Dr. Joan Lynaugh at right with ICN Centennial History Group.

This past June saw the convening of yet another Congress of the International Council of Nurses (ICN). We only imperfectly understand the "glue" that has held the ICN together for nearly 100 years through war, political and economic chaos, and racial and religious strife. Nevertheless, there it was, in Vancouver, British Columbia, thriving, and attended by well over 6,000 nurses from all over the world. In anticipation of its 100th birthday in 1999, we want to share a bit of its story in this issue of the Chronicle.

The idea and essentialness of nursing is as old as the family and the tribe but the spread of hospitals and the invention of organized nursing swept across Europe and North America in a relatively short time during the 19th century. It was in this atmosphere of social change that a handful of women, who took up this new field of nursing, had their great idea. These nurses were also deeply engaged in the international women's movement which sought recognition of women as achievers in society and women's right to vote. It was this intoxicating mixture of women's rights and organizing nursing that brought Ethel Gordon Fenwick and Lavinia Dock and later, Agnes Karll, together. I think of the ICN being born and raised on the busy intersection of woman's rights, social progressivism, and health care reform.

Ethel Gordon Manson (Fenwick) traveled to the United States in 1893 to attend the "World Congress of Representative Women" at the Chicago World's Fair. The previous year, while in the United States planning for the Congress, she made it a point to visit Isabel Hampton at Johns Hopkins University Hospital School of Nursing in Baltimore, Maryland. While there she also met Lavinia Dock. Mrs. Fenwick would often say, "the seed of the International Nursing movement, now so full of vitality, was then (1892) sown."

By 1899 Mrs. Fenwick was ready to propose that nurses of various countries unite in an international nursing organization. One year later the ICN constitution was approved; Ethel Fenwick was elected President, Lavinia Dock was elected Secretary, and Canadian Agnes Snively was elected treasurer. They held the first ICN meeting in Buffalo in 1901 in conjunction with the Pan American Exposition.

The ICN was to be a federation of national nurse bodies. According to its Constitution, to join the ICN federation a national nursing body must be headed by a nurse, free of state control, and represent only nurses. Actually, no country had such a national body. In 1904, when the five year old ICN convened in Berlin, only three countries, Germany, Great Britain, and the United States, were ready for federation under the Constitution. Led by Agnes Karll, German nurses eagerly joined the international movement.

Sarah McGahey of Australia was elected President, Lavinia Dock continued as Secretary (as she would until 1922), and Margaret Breay became Treasurer. It is important to realize that the ICN really had no funds and no office; the members had no means of communicating with each than telegraph or mail. All the participants used their own personal funds to attend meetings and conduct business. Agnes Karll served from 1909 to 1912 as President; she was followed by Annie Goodrich of the United States. New nurses from as far away as Japan were attracted to this new idea and came to ICN meetings to find out what it was about. Notwithstanding their lack of resources during these early years, the ICN nurses pressed for statutory legislation to protect nursing practice in all countries and to support women's suffrage. Their plans for advancing the cause of nursing around the world were, however, violently interrupted in 1914 by World War I.

Nurses mobilized for the war as the devastation of Europe shocked the world. Nurses at the ICN, now headed by Hennie Tscherning of Denmark, could only hold on and grieve for their lost and separated comrades. Finally, in 1922, Mrs. Tscherning was able to convene the ICN leadership in Copenhagen and try to pick up the pieces of their organization and its mission.

The next President, Sophie Mannerheim of Finland, proved to be the right leader for the ICN at this low point. She forged links with international nurses while, at the same time, fighting off efforts by the League of Red Cross Societies to direct post war nursing. Christiane Reimann, who became the first paid ICN secretary in 1922, played a crucial role. She was an accomplished Danish nurse who spoke and wrote several languages, she willingly gave of her own funds to accomplish ICN goals, and she traveled extensively seeking to attract more national nursing organizations to join ICN. And, indeed, many countries established educational programs for nurses and created national nursing organizations. For example, China joined the ICN in 1922.

Links with the American Red Cross and with the Rockefeller Foundation strengthened the ICN to become a voice representing nursing. But, as the 1930s drew to a close, it became obvious to most that war was again part of their reality. The German Nurses Association, a founding member of ICN, had already been disbanded by the National Socialist Party (the Nazis). The same happened earlier in Italy. In the early summer of 1939, the ICN offices (now located in London) seemed vulnerable. Before the ICN Board could make plans war broke out as Hitler moved west in September of 1939.

American Effie Taylor, elected ICN President in 1937, found herself caught up in an explosive war situation. Along with Calista Banwarth (an American studying at Bedford College, London) she packed up the ICN records and office materials and moved the ICN to her offices at Yale University in New Haven, CT. The London ICN offices were destroyed by bombs in 1942. All the money in the ICN's bank accounts was sequestered in Great Britain for the duration of the war.

Finally, in 1947, the ICN was able to once again convene a Congress in Atlantic City, New Jersey. The new President, Gerda Hojer of Sweden, welcomed 6,500 nurses. In a happy reunion spirit the ICN honored its "old guard," former President Annie Goodrich, and its original and long time secretary and critic, Lavinia Dock. Goodrich and Dock were lauded and feted; and everyone enjoyed the lift after the long burden of war.

The post war ICN became much more of an activist organization; it linked itself with the United Nations and campaigned to be recognized by the World Health Organization. In addition to aiding thousands of displaced nurse refugees, the ICN absorbed the Florence Nightingale International Foundation and made it its education arm. The membership committee sought out and reviewed applications for membership from national nursing organizations in the middle east, South America and Africa. By 1957 the ICN included 46 national associations with 17 countries in associate status. The new members illustrate the new internationalism of the ICN . .. Haiti, Korea, Turkey, Chile, Ceylon, Jamaica, Luxembourg, Pakistan, Trinidad/Tobago, Zambia, Southern Rhodesia, Barbados, Columbia, Ethiopia, Iran, Liberia, Malaya, Panama, Uruguay, Yugoslavia ... and several countries separated by war re-joined ... Italy, Germany, Austria, and Japan.

On the other hand, the Cold War deeply affected the ICN. Neither Russia nor the members of the Soviet bloc joined or rejoined the ICN after the war. The national nurses associations previously members of the ICN federation ... Bulgaria, China, Czechoslovakia, Estonia, Hungary, Poland, Romania and, until 1957, Yugoslavia, were reluctantly classified by the ICN Board as "temporarily inactive."

The ICN strengthened its relationship to the International Labour Organization and officially represented nurses on employment issues. Changing economies and conditions for women's work in regions of Africa, the Asian-Pacific, and Central and South America helped enhance nurses' ability to create organizations.

Issues of how to define the professional nurse, what should be the educational standard for professional nursing around the world, who should represent nurses, and what to do about members that did not pay their dues were debated as they had been since the founding of the ICN. But the ICN made progress on some of these questions. In 1959, it approved publication of a booklet by Virginia Henderson called "Basic Principles of Nursing Care." Re-printed six times during the next decade it was ultimately translated into 25 languages. What captured the imagination of nurses who read her book was Henderson's idea of the essential or unique function of the nurse. In the absence of a shared international definition she offered this: "the unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge." Today's ICN definition of nursing, drawn up in 1987, relies heavily on Henderson's 1960s ideas.

A long simmering issue finally came to a head in 1973 when the ICN insisted that the South African Nurses Association fully integrate its association and board or face expulsion from the organization. The Swedish Nurses Association and the Nurses Association of the Netherlands introduced the resolution to expel South Africa and it was done. The South Africans then resigned; the ICN had, after decades of debate, taken the painful but final step to eject one of its oldest member nations to show its revulsion against racism. Today, an inclusive South African nursing organization participates in ICN.

By 1985 the ICN federation totaled 97 countries. But eleven countries, Japan, United States, Canada, United Kingdom, Sweden, Denmark, Australia, Spain, Norway, Finland and Switzerland, accounted for 86% of the ICN membership. As has always been true, ICN reflects the agenda and the economies of the industrial and post industrial world. During the 1980s, ICN leaders and Executive Director Connie Holleran faced problems ranging from the demise of the Iranian Nurses Association after the fall of the Shah to political coups in Liberia and human rights violations in Chile.