve this problem. Thus, some doctors consid-
ered reintroducing members of religious orders at the hospi-
tals, while others defended the creation of nursing schools.
4
The second opinion prevailed because it allowed for training
those that were already working at the hospital (Vieira, Silva,
and Pinto 2010, 45).
It is in this context that nursing schools were created in
Portugal at the end of the nineteenth century. However, the
Portuguese nursing schools accepted both men and women
as students, contrary to what was happening in the United
Kingdom or in France. In Portugal, the nursing schools cre-
ated in Coimbra (1881), Lisbon (1886), Oporto (1896) and
Braga (1911) can be considered examples of this situation.
Despite being mixed-gender nursing schools, students had
their lessons separated by gender (Santa Casa da Misericor-
dia do Porto 1896, 23).
The rst nursing schools created in Portugal were more
similar to the French ones
5
than to the British (Nightin-
gales model) because at the end of the nineteenth century,
the Portuguese elite was closer to France in terms of culture,
politics and science. The founders of the rst Portuguese
nursing schools had visited several French nursing schools
and therefore did not follow Nightingales model. As a
result, in the Portuguese nursing schools, doctors were
responsible for the theoretical and practical training, with-
out the collaboration of a matron, who would be responsible
for the selection and moral education of the nursing stu-
dents. Most of the students were already working at the hos-
pital without any qualications and could hardly write and
read. On the other hand, there were also differences
between nursing education in Portugal and France, the most
important being the acceptance of both men and women as
students in the Portuguese schools, without any particular
selection.
2
For example: in the United Kingdom, Belgium and France. In Spain, hospital
nursing became exclusively for women in 1931 (Adao 1945, 22).
3
Further readings: Foucault M. 2003. The birth of the clinic. UK: Routledge; Fou-
cault M. 1977. Discipline and Punish. New York: Pantheon Books.
4
In Portugal, as in France, the creation of nursing schools was the result of the
action of physicians, who thought about training nurses, while the nursing staff
remained passive in this regard. In the case of Portugal, there was a constant
interference of the medical staff in nurses training through the rst half of the
twentieth century, in contrast with the situation in the United Kingdom or the Uni-
ted States, where nurses were very active and demanded reforms (Silva 2010,
191209).
5
The nursing schools administered by the Assistance Publique de Paris (in differ-
ent hospitals like Pitie, Salpetrie`re, Bicetre and Lariboisie`re) served as a model to
the Portuguese ones.
2012 John Wiley & Sons Ltd 177
Being a male nurse
Nursing schools in France were created as a result of the
secularisation of public hospitals and their nursing staff.
Although nursing had also been a mixed-gender activity in
France, the creation of nursing schools in the 1870s contrib-
uted to the feminisation of the nursing staff.
6
Female nurses
were then seen as obedient, submissive and less expensive
than male nurses. On the other hand, the severe working
conditions and the low wages did not attract men that could
nd better paid jobs elsewhere (Poisson 1998, 10722).
In France as well as in the United Kingdom, there was a
sort of dogma around the superiority of women in the
domain of nursing, with gender discrimination. The charac-
teristics were the same as the ones of a mother: the nurse
would tend to the sick and wounded as she would care for a
son in need (Knibiehler et al. 1984, 61). However, at the
end of the nineteenth century, in Portugal, there was no dis-
cussion on the gendering of nursing. Doctors and hospitals
administrators wanted to provide a technical training to sec-
ular nurses (male and female) who were already working at
the hospitals. Doctors believed that nurses training was
essential to improve nursing services and to avoid having
nurses (male and female) of Catholic orders working again
in the Portuguese hospitals (Silva 2007a, 4142).
The nursing school located at the Hospital Geral de Santo
Antonio
7
(Saint Anthonys General Hospital) is an example
of this situation. This was a private hospital, controlled not
by the Portuguese state but by the Santa Casa da Misericordia
(Holy House of Mercy).
8
This school was created in 1896 to
provide a professional training to hospital workers but also
to external individuals of both genders. Lessons were in the
evening, two lessons per week, divided by sex, so that each
gender had one weekly lesson. A data analysis of the Minutes
Books of the Administrative Direction of the Hospital Geral de
Santo Antonio [18931933] and of the Registers Books of this
nursing school [192948] revealed a total of 1961 students
(54% women and 46% men) registered at the rst year of
the General Nursing Course from 1896 to 1947. During this
period, there was always a very high proportion of men. As
shown in g. 1, male students were even the majority in
some years, particularly at the end of the 1920s.
This situation started changing in the 1940s with the cre-
ation of several new nursing schools that only accepted
young women as students. Some of them were largely inu-
enced by British and American nursing schools and had the
support of international organisations such as the Red Cross
and the Rockefeller Foundation. These schools advertised
nursing as the ideal and the most beautiful profession for
women (Boletim do Instituto Portugues de Oncologia 1940, 1;
AAVV 1950, 2021). Secondly, several doctors started
expressing a strong negative opinion about male nurses, gen-
erally because of their visits to hospitals of other European
countries, where nursing was a profession exclusively for
women. This was the case of Doctor Luis Adao,
9
director of
the Nursing School Artur Ravara, in Lisbon. He argued that
the male nursing students were a disadvantage for the Portu-
guese nursing schools and that they should therefore
be excluded from them (Adao 1945, 93). Nursing journals
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Men
Women
Figure 1. Nursing Students Registered at the First Year of
General Nursing (Oporto, 18961955). Total number of
cases: 2220. Source: Livro de Actas das Sessoes da Direccao
Administrativa do Hospital Geral de Santo Antonio [Minute Book of the
Administrative Direction of Saint Anthonys General Hospital], no.
415, 18931933 [Archives of Saint Anthonys General Hospital];
Livro de Diplomas da Escola de Enfermagem do Hospital Geral de Santo
Antonio [Registers Book of the Nursing School of Saint Anthonys
General Hospital], no. 15, 192956; Livro de Matrculas da Escola de
Enfermeiros do Hospital Geral de Santo Antonio [Registers Book of
Nurses School of Saint Anthonys General Hospital], no. 17,
192955 [Archives of Oportos Nursing School].
6
Doctor Desire Bourneville, the founder of the rst nursing school in Paris,
believed that any woman with primary and professional education could become
a good nurse (Leroux-Hugon 198081, 91). In 1905, the principle of the femini-
sation of the nursing staff was adopted in France (Leroux-Hugon 1992, 81, 127),
although male nurses remained working with psychiatric patients (Magnon 2001,
57).
7
The construction started in 1770, but the project of the British architect John
Carr was enormous, and it was never achieved. The hospital started receiving
patients in 1799 when the work was still ongoing.
8
A set of Portuguese confraternities established since 1498 by D. Leonor, sister
of the king D. Manuel, who also supported these institutions as did the following
kings. Further readings: Sa IdG. 2004. Catholic Charity in Perspective: the social life
of devotion in Portugal and its Empire (14501700). E-journal of Portuguese his-
tory 2 (1). http://www.brown.edu/Departments/Portuguese_Brazilian_Studies/
ejph/html/Summer04.html (accessed 20 January 2012); Sousa ICd. 1999. Da
descoberta da Misericordia a` Fundacao das Misericordias (14981525) [From
the discovery of Mercy to the Foundation of the Holy Houses of Mercy (1498
1525)]. Porto: Granito Editores e Livreiros.
9
Portuguese doctor and surgeon, he also taught chirurgical clinic at the Lisbon
Faculty of Medicine. He visited the Nursing Schools in Spain and drew a compari-
son with the situation in Portugal.
178 2012 John Wiley & Sons Ltd
H da Silva
published articles against male nurses, arguing that women,
contrarily to men, were naturally apt to this profession.
Another argument used by those who wanted nursing to be
exclusively for women was that in other countries male
nurses did not exist, even in psychiatry. In these articles, the
authors did not give any proof of their statements that seem
to exaggerate the absence of male nurses in hospitals (Vas-
concellos 1950, 17).
Further to this, the Portuguese state started interfering
in the organisation of nursing schools and consequently in
the profession by dening who the students and future pro-
fessionals should be. From their origins, the Portuguese
nursing schools were organised and controlled by the admin-
istrations of the hospitals in which they were settled. This sit-
uation changed drastically in the 1940s, with the Portuguese
state dening rules and imposing restrictions to the different
nursing schools. This governmental interference is linked
to the Portuguese political context. Antonio de Oliveira
Salazar
10
(18891970), after being the Minister of Finances
during a period of economic crisis, became Prime-Minister
in 1932, when he created the New State regime (Estado Novo
193374), an authoritarian, nationalist, conservative, anti-
democratic and anti-communist dictatorship. The Concor-
dat of 1940 established a political alliance and strengthened
ties between the Catholic Church and the Portuguese
State.
11
The dictatorial regime controlled culture as well as
education and was helped by structures such as a political
police and a censorship department.
A PATH CHANGED BY SALAZARS
DICTATORSHIP
Salazars government aimed at having homogeneous nursing
schools fully controlled by the state by imposing a common
system that followed the model of American and British
nursing schools. This model was seen as the most appropri-
ate by several Portuguese doctors that had travelled abroad
and that inuenced the states decision. Furthermore, the
gendering of nursing followed the ideology of Salazars dicta-
torship that saw women as caregivers, dedicated and devoted
to patients as to their family. Thus, the laws imposed by Sala-
zars government established a gender discrimination, which
was strictly implemented. It was the decree-law number
36 219 of the 10th April 1947 that declared, for the rst
time, a clear preference for female nursing students and sub-
sequently for a female nursing staff. The two exceptions were
the services of psychiatry and urology (Diario do Governo
1947, 278). The idea of this preference was repeated in the
subsequent laws (Diario do Governo 1952, 879).
As a consequence to the publication of these laws, the
existing nursing schools, public and private, had to give pref-
erence to female nursing students. Therefore, these laws
contributed to the reduction of the number of male nursing
students and future professionals. The journal Revista de En-
fermagem
12
conrmed that the number of registered men in
the nursing schools was reduced and that this was the result
of copying the situation in other countries (1955, 7). The
Nursing School at the Hospital Geral de Santo Antonio (Opor-
to) is a good example of this change in the selection of nurs-
ing students, especially during the 1950s, as shown in g. 1.
The percentage of male nursing students registered in the
rst year of the General Nursing Course dropped from 46%
(903 men and 1058 women) between 1896 and 1947 to
26.3% (68 men and 191 women) between 1947 and 1955
13
.
In the 1940s and especially in 1950s, Portugal faced a
shortage of nurses and could not meet the health sectors
needs. In an attempt to solve this problem, several new nurs-
ing schools were created and most of them only accepted
women as students. Such was the case of the Escola Tecnica de
Enfermeiras (founded in Lisbon in 1940, with the nancial
and technical support of the Rockefeller Foundation),
14
Esco-
la Enfermagem Rainha Santa Isabel (founded in Coimbra, in
1946), Escola de Enfermagem da Cruz Vermelha (founded in Lis-
bon, in 1952), Escola de Enfermagem do Hospital de S. Joao
(founded in Oporto, in 1954) and the Escola de Enfermagem do
Hospital de Santa Maria (founded in Lisbon, in 1956) (Escobar
2004, 6062). In the Escola de Enfermagem de S. Joao de Deus,
founded in E

vora in 1955, the number of male students was

limited by the schools regulation to 10% each year.
10
Further readings: Meneses FRd, 2009. Salazar: a political biography. New York:
Enigma.
11
During Salazars dictatorship, several Catholic orders re-established in Portugal,
returning to hospital wards (mainly small sized hospitals) and some orders
founded their own health establishments. These were mainly female religious
orders, respecting the law that gave preference for female nurses. As for male reli-
gious orders, the most important was the Order of St. John of God, which had its
own nursing school and hospitals and worked in psychiatric nursing.
12
Journal published by the Portuguese Nursing Trade Union (Sindicato Nacional
dos Prossionais de Enfermagem) from October 1953.
13
Figure 1 reveals that male students were high in number and that in several
years they were even the majority, as at the end of the nineteenth century and at
the end of the 1920s. After this period, the number of male students started
decreasing, apart from years like between 1946 and 1948, when they were
again the majority. This exception was probably a consequence of the changes in
nursing schools legislation, which led men to get registered at these schools proba-
bly because they feared they would not be able to do it afterwards. Since the
1950s, their number has remained much lower than that of female students.
14
The relationship between the Rockefeller Foundation and Salazars Portugal is
still to be studied.
2012 John Wiley & Sons Ltd 179
Being a male nurse
The law that gave preference to the access of women to
nursing schools was clearly seen as a problem for the nursing
profession because it contributed to the shortage of person-
nel. This law forbade men to become nurses and to follow
this profession, with a clear discrimination by gender, based
in the so-called superiority of women to take care of the sick
and wounded. Those that would like to choose this profes-
sion had to ght against this preconceived idea. Several nurs-
ing periodicals expressed their disagreement towards this
law and their incomprehension for the reasons that led to its
publication. According to an article published in the Revista
de Enfermagem, Portuguese men with a vocation for this pro-
fession could not follow it or get registered in the nursing
schools (1958, 354). This journal added that the ones that
eventually did get registered claimed to be treated differently
than women. Those young men that decided to get regis-
tered in a nursing school had to face a different training, in
comparison with female students.
MALE STUDENTS IN THE NURSING
SCHOOLS
Men who wanted to study nursing had reduced choices over
schools and forbidden access to the most prestigious ones.
The interviewed male nurses declared they had no difcul-
ties to get registered in the nursing school of their choice,
because it accepted men as students. However, their training
was slightly different than that of female nursing students.
An article published in the journal Revista de Enfermagem
mentioned that the training of the future male nurses was
different and discriminatory (1973, 3). Indeed, both male
and female students had theoretical lectures together, apart
for some exceptions. From eight interviewed nurses (male
and female), seven stressed this situation. The theoretical
lectures were mixed except for anatomy, when students had
to learn the sexual reproductive system. When the lesson
subject was the male reproductive system, the young ladies
had a holiday that day mentioned Em lia, and when it was
the female reproductive system, the male students would go
out of the classroom, declared Teresa and Ana. Joao was the
only male student of his year, so he admitted that sometimes
he had classes alone but not many.
Training practice at the hospitals was also different: male
students did the training in the male wards (Joao). The
1953 regulation of the Nursing School Artur Ravara (Lis-
bon) and the 1948 and 1954 regulations of the Nursing
School at the Hospital Geral de Santo Antonio (Oporto) men-
tioned these different training periods according to the gen-
der of the students (Santa Casa da Misericordia do Porto
1948, 13; Diario do Governo 1953, 824). Thus, male students
had no training in the services of obstetrics, gynaecology,
paediatrics, kitchen, diets and laundry. However, men were
obliged to do a period of training at the services of venereol-
ogy and urology, from which female students were excluded
(Santa Casa da Misericordia do Porto 1954, 17). Several of
the interviewed nurses recalled this situation (female stu-
dents didnt have urology declared Joao) underlying the
separation that existed and the fact that male nurses always
practised in male wards (always menalways men men-
tioned Joaquim). The female nurse Aurora conrmed that
only they [men] were going to urology. We [women] never
learnt to catheterize a man (Aurora) as male students
never learnt how to insert a urinary catheter in a female
patient. Male nurse Joaquim added that in the Hospital in
Braga (in the 1950s), ophthalmology was also only for
female nurses. It is also interesting to know that the nurse
superintendent, a woman, who was supposed to follow stu-
dents in their hospital training, did not do it in urology.
Joao, who studied in the Nursing School in Braga (1954
57), remembered that his superintendant, a sister of St.
Joseph of Cluny,
15
only didnt guide in urology. Besides she
did guideI was the less guidedI was moreI was more
connected to the male nurses in head of the services.
Besides these differences in training (theoretical and
practical), several Portuguese nursing schools invested in res-
idences for nurses, during the 1940s and 1950s, to give a
moral education to their students. However, these residences
were only for female nursesonly girls, there were no boys
one boy was at his family home and the other was also
from here, so but there were others that were in a guest-
house, mentioned Ana. When questioned about this situa-
tion, male nurses did not give any importance to this subject
and answered almost automatically, saying that they just
could not live at the nurses home so they lived with their
parents.
Concerning the relations between the students of the
two genders, the interviewed nurses, who studied between
1949 and 1959, mentioned no problems between men and
women. On the contrary, they mentioned the good relations
in spite of a certain division (Teresa) and some stated that
they were true classmates, we loved it [nursing] (Em lia); or
it was goodthey werent many butwe [female students]
called them [male students] by their rst name (Aurora).
Joao added It was good, it was so good that Ive married
15
Religious order founded in France, in 1807, by Ana Maria Javouhey. The rst
religious women of this order arrived in Portugal in 1881 to prepare the Portu-
guese novices to work as nurses or as teachers (Vieira 2000, 4746). However, it
was only during Salazars dictatorship that this religious order became more pow-
erful as it was the case for others (mainly female orders).
180 2012 John Wiley & Sons Ltd
H da Silva
one[classmate]. Despite a gender division, students were
socially related with each other. Amongst the eight inter-
viewed nursing professionals, two of them married a nurse
that they met at the nursing school or at the hospital where
they worked.
Another difference was the uniform, although for both
genders the rules were very strict. According to Joao, right
after entering the school, we had to put on the uniform.
Female nurses had a cloak to use outside the hospital, but
male nurses did not. Male uniform consisted of a smock,
trousers and white shoes and the beard trimmed and for
women a smock and a cap (Joao). This male nurse, who stud-
ied in Braga, mentioned that men had some sort of cap but
we didnt use it. [We used it] only when we were at the surgery
room. However, male nurse Antonio afrmed that inOporto
they had a white round cap that they always used because we
couldnt work without it. This last nurse also mentioned that
male nurses did not wash and iron their uniform themselves.
No it was the hospital, the laundrywell, female nurses, in a
general way did it themselves but men it was more sim-
plebut female nurses were more neat and quite often they
washed and ironed their uniform. Nevertheless, in Braga,
Joao stated that every weekend he was taking home his uni-
form to be washed. So in the case of Oporto, men were posi-
tively discriminated because this task (washing and ironing
the uniform) was someone elses function.
Portuguese hospitals had different rules concerning the
uniforms of the nursing staff, but in most of them, men had
no cloak or cap, which were symbols of the nursing profes-
sion. Male nurses training skills were different from female
ones, which affected their professional life, when they were
suddenly obliged to perform treatments for which they had
never obtained the theoretical or practical knowledge.
WORKING OPPORTUNITIES FOR MALE
NURSES
The interviewed nurses initially worked at the hospital where
they studied but later several of them left to nd other jobs.
These male nurses were not forced to leave the Portuguese
hospitals, because most hospitals kept hiring male nursing
staff to work in the male wards and to care for male patients.
Thus, if they had stayed in the hospital, they would have
worked in a male-dominated environment with other male
colleges (orderlies, auxiliary nurses, nurses and doctors) and
would have had to respect a strong hierarchy, expressed by
the different uniforms according to the categories of the
hospital staff.
As we will see, they chose to leave the hospitals for several
reasons, including the fact that it was then easier for a male
nurse to nd another job outside the hospital than for a
female nurse, whose scope of action was restricted by strong
moral values. Indeed, it was not socially accepted for women
to be independent because they should rely on men in their
everydays life.
16
Although the Portuguese state defended
that hospitals should preferably hire women for nursing ser-
vices, the feminisation of Portuguese hospitals was a progres-
sive process.
17
The long working hours and the conditions at the hospi-
tal made some nurses choose another job. This was for
instance Antonios case. He worked at the Hospital Geral de
Santo Antonio, in Oporto, and for him,
at that time it was a service of slave I started at 7:30 in the
morning and I worked all day long until 8 oclock in the
evening. If I was doing the night service, the night service
was divided in two parts: one from 8 pm until 1 am and
from 1 am until 7 am. So if I was doing the night service I
would work on until the morning.
He worked all days of the week and if a colleague was
sick, I had no day off. Antonio slept at the hospital, I had
a bed in the ward, I had a bed next to the patients.
Because of a personal conict with the hospitals administra-
tion, Antonio thought he did not have many possibilities of
evolving in his hospital career, so he planned to go to Africa,
more precisely to Mozambique.
As for Joao, who worked at the Hospital de Sao Marcos
(Saint Marcus Hospital), in Braga, the reasons to leave this
hospital were linked with the salary. He chose to work at a
company that operated several hydro-electrical barrages and
where his salary was three times higher than at the hospital.
In addition to the salary, he had other advantages: fur-
nished house, water, lighteverything for freeand more:
I had gratuities at Christmas, at Easter and at the opening of
new barrages. And a subvention for holidays. Finally, he also
found a place at the company for his wife, who was also a
nurse, which allowed her to work closer to her husband and
enabled them to live together in a house and not in the con-
ditions offered at the hospital (sleeping regularly in a bed at
the ward or contiguous to it and very few days off to spend
some time at home).
At the hospital, these male nurses were only caring for
men, as they had been trained to. However, when they
started working outside the hospital, male nurses had to
treat women. Joao mentioned that he never had any prob-
16
Many actions were not possible for women without their husbands agreement;
for instance, this was the case for leaving the country. As a result, female nurses
had fewer choices for their career.
17
Feminisation was faster in the new state hospitals opened since the 1950s,
where most of the staff had recently graduated.
2012 John Wiley & Sons Ltd 181
Being a male nurse
lem because women did not mind to be treated by male
nurses,
The company gave assistance to the employees as to the
local populationthere was nothing else so it had to be like
that. So there, the rst person to be contacted when there
was a problem was the male nurse.
It was in this context that Joao had to do childbirths,
although he did not have any specic training or any experi-
ence.
The child was being born and I had no other solution
The doctor was never coming it was not complicated, it
was just helping to come out well the child was born
after, the bath and so on, it was not with me because there
were always other women that would do those things but
the most difcult was to cut the umbilical cord and wait for
the placenta to fallbut there was no other problem at all.
Antonio also worked for an insurance company that was
building a barrage so he had over 2000 workers to care for at
a very risky construction. He said that it was work day and
night I was 24 hours available I had no days off, I had
nothing. But the salary was better than at the hospital,
plus I could practice my profession privately, inside the cen-
tre, charging and he had his own house.
These two male nurses insisted that working at these
companies was a good experience and that they have learnt
many things on their own because doctors were almost
always absent. I had a doctor twice a week and I was alone
I had a doctor twice a week and most of the times he did
nothing I had to do everything (Antonio). Joao also
mentioned that the doctor was working twice a week, but
sometimes, he was absent so he had to solve things alone.
Eighty maybe eighty-ve percent of the situations I was the
one solving them and in this context he even had to extract
a tooth with the doctors authorisation, because he was
absent for several weeks. As a result,
the man was so happy Of course, I was doing it for the
rst time so I was extremely careful. And it did not hurt him
a thing. So the man advertised in that area so then other
people were coming and they did not want the doctor
(Joao).
This statement revealed how much the local population
appreciated this male nurse as his work and that they felt no
inconvenience to be treated by him, instead of a female
nurse.
Apart from working in a company, there were other pos-
sibilities for male nurses like working at the medico-social
service (today the healthcare centres). Joaquim started
working there, replacing other nurses that were sick or on
holidays. He declared: I was almost exclusively going to the
patients home, doing the domiciliary visits, because the
girls, it was unthinkable that they would do home nursing.
He was going alone to the patients home where he treated
men and women without any problems. Because the salary
was much higher than at the hospital, he decided to con-
tinue working at these services. For a moment, he was also
working privately on his free time; however, he relinquished
these private services because he had to pay high taxes, but
carried on doing them for free. Like other nurses, he also
though of going to Africa so he bought several books and
nursing material and he planned to join his brother that was
already living there. However, for personal reasons, he never
left. Joao stated that many nurses left to work in the Portu-
guese colonies in Africa. Indeed, Antonio also planned to go
to Africa and he had everything ready to leave to Mozam-
bique in 1950. He had already a working position and some
members of his family there. However, some days before
shipping, he got sick with tuberculosis so he never left. Once
recovered, he had difculties to nd another job in Portugal,
so he did some home nursing until he got a nursing position
at an insurance company in Oporto.
This analysis revealed the different working opportuni-
ties for male nurses who were not preferably hired in public
hospitals. Despite this situation, male nurses actually had
more and better working opportunities. Outside the hospi-
tals, they found better paid jobs, with more interesting work-
ing conditions, wider nursing experiences (including having
female patients to care for) and also a larger independence
from doctors, nursing colleagues and hospital administra-
tions. Probably due to the limited number of male nursing
professionals, there was a real demand for their services in
Portugal. The limited number of male nurses did not keep
them away from nursing associations. On the contrary, male
nursing professionals encouraged nurses voice to be heard.
MALES NURSES CONTRIBUTION TO THE
PROFESSION
Despite the dictatorial regime and the censorship estab-
lished in Portugal, there was a National Professional Nursing
Trade Union
18
and different nursing associations. The foun-
dation of this nursing trade union was partly the action of
the male nurse Domingos Pereira Bento (Tavares 1943, 14),
who became the rst chairman. He had already worked in
favour of nursing professionals as one of the founders of the
Male and Female Nurses Association (created in 1925) and
18
Created in August 1945, in Lisbon, this nursing trade union united all the Portu-
guese nurses and midwives, male and female. The main ofce was in Lisbon, but
there were several ofces a bit all over the country.
182 2012 John Wiley & Sons Ltd
H da Silva
as director and editor of the journal Arquivo do Enfermeiro
(Nurses Archives published between 1925 and 1927 and
between 1943 and 1945). After his death in 1948, another
man became the chairman of this trade union: Manuel Lei-
tao Branco, nurse at the Lisbon Tramway Company. He con-
tinued to be the chairman until 1957, when nurse Daniel
Pinto became his successor (Revista de Enfermagem 1953, 2,
1957, 813).
We can see that men were in a higher number at the
board of directors and that they occupied the most impor-
tant positions, such as chairman. At the head of the different
ofces of the National Professional Nursing Trade Union
across Portugal were also men; of the thirteen ofces men-
tioned in the Revista de Enfermagem (1955, 7886), there was
no woman at the head. The role played by female nurses at
the board of directors was still reduced, especially if we take
into consideration that this was a profession seen as the
ideal for a woman.
On the other hand, women may have wished to become
chairwomen but were blocked because the choice over the
board of directors was partly controlled by the Portuguese
state.
19
The absence of freedom of choice over trade unions
boards was described by two of the nurses interviewed. Joao
mentioned the puppet elections and Antonio described
the elections as fabricated and manipulated. Joao added
that there were not many people prepared to full the
duties at a unions board of directors; the Portuguese gov-
ernment probably shared this idea, especially towards
women. This situation revealed a contradiction because the
Portuguese state wanted nursing to be a profession for single
women, but the nursing trade union, like other associations,
was controlled by men.
Contrary to the situation in other countries, in Portugal,
there was only one nursing association led by women
(National Female Nurses Trade Union of Lisbon District)
20
because it was a female nursing association. This union was
an exception in Portugal, where the number of women with
a political role at the time was extremely reduced, especially
amongst married women. This may help explain why a
reduced number of women took part in the Portuguese
nursing associations, where there was a majority of men. The
situation only started changing at the end of the 1960s.
As shown in g. 2, the representation of female nurses
members of the National Professional Nursing Trade Union
was lower than male nurses between 1945 and 1970. After
signicant growth at the end of the 1940s, the number of
men at this union increased slightly, at a lower pace than the
number of women. Even if male nurses were the majority
members all through this period, the difference was being
reduced, with 1970 the lowest for this period.
The presence of men at the Portuguese nursing trade
union and associations was important because they contrib-
uted to the unication of nursing professionals and to the
development of the profession. Joao tried to found a union
in 1965, but he ran into difculty with the dictatorial regime,
its laws and censorship. Antonio was president of the Associa-
tion of Male Catholic Nurses (1953), where he organised
conferences and excursions to Galicia to meet with Spanish
male nurses. The National Professional Nursing Trade
Union, a mixed-gender union, used to organise various activ-
ities such as conferences and gatherings, as in 1950, when
over 1000 male and female nurses gathered in Lisbon. Male
nurses also fought for better salaries and better working con-
ditions, including a demand to stop the preference for
female nurses at the Portuguese hospitals (Servir 1950, 7).
However, they did not succeed at this claim because the
female preference continued to be defended by the Portu-
guese state.
FINAL REMARKS
This documentary analysis and the interviews carried out
revealed how the gendering of nursing took place in
Portugal, where a dictatorial regime tried to duplicate the
international model without taking into consideration the
traditional Portuguese nursing model. An exaggerated view
of the western nursing model was presented by the dictato-
rial regime as being exclusively feminine to justify their
0
500
1000
1500
2000
2500
1
9
4
5
1
9
4
7
1
9
4
9
1
9
5
1
1
9
5
3
1
9
5
5
1
9
5
7
1
9
5
9
1
9
6
1
1
9
6
3
1
9
6
5
1
9
6
7
1
9
6
9
Men
Women
Figure 2. Nurses members of the National Professional
Nursing Trade Union (194570). Total number of cases:
77573. Source: Instituto Nacional de Estat stica. 194570. Anuario
Estatstico de Portugal [Statistical Yearbook of Portugal]. http://www.
ine.pt (accessed 20 April 2010).
19
It seems that no particular efforts were made by women to gain more leader-
ship in these unions, which can be explained by the traditional place of women in
the Portuguese society at that time and their reduced presence in politics.
Womens suffrage was only ofcially granted under certain conditions in 1931.
20
Trade union founded in 1936 by Isabel Gabriela de Albuquerque dOrey, certi-
ed nurse and chairman of this union until 194142, when Maria Leopoldina
Perestrello de Vasconcelos took her position. This union was active until 1943.
Revista de Enfermagem 1956, 1113; Vasconcelos 1942, 1920.
2012 John Wiley & Sons Ltd 183
Being a male nurse
political desire to change the nursing profession. However,
the presence of male nurses and their actions in professional
organisations were still important and, as a consequence, this
gendering was limited and varied according to the context.
Nevertheless, it has affected the profession ever since.
The feminisation of nursing started during training,
because taught content and practice were adapted to the
gender of the students and to what the Portuguese state
thought their future occupation should be. Unlike women,
male students did not have a strict moral education in the
nursing home. Their relationship with colleagues, doctors
and patients was positive, demonstrated not discrimination
but trust.
The gendering of nursing also was different, inside and
outside the hospitals, with different working opportunities
for each gender. Surprisingly, male nurses left the Portu-
guese hospitals not because they were obliged to but mainly
because of the better working conditions they found outside,
including a better salary and material advantages. In general,
male nurses had some difculties nding their rst job:
some replaced colleagues, others did domiciliary nursing,
and many thought of going to the Portuguese colonies in
Africa. In the end, they had quite a wide range of job oppor-
tunities in Portugal, outside the main hospitals, to occupy
the positions such as domiciliary nursing that were forbid-
den for female nurses.
This different gendering of nursing was also visible in
nursing trade unions, where male nurses played an active
role in the professional organisations, in spite of the censor-
ship. Male nurses contributed, within their scope of action
set by the dictatorship, to the development of their profes-
sion, to improve the contacts amongst nursing professionals
and to ght against those that worked without a nursing
diploma.
Although men were discriminated against in access to sev-
eral nursing schools, especially the most prestigious ones,
those that obtained the nursing diploma managed to have
interesting nursing positions. Furthermore, they had no inter-
diction to marry (unlike female nurses) and signicantly con-
tributed to the development of the nursing profession as
active members of associations and trade unions. The Portu-
guese dictatorial regime tried to copy the Nightingale model
and to feminise the nursing profession, but the tradition of a
mixed-gender profession was still strong. Therefore, male
nurses continued practicing this profession because they were
accepted by patients, doctors and nursing colleagues.
The case of the feminisation of nursing in Portugal dem-
onstrates the importance of the Nightingale model and
how it settled progressively throughout the world and cre-
ated cultural limits to such a way of working. Nowadays, in
an evermore globalised world, where the nursing profession
is well dened and somehow standardised by international
trends, studying such a case with todays hindsight helps our
understanding of how lengthy and complex it can be to fol-
low an international model when there are different and
strong traditions.
ACKNOWLEDGEMENTS
This study was the result of a research supported by a grant
from the Calouste Gulbenkian Foundation. An earlier ver-
sion of this study was presented at the Society for the Social
History of Medicine Postgraduate Conference in Dublin
2009. I acknowledge the critical comments of those that were
present at that conference.
REFERENCES
AAVV. 1950. Escola de Enfermagem Rainha Santa Isabel [Nurs-
ing School Queen Saint Elizabeth]. Coimbra: Graca
de Coimbra.
Adao L. 1945. Relatorio da viagem a Espanha para estudo das Esc-
olas de Enfermagem desse pas [Report of the journey to
Spain to study the Nursing Schools of this country]. Lis-
boa: Casa Progresso.
Boletim do Instituto Portugues de Oncologia [Bulletin of the Por-
tuguese Institute of Oncology] VII (5), May 1940: 1.
Diario do Governo [Ofcial Journal] I (80), 1947. Decreto-Lei
n 36219: 278.
Diario do Governo [Ofcial Journal] I (190), 1952. Decreto-
Lei n 38885: 879.
Diario do Governo [Ofcial Journal] I (121), 1953. Portaria n
14416: 824.
Escobar L. 2004. O sexo das prossoes: Genero e identidade socio-
prossional em enfermagem [The sex of professions: Gender
and socio-professional identity in Nursing]. Santa Maria
da Feira: Edicoes Afrontamento.
Foucault M, BB Kriegel, A Thalamy, F Beguin and B Fortier.
1995. Les machines a` guerir: Aux origines de lhopital moderne
[Curing machines: At the origins of the modern hospi-
tal]. Belgique: Mardaga.
Knibiehler Y, V Leroux-Hugon, O Dupont-Hess and Y Tast-
ayre. 1984. Cornettes et blouses blanches: Les inrmie`res dans
la societe francaise (18801980) [Wimples and white uni-
forms: Nurses in the French society (18801980)]. Paris:
Hachette.
Leroux-Hugon V. 198081. Inrmie`res des hopitaux Paris-
iens 18711914: E

bauches dune profession [Nurses of

the Parisian hospitals 18711914: Drafts of a profession].
PhD diss., Universite de Paris VII, France.
184 2012 John Wiley & Sons Ltd
H da Silva
Leroux-Hugon V. 1992. Des saintes laques: Les inrmie`res a`
laube de la troisie`me Republique [The secular saints: Nurses
at the dawn of the third Republic]. Paris: Sciences en
Situation.
Magnon R. 2001. Les inrmie`res: Identite, specicite et soins inr-
miers, le bilan dun sie`cle [Nurses: Identity, specicity and
nursing, the balance of one century]. Paris: Masson.
Poisson M. 1998. Histoire de la profession inrmie`re en France:
Origines republicaines dun mode`le inrmier (18701900)
[History of the nursing profession in France: Republican
origins of a nursing model (18701900)]. Vincennes:
Ed. Hospitalie`res.
Revista de Enfermagem [Nursing Revue] 1, 1953: 2.
Revista de Enfermagem [Nursing Revue] 12, 1955: 7, 7886.
Revista de Enfermagem [Nursing Revue] 14, 1956: 1113.
Revista de Enfermagem [Nursing Revue] 1920, 1957: 813.
Revista de Enfermagem [Nursing Revue] 28, 1958: 354.
Revista de Enfermagem [Nursing Revue] 20 (5), 1973: 3.
Santa Casa da Misericordia do Porto. 1896. Regulamento dos
servicos tecnicos do Hospital Geral de Santo Antonio [Techni-
cal services regulations of Saint Anthonys General
Hospital]. Porto: Ocina Tipograca do Hospital de
Alienados do Conde de Ferreira.
Santa Casa da Misericordia do Porto. 1948. Regulamento da Esco-
la de Enfermagem do Hospital Geral de Santo Antonio [Nursing
School Regulations of Saint Anthonys General Hospital].
Porto: Tipograa do Hospital Conde de Ferreira.
Santa Casa da Misericordia do Porto. 1954. Escola de Enferma-
gem Dona Ana Jose Guedes da Costa [Nursing School
Mrs. Ana Jose Guedes da Costa]. Porto: Tipograa do
Hospital Conde de Ferreira.
Servir [To serve] II(19), 1950: 7.
Silva H. 2007a. From mixed nursing schools to a preference
for female nursing: The situation in Portugal. Boletim In-
formativo do NEPS [Information Bulletin] II (1): 4054.
http://www.neps.ics.uminho.pt/boletins/boletim_II_
N1.pdf (accessed 20 January 2012).
Silva H. 2007b. O nascimento das escolas de enfermagem
em Portugal (nais do seculo XIX) [The birth of nursing
schools in Portugal (end of the nineteenth century)]. In
Noroeste, Revista de Historia, Congresso Internacional de Histo-
ria: Territorios, Culturas e Poderes, Actas [Northwest, Revue
of History, International History Congress: Territories,
Cultures and Powers, Minutes] ed JV Capela, vol II, 749
756. Braga: Universidade do Minho.
Silva H. 2010. Do curandeiro ao diplomado: Historia da pro-
ssao de enfermagem em Portugal (18861955) [From
healer to graduate: History of the nursing profession in
Portugal (18861955)]. PhD diss., Ecole des Hautes
Etudes en Sciences Sociales and Universidade do Minho,
France and Portugal. http://hdl.handle.net/1822/
11627 (accessed 25 January 2011).
Tavares MS. 1943. Enfermeiros Portugueses, duas palavras
apenas [Portuguese male nurses, only two words]. Arqu-
ivo do Enfermeiro [Nurses Archives] II(1): 14.
Vasconcelos MLPd. 1942. Relatorio de 194142 [Report of
194142]. A Enfermeira [The Nurse] 6: 1920.
Vasconcellos MLPd. 1950. Alerta Enfermeiras [Nurses Alert].
Servir [To serve] I (12): 17.
Vieira MdP. 2000. Irmas de Sao Jose de Cluny [Sisters of St.
Joseph of Cluny]. In Dicionario de Historia Religiosa de Por-
tugal [Dictionary of Religious History of Portugal], ed
CM Azevedo, vol II, 4746. Lisboa: C rculo de Leitores e
Centro de Estudos de Historia Religiosa da Universidade
Catolica Portuguesa.
Vieira F, H Silva and P Pinto. 2010. Evolution of nursing edu-
cation in Portugal: A historical analysis of the Nursing
School at the Hospital Geral de Santo Antonio in Porto
(18961947). E-journal of Portuguese History 8 summer:
111. http://www.brown.edu/Departments/Portuguese_
Brazilian_Studies/ejph/html/issue15/pdf/v8n1a04.pdf.
(accessed 25 January 2011).
2012 John Wiley & Sons Ltd 185
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