From Sigma Theta Tau International

Response to Concerns Voiced by the Nightingale Society

The purpose of this response is to address concerns raised by Mark Bostridge author of Florence Nightingale: The Making of an Icon (2008) and others affiliated with the Nightingale Society in an email on 27 October 2016.

Background

The narrative in Chapter 5 of Transforming Interprofessional Partnerships: A New Framework for Nursing and Partnership-Based Health Care (Eisler & Potter, 2014) elevates nursing exemplars from history that expressed their lived experience through autobiographies. The inclusion of one nurse exemplar is not meant to diminish or detract from the other exemplars. Each exemplar is an independent narrative that expresses the internal reflections and thought processes related to being a nurse. The purpose of using autobiographies rather than histories is to illuminate the lived experience of being a nurse. This is because histories generally involve an external source that describes the actions of nurses.

Responses to specified concerns (complaints are directly quoted and are in bold print):

Seacole precedes Nightingale in coverage (pp 106-8), and the two are together are called “early nurses.”

The narrative begins with Seacole because she was born in 1805 and she starts her narrative at an earlier date than Nightingale’s narrative. She described watching her mother, who Seacole identifies as a doctress, care for officers and their wives, “But I saw so much of her, and her patients that the ambition to become a doctress early took firm root in my mind; and I was very young when I began to make use of the little knowledge I had acquired from watching my mother, upon a great sufferer- my doll” (Seacole, 1857/2005, p. 12).

The section did not begin with Mary Seacole because she is thought of as more important than Florence Nightingale or to demonstrate who we believe deserved to come first. Rather, the narratives begin with her because her own interest in caring for others as described in her autobiographical narrative started before Florence was born (b. 1820).

The Seacole section begins with a quotation from Salman Rushdie’s Satanic Verses complimenting Seacole, although it does not quote his calling Nightingale a “whore” in Grimus: a Novel. How did he get to be an expert on the Crimean War or nursing history?

The quote: “See here is Mary Seacole, who did as much in the Crimea as another magic-lamping Lady, but being dark could scarce be seen for the flame of Florence’s candle” –Salman Rushdie (1988, p. 301)

Rushdie’s quote, even if he is not an expert on Crimean War or nursing history, suggests that Seacole suffered racial prejudice due to her dark skin that diminished her contributions. Racial prejudice remains an issue pertinent to modern nursing. As this quote relates to the section on Mary Seacole and not Florence Nightingale (or Salman Rushdie), it would have been wildly inappropriate to include quotes related to Nightingale, especially one as inflammatory as the one offered in your email.

Eisler and Potter’s topology, Partnership Principle Illustrated, makes Seacole into a partner of Nightingale – although she was a businesswoman and the two met for only about 5 minutes and never discussed nursing!

The entire book approaches partnership as defined by Riane Eisler in her cultural transformation theory (1987, 2002). The book’s use of the word partnership or partners has nothing to do with a business partnership.

Seacole is said to have promoted a “democratic and economically equitable structure of linking and hierarchies of actualization in both family and state”, “conflict creatively used to arrive at solutions.” Any evidence for this claim? We know of none.

The three statements “democratic and economically equitable structure of linking”, “hierarchies of actualization in both family and state” and “conflict creatively used to arrive at solutions” are characteristics of partnership relationships according to Eisler (1987, 2002). Table 5.1 (Eisler & Potter, 2014, pp. 132-134) summarizes the partnership characteristics that the authors felt were evident in the writings of each exemplar. Seacole’s narrative demonstrates some level of “democratic and economically equitable structure of linking”, “hierarchies of actualization in both family and state” and “conflict creatively used to arrive at solutions.”

_Samples of supporting evidence from Seacole (1857/2005): _

Democratic and economically equitable structure of linking:

-“It must be understood that many of those who could afford to pay for my services did so handsomely, but the great majority of my patients had nothing better to give than thanks” (p. 31).

-“I attended to the wounds of many French and Sardinians, and helped to lift them into the ambulances, which came tearing up to the scene of action. I derived no little gratification from being able to dress the wounds of several Russians; indeed they were kindly treated as the others” (p. 142).

Hierarchies of actualization in both family and state:

-“Against the negroes, of whom there were many in the Isthmus, and who almost invariably filled the municipal offices, and took the lead in every way, the Yankees has a strong prejudice; but it is wonderful to see how freedom and equality elevate men, and the same negro who perhaps in Tennessee would have cowered like a beaten child or dog beneath an American’s uplifted hand, would face him boldly here, and by equal courage and superior physical strength cow his old oppressor” (p. 44)

Conflict creatively used to arrive at solutions:

-“Let what might happen, to the Crimea I would go . . . I would have willingly given my services as a nurse; but as they declined them, should I not go and open a hotel for invalids in the Crimea in my own way?” (pp. 73–74)

The pair are called “early nurses” who “considered practice and listening to narratives to be important parts of their care.”

The book states, “The autobiographies also provide evidence that these early nurses considered presence and listening to narratives to be important parts of their care” (Eisler & Potter, 2014, p. 106). This quote is the prelude to the narratives of the exemplars. It broadly covers characteristics of all of the exemplars selected. Seacole is described widely in other works as being a nurse. The fact that she can also be described as a businesswoman does not take away from her experience as a caregiver.

Seacole’s mother is incorrectly credited with managing a boarding house for “disabled British soldiers” (p 106) when she ran a small hotel for British officers.

“My mother kept a boarding-house in Kingston” (Seacole, 1857/2005, p. 11).

“When I was about twelve years old I was more frequently at my mother’s house, and used to assist her in her duties; very often sharing with her the task of attending upon invalid officers or their wives, who came to her house from the adjacent camp at Up-Park, or the military station at Newcastle” (p. 13)**

She combined “care and cure” in her “healing ministry,” a strange conclusion given that she added lead and mercury to her cholera remedy to make it more effective, and admitted “lamentable blunders” (WA p 31). Any evidence that dehydrating. [sic]

The quote: “Traditional healers did not split care and cure; therefore, Seacole combined both in her healing ministry. She was just as apt to dress a wound and care for a feverish patient, as she was to reach into her medicine bag for an effective herbal treatment (Seacole, 1857/2005)” (Eisler & Potter, 2014, p. 106).

It is not the intent of these narratives to evaluate the efficacy of specific treatments or approaches. We recognize that in the last 160 years there have been improvements in nursing care and some of Seacole’s treatments are no longer considered effective, and we feel it is unrealistic to criticize 19th century caregiving based on modern standards.**

Seacole is next said to have treated British soldiers in Panama for dysentery and cholera, but the British Army was not there – her customers and patients were men on their way to the California Gold Rush.

The chapter includes the sentence: “Early in Seacole’s career, she gained recognition for the care she provided for British soldiers suffering from cholera and dysentery in Panama” (p. 106). Admittedly this sentence is incomplete, probably due to a mistake during editing or proofreading. The sentence should have said, “Early in Seacole’s career, she gained recognition for the care she provided for British soldiers and for people suffering from cholera and dysentery in Panama.” The existing sentence will be amended as noted above.

Supporting evidence included:

“I had gained a reputation as a skillful nurse and doctress, and my house was always full of invalid officers and their wives from Newcastle, or the adjacent Up-Park Camp” (p. 16).

“Among the diseases which I understood were most prevalent in the Crimea were cholera, diarrhea, and dysentery, all of them more or less known in tropical climates; and which as the reader will remember, my Panama experience had made me tolerably familiar” (p. 71).

Any evidence that her “care and cure,” which entailed dehydrating bowel patients, actually cures? The effective treatment is oral rehydration therapy, the opposite of using emetics, purging from the bowels and blistering fo [sic] sweat the patient, as Seacole did.

Please see previous comment about care and cure.

Seacole is said, when she read newspaper reports “on the terrible conditions and high mortality rate of British soldiers fighting in the Crimea War, she immediately left for London” (p 107). A reference is given to her book, but no page number, perhaps because nowhere does such a statement appear. Rather, she acknowledged arriving in London, shortly after the first battle (September 20), or before any account of high mortality could have appeared.

The narrative states, “When she read newspaper reports of the terrible conditions and high mortality rate of

British soldiers fighting in the Crimean War, she immediately left for London” (Eisler & Potter, 2014, p. 107). This sentence will be rewritten to reflect Seacole’s presence in London at the time reports of casualties were being received. This will correct Seacole’s travel timeline and sequence of events. The revised sentence will be, ““While in London, she heard news reports of the terrible conditions and high mortality rate of British soldiers fighting in the Crimean War.”

Supporting evidence:

“As the winter wore on, came hints from all quarters of mismanagement, want, and suffering in the Crimea” (p. 70) and, “While all England was reeling beneath the shock of that fearful victory, came the sad news that hundreds were dying whom Russian shot and sword had spared, and that the hospitals of Scutari were utterly unable to shelter, or their inadequate staff to attend to The ship loads of sick and wounded which were sent to them across the stormy Black Sea” (p. 70).

She did immediately go to the War Office in London to apply for the post of hospital nurse (Seacole, 1857/2005, p. 71).**

Supporting evidence:

“I made up my mind that if the army wanted nurses, they would be glad of me, and with all the ardour of my nature, which ever carried me where inclination prompted, I decided that I _would _go to the Crimea; and go I did, as all the world knows” (Seacole, 1857/2005, p. 71).

“My first idea (and knowing that I was well fitted for the work, and would be the right woman in the right place, the reader can fancy my audacity, was to apply to the War Office for the post of hospital nurse” (Seacole, 1857/2005, p. 71).

She is said to have “borrowed money” to get there (p 107), although her own account states that she had capital acquired from her previous business (Wonderful Adventures, p 80).

That she seems to have borrowed money was inferred from her statement:

“My funds, although they might, carefully husbanded, carry me over the three thousand miles, and land me at Balaclava, would not support me there long” (p. 70).

While it is beyond the scope of the chapter to explain Seacole’s business arrangements and funding, the reference to “borrowed money” will be removed to provide a more accurate account. The sentence will be modified to say, “…When the traditional route of service was barred, she creatively forged another path and made her own arrangements to travel to Crimea.”

Eisler and Potter’s bizarre account has Seacole deciding to “move to the Crimean peninsula near Sebastopol” after she found out that the Barrack Hospital was in Turkey. But Seacole knew this all along; when she met Nightingale at the hospital, her passage was booked to the Crimea and she only wanted a bed for the night (WA, p 91).

The chapter states, “When she arrived, she discovered that the British hospital managed by Nightingale was in Scutari on the opposite shore of the Black Sea far from the Crimean battlefront. So Seacole decided to set up a suttler’s house or hotel on the Crimean peninsula near Sevastopol, a few miles from the front (Seacole, 1857/2005)” (Eisler & Potter, p. 107).

Supporting evidence:

“One thought never left my mind as I walked through the fearful halls of suffering in that great hospital. If it is so here, what must it not be at the scene of war- on the spot where the poor fellows are stricken down by pestilence or Russian bullets, and days and nights of agony must be passed before a woman’s hand can dress their wounds. And I felt happy in the conviction that I must be useful three or four days nearer to their pressing wants than this” (Seacole, 1857/2005, p. 81).

The sentence in the book could have said, “When she toured the British hospital managed by Nightingale in Scutari on the opposite shore of the Black Sea far from the Crimean battlefront, she discovered the impact that the distance between battlefront and hospital must have had on the men, confirming her decision to set up a suttler’s house or hotel on the Crimean peninsula near Sevastopol, a few miles from the front (Seacole, 1857/2005).” The existing sentence will be amended as noted above.

In conclusion, as noted above there are several statements that can be amended or replaced in order to more accurately reflect the details of Seacole’s early nursing experience and involvement in the Crimean War. While we do not believe that the statements as originally printed detract from the purpose of the narrative, it benefits all readers to make corrections in order to better reflect the facts. We thank The Nightingale Society for bringing them to our attention. We do maintain, however, that the inclusion of Mary Seacole in no way diminishes the contributions of Florence Nightingale, and we do not feel that Nightingale has been unfairly portrayed in the chapter. We believe that both women can be celebrated for their skills, accomplishments – and differences.

Teddie Potter, PhD, RN
Riane Eisler, JD, PhD(h)
Dustin Sullivan, Publisher, Sigma Theta Tau International

Other expert views of Mary Seacole:

From RCN President Sylvia Denton OBE FRCN

“Today, we understand as nurses that we have to work in partnership with our patients and their families. But the finest nurses, like Mary Seacole, have always done that, as we can see from accounts how warmly her patients liked and respected her” (cited in Anionwu, 2005, p.15).

Foreword written by RCN General Secretary Beverly Malone RN, PhD, FAAN

Nurse, leader, entrepreneur and doctress; there are many labels that could be used to describe this unique and utterly absorbing figure in nursing’s history- but in truth, she defies labeling. This formidable Victorian overcame innumerable hurdles- not least the innate racism attitudes of her time- to provide care for the soldiers in the Crimean War, thousands of miles from her home in Jamaica…

It is Mary Seacole’s confidence in the pure power of nursing and her enthusiasm for delivering that shines out and is an inspiration to nurses today. Mary carved out an important place for herself and for nursing amidst the hideous conditions of war, using as tools her natural flair for leadership, her clinical skills, and above all her commitment to providing superb patient care. As this history shows, her contemporaries recognized her bravery and caring. (cited in Anionwu, 2005, p. 1)

From former Editor-in-Chief of the Journal of Advanced Nursing

“Alas, their names and contributions to the professional development of nursing are almost in danger of being erased from the collective memory of the nursing profession. That should be checked. The same fate befell the outstanding work of Mary Seacole, a nineteenth century black British nurse. Fortunately she has been brought back to the notice of the profession again (Alexander & Dewjee 1984). She is a marvelous role model for today’s nurses –black and non-black alike.” (Smith, 1997, p. 437)

References:

Anionwq, E. N. (2005). A short history of Mary Seacole: A resource for nurses and nursing students. London, UK: Royal College of Nursing.

Bostridge, M. (2008). Florence Nightingale: The making of an icon. New York, NY: Farrat, Straus, and Giroux.

Eisler, R. (1987). The chalice and the blade: Our history, our future. San Francisco, CA: Harper & Row.

Eisler, R. (2002). The power of partnership. Novato , CA: New World Library._ _

Eisler, R., & Potter, T. (2014). Transforming interprofessional partnerships: A new framework for nursing and partnership-based health care.Indianapolis, IN: Sigma Theta Tau International.

Rushdie, S. (1988). _The satanic verses. _New York, NY: Picador.

Seacole, M. (2005). _Wonderful adventures of Mrs. Seacole in many lands. _New York, NY: Penguin Boos. (Original work published 1857)

Smith, J. P. (1997). Liminal nurses urgently needed for the challenges ahead. Journal of Advanced Nursing 26 (3), pp. 437-438.