Posts filed under “Correspondence on Nightingale/Seacole misinformation”

To Sir David Cannadine

Sir David Cannadine
Oxford Dictionary of National Biography
14 May 2020

Dear Sir David

We hope this letter finds you well in these difficult and unprecedented times.

We were pleased to see the greatly improved entry on Nightingale (as of August 2019), not only because the names of a number of us make it into the references. It was good to see it available for the bicentenary of her birth.

However, the flawed entry on Mary Seacole remains unchanged. As you may recall, the members of the Nightingale Society wrote you on 11 October 2016 with the details of the errors (appended). As we noted in our 2016 letter to you, the errors of the ODNB are then repeated in coverage in other places, such as English Heritage and elsewhere. We urge you make these amendments.

Can you please confirm your action on this matter?

Yours sincerely
[10 members of the Nightingale Society]

To Baroness Scotland, re history of nursing

Rt Hon Baroness Scotland, QC
Director-general, Commonwealth Secretariat
Marlborough House, Pall Mall, London SW1Y 5HX

April 2020

Dear Baroness Scotland

We are concerned about your remarks at the conference of the Commonwealth Nurses and Midwives Federation March 6. The World Health Organization chose 2020 for the Year of the Year of the Nurse and Midwife precisely because of that year being the bicentenary of Nightingale’s birth. Yet, in your remarks you included Mary Seacole along with Florence Nightingale, as if she had made any kind of similar contribution. You made three such references, as if equals, and indeed your third reference gave precedence to Seacole. She was an interesting, independent and generous person, and her business for officers much appreciated. What exactly, we ask, did Seacole do as a founder either of nursing or midwifery. Specifically, kindly state:

You referred to Nightingale and Seacole together three times, as if equals, and indeed your third reference gave precedence to Seacole. Kindly say (also for colleagues) what exactly Seacole did as a founder either of nursing or midwifery. She was an interesting and generous person, and her business for officers much appreciated, but do say:

  • At what hospital(s) she ever nursed
  • What nurses she trained or mentored
  • To what countries did she sent nursing leaders
  • What books, articles or chapters she produced on either nursing or midwifery.

Seacole’s three forays onto the battlefield post-battle are documented—yes, kind acts, but so did many people perform such kind acts and they are not credited as founders of the nursing profession. She distributed magazines (donated by officers and their wives) to the hospital close to her business, and took the patients there mince tarts on New Year’s Day 1855. Again, kind acts, but hardly close to what Nightingale did.

In Seacole’s fine memoir, it is clear that she was running a business. She never called herself a “nurse,” but did use the expression “doctress, nurse and mother”; “nurse” she used for Nightingale and her nurses. She described her “remedies,” and also acknowledged that she made “lamentable blunders,” and certainly the addition of lead and mercury would qualify.

In short, your assessment of Seacole’s contribution reflects the common propaganda for her, which is not based on fact. It is unacceptable that you should foist your personal opinion at a Commonwealth event to which you were invited for your position as secretary general.

Not the least of the harms done by the Seacole propaganda campaign is the failure to recognize significant BAME nursing leaders. A prime example is Kofoworola Abeni Pratt, a Nigerian (Nigeria is in the Commonwealth), who trained at the Nightingale School in London, then led in the introduction of professional nursing by Nigerians in Nigeria.
See: http://nightingalesociety.com/backgrounders/8-kofoworola-abeni-pratt/
Also: http://nightingalesociety.com/backgrounders/13-florence-nightingale-and-the-commonwealth/

Yours sincerely

[ 17 members of the Nightingale Society ]

The real goods and the oversell

by Lynn McDonald

Significance, Volume: 17, Issue: 2, Pages: 18-21, First published: 20 March 2020, DOI: (10.1111/1740-9713.01374)

Abstract

To many, Florence Nightingale is a hero. But like all heroes, elements of her story have been exaggerated. Lynn McDonald, editor of Nightingale’s collected works, sorts fact from fiction.

Florence Nightingale (1820–1910), the first woman Fellow of the Royal Statistical Society, elected in 1858, and an honorary member of the American Statistical Association from 1874, deserves all the attention she is getting in 2020, the bicentenary of her birth. At one time it became fashionable for some historians to deprecate her work. But statisticians and quantitative researchers in general have continued to revere her. She was, after all, a pioneer of evidence‐based health care.1

Her contributions, however, have been exaggerated by such eminent statisticians as Edwin W. Kopf and I. Bernard Cohen, as well as by military and medical historians and other ordinary mortals. Kopf, for example, writing of Nightingale’s work as a nurse in military hospitals during the Crimean War (1854–6), stated correctly that “none of the statistical records were kept in uniform manner”, then added, incorrectly, that “she was able to introduce an orderly plan of recording the principal sickness and mortality data of the military hospital establishments which came within the sphere of her influence”.2 Nightingale did not introduce any plan for recording hospital data – but her analysis of the data, post‐Crimea, using official War Office statistics, covered all the hospitals, not just those under her jurisdiction.

These exaggerations, no matter how minor, serve to embellish Nightingale’s story while making a muddle of her legacy. On the 200th anniversary of her birth, it is important to understand what Nightingale did and did not do, so that we might put her real contributions into better perspective.

What Nightingale did not do

To many statisticians, Nightingale will be best known for her Notes on Matters Affecting the Health, Efficiency, and Hospital Administration of the British Army and the striking diagrams within, such as Figure 1, showing the proportions of deaths from various causes during the Crimean War.3 But, contrary to belief, Nightingale never collected data on death rates in Crimean War hospitals, nor could she have. She had no mandate to do so, and no staff. This should be obvious, as the published data show death rates from April 1854 (when the British Army arrived in Turkey), while Nightingale and her nurses arrived only in November.

Nightingale’s famous polar area chart, “Diagram of the causes of mortality in the army in the East”. The chart appeared in Nightingale’s 1858 publication Notes on Matters Affecting the Health, Efficiency, and Hospital Administration of the British Army,3 but the version above is from her 1859 publication A Contribution to the Sanitary History of the British Army during the late War with Russia.5

Also during the Crimean War, Nightingale did not save lives by bedside nursing or her famous walks with a lamp by night, much as they were appreciated by the soldiers. Nor did she ever claim to have. Bedside nursing, however dedicated, cannot overcome the faults of overcrowding, poor ventilation, polluted water and inadequate nutrition (many soldiers arrived with scurvy along with their bowel diseases, fever or wounds).

She also did not invent the chart type shown in Figure 1: often referred to as a polar area chart. But she and Dr William Farr, the leading medical statistician at the time, worked together to produce effective charts, better than any Farr had published before. These charts vividly showed how much “preventable deaths” were of the total, and then showed how the rates came down with the arrival of the British government’s Sanitary Commission in Crimea.

Nightingale probably did not do the mathematics or prepare charts such as these herself. Equations are included in her evidence to the Royal Commission on the Crimean War, and historians of statistics point out that she was instructed in mathematics by an expert, Joseph Sylvester. However, there is nothing in her own hand describing what she learned or how she used it, and the instruction lasted no more than 6 weeks, in April and May 1840. Letters sent to Farr following the Crimean War thank him and his staff for sending tables, and letters from Farr advise of material about to be sent.

It was through her work with Farr and others that Nightingale helped to save lives – if not in the way often supposed. She and her team (and she always worked with experts) arguably saved many more lives by what they learned from the Crimean War than what she and others did during the conflict.

Nightingale’s key contributions

Nightingale was an expert on asking the right questions, analysing data and writing it up persuasively. This was simple data analysis, columns and rows, well organised so that relevant comparisons could be made. For her studies of the Crimean War, she and her team paid attention to time, tracking hospital admissions and deaths month by month. At the time, standard statistical tests were not in use and regression analysis was still decades in the future, so the judgements they made were based on eyeball assessments.

This work was not easy, for there were conflicting sources of death data. Nightingale discussed the problem of discrepancies, noting the troubling fact that the number of burials, collected by the Adjutant‐General, was higher than the number of deaths in three different sets of data collected by army doctors.

In 1858, she published her Notes on Matters Affecting the Health, Efficiency, and Hospital Administration of the British Army,3 a comprehensive 853‐page report, while the Royal Commission published her much shorter evidence to it.4 In 1859, she published a very short paper, A Contribution to the Sanitary History of the British Army,5 which also contained the famous polar area charts. In the latter publication, she specified that certain tables were prepared by Farr and his office, working from “official documents” presented to Parliament – meaning the two‐volume Medical and Surgical History of the British Army, which was to become the official report of the Crimean War.6

But unlike this official report, Nightingale gets the story right about causal factors. The official report includes charts of deaths by barometric pressure and temperature, evidently considering them to be causes, and indeed death rates were higher in hotter months than in cooler ones. Nightingale’s polar area chart, by contrast, which shows the great decreases in death rates achieved, noted the arrival of the Sanitary Commission sent by the British government. This commission, and the Supply Commission that was also sent, were led by civilian experts who were given a mandate to act, not merely report. The leaders of the Sanitary Commission, Dr John Sutherland, a public health expert, and Robert Rawlinson, a civil engineer and water expert, acted vigorously. Their report included detailed amounts, measured variously by cartload or tonne, of “filth”, meaning faecal material, and dead horses removed from the water supply. No barometric pressures or temperatures were noted.

The official report gave no credit to either commission, both of which were sent out by the civilian government of Lord Palmerston, not the Army Medical Department or the War Office. Palmerston, who understood “sanitary science” – or “public health”, as it would later be called – was a neighbour of the Nightingale family in Hampshire, and would be an ally on post‐Crimea reforms.

Beyond Crimea

Nightingale’s great ally in the reforms made after Crimea was Sidney Herbert, the junior war minister at the outset of the war and the person who got her appointed to lead the nursing team (they were friends from meeting in Rome in 1848, when the Herberts were on honeymoon). He chaired the four sub‐commissions established to implement the major reforms recommended in the Royal Commission Report, and he and Nightingale worked together for five years after the war, until his death in 1861. Enormous changes were made in hospitals and barracks for the British Army, changes that brought down their death rates.

Nightingale’s compliment to her friend – his obituary, in effect – was a short paper published in 1863, titled Army Sanitary Administration, and Its Reform under the Late Lord Herbert.7 In it, she gave three bar charts that succinctly show Herbert’s success in saving lives (Figure 2). The first chart gives the baseline mortality of the English male population, followed by a chart each for army deaths for the years 1837–46 (before Herbert’s term in office) and 1859–61 (after his term), with dramatic decreases clearly visible.

Nightingale’s visual tribute to her great ally, Sidney Herbert: “Diagram representing the relative annual mortality from zymotic diseases, chest & tubercular diseases & other diseases in the English male population aged 15–45, and in the infantry of the line, serving at home, before & since Lord Herbert’s administration”. From Nightingale’s Army Sanitary Administration, and its Reform under the late Lord Herbert.7

After Crimea, Nightingale continued to apply her talents for asking questions and analysing data, including for a Royal Commission on India, reporting in 1863, and subsequently working with medical officers on their statistical reports to make them both more accurate and more useful.

In 1862 she wrote an unpublished “Note on the Supposed Protection Afforded against Venereal Disease, by Recognizing Prostitution and Putting It under Police Regulation”,8 which served as a refutation of police regulation of prostitution (compulsory inspection and treatment of women, never men) by showing that rates of venereal disease were no lower in army bases where such a system was in effect than in places where it was not.

For the 1863 publication Sanitary Statistics of Native Colonial Schools and Hospitals, Nightingale showed that death rates were roughly twice what they should be.9 She called for ongoing monitoring, which did not happen. (Incidentally, with this publication, Nightingale became the first person to reveal the defects of residential schools, which would become notorious later in Canada for their destruction of language and culture, and sexual and physical abuse.)

Then, when a midwifery programme and maternity ward at King’s College Hospital was closed on account of high death rates, Nightingale conducted a comprehensive analysis. Data collection was a great challenge, as there was then no routine recording of maternal deaths, and she was disappointed with what she managed to obtain from sympathetic doctors, including a workhouse doctor, and a small number of publications with comparative data from Europe. Still, her research in the report, Introductory Notes on Lying‐in Institutions, published in 1871, marks an enormous advance on the subject.10

Nightingale understood the importance of population data, but was unsuccessful in her attempt, in 1860, to get two new items added to the census form for 1861, on health status and housing – the latter being seen as a major cause of sickness (whether a person lived in a hovel, a stable or a mansion). She was turned down then, but housing questions were gradually brought into the census in later decades.

Late in life, Nightingale sought to obtain a university chair or readership in “social physics”, a term that originated from Belgian statistician Adolphe Quetelet in his major publications.11 Quetelet was Nightingale’s main source on statistics and social science research more broadly. She knew his work well, commented on it in detail (as an exercise) and met him when he was in London for the International Statistical Congress in 1860. She regretted that his work was not used in the UK as it could be, although his major books had been translated into English. She chose Oxford University as the venue for her desired chair, as it was the university that trained the most senior civil servants and politicians – that is, the people who should be, but were not, using social data. Indeed, she complained that while governments collected vast amounts of statistics, much of it was stuck in ministers’ pigeon‐holes, “which means not at their disposal”.1

Nightingale approached the eugenicist Francis Galton to be the intermediary with Oxford, but nothing came of it. The statistician Karl Pearson, in his Life, Letters and Labours of Francis Galton, judged that Galton had messed up and that Nightingale had had a very good idea. What she wanted was data to assess public policy – what works and what does not. Her examples were: the effects of the Education Act that established (compulsory) state schools, including its effect on crime (increasing or decreasing); results from secondary schools, night schools and workhouse schools; general effects of workhouses (children of workhouse inmates becoming inmates themselves); and, in India, the effect of British administration in making the people richer or poorer, their trade and handicrafts flourishing or perishing. This was a call for no less than evidence‐based public policy on a great range of concerns. But her call was not to be answered.

Conclusion

Nightingale’s research was geared towards saving lives, especially of soldiers, the sick poor, famine victims, indigenous peoples, birthing mothers and nurses – people who were not, by and large, priorities in public policy at the time. She not only worked relentlessly herself, but also developed a team of committed experts to pursue these issues. In the course of her work, she and they saw to improvements in the routine collection of data, its analysis and presentation.

Making results accessible – and persuasive – was always part of her mission. She failed in many of her particular endeavours, not because her ideas were poor, but because she was too far ahead of her time. What she did accomplish was formidable. Queen Victoria wished that Nightingale could run the War Office. I would have liked to see her in charge of climate change.

Endnotes

1. McDonald, L. (2001) Florence Nightingale and the early origins of evidence-based nursing. Evidence-Based Nursing, 4(3), 68–69.

2. Kopf, E. (1916) Florence Nightingale as statistician. Publications of the American Statistical Association, 15(116), 388–404.

3. Nightingale, F. (1858) Notes on Matters Affecting the Health, Efficiency, and Hospital Administration of the British Army. London: Harrison.

4. McDonald, L. (ed.) (2010) Florence Nightingale: The Crimean War. Waterloo, ON: Wilfrid Laurier University Press.

5. Nightingale, F. (1859) A Contribution to the Sanitary History of the British Army. London: John W. Parker and Son.

6. Great Britain, Army Medical Department (1858) Medical and Surgical History of the British Army which Served in Turkey and the Crimea during the War against Russia in the Years 1854-55-56. London: Harrison and Sons.

7. Nightingale, F. (1863) Army Sanitary Administration and its Reform under the late Lord Herbert. London: McCorquodale.

8. McDonald, L. (ed.) (2005) Florence Nightingale on Women, Medicine, Midwifery and Prostitution. Waterloo, ON: Wilfrid Laurier University Press.

9. Nightingale, F. (1863) Sanitary Statistics of Native Colonial Schools and Hospitals. London.

10. Nightingale, F. (1871) Introductory Notes on Lying-in Institutions. London: Longmans, Green, and Co.

11. Quetelet, L. A. J. (1869) Physique sociale, ou essai sur le développement des facultés de l’homme. Brussels: Muquardt.

Ethics, Censorship and the British Journal of Nursing

by Lynn McDonald

Below is an article accepted by the BJN for publication in January 2020, but subsequently rejected (further on this below).

The Real Pioneers of Nursing and Founders of the ProfessionKey words: Florence Nightingale, pioneer nurses, National Health Service, Nigerian nursing, Workhouse infirmaries, universal access to health careQuestions for discussion:

What criteria should be used in choosing model pioneer nurses?

How important was Florence Nightingale in founding the modern nursing profession?

What five (or up to ten) nurses would you choose as pioneers? And why?

Apart from providing direct nursing services, what role do nurses play in the NHS? And what role could they play?

Is universal access to quality health care at risk in the U.K.? If so, how?

Major themes:

The article contests Price-Dowd’s choice of four pioneer founders of nursing and proposes others.

It notes the failure of the author to give any instances of nursing leadership by its top choice, Mary Seacole, but, instead, gave false ‘information,’ about her, namely that she was twice refused as a nurse by the British government, without providing a credible source, or any source.

It notes that Seacole’s own memoir records no hospital experience, nor the submission of the required formal application to become a Crimean War nurse.

The significance of Nightingale’s leadership in founding the profession is noted (absent in the article). This includes her early articulation of the principles of the National Health Service.

It commends the author’s fourth choice as nursing leader, Kofoworola Pratt, the first black nurse in the NHS, and adds material to show why she deserves recognition as a significant founder of the profession.

The article proposes inclusion of Agnes Jones, for her pioneering contribution to workhouse nursing, an essential step for the raising of the workhouse infirmaries to hospital status, and Angelique-Lucille Pringle, for her taking professional nursing from the Nightingale School to Scotland, at the Edinburgh Royal Infirmary, and later to an Irish Roman Catholic hospital.

  • Title Page
  • The Real Pioneers of Nursing and Founders of the Profession
  • Ethical: no human subjects
  • Funding: No grants
  • The Real Pioneers of Nursing and Founders of the Profession

Price-Dowd in a recent article (2018) made the case for four ‘real founders of nursing,’ the ‘great leaders,’ the ‘pioneers who turned nursing into the profession we see today. Leading the list is Mary Seacole (1805-81), for whom not one qualification in or experience of nursing was given. Instead a false statement is made about her (without any source) that she was ‘refused twice by the British government’ to go to the Crimean War. Examination of her fine memoir, Wonderful Adventures of Mrs Seacole in Many Lands, 1857, shows that she never submitted an application to become a war nurse, but instead, after Nightingale and her team had left for the war, dropped into various government and war related offices, informally, to try to be sent as a nurse. She had spent two months in London when the teams were being assembled attending to her gold investments, but missed even the second team.

Seacole was a businesswoman who went to the Crimean War to join her business partner to open a for-profit business for officers. This is perfectly clear in her memoir (Chapters 8-18), a basic point that typically ignored by Seacole commentators. Also absent in sources is the fact that she missed the three most important battles of the war (Chapter 8). She did provide much aid and comfort, primarily to officers (Chapters 14-18), and certainly became a celebrity, but she did not nurse one day in any hospital in any country, train any nurse, write any book or article on nursing, or mentor any nurses, work that the four founders to be related here did.

Price-Dowd’s second leader was Florence Nightingale, described as the person that ‘most people see as the epitome of the nurse’ and who was also, she acknowledged, adept at statistics. These points are valid, but more to the point would be that Nightingale was the major founder of the modern nursing profession as the founder of the first nursing school in the world (Abel-Smith, 1960; Baly 1960; McDonald, 2009; Seymer, 1960), author of Notes on Nursing, 1860, with its influential environmental theory of health and health care, and that she mentored many nurses who took the nursing cause to other hospitals and countries.

Nightingale and the NHS

Neglected also is the salient fact that Nightingale was the first person to articulate the vision that the National Health Service embodies, of quality care for all, regardless of ability to pay—not that she had any notion that such a centralized organization would ever materialize. Yet it was she, in 1866 and 1867, who pressed for legislation that would provide professional nursing care in the worst hospitals of the country—the workhouse infirmaries—the only hospitals open to those who could not afford the fees of regular hospitals. She, with a team of people with similar goals, pressed for the next reforms that got skilled nursing into workhouses, and for some workhouses, better buildings, as well. The NHS could hardly have started operations in 1948 if 80% of its hospitals still had bed sharing and only ‘pauper’ nurses, meaning untrained women who notoriously drank their (small) earnings as “nurses.” It was Nightingale who called for quality care for all, to include the destitute. It was she, also, who called for health promotion and disease prevention to be prime goals of the health care system, not only treatment. This was realized in the National Health Services Act of 1946, the legislation that grounded the NHS, which itself opened in 1948.

Universal access to health care

Nightingale is, thus, a pioneer contributor to what is now known as ‘universal access to health care,’ an unthought of concept in her day, when access to a charity ward was the best the ‘sick poor’ could aspire to–most would have to settle for the workhouse. The NHS was the first single-payer system of health care in the world—Germany, notably, had early provided wide access through an insurance system, but the provisions of the NHS were greater and bolder.

Universal access to health care is a key component of the United Nations

‘Sustainable Development Goals,’ issued as a millennial project, and which remain unrealized in most countries. The World Health Organization is recognizing 2020 as the ‘Year of the Nurse,’ not coincidentally, the bicentenary of Nightingale’s birth. Her leadership aiming at universality is worth noting.

Price-Dowd named Edith Cavell as her third choice of nursing founder, but Cavell, who deserves celebration for her patriotism and courage, hardly had the opportunity to contribute much to nursing, certainly not to the NHS. After working as a governess in Belgium, she returned to England to train as a nurse at the London Hospital, whose eminent matron, Eva Luckes, Nightingale mentored. Cavell served as night superintendent at St. Pancras Workhouse Infirmary, whose nursing was started by a Nightingale team. In 1907, she founded Belgium’s first nurse training school. However, on the invasion of Belgium in World War I, she turned to army nursing. She was executed by the Germans in 1915 for assisting British and Belgian soldiers escape to neutral Switzerland.

Kofoworola Abeni Pratt (1915-92), the Nigerian nurse who was Price-Dowd’s final choice as a nursing founder, was an important nursing leader, relevant also as the first black nurse in the NHS. Pratt came to England to train at the Nightingale School because she was inspired by Nightingale. She started training in 1946 and had passed the school’s examinations with honours, and the preliminary state examinations by the time of the launching of the NHS, June 1948, then passed the final state exams in 1949. Pratt took further training in midwifery, tropical diseases and the ward sister’s course. She was encouraged to return to Nigeria to lead in the transformation of Nigerian nursing, then in its earliest stage with a small number of British ex-pat nurses. Pratt was enormously successful in this, rising from ward sister to deputy matron and then matron, the first Nigerian to hold such posts. She made one further trip to England to do the Administration Certificate of the Royal College of Nursing. She won scholarships to travel and observe nursing practices in other countries (Bell, 1967). Pratt as well held top administrative positions in her country, as chief nursing officer for the federal Nigerian government (1965-72) and commissioner for health in Lagos state (1972-75).

Pratt gave back with her leadership in Nigeria, notably starting the first Nigerian training school at University College Hospital, Ibadan, which became the base for starting professional nursing elsewhere in the country (Lagos was second). She oversaw the transition of the hospital-based school into the university system–her school at Ibadan the first, in 1965. Pratt gave back also with leadership in the International Council of Nurses.

Along the way she had racism to confront, which she successfully handled. Here she had the support of leading British nurses, both in England (she had an English patient who objected to her being his nurses) and, in Nigeria, when a British doctor did not want her as his ward sister, despite her having the required British qualifications. In this case, the (British) matron insisted, and Pratt’s own considerable ability was so obvious that the doctor himself was convinced that she was the best wards sister that he had ever had, in the U.K. or Nigeria.

Among the many honours Pratt received, she was made a fellow of the Royal College of Nursing in 1979, and a fellow of the West African College of Nursing in 1980.

Establishing Professional Nursing in the Workhouse Infirmaries

After Nightingale, and often with her considerable assistance and encouragement, numerous other leading nurses can be identified who did much to establish the profession in the U.K. and in other countries. An excellent choice for the next pioneer nurse, after Nightingale, is Agnes Jones (1832-68), founder of professional nursing at the Liverpool Workhouse Infirmary in 1865. William Rathbone, member of a prominent Liverpool family, and himself later an MP, paid for the “experiment” in trained nursing to take place, and worked closely with Nightingale to see it realized. Liverpool thus became the first city to provide skilled nursing care to its indigent, ‘pauper’ population (McDonald, 2004). Jones, who came from a well-off Anglo-Irish family, was motivated by her faith to take on the challenge of leading a team, trained at the Nightingale School. The difficulties were many, but Jones and her nurses were dedicated, and had the full support of Rathbone and Nightingale. Jones sadly died on the job on typhus fever, in 1868, in the third year of the project. Other workhouse infirmaries, in time, got trained nurses, too, and soon got had training schools established at them. St Pancras (Highgate) and St Marylebone in London are good examples, and there were good examples also in Belfast and Birmingham.

Jones’s death caused numerous difficulties, as trained nurses were then so scarce. Nightingale published a tribute to her, ‘Una and the Lion’ (1868), which called on British women to take up the challenge. Many did, not dissuaded by the dangers.

The importance of this workhouse infirmary reform can hardly be understated, as at least 80% of the British population had to use them, so that their improvement was essential. Well trained nurses came to work at them, including Edith Cavell, who was night superintendent at the St Pancras Workhouse Infirmary.

Extending Professional Nursing throughout the U.K.

The Nightingale School at St Thomas’ Hospital was always, for Nightingale, the first, to be followed by others. She looked to nursing schools being established generally, that they would be as common as medical schools at hospitals. It took trained persons, a matron and team of nurses, to make the transition from the old-style, disreputable, untrained nurses to trained professionals. Of the many dedicated nurses who took on the task of establishing nursing at other hospitals, Angelique-Lucille Pringle (1846-1920) deserves special mention. She was part of the team that went to the Edinburgh Royal Infirmary in 1872, the large and rough hospital, that “den of thieves,” as Nightingale called it—excellent for its medical school, but still (largely) with the all too familiar untrained nurses. Pringle took over as matron when the matron sent from London proved to have a substance-abuse problem (opiates and alcohol). Pringle rose to the occasion, presided over the training school when it was established, and was instrumental in getting trained nurses into other Scottish hospitals. She returned to London later to take over the superintendence of the Nightingale School when its matron, Sarah E. Wardroper, retired. Pringle, however, resigned that position on her conversion to Roman Catholicism. She tried, with little success, to get nurse training into Irish workhouse infirmaries, but they continued to use untrained Roman Catholic nuns. In 1902, she was (finally) appointed head of an Irish (R.C.) training school, St. Philomena, in Belfast, attached to the Irish Sisters of Mercy hospital, Mater Informorum. Pringle was next matron for two years at the Waltham Training School, near Boston, and served yet again in Scotland at a war hospital during World War I. Altogether she gave leadership to professional nursing in Scotland, England, Ireland and the United States, in hospitals of the (established) Church of England, and Roman Catholic and secular hospitals. She produced one book on nursing, A Study of Nursing, 1905.

Nursing leadership in the future

Price-Dowd reasonably enough calls for future leaders to ‘lead at the system level,’ and that knowledge is held ‘with others’ (Box 1). This is exactly how Nightingale led. She always worked with a team, multi-disciplinary, with doctors, architects and engineers, to attend to issues of hospital design, and with political leaders, on legislation, regulations and finance. She was not only good at statistics, but saw how they could be used to influence public opinion to call for needed reforms. Spiegelhalter argued this cogently in his 2019 Nightingale Lecture on Statistics, Oxford University.

The NHS Leadership Academy might adopt Nightingale’s requirements for nursing students, that they be ‘honest, truthful and trustworthy,’ redundant, indeed, but accuracy and integrity are essential in addressing public health policy and future needs. Oddly enough, Nightingale’s old-fashioned principles are still worth respecting, as is her vision of quality care for all, and her example of using data—good, hard statistics—to argue for policy advances.

References

Abel-Smith, B. (1960). A History of the Nursing Profession. London: Heinemann.

Baly, M. (1986) Florence Nightingale and the Nursing Legacy. London: Whurr.

McDonald, L. (2004). The Reform of Workhouse Infirmaries. Florence Nightingale on Public Health Care. Waterloo ON: Wilfrid Laurier University Press.

Bell, L.M. (1967) Kofoworola Abeni Pratt: Third vice-president, International Council of Nurses. Int. Nurs. Rev. 14 No. 5: 7-11.

McDonald, L. (2009) ed. Florence Nightingale: The Nightingale School. Waterloo ON: Wilfrid Laurier University Press.

Nightingale, F. Una and the Lion. Good Words (1 June 1868):360-66.

Price-Dowd, C. The changing face of nursing: from the pioneers to the future of leadership. British Journal of Nursing 27 No. 13 (2018).

Pringle, A.-L. (1905). A Study in Nursing. London: Macmillan.

Seymer, L.R. (1960). Florence Nightingale’s Nurses: The Nightingale Training School 1860-1960. London: Pitman Medical.

Spiegelhalter, D. (2019). What would Florence Nightingale make of the way data is being used today? Oxford University Nightingale Lecture 30 April.

Article accepted

Ref.: Ms. No. bjon.2019.0142
The Real Pioneers of Nursing and Founders of the Profession
British Journal of NursingDear Professor Lynn McDonald,I am pleased to tell you that your work has now been accepted for publication in British Journal of Nursing. It was accepted on 23 Sep 2019The next step is for the article to be copy-edited and formatted into the journal’s house-style. In due course, you will receive another email from us asking you to check a proof copy of the edited article.
Thank you for submitting your work to this journal.
With kind regards
Sophie Gardner
Editor, British Journal of NursingScheduled publication:From: British Journal of Nursing <bjn@markallengroup.com>
Date: November 18, 2019 at 9:59:31 AM EST
To: Lynn McDonald <lynnmcd@uoguelph.ca>
Subject: Re: Your Submission – bjon.2019.0142 – [EMID:fa2b26f848a77fc7]

Dear Lynn,

We have scheduled your article for the first issue of January as the topic fits nicely with the start of International Year of the Nurse.

You should get a proof to check in the first week of December. Can you let us know if you will be available to check it and send back answers to queries and any change? It will be getting close to the Christmas holidays and we will need to finalise the issue by December 15.

Best wishes,

Janet Perham, Senior sub-editor

British Journal of Nursing

First delay in publication

From: British Journal of Nursing <bjn@markallengroup.com>
Date: December 19, 2019 at 11:12:43 AM EST
To: Lynn McDonald <lynnmcd@uoguelph.ca>
Subject: Re: Your Submission – bjon.2019.0142 – [EMID:fa2b26f848a77fc7]

Hi Lynn, We have found that we have a full issue for the first new year edition. So this is just to let you know that we will not working on your article until 2020 now.

Hope you have a relaxing Christmas and New year break.

BW, Janet

Rejection:

From: British Journal of Nursing <bjn@markallengroup.com>
Date: January 7, 2020 at 5:27:30 AM EST
To: Lynn McDonald <lynnmcd@uoguelph.ca>
Subject: Re: Your Submission – bjon.2019.0142 – [EMID:fa2b26f848a77fc7]

Dear Lynn,

Many thanks for submitting your article to the BJN. Unfortunately, on further reading, we realised that it should have been submitted as a letter to the editor, not as a comment piece. New policy states that a letter should be published within a year of the referenced article. As the article you are referring to was published in July 2018, too much time has passed for it to be published as such.

We wish you luck in publishing your article elsewhere.

Kind regards,

Sophie

Sophie Gardner

Editor, British Journal of Nursing

Associate Publisher, Secondary Care Team

To Stephen Hart, NHS Leadership Academy

Stephen Hart
Managing Director,
NHS Leadership Academy

June 2019

Dear Mr Hart

We wish to raise two matters with you, one positive, one negative, and ask a question.

The positive is the promotion of an outstanding nursing leader, Kofoworola Abeni Pratt (1915-92), the first black nurse in the NHS, who remains remarkably unknown and uncelebrated. We want to see her recognized, such as by the naming of a Leadership Award after her. We can send you a link detailing her accomplishments, and there is a fine biography available on her.

The negative is the continuing downgrading of the work of Florence Nightingale (1820-1910), the first person to articulate the vision that became the core principles of the NHS. This neglect is combined with misinformation (now going on for many years) of Mary Seacole, a fine and generous businesswoman and volunteer hospital visitor during the Crimean War, but who was not a pioneer nurse, nor ever claimed to be one.

We note the bizarre ranking of Seacole as the top pioneer/ leader, by Clare Price-Dowd, of the NHS Leadership Academy, in an article published in the British Journal of Nursing. Price-Dowd gave no achievements by Seacole to justify that ranking. A letter to her follows which sets out our concerns in detail.

We note that the NHS Leadership Academy has programmes named after Edward Jenner, Rosalind Franklin, Elizabeth Garrett Anderson and Nye Bevan, all well qualified for the honour. There is no nursing leader, however, but Mary Seacole is named as one, without good grounds. She has many noteworthy achievements, but can you name anything she did in hospital nursing herself, or training nurses, mentoring nurses, producing books or articles on nursing and effecting change for the better in the profession?

We note that the Bicentenary of Nightingale’s birth will be celebrated next year, and ask what the NHS Leadership Academy plans to do to for this celebration.. We would be happy to provide you with information on the importance of Nightingale’s vision and work towards making quality health care available to all, regardless of ability to pay.

Yours sincerely

[ 18 members of the Nightingale Society ]

To Clare Price-Dowd, NHS Leadership Academy

Clare Price-Dowd
NHS Leadership Academy
June 2019

Dear Dr Price-Dowd

We write with concern about the position you took, and your failure to provide reasons for it, in your article in the BJN “The changing face of nursing: from the pioneers to the future of leadership.” Your choices of leaders/pioneers are odd, and you failed to give references on points of fact. There is so much misinformation about Mary Seacole in circulation that it is difficult to get the facts right, but there are adequate primary sources.

  1. Listing Seacole as the top choice of nursing leader/pioneer, without noting so much as one qualification: what nursing did she herself do? (apart from selling “herbal” remedies, which sometimes contained lead and/or mercury)? What hospital(s) did she nurse at? What books/articles on nursing did she write? What nurses did she train or mentor? We are aware of none.
  2. Nightingale’s work is well known, and she was, would you not agree? the major founder of the profession. You describe her rather as “the person most people see as the epitome of the nurse,” but why not say what she did? Especially as you later address the qualities needed for leadership in the future. You state that she used “models and theories to influence others to make changes in health care.” We would say that she used evidence, well argued and illustrated, to influence decisions in health care.
    Since your position is with the NHS Leadership Academy, it might be well to acknowledge that she was the first to call for the key components of the NHS, and that in 1866 and 1867! None of your other choices did anything close to what she did for the formation of the NHS.
  3. We wonder about the choice of Edith Cavell as a nursing founder, when her life was tragically cut short. She deserves celebration for her courage and patriotism, but she had only a few years giving leadership in nursing when she was executed.
  4. Kofoworola Abeni Pratt does deserve inclusion as a pioneer and founder, and it is time that the NHS Leadership Academy recognized her. Sadly, it seems still, as you yourself, more keen to repeat the misinformation of the Mary Seacole campaign than to provide credible BAME models for today’s nurses. You could start with Pratt! (See a backgrounder on her at nightingalesociety.com/backgrounders/8-kofoworola-abeni-pratt/

We urge you to go back to primary sources–much of the misinformation on Seacole can be seen to be wrong when her own memoir is consulted. The bicentenary of Nightingale’s life will be celebrated in 2020. We look to nursing leaders to make a positive contribution in crediting her for what she did. Celebrating Pratt, a Nigerian who chose to study nursing at the Nightingale School, is a fine example of Nightingale’s ongoing relevance–she inspired future leaders!

Yours sincerely

[18 members of the Nightingale Society]

Please reply to contact@nightingalesociety.com

To Clare Price-Dowd, NHS Leadership Academy

Clare Price-Dowd
NHS Leadership Academy
June 2019

Dear Dr Price-Dowd

We write with concern about the position you took, and your failure to provide reasons for it, in your article in the BJN “The changing face of nursing: from the pioneers to the future of leadership.” Your choices of leaders/pioneers are odd, and you failed to give references on points of fact. There is so much misinformation about Mary Seacole in circulation that it is difficult to get the facts right, but there are adequate primary sources.

  1. Listing Seacole as the top choice of nursing leader/pioneer, without noting so much as one qualification: what nursing did she herself do? (apart from selling “herbal” remedies, which sometimes contained lead and/or mercury)? What hospital(s) did she nurse at? What books/articles on nursing did she write? What nurses did she train or mentor? We are aware of none.
  2. Nightingale’s work is well known, and she was, would you not agree? the major founder of the profession. You describe her rather as “the person most people see as the epitome of the nurse,” but why not say what she did? Especially as you later address the qualities needed for leadership in the future. You state that she used “models and theories to influence others to make changes in health care.” We would say that she used evidence, well argued and illustrated, to influence decisions in health care.
    Since your position is with the NHS Leadership Academy, it might be well to acknowledge that she was the first to call for the key components of the NHS, and that in 1866 and 1867! None of your other choices did anything close to what she did for the formation of the NHS.
  3. We wonder about the choice of Edith Cavell as a nursing founder, when her life was tragically cut short. She deserves celebration for her courage and patriotism, but she had only a few years giving leadership in nursing when she was executed.
  4. Kofoworola Abeni Pratt does deserve inclusion as a pioneer and founder, and it is time that the NHS Leadership Academy recognized her. Sadly, it seems still, as you yourself, more keen to repeat the misinformation of the Mary Seacole campaign than to provide credible BAME models for today’s nurses. You could start with Pratt! (See a backgrounder on her at nightingalesociety.com/backgrounders/8-kofoworola-abeni-pratt/

We urge you to go back to primary sources–much of the misinformation on Seacole can be seen to be wrong when her own memoir is consulted. The bicentenary of Nightingale’s life will be celebrated in 2020. We look to nursing leaders to make a positive contribution in crediting her for what she did. Celebrating Pratt, a Nigerian who chose to study nursing at the Nightingale School, is a fine example of Nightingale’s ongoing relevance–she inspired future leaders!

Yours sincerely

[18 members of the Nightingale Society]

Please reply to contact@nightingalesociety.com

To the Lincoln Center, New York

to: Lincoln Center for the Performing Arts,
10 Lincoln Center Plaza, New York, NY
March 25, 2019

Dear Sirs/Mesdames

Kindly pass on this letter to those connected with the Marys Seacole biodrama –- writer, director, actors, etc. Please note that we the undersigned, all living some distance from New York, have not seen the performance, but are using reviews in the New York Times and the New Yorker as the sources for our concerns.

Mary Seacole was a remarkable, independent, woman and many good things can be said of her, but your biodrama repeats an all too frequent, but false, accusation against Nightingale, as “haughty,” with “an icy sneer.” Seacole’s own memoir reports only one encounter with her, when she asked Nightingale for a bed for the night at her (overcrowded) hospital, and got one. Seacole was on her way to the Crimea to join her business partner to start their business. The encounter was entirely friendly, according to Seacole.

The “tireless work on the battlefields” is a gross distortion. Seacole’s memoir shows that she missed the first three, major battles of the war–she was in London attending to her gold investments. She was present for three later battles, thus was on the battlefield on three occasions, in each case for at most a few hours, after selling wine and sandwiches to spectators. Perilous? Hardly, and many people went onto the battlefield post-battle.

Nurse and healer? But Seacole herself admitted adding lead and mercury to her “herbal” remedies, and frankly admitted that she had made “lamentable blunders.” Lead and mercury are both toxic in any quantity, and counter-productive for bowel patients. We might suggest that a more honest presentation would also be of greater interest.

That this is the Lincoln Center is particularly inappropriate. Nightingale was a leading anti-racist. Her grandfather worked with William Wilberforce on the abolition of slavery. Her material for war hospitals was used by the United States Army in the Civil War. She wrote on the disappearance of the Australian aboriginal races. She supported Indian nationals in their struggles. She wrote a campaign letter for the first Asian to be elected to Parliament, etc.

Yours sincerely

Chris Brice, Rev., Church of England priest
Gerald Calver, B.A. (Hons.), legal costdraughtsman
Ann Cameron, PhD, professor emerita of developmental psychology
Robert Dingwall, PhD, FacSS, HonMFPH, prof emeritus, Nottingham University, founding director, Institute of Science and Society
Rose Dyson, EdD, Ontario Institute for Studies in Education
Charlene Harrington, PhD, Professor emeritus, UCSF
Susan James, MA, international development professional
Lynn McDonald, PhD, LLD (hon), emerita professor
Aroha Page, PhD, assoc professor nursing, Nipissing University
Rev. Chris Pettet, Vicar, St. Margaret’s, Wellow
Harold E. Raugh, Jr, Lt Col, PhD, FRHistS, FRAS, US Army, ret
Dorothy Goldin Rosenberg, MES, PhD, lecturer, env. health
Deborah Tregunno, RN, PhD, assoc. professor, School of Nursing
Joan Thompson, OBE, RRC, BA (hons), SRN
Gwyneth Watkins, MA, retired teacher
Bruce Webber R.N. (ret.)

to Sir David Cannadine, director, Oxford Dictionary of National Biograpahy

Sir David Cannadine, director
Oxford Dictionary of National Biography

Dear Sir David

We have received no reply from you to our letter on the egregious errors in the coverage of Florence Nightingale in the ODNB. We note that the Bicentenary of her birth takes place in 2020, which will likely encourage reference to the ODNB for information. Instead, they will find a host of errors, introduced by the first editor, Colin Matthew, who fell for F.B. Smith’s (now) much discredited book, Florence Nightingale: Reputation and Power, 1982.

Why make such misleading statements, and misinform so many students, that Nightingale “continued to disregard the germ theory of infection”? when she did not.

Why continue such sexist practices as reserving surnames and honorifics for men, nicknames good enough for women?

Why omit so much important work Nightingale did? Your ODNB entry does not even discuss Notes on Hospitals or her Introductory Notes on Lying-in Institutions, both pioneer studies that were enormously influential.

Why no mention of her later writing? Which shows how much nursing and medical care had evolved, and Nightingale with it. Her 1860 Notes on Nursing was enormously influential, and so were her later works. We call for a re-write of the entry, for accuracy and relevance.

Yours sincerely
[34 members of the Nightingale Society]

to Lord Crisp, former chief executive, NHS

February 13, 2019
The Lord Crisp KCB
House of Lords

Dear Lord Crisp,

We were disappointed to see your remarks about the celebration in 2020 of the Bicentenary of Florence Nightingale, when you called for this to be the occasion to celebrate “other great nurses such as Mary Seacole.” Yet you did not state, nor have we seen any information anywhere, as to how Mary Seacole qualifies as a “great” nurse, or indeed any kind of a nurse. She was a remarkable person, but a businesswoman, and a kind hospital volunteer visitor, but never a nurse, and never claimed to be.

Would you care to name one hospital where she nursed, as opposed to distributing donated magazines (which she did at the Land Transport Corps Hospital, near her business)?

Please name any book or article on nursing she wrote, or one nursing school she founded (there are lots for Nightingale).
Can you explain how Seacole’s using lead and mercury (added to her herbal “remedies” for bowel diseases!!) is good nursing? When the cure for cholera, etc., is rehydration, why would dehydration constitute great nursing?

Do you recall that Seacole herself admitted to “lamentable blunders” in her remedies? For information on her, based on primary sources, not propaganda, see www.maryseacole.info

We particularly regret your failure, and that of the Dept. of Health and the NHS, to recognize valid black nursing leaders. We recommend Kofoworola Abeni Pratt, a Nigerian who did nurse training in London, won an RCN scholarship, and was nursing at St. Thomas’ Hospital when the NHS started. She was probably the first black nurse in the NHS, and she went on, after returning to Nigeria, to lead in founding professional nursing there. Why ignore her and her important work?

It is regrettable that you, as a former chief executive of the NHS, seem to have no understanding of the importance of Nightingale’s work in making the NHS possible. Are you aware that she was the first person, in 1866, to articulate the vision of quality care for all, regardless of ability to pay (in a letter to Edwin Chadwick)?.The launch of the NHS in 1948 would not have been possible if the great reforms she worked for (successfully) in the old workhouse infirmaries had not been achieved. Note that, at the time, 80% of hospital patients were in workhouses, which still had bedsharing and pauper “nurses.” There is much to celebrate in Nightingale’s work, but you mentioned nothing. She was a pioneer in evidence-based health care, surely a concern of today.

We would be glad to provide you with a briefing on Nightingale and Seacole. Indeed we would be glad to debate you publicly on the subject.

Yours sincerely
[34 members of the Nightingale Society]

from Sarah John, Notes Directorate, Bank of England

from: Sarah John
Chief Cashier, Notes Directorate
sarah.john@bankofenqland.co.uk

20 December 2018

Dear members of the Nightingale Society,

Thank you for your letter dated 9 December addressed to the Governor. As Chief Cashier with responsibility for banknotes, and a member of the Banknote Character Advisory Committee, he has asked me respond on his behalf.

Thank you for taking the time to write to us with your views about Mary Seacole. As you will have seen in the press, the selection of the character for the next £50 note has attracted a lot of attention. We are delighted by the way the nomination process has captured the imagination of the public, and provoked some very interesting debates on the relative merits of potential candidates to appear on the banknote.

This is, however, just the start of the process. As the Banknote Character Advisory Committee works through the shortlisting process, we will be undertaking detailed historical research on each of the leading potential characters. I can assure you that the final decision, to be taken by the Governor, will be made in light of all the relevant available facts about the life and achievements of the shortlisted characters.

Yours sincerely,
Sarah John
Chief Cashier