Defending Florence Nightingale’s Reputation (Kai Tiaki Nursing New Zealand)

A leading international Florence Nightingale scholar rebuts Grant Brookes’s and Kerri Nuku’s viewpoint on the founder of modern nursing, 1 published in the April issue of Kai Tiaki Nursing New Zealand calling it ‘a thoroughly nasty and outrageously inaccurate attack’.

By Lynn McDonald. Published in Kai Tiaki Nursing New Zealand, Vol.26 No.4 (May 2020)

Of course New Zealand nurses should celebrate New Zealand nurses, certainly indigenous nurses. No contest. But vilifying Nightingale, who in fact was a leading anti-racist, at a time when racism was rampant, is wrong.

Have a look at what she wrote that the authors variously misconstrue or omit. Note also their sexism, calling her, an adult woman, by a first name as if she were a child, while men get their surname and title (eg Governor Grey). Yet the authors claim to be speaking for “feminist nurses.”

Some of the criticism levelled by Brookes and Nuku shows a gross lack of knowledge of historical context.

Yes, Nightingale said that to be a “good nurse,” one had to be a “good woman,” a statement that would need to be re-worded to “person” to apply nowadays. One must realise that many British “nurses” in Nightingale’s time were disreputable women, notorious for drinking on the job, taking opiates and demanding bribes for services. They were badly paid and their working and living conditions were appalling.

It is hard to imagine how any hospital would accept trained nurses from Nightingale’s (or any other) school, if they could not count on them being sobre on the job and honest. Nightingale wanted nurses to have decent pay, living and working conditions, and had to be able to supply reputable nurses to get them.

Nightingale’s anti-racism

Nightingale’s MP grandfather for decades worked with William Wilberforce on the abolition of the slave trade and slavery. She grew up with values of racial equality. Her Sanitary Statistics of Native Colonial Schools and Hospitals gives a clear statement of that belief. She was appalled by the high death rates of indigenous school children, “double that of English children”. 2 3 They should not be higher, and that they were indicated bad living conditions. She argued: “By far the greater part of the mortality is the direct result of mitigable or preventable disease.” 2

Those diseases should be prevented! This required practical efforts and research to see what worked.

Much of the critique of Nightingale on race is an accusation that she used the terms of the time, not of the 21st century. But they were the terms of the scientific literature, not pejorative, which she never used. “Civilisation” and “civilized” referred to societies with permanent settlements, implying nothing about race. Clearly many non-white societies had cities, even very large ones.

The term “native” simply refers to being born in, as opposed to having come from another country. And terms change. When I worked with Canadian indigenous women on rights issues in the 1970s and 1980s, they had organisations with names like “Indian Rights for Indian Women” and “Native Women’s Association of Canada,” which latter is still a force.

Nightingale did refer to the “blessings of Christian civilization,” but she also qualified it as “Christian in name, but far from Christian in reality,” which is not mentioned in the viewpoint.

She agreed also that imperial rule was “violent,” “overbearing,” “self-seeking” and “oppressive”. 4

In a letter to Sir George Grey, she was rude about the New Zealand missionaries: “what idiots those missionaries, not the converts, must be”. 5

Brookes and Nuku incorrectly accuse Nightingale, in her Sanitary Statistics of Native Colonial Schools and Hospitals, of explaining the high indigenous mortality rates in terms of the “discredited miasma theory.” Discredited? Hardly. Miasmata were the physical habitat of unseen germs or bacilli. When Nightingale wrote Sanitary Statistics, bacilli had not been identified. That study (as her earlier books) predates even Joseph Lister’s 1867 breakthrough with antiseptic surgery (but even he did not use “germs” in the article). Acceptance of germ theory is commonly dated to 1879, with bacteriologist Robert Koch’s publication of the “four postulates” theory.

In any event, belief in miasmata did not hinder disease prevention, for in getting rid of the disease-laden miasmata, one also got rid of the bacilli. The head of the Sanitary Commission, that did the most to bring down the death rates in the Crimean War hospitals, Dr John Sutherland, only accepted germ theory after the discovery of the cholera bacillus, in 1883, when, also, Nightingale made the switch.

Other misinformation

Nightingale did not oppose higher education for women, but actively supported it. But note that no higher education for women was available in the United Kingdom when she started her nurse training school. The first women university graduates (and then only a few) date to the 1880s. Training at her school, from 1860 on, included lectures, academic content that raised the educational level of nurses and probably helped to open up higher education for women.

The complaint about her not supporting nurse “registration” can be applied fairly only to the particular proposal for state registration advanced by the Royal British Nursing Association (RBNA), which had serious defects. It failed to protect the public, as no nurse could be removed, even on a criminal conviction or malpractice.

The RBNA was run by male doctors, with, as president, Princess Christian, daughter of Queen Victoria but no nurse. Nightingale believed that nurses should run their profession, not doctors.

Recall that, in Nightingale nursing, nurses would take medical orders from doctors, for only doctors were qualified to diagnose. But nurse administrators should make all the decisions on hiring, dismissal, discipline and dismissal.

Did Nightingale foster “the eventual dominance of the medical model of health,” as Brookes and Nuku state? No again. She saw medical science as important, but so were public health measures: health promotion and disease prevention, principles she advocated throughout her life. Better to prevent disease than have to treat it after it sets in.

In Notes on Nursing (Conclusion) she could not have been clearer, that neither medicine nor surgery could “cure,” but only remove the obstacles to healing: “nature alone cures.” 6

Nightingale complained that “nursing” used to signify little more than “the administration of medicines and the application of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet and the proper selection and administration of diet – all at the least expense of vital power to the patient.” (Introductory) 6

The nurse’s task was to aid Nature, mentioned frequently in Nightingale’s writing. 7 Brookes and Nuku have it backwards!


Lynn McDonald is the director of the 16-volume Collected Works of Florence Nightingale (2001-2012) and a co-founder of the Nightingale Society. She did her PhD at the London School of Economics, is a Member of the Order of Canada, a Fellow of the Royal Historical Society and is now a professor emerita in sociology at the University of Guelph, Ontario. She has also been a successful health-care reformer. As a New Democrat MP, she authored Canada’s Non-smokers’ Health Act, 1988, the first legislation in the world to establish smoke-free work and public places.

References

1. Brookes, G.,& and Nuku, K. (2020). Why we aren’t celebrating Florence’s’ birthday. Kai Tiaki Nursing New Zealand, 26(3), 34-35.

2. Nightingale, Florence. (1863). Part I Sanitary Statistics of Native Colonial Schools. Transactions of the National Association for the Promotion of Social Science, 477.

3. McDonald, L (ed.) (2004) ed. Florence Nightingale on Public Health Care. Waterloo, ON: Wilfrid Laurier University Press.

4. Nightingale, Florence. (1864). Note on the Aboriginal Races in Australia. Transactions of the National Association for the Promotion of Social Science, 475-88.

5. Nightingale, Florence. (1860). Letter to Sir George Grey, (April 26). Auckland Public Library. Auckland, New Zealand.

6. Nightingale, Florence. (1860). Notes on Nursing: What It Is and What It Is Not. London: Harrison.

7. Nightingale, Florence. (1893). Sick-nursing and health-nursing. Woman’s Mission: A Series of Congress Papers, 184-205. Ed Angela Burdett-Coutts. London: Sampson, Low.