Nursing care and nurses’ good service in 1821-1822

Background: The first elected chamber of representatives of the Portuguese nation started operating after the 1820 Liberal Revolution. Although historically distant from nursing professionalization, education, regulation, and control, several references were made to nurses in this chamber. Objectives: To analyze the discussions about nurses and nursing in the Sovereign Congress in 1821-22. Methodology: An historical search was conducted in the daily session records, followed by the collection, analysis, and interpretation of sources. Results: Five themes were identified: the figure of enfermeiro-mor; the Proposal for a General Public Health Regulation; references to nurses; the presence of midwives and bleeders; and the organization of nursing wards and hospitals. Conclusion: No explicit reference was made to nursing, only to nurses. The definitions of enfermeiro-mor and nurse differed. Bleeders were frequently mentioned, as well as the structured organization of midwives. Nurses appeared as caregivers in hospitals and at home, in a different category of other care delivery activities; however, nursing was still far from professionalization. Finally, there were references to issues related to hygiene, safety, qualifications, and care organization.


Introduction
In Portugal, one of the first signs of nursing professionalization can be the official structuring of nursing education, in 1881, as a formal school in Coimbra, founded by Costa Simões.However, there is no question that the professionalization of nursing is a secular movement, which was only completed by the end of the 20 th century, when the Professional Nursing Practice Regulation was published and the regulatory body -the Portuguese Order of Nurses (Ordem dos Enfermeiros) -was created.Nevertheless, there are earlier references to nursing and nurses.Systematic knowledge should be set apart from the scarce and disconnected knowledge that is often idealized and built around gentle figures.When integrated into social movements, systematic knowledge allows identifying the timelines of ideological and societal construction of today's nursing.In this context, all written documents, if available and accessible, must be analyzed for their potential contribution to the explanation of the nursing affirmation movement as an autonomous activity and its professionalization.We now have electronic access to almost all sessions of the various Chambers of Representatives that have operated in Portugal since 1821.It is important to investigate and explore, from an historical perspective, what was discussed, analyzed, presented, and voted for debate in these Chambers regarding nursing and nurses.The purpose of this study was to collect, read, analyze, and interpret the records from the daily sessions between 1821 and 1822.In Portugal, the 1820 Liberal Revolution dealt a severe blow to the Absolutist Monarchy and opened the way to Liberalism and democratic experiences with the creation of Chambers of Representatives to represent the people.Such was the case of the General and Extraordinary Cortes of the Portuguese Nation (Cortes Geraes e Extraordinarias da Nação Portugueza), also known as Sovereign Congress (Soberano Congresso).The "1820 Revolution constitutes the founding moment of the 19th century Liberalism in Portugal" (Vargues, 1993, p. 45).This movement of rupture and discontinuity occurs at a time when "the Portuguese society still followed ancient routines in virtually every domain of its existence.With a population of only three million inhabitants, the country was overwhelmingly rural, extremely poor and, of course, illiterate" (Bonifácio, 2010, p. 13).In December 1820, the Extraordinary Cortes were elected, along with the deputies in charge of drafting a Constitution.They were held between 24 January 1821 and 4 November 1822, during which period the first Portuguese Constitution was drafted and then approved on 30 September 1822.According to Vargues (1993), "the establishment of the first Liberal Parliament in Portugal . . .marked the achievement of the first objective of the 1820 Revolution" (p.61).This Chamber, which had a constitutional role, also operated as a sovereign body and "there were many Portuguese people who also wanted to intervene, and sent . . .hundreds of proposals . . . to the Sovereign Congress" (p.61).According to Bonifácio (2010), "the Sovereign Congress, . . ., on its own, committed to draw up a completely radical Constitution -a Republic disguised as a Monarchyquite contrary to what was observed in Europe, with the exception of Spain" (p.27).With the purpose of analyzing the discussion about nursing and nurses in the Sovereign Congress between 1821 and 1822, the following questions were considered relevant: In Portugal, what was happening in this Chamber regarding nursing during this period?What were the elites of this Chamber discussing about nursing?

Methodology
This research study was conducted using the historical methodology, guided by the methodological positions described below: It is necessary to take into account three moments in the elaboration of historical discourse, which are, first, the examination of the past through its milestones, then the mental representation resulting from that examination, and, finally, the production of a written or oral text that allows communicating with others.(Mattoso, 1997, p. 16) However, the elaborated discourse must consider that "the scientificity of history as a modern science no longer consists in narrating, but rather in describing, analysing, explaining."(Rüsen, 2001, p. 119).Furthermore, it should address History as "a complex, broad, and defined knowledge that seeks to both explain and question" (Torgal, 2015, p. 50).This study is based on the collection and analysis of documents that were available at the website of the Portuguese Assembly of the Republic, particularly the daily sessions of the General and Extraordinary Cortes of the Portuguese Nation.The search was conducted using the following descriptors in the search engine of the website: enfermeiro (male nurse), enfermeiros (male nurses), enfermeira (female nurse), enfermeiras (female nurses), enfermaria (nursing ward), enfermarias (nursing wards), enfermagem (nursing), parteira (midwife), parteiras (midwives), sangrador (bleeder), and sangradores (bleeders).This task included the selection and classification of sources, followed by the assessment of their quality and relevance (Filho et al., 2015).After a careful reading, the topics were analyzed, contextualized, and described based on the following objectives: the collection of topics related to nursing and nurses; the analysis of the documents and the thematic and collective interpretation of the sources found regarding the 2-year period; the identification of the themes and issues that prompted the interest of the legislative elites; and the elaboration of an analytical and interpretive written text, strongly illustrated with quotations from the sources and conclusive in terms of the interpretative proposal put forward by the researchers.It should be noted that, as an historical research process, document analysis provides opportunities to study the impact of nursing in the Portuguese society through the identification of the topics related to nursing and nurses discussed and the study of the missing topics over a given historical period (Queirós, Filho, Monteiro, Santos, & Peres, 2017).

Results and discussion
A total of 37 pages of daily sessions was found in the search: 23 pages from 1821 and 14 from 1822.The pages were retrieved from 27 daily sessions (16 from 1821 and 11 from 1822) out of a total of 481 daily sessions that were published during the 2-year period (263 in 1821 and 218 in 1822).In other words, the topics searched using the descriptors were mentioned in only 5.6% of the daily sessions.At a first glance, this percentage may be considered extremely low and non-significant; however, it is of utmost importance that these topics were discussed at all at such an early period in history and by such a prominent legislative body.The descriptors enfermeiro and enfermeiros produced the highest number of results (25 entries), followed by enfermaria and enfermarias with 11 entries, parteira and parteiras with five entries, and sangrador and sangradores with five entries.No entries were found using the descriptors enfermeira, enfermeiras and enfermagem (Table 1).The analysis of the results produced by the descriptors raises the following questions: Why are there no entries with the descriptors enfermeira, enfermeiras?Were there no female nurses?Did the use of the masculine form refer to both male and female nurses?Was the role of female nurse restricted to midwifery and, therefore, the descriptor does not appear?When did the female nurse started to be referred to as an autonomous figure in the daily sessions?These questions will be discussed in subsequent studies which will be conducted after the analysis of the Constitutional Monarchy timeline .In addition, it would also be worth to question why there are no entries for the descriptor enfermagem, which may be explained by the fact that the process of nursing affirmation as a profession was only starting to emerge at that time.

Enfermeiro-mor
The enfermeiro-mor had an administrative and management role.In Lisbon, on 29 June 1564, the St. John the Evangelist priests, also known as the Friars of Lóios, were replaced as administrators of the Todos os Santos Hospital by "the Irmandade da Santa Casa da Misericórdia de Lisboa, and the position of the provedor was replaced by the enfermeiro-mor, who was also the provedor of the Irmandade, and, therefore, lived in the hospital" (Sousa, 2013, p. 92).
The material provided by the Sovereign Congress daily sessions provides some insights about the enfermeiro-mor at that time.Daily session 199, dated 13 October 1821 (Assembleia da República, 1821-1822), makes reference to a Proposal for a General Public Health Regulation according to which all hospitals would be administered by a council composed of the enfermeiro-mor, the administrator, the most senior doctor, the most senior surgeon, and a clerk.Each role was generally defined as follows: the administrator shall be in charge of everything related to house economy; the enfermeiro-mor is responsible for everything related to the people caring for the patients and to all employees; the doctor shall be responsible for the acceptance, diet prescription, and treatment of patients in the medical ward, and for enforcing the regulation in the ward.(Diário nº 199, de 13 de outubro de 1821; Assembleia da República, 1821-1822, p. 2644).The figure of enfermeiro-mor is referred to in the daily sessions regarding other issues, which are describe below.On 24 March 1821, the Public Instruction Commission of the General Cortes issued an opinion stating that it saw no inconvenience in having a French class in the São José Hospital, which would be useful for those attending the surgery course.However, it also mentioned that it lacked the "necessary permission from the Hospital's Enfermeiro Mór who shall be in charge of everything related to this Class" (Diário nº 42, de 24 de março de 1821; Assembleia da República, 1821-1822, p. 359).On 1 May 1821, the Cortes received an employment application of António Baptista, who had served as enfermeiro-mor in military hospitals, to the Army's Arsenal.The daily session of 25 May 1821 refers to the Kingdom's regency decree, in the name of his Majesty King John VI of Portugal, represented by the enfermeiro-mor of the São José Hospital, who expressed his doubts about receiving a quarter of the rights to foreign flours, as well as the exemption of foreign duties regarding the wheat consumed in that hospital.On 12 December 1821, the situation is discussed, taking into consideration the right of the São José Hospital to a quarter of the sold grains, which had been previously assigned on 14 April 1782 due to the scarcity of resources: assistance, which is currently even more necessary due to the greater number of patients who are treated there, over 1200 patients, and without it there is no way to provide patients with the basic medical supplies and essential goods (Diário nº 248, de 12 de dezembro de 1821; Assembleia da República, 1821-1822, p. 3396).The Cortes, "when presented with the bill of the São José Hospital's enfermeiro-mor", decided that "due to the low income . . . the part of the sold grains should remain assigned to that hospital, as it was assigned before" (Diário nº 248, de 12 de dezembro de 1821; Assembleia da República, 1821-1822, p. 3397).The daily session of 21 July 1821 refers to a letter sent by the São José Hospital's enfermeiro-mor to the medical and surgical body, concerning the prohibition of access of patient's relatives or friends to the hospital.In the daily session of 1 April 1822, the deputies received 160 copies of the São José Hospital's income and expense statement for the previous year, which had been sent by the enfermeiro-mor.On 14 August 1821, as well as on 1 and 18 April 1822, the daily sessions make reference to a controversy regarding the doctors placed by the enfermeiro-mor at the São José Hospital: the enfermeiro-mor is free to propose the doctor that he judges best, but, on equal terms, he should prefer doctors who have served in pious establish-ments, hence quelling doubts when comparing the merit and quality of the doctors proposed by the enfermeiro-mor to the current doctors of the misericórdia (Diário nº 60, de 18 de abril de 1822; Assembleia da República, 1821-1822, p. 862).The reason for the controversy was that "one of the doctors proposed by the enfermeiro-mor was awarded every year by the University, a qualification that the doctors of the Misericórdia did not have: thus, he certainly prefers them."(Diário nº 60, de 18 de abril 1822; Assembleia da República, 1821-1822, p. 862).The Cortes issued a conciliatory opinion between the merit of pious services and the academic merit.
The Proposal for a General Public Health Regulation: safety, qualification, and organization concerns On 13 October 1821, deputy Francisco Soares Franco (1771-1844), as a member of the Public Health Commission, presented a Proposal for a General Public Health Regulation to the Cortes (Diário nº 10, de 08 de fevereiro de 1821; Assembleia da República, 1821-1822).The preamble of this proposal describes the reasons why it is necessary, namely that one of the most important goals of any government is to maintain the public health of the populations, as it is more useful to prevent diseases than to "face the enormous effort of treating them, which brings about many risks and expenses."The lack of a governing body responsible for monitoring and addressing the proposed objectives is another reason why the Commission proposed this regulation.Therefore, the Commission intended to "create a simple, standardized public health regulation throughout the Kingdom, dependent on a single central governing body in charge of its supervision" (Diário nº 199, de 13 de outubro de 1821; Assembleia da República, 1821-1822, p. 2639).The legislative proposal had 146 articles organized into the following eight sections: the public health council; health workers and their qualification; people who are exposed; hospitals; the medical police; the health service at seaports of the Kingdom of Portugal and Algarve and its islands; the Lazareto; offenses and penalties of public health workers.(Diário nº 199, de 13 de outubro de 1821; Assembleia da República, 1821-1822, p. 2639-2649) An important aspect of this proposal was the creation of a public health council in Lisbon, which was chosen by the King and composed of three doctors, a surgeon, and an apothecary.This council met three times per week and was in charge of assuming the previous role of the Kingdom's físico-mor and cirurgião-mor; managing all existing and future health facilities; communicating orders to the health inspectors of the chambers and parties' doctors; issuing diplomas and letters to doctors, surgeons, and apothecaries; monitoring bleeders, midwives, and nurses; elaborating quarterly and biannual reports about the health of the populations; and printing the "Annals of public health in Portugal" (Annaes de saude publica em Portugal) every year.Article 17 of the proposal identifies doctors, surgeons, apothecaries, and midwives as health workers.Nurses are not explicitly mentioned in this article, but article 10 refers district health inspectors' monitoring role: hospitals' conditions, namely the repair of buildings, their good or bad localization, their cleanliness, the number of patients, the quality of diseases, the care and assistance provided by doctors and surgeons, the care and good service of nurses, the adequate supply of apothecaries, the healthiness of food, and the provision of clothing.
(Diário nº 199, de 13 de outubro de 1821; Assembleia da República, 1821-1822, p. 2640) The Proposal for a General Public Health Regulation suggests the organization of the public health system into lines of hierarchy, according to which "each district [shall have] a doctor with the title of public health inspector"; lines of command, according to which the district public health inspector "shall communicate his orders to the health inspectors of the chambers, via his secretary"; and also lines of control, evaluation, and accountability, according to which the district public health inspector "shall report every six months to the ministry, and every year to the Cortes on the health status of the populations" (Diário nº 199, de 13 de outubro de 1821; Assembleia da República, 1821-1822, p. 2639).In addition to its preamble, the regulation also focuses significantly on prevention when it considers: the regulation of vaccination; of the exposed people and their education; of the control of the entry into the national territory, quarantines, and the organization of the Lazareto; the attention to apothecaries and medications; the environment and health, burials, and cemeteries.The regulation of the training of "health workers" was also emphasized, as well as its recognition through licenses and letters, and penalties for illegal practice.Article 25 refers to the regulation of professional practice: If a health worker does not perform well by omission, or ignorance, the party's doctor, and if the latter is the one found guilty, the chamber shall report him to inspector of the corresponding district, who shall report him to the council, which shall take the measures deemed convenient.If there is no correction, the worker may be suspended from his role (Diário nº 199, de 13 de outubro de 1821; Assembleia da República, 1821-1822, p. 2641) On several occasions, the Regulation proposal explicitly refers to midwives, their job, preparation, and training, as well as to their illegal practice.These references will be latter analyzed.The enfermeiro-mor was also mentioned as a member of the hospitals' administrative council.Still with regard to the concerns with prevention, article 85 of the Regulation proposal determines the existence of a separate ward in every hospital for "contagious febrile diseases and a convalescent house".In addition, the hospital of each capital city shall have a "private and demure [ward] (in certain cases) for women in labor" (Diário nº 199, de 13 de outubro de 1821; Assembleia da República, 1821-1822, p. 2644).The Regulation proposal was submitted to the Cortes Chamber on 12 October 1821 and was then sent to be printed to be discussed.However, "it was not discussed or approved, because, in the meantime, the Cortes were extinguished" (Subtil, 2016, p. 179).In any case, it reveals the legislative spirit and thinking of the nation's representative elites at the time.The legislative proposal also allows reflecting about how nurses, midwives, and bleeders were viewed at the time.Within this framework, the Navy Minister sent a concerned letter to the Sovereign Congress on 18 October 1822, "demanding immediate measures aimed at the various public health-related objects of the kingdom" (Diário nº 72, de 25 de outubro de 1822; Assembleia da República, 1821-1822, p. 886).The Public Health Commission, when faced with the delayed evaluation of the Regula-tion proposal and the Minister's statement, proposed that the General Cortes should include only 12 articles, which is a short version of the previously mentioned project.In this proposal, four articles refer to midwives, bleeders, and nurses.This abbreviated decree proposal was presented to "the President [of the Cortes] to include it in the agenda when convenient" (Diário nº 72, de 25 de outubro de 1822; Assembleia da República, 1821-1822, p. 886).

Nurses -their activities and functions
On 6 November 1821, the Cortes received this interesting request: Bernardo José de Sousa Lobato asks permission to leave the house with a nurse for the walks necessary to his recovery, which are prohibited by decree of the Cortes that only allow him to recover inside his house.(Diário nº 218, de 6 de novembro de 1821; Assembleia da República, 1821-1822, p. 2963).On the same date, the Cortes decided to "inform the government that there is no inconvenience in giving the petitioner the requested permission" (Diário nº 218, de 6 de novembro de 1821; Assembleia da República, 1821-1822, p. 2970).Nurses' role included helping people, private individuals, to recover their health at their homes.These individuals would certainly have a prominent status in society.This is the case of Sousa Lobato, who was a nobleman and persistent supporter of King John VI of Portugal, as well as the person responsible for the King's clothes.Upon his arrival from Brazil, he was ordered to leave Lisbon, which explains the need to request permission to exit the house to which he was confined by judicial decision.Most references to nurses were found in hospital settings, where "nurses' care and good services" are expected (Diário nº 199, de 13 de outubro de 1821; Assembleia da República, 1821República, -1822República, , p. 2640)), and in military hospitals, where, among other duties, nurses manipulate drugs although "their studies do not qualify them for such work" (Diário nº 223, de 12 de novembro de 1821; Assembleia da República, 1821República, -1822, p. 3051), p. 3051).In addition, there is also reference to João António Oliveira, a prisoner sentenced to exile, who "started working as a nurse . . .and, as if he spent years studying the principles of surgery, he has been performing the duties of this position with intelligence and zeal" (Diário nº 50, de 2 de abril de 1822; Assembleia da República, 1821República, -1822, p. 688), p. 688).For this reason, the commission in charge of improving jails in Porto asked that "he serve his sentence to exile working as a nurse" (Diário nº 50, de 2 de abril de 1822; Assembleia da República, 1821-1822, p. 688), even because it was said that the Misericórdia of Porto could not employ payed nurses due to its lack of resources.There is reference to "two semi-clergymen who had the name and income of nurses, but not the service" in the military hospital of Mozambique (Diário nº 20, de 29 de maio de 1822; Assembleia da República, 1821-1822, p. 295), as well as to a "petitioning surgeon nurse from the nobles' college who had served as first surgeon for years, a position that is now vacant, requests His Majesty, . . . the grace of assigning him to that position for services rendered" (Diário nº 50, de 8 de julho de 1822; Assembleia da República, 1821-1822, p. 732).Also, the daily session no.27, dated 3 September 1822, (Assembleia da República 1821-1822, p. 333) reported that Manoel Antonio Lourenço, born in Galicia and living in Portugal for more than 20 years, "where he has worked as nurse in military hospitals and, having devoted himself to study and surgery, he currently practices this profession", requested the Portuguese nationalization.Finally, it is also mentioned that, in the absence of doctors, "bleeders may care for patients as nurses" (Diário nº 72, de 25 de outubro de 1822; Assembleia da República, 1821-1822, p. 886).

Midwives and bleeders
According to article 17 of the Proposal for a General Public Health Regulation, midwives are health workers alongside doctors, surgeons, and apothecaries.In the same document, district health inspectors were responsible for ensuring that the chamber parties' doctors performed their duties well, that surgeons do not overstep their responsibilities, and that "midwives are capable of providing the care that is expected of them" (Assembleia da República, 1821-1822).These midwives would be taught in the art of obstetrics, "they shall be able to read and write; and some brief instructions shall be printed, by order of the district health inspector.They shall also have a certificate of practice with a certified midwife" (Diário nº 199, de 13 de outubro de 1821; Assembleia da República, 1821-1822, p. 2641).District surgeons who have experience in obstetrics could offer an annual childbirth training course for women intending to become midwives.However, "every midwife without a certificate of examination, and approval who is found doing this job shall be ordered to stop by the health inspector; and in case of repeat offenses, a penalty shall be imposed".It also reveals the idea of hospitalization for childbirth in "a private and modest ward . . .for women in labor, where they shall be treated with the care and secrecy required by the circumstances" (Diário nº 199, de 13 de outubro de 1821; Assembleia da República, 1821-1822, p. 2644).The previously mentioned decree proposal, which was submitted to the Cortes on 25 October 1822, mentioned the bleeder and the midwife in the following terms: No person can perform the duties of a doctor, surgeon, apothecary, bleeder, and midwife without having submitted a letter of examination to the district chamber . . ..Until the general health regulation is published, all examinations for bleeder, apothecary, and midwife shall be done in the presence of the district inspector, who shall appoint two examiners for each examination.(Diário nº 72, de 25 de outubro 1822; Assembleia da República, 1821-1822, p. 886).Since this decree is a compromise between the emergence of measures and the failure to discuss and approve the Proposal for a General Public Health Regulation, it also mentioned two clearly provisional situations that governed bleeders and midwives.It stated that, in the regions "where there are no certified midwives", women who "assist their neighbors, friends, or relatives during labor free of charge" shall not incur any penalty (Diário nº 72, de 25 de outubro 1822; Assembleia da República, 1821República, -1822, p. 886), p. 886).It also said that, "in the villages where there are no doctors, bleeders may care for ill people as nurses", but they must consult with a doctor from a neighboring region who shall advise them, and, in such circumstances, they can practice without "being found guilty" (Diário nº 72, de 25 de outubro 1822; Assembleia da República, 1821República, -1822, p. 886), p. 886).Furthermore, a daily session, dated 16 July 1822, reported that there were problems in the Misericóridia and hospital of Montemor-o-Novo, where the wages of the secretary, organist, and bleeder had been irregularly increased by a third.The Cortes decided that this increase shall cease to be applied since the local Misericóridia already paid wages to a secretary, an apothecary, two doctors, two surgeons, and a bleeder.
The daily session no.56, dated 7 October 1822, made reference to an eight-section plan for the surgery schools of Lisbon and Porto.Point 7 of this plan clarified that: There will no longer be a difference between bleeder, minor surgery surgeon, and surgeon; in the future, there shall be no more than one [set of ] surgery letters, and only those who have them in the form of the preceding article [exams in the 3rd year for the Bacharel degree in the 4th year for the graduation], or those from the Faculty of Medicine and Surgery of the University of Coimbra, shall be authorized to do this job (Diário nº 56, de 7 de outubro 1822; Assembleia da República, 1821-1822, p.716).In the years of 1821 and 1822, bleeding was still a therapeutic method.It is known that "barber-bleeders, who also shaved beards, were authorized in 1572 to exercise their office autonomously by the Municipal Senate of Lisbon, via a letter issued by the cirurgião-mor" (Sousa, 2013, p. 639).This practice was abandoned in the 19th century, "much to the credit of French doctor Pierre-Charles-Alexandre Louis" (Sousa, 2013, p. 28), who proved its total ineffectiveness using statistical methods.With regard to midwives, they were clearly identified as health workers and received training.According to daily session no.199, there were plans to "open an annual childbirth course aimed at women interested in it" (Diário nº 199, de 13 de outubro de 1821; Assembleia da República, 1821República, -1822República, , p. 2640)).These women should be able to read and write.Some brief instructions would be printed about this art based on which they would be examined and certified.Those who practiced without a license would be incur a penalty.As can be seen, unlike nurses, midwives' training and practice was regulated.

Wards -degraded and unsanitary spaces and poor hygiene
The daily session, dated of 22 March 1821, mentions that the interim government was offered four hundred thousand reais by a benefactor to plan the creation of a facility to accommodate: beggars, the elderly, and poor, blind, or crippled people that flood Lisbon . . ., this plan shall provide the miserable ones not only a livelihood, . . ., but also, in the case of illness, a ward, and medicine.(Diário nº 40, de 22 de março 1821; Assembleia da República, 1821-1822, p. 328).In Sintra, "the ward facilities are very small and nearly underground" (Diário nº 87, de 23 de maio 1821; Assembleia da República, 1821República, -1822República, , p. 1003)), which caused the Cortes to issue, and send to the government, an opinion requesting "for prompt action" (Diário nº 87, de 23 de maio 1821; Assembleia da República, 1821-1822, p. 1003).At the same time, the residents of Faro presented a petition to the Sovereign Congress regarding the intention of placing military patients in the Hospital dos Pobres, arguing that this hospital was so small and that it had only two wards, one for men and one for women.They emphasized that, by transferring some priests to Tavira, the old Jesuit convent in Faro could be used as the military hospital.The discussion of this topic began on 25 June 1821 and continued on 21 August: The Commission meticulously examined all this information and concluded that the best place for the military hospital in Faro is the College that once belonged to the Jesuits, currently occupied by the Discalced Carmelites: that it is not inconvenient that the priests, who are few and have a rich convent in Tavira, should be moved there.(Diário nº 157, de 21 de agosto 1821; Assembleia da República, 1821-1822, p. 1971) The deplorable situation of the hospital in Guimarães, which only had two small wards, was also noted: the air breathed by a large number of patients is full of toxic exhalations, so that the person convalescing from an uncharacteristic fever relapses for being infected with a malignant fever; and the condition of the patients with wounds or ulcers worsens because of the continuous influence of the bad air that is breathed and lived in.(Diário nº 214, de 31 de outubro 1821; Assembleia da República, 1821-1822, p. 2884) In addition to these wards, there were two underground wards to heal venereal diseases that look more like graves rather than healing places . . .and, since the ward area is so small, the patients are very close to each another, and often convalescent patients are right next to dying patients (Diário nº 214, de 31 de outubro 1821; Assembleia da República, 1821-1822, p. 2884).On this topic, the Cortes issued an opinion stating that "the Carmelites convent in the town of Guimarães shall be assigned to the Misericórdia to serve as hospital for the benefit of those people; and that the current nuns shall be moved to the Santa Clara convent in the same town" (Diário nº 214, de 31 de outubro 1821; Assembleia da República, 1821-1822, p. 2884).In Vila Franca de Xira, the right to the property where the Confraria da Misericórdia built a hospital "at the expense of vast charitable contributions by its brothers, and farmers, and established it in some houses on loan by a devout lady" (Diário nº 69, de 22 de outubro de 1822; Assembleia da República, 1821-1822, p. 864).There was a discussion on the precariousness of the facilities due to health and hygiene concerns.The solutions included the use of convent facilities.On this matter through the 2-year period, Bonifácio (2010, p. 31) stated: "The King's rights had been reduced to dust and those of the Catholic Church were strongly hit by the nationalization of its assets".

Conclusion
The study allows drawing some conclusions based on the common denominator that is the process of restructuring of health occupations and professions.The descriptors showed only individual and masculine references.There is no reference to nursing, only to nurses.Several references were made to the enfermeiro-mor, who was a prominent social figure, different from the nurse figure, and, therefore, not a nurse.He had an administrative and management role and was responsible for all matters related to the people caring for patients and all workers.His functions also differed from those of the administrator and other clinical workers.The enfermeiro-mor may be the predecessor of the subsequent general nurse, the current director of nursing, within an evolutionary path that included the distinction between enfermeiro-maior and enfermeiro-menor, which requires further research.There were references to earlier professions such as the bleeder (no longer the clistereiros who administered clysters during the Middle Ages), to the evolution from the minor surgery surgeon to surgeon, as well as brief references to nurses' activities.Midwives had a clear role, and, similarly to doctors and surgeons, were identified as health workers.Midwives received training, were certified and their practice was regulated.The innovative Proposal for a General Public Health Regulation emphasized several concerns related to hygiene, organization, qualifications, and safety.Degraded care facilities were to be reorganized based on a set of solutions that included the seizure of monastic property.Nurses' activities were supervised and included the care and monitoring of patients.Nurses were expected to deliver care and good service in hospitals.In home settings, both indoor and outdoor, the nurse's role was to assist in the recovery.Nurses' activities differed from those of the other professions such as bleeders, surgeons, and midwives, and were still far from the characteristics of the professionalization of modern nursing.Unlike midwifes, nurses were not explicitly referred to as health workers, received no formal training, and were not certified.The study of the history of nursing includes searching for connecting threads in the evolution of nursing as an occupation and a profession.The identification of the moments and phases in the process of professionalization contributes to the understanding of the current constraints and possibilities in the development of nursing, both as a profession and as a science.