by Lynn McDonald

Florence Nightingale, of course, as a woman, never had the opportunity to go to university, but she did have a wonderful visit as a young woman, with her father, attending meetings of the British Association for the Advancement of Science, in 1847 (she had attended their meetings also the previous year in Southampton). The Oxford meetings were notable for papers on the discovery of Neptune. The astronomer Sir John Herschel brought the two (independent) discoverers together: the French LeVerrier and the British John Crouch Adams. The two sat “like turtledoves” on either side of Herschel.

Nightingale was interested in the process of discovery, and noted how the discovery was made by their seeing perturbations in the orbit of the planet Uranus. Lalande had made the same discovery of perturbations in 1795, but thought he had made an error.

Faraday gave a lecture on magnetism she liked; she read him carefully and later corresponded with him.

She described “tea and cakes” at ChristChurch, followed by a curious episode with the son of the dean, Bucklands, who had a three-month year old bear chained to his door. Said bear managed to get into the butter and became obstreperous, especially when his master put a cap and gown on him. Her friend, poet Richard Monckton Milnes, then mesmerized the bear, who yawned and stretched out and slept.

Nightingale enjoyed seeing Oxford, beautiful in June. On Sunday, she joked, they went to church every two hours. There were “glorious services” at New College and Magdalene.

She described in a letter to a friend that she wished she were “a college man.”

Acland and public health

Sir Henry Dyke Acland, regius professor medicine at Oxford, was a close ally of Nightingale’s on numerous issues of public health. The Bodleian has a substantial collection of their correspondence. He sought her opinion on many issues, and flagged her work in speeches he made as president of the British Medical Association and the Committee on State Medicine (then the term used for public health).

She paid tribute to him late in life: “Do you know, I hear from and of you almost every day? In this way I can remember when pyemia was almost as common a thing in hospitals as any case coming from without– I mean pyemia generated in hospital. Now, we shout so loud when there is a case that they can hear us all over London. This is an amazing change. And we owe it principally to you and what you have taught us.”

The Radcliffe Infirmary

Nightingale sent the first trained matron to the Radcliffe to get professional nursing started in 1891. Flora Masson was a most suitable choice for a university town, daughter of the astronomer royal, well educated, for a woman, herself, and the author of two books before she took up nursing.

Balliol College and Benjamin Jowett

Nightingale had a long and happy association with Benjamin Jowett, a priest of the Church of England and professor of Greek. He is often described as Nightingale’s “spiritual advisor,” but the relationship between the two was remarkably egalitarian. Each read and advised the other on their academic interests. He read and commented on her bold Suggestions for Thought and she sent him her sermons and ideas for his.

Jowett had his four-volume translation of the Dialogues of Plato sent to her, which she carefully read and annotated. She did not complain about any of his translations, but objected strenuously to many of his comments. On the communal upbringing of children in The Republic, she explained the high death rates of foundling hospitals and gave figures. She told him, “Plato does not know that crèches are the death and deterioration, the slaughterhouses, of infants, not their nurseries. See 90 percent in the good soeurs’ crèches and in all the French institutions…. All children in his state are foundlings. It never occurred to him that the greater part of them, according to universal experience, would have perished. For children can only be brought up in families.” She advised Jowett to leave out his explanation of the “cave.”

Jowett’s second edition was a fuller five volumes. In many places, he added a paragraph or two repeating or paraphrasing her words.

Jowett had a love for life that Nightingale admired. For many years, he held Holy Communion services for her at her home in London, often with a friend or relative attending. Reforms in India were causes the two shared. Balliol was the college that welcomed the most Indian students.

In her tribute to him on his death, she called him “the friend of God who has now received the crown of life.” Jowett, however, despite his twice signing the 39 Articles of the Church of England, did not believe in any individual resurrection, but rather a generalized absorption.

Project for “social physics” at Oxford: the case for evidence-based social policy

In 1891, Nightingale formed the project of getting a chair or lectureship in “social physics” established at Oxford, the university that trained the most senior politicians and civil servants, the people who most needed to have statistical knowledge at hand. She complained that plenty of statistics were collected, but they “remained in their pigeon holes, which means not at their disposal,” and thus “absolutely useless.” The term “social physics” is from the work of the Belgian statistician L.A.J. Quetelet, and means effectively applied social science. For subjects, she proposed the effect of state schools (compulsory education was new), the effect of workhouses on children, the effect of British administration in India (whether people richer or poorer, their trades and handicrafts flourishing or perishing).

Nightingale is recognized as the founder of evidence-based health care. Here she called for evidence-based social policy generally.

by Lynn McDonald, for the Nightingale Society

So many of the reforms that Nightingale sought in health care (nursing being a major part of it) required political change, sometimes legislation, sometimes new regulations and sometimes increased budget.

Politics was part of Nightingale’s own upbringing. Her mother’s father, William Smith, was a radical MP who worked with Wilberforce on the abolition of slavery. Her brother-in-law and various cousins were Liberal MPs. Her own father ran once, unsuccessfully, for the Liberal Party. She was both a Liberal Party supporter, lifelong, and a small-l liberal in her views.

Of course, as an activist, she needed, and had, allies in the Conservative Party as well. Leading Conservative MPs and peers worked with her. As well, she was often disappointed with what the Liberal government did.

Sir Edmund Boulnois, a Conservative businessman and Conservative MP, as chair of the Board of Guardians at the St Marylebone Workhouse Infirmary, was instrumental in getting trained nurses into it, and indeed a nursing school and a better building. He later served as chair of the Nightingale Fund.

Other prominent Conservative allies were Lord Stanley, the earl (who later became a Liberal), Lord Shaftesbury (the 7th earl), W.H. Smith, Conservative MP and war secretary; and Robert Loyd-Lindsay, later Baron Wantage (they worked together on the National Aid Society, forerunner to the Red Cross), She thought highly of Conservative viceroy of India, Lord Mayo. However, she had nothing good to say about “Derby and Dizzy,” while “Lord Randolph and me/We don’t agree.”

Legislation for workhouse reform

Reforming the dreaded workhouse infirmaries was an early and ongoing concern of Nightingale’s. The first reform, in Liverpool, in 1865, required only the consent of the workhouse Guardians and the donation of funds. To upgrade the London workhouse infirmaries, however, required legislation, achieved in 1867 with the adoption of the Metropolitan Poor Act. Nightingale submitted a comprehensive brief to the “Cubic Space Committee” studying workhouses, and did much behind the scenes on the legislation itself.

She had hoped that the Act would require workhouses to employ trained nurses, to replace the “pauper nurses” who drank their meagre wages. It did not go that far, but only permitted the hiring of trained nurses. Reforms had to be brought in piecemeal, which gradually happened. Nightingale’s Liberal brother-in-law, Sir Harry Verney, moved an amendment for another advance, to permit workhouse infirmaries to train nurses, which was accepted unanimously.

The bill itself was the work of a Conservative government, with Gathorne Hardy, president of the Poor Law Board, a Cabinet position, in charge.. Although Nightingale was disappointed with the bill, in time how much it achieved came to be recognized.

With the benefit of hindsight, the Metropolitan Poor Act can be seen as the first step towards universal access to health care, established with the launching of the National Health Service in 1948. The NHS could not have been created without the gradual transformation of the old workhouse infirmaries (used by 80% or more of the population) into regular hospitals, with trained nurses and adequate facilities (the old workhouses had bed sharing and lacked basic sanitation).

Petitions to Parliament

Nightingale signed the first petition to Parliament for the vote for women, in 1866, and many more after it. Some MPs in debate on women’s suffrage cited the anomaly that someone like Nightingale not have the right to vote. She also signed petitions for other reforms for women, notably the Married Women’s Property Act.

Nightingale’s name headed the list of signatures on a petition of 1873 to W.E. Gladstone, and on one in 1874 to Disraeli. Ironically, the Conservative Disraeli supported the vote for women, while her fellow Liberal Gladstone, who greatly liked and respected her, opposed it.

Support for key candidates

Nightingale, naturally, wanted MPs to be elected who would be strong advocates for reform on health care and on India. She wrote a letter of support for Dadabhai Naoroji, founder of the East India Association and the first Asian to be elected to Parliament.

Her regard for Parliament

When Italian independence leader, General Garibaldi, made a triumphant visit to England in 1864, and spoke in Parliament, he wanted to meet Nightingale. After their meeting, she complained that he wanted a representative government, like theirs, but could not “take the evils and the good of a representative government (as I have to do) every day.” She also noted that she, like Garibaldi, could not pass the House of Commons without tears.”

by Lynn McDonald, for the Nightingale Society

When racist views were socially acceptable, Nightingale was an exception. Her own family was liberal and progressive. Her grandfather was a radical MP who supported the right to vote for Jews, Roman Catholics and “dissenters” (Protestants not in the Church of England). He worked with William Wilberforce for the abolition of slavery.

Nightingale had the opportunity, on her travels, to see slavery in action, which reinforced those liberal, anti-racist values. On her Egyptian travels, she witnessed a slave market where Nubians, captured as girls, were sold (letter 24 November [1849], in Vallée, Mysticism and Eastern Religions, 157).

After the Crimean War, one of Nightingale’s earliest research projects was on mortality and illness in “colonial schools and hospitals,” meaning for Indigenous people in the Australian colonies, Ceylon (Sri Lanka), southern Africa and (pre-Confederation) Canada. Although the data were shoddy, there was enough to show that the rates of death and disease were twice what they should be (Sanitary Statistics of Native Colonial Schools and Hospitals, in McDonald, Florence Nightingale on Public Health Care, 168-83). She made her point succinctly: “By far the greater part of the mortality is the direct result of mitigable or preventable disease.”

Australia. Nightingale carried on the research to papers on the disappearance of Indigenous people both for Australia and New Zealand (“Note on the New Zealand Depopulation Question,” McDonald, Florence Nightingale on Public Health Care, 183-85). She succeeded in getting Australian public opinion interested – newspapers gave her papers good coverage – but this did not lead to any action.

Canada. Sexual and physical abuse in residential schools has only recently been recognized as a terrible legacy from the past. Nightingale’s work was not on those aspects of abuse, but simply disease and death. She was the first person to make public the high rates of disease and death in residential and day schools in Canada.

Unfortunately, Nightingale was unsuccessful in getting the Colonial Office to continue to collect data, let alone make necessary improvements. She turned to working on India, where she was able to have more (albeit limited) impact.

India. On her many years of research and publication on India, Nightingale supported the work of leading Indian national social and public health experts and organizations. She published in their journals. She met with and encouraged their officials.

She wrote a campaign letter for the first Asian to be elected to Parliament (in Finsbury), Dadabhai Naoroji. W.E. Gladstone, the Liberal leader, also wrote a campaign letter for him, but hers was stronger. Naoroji was the founder of the East India Association, the precursor to the Indian National Congress, that (eventually) won independence for India. Nightingale had a major paper read at one of its meetings (reproduced in McDonald, Florence Nightingale on Politics, 364-5). When Gandhi came to England, he carried with him a letter of introduction to Naoroji, and Gandhi had a high opinion of Nightingale.

Her worldwide inspiration. Nightingale encouraged women in other countries in the pursuit of their goals, in numerous fields.

A fine example in medicine is Rukhmabai, the Indian woman who opposed child marriage and enforced widowhood. In law, there is Cornelia Sorabji, the first woman graduate from Bombay University and the first to practise law in India and the U.K.

The superb Nigerian nursing leader, Kofoworola Abeni Pratt, chose to pursue nursing at the Nightingale School precisely because of her admiration of Nightingale. Mrs Pratt became the first black nurse in the National Health Service, when it was launched in 1948. She later led in the establishment of Nigerian nursing, nurse training in Nigeria and its incorporation into the university system, which in turn encouraged nursing developments elsewhere in Africa. Pratt was named the first chief nursing officer of Nigeria, the first commissioner of health for Lagos, and served on the International Council of Nurses and UN committees.

by Lynn McDonald

It depends on the sources used: primary sources from the time are of a Jamaican businesswoman, independent, feisty, kind and generous, but not at all the “battlefield nurse, “pioneer nurse” or “first nurse practitioner” shown wearing medals awarded to her for her bravery.

There are solid, contemporary primary sources:

• Seacole’s own memoir, Wonderful Adventures of Mrs Seacole in Many Lands, 1857, much reprinted
• newspaper accounts (especially the Times)
• letters and memoirs published by army officers and doctors post-war
• her will.

However, there is no independent corroboration of her activities pre-Crimea, either in Jamaica or Panama.

The chief myths

• volunteered as a nurse for the Crimean War, rejected (1-4 times), rejected specifically by Nightingale (1-4 times)
• Crimean War nurse, built a hotel, or clinic (or hotel with a clinic on top) to nurse soldiers (frequent mentions)
• more “hands on” experience than Nightingale (“the young novice nurse”)
• successful healer, developed medicines to treat cholera and yellow fever (without claims of success, but acknowledgment of blunders)
• nursed on the battlefield, under fire (many mentions)
• medal winner, 1-5 medals (numerous mentions)
• her reputation rivalled that of Nightingale’s, but then forgotten (Times coverage shows 10 – 1 items for Nightingale compared with Seacole)
• a founder of the nursing profession, contributor to health care system in England: the first example of someone from overseas who made an overwhelming difference to health care in the U.K. (NHS Northwest, “Mary Seacole: The Ultimate Role Model”).
• first black woman to write an autobiography (this was Mary Prince, three decades earlier)
• Inaugural writer in African-American literature

What primary sources say:

Seacole’s own memoir is the major source for refutation of the myths. After brief coverage of her origins and her mother’s boarding house in Kingston, she describes her travels (none for nursing), her business in Panama (3 chapters on it), her trip to London to attend to her gold investments, then her attempts to get a post as nurse (after the others had all left). She gave 3 chapters to her business in the Crimea, with much material on the food and drink she served, her elite customers (including Omar Pasha). Ordinary soldiers could come to purchase her medicines, but otherwise get only one mention “a canteen for the soldiery” (soldiers and officers did not mix socially).

On the battlefield: Seacole described her going out on battle days, three of them (she missed the first three, major battles). She claimed to have been the first woman to get into Sebastopol after the Russians left (not to nurse, it was an expedition of friends). Her business did well over the winter, as the fighting was over. She and her business partner over-stocked, and then could not sell their goods. No complaints!

Far from claims of successful treatment for cholera and yellow fever, Seacole describes “lamentable blunders” on her cholera remedies (she added lead and mercury) and no successes on yellow fever (when she bravely stayed up all night with the sufferers).

Primary sources: The Times

1855: Announcement of her business: “Inter alia, we are to have a hotel at Balaclava. It is to be conducted by Mrs Seacole, late of Jamaica. I suppose the lady calculates on a liberal share of the patronage when the excursion visitors come out to the siege in the summer” (9 March 1855, 9).

Her catering at a horse race: “[she] presided over a sorely invested tentfull of creature comforts” (17 December 1855, 7).

1856: Fund-raising events for Seacole: “whose appearance awakened the most rapturous enthusiasm. The soldiers not only cheered her, but chaired her around the gardens” (26 August 1856, 7).

Portsmouth event: “The soldiers will be gratified to hear that the father of Miss Nightingale has given a handsome donation to the fund and a hamper of game for their entertainment” (15 September 1856, 15.

Bankruptcy court: ”Mrs Seacole is a lady of colour and has been honoured with four Government medals for her kindness to the British soldiery. She was present in person and attracted much attention, the gaily coloured decorations on her breast being in perfect harmony with the rest of her attire” (7 November 1856, 9).

Letter-to-the-editor on her bankruptcy: commends her for “acts of benevolence which were characteristic of Mrs Seacole in her capacity of vivandiere of the British Army in the Crimea” (24 November 1856, 8).

Lord Rokeby letter-to-the-editor on a subscription for Seacole when she got her certificate from Court of Bankruptcy “to enable her to recommence the business to which she is accustomed” (25 November 1856, 6).

Seacole’s letter to Rokeby in appreciation (29 November 1856, 12).

“A Stir for Seacole” Punch cartoon of her (3 December 1856, 4).

1857: “Bankruptcy. Seacole and Day” (8 January 1857, 11).

“The bankrupts were provision merchants and proprietors of stores at Balaclava” (31 January 1857, 11).

Letter-to-the-editor by Thomas Day, her business partner: “The principal causes of the bankruptcy…were losses by the elements and by robbery and the depreciation of stock-in-trade and buildings subsequent on the unexpectedly rapid evacuation of the Crimea on the conclusion of the war” (14 April 1857 7).

“Seacole Fund” list of patrons (13 June 1857, 9).

“Seacole Fund” list of donors (1 July 1857, 9).

“Seacole Fund” Tickets for Surrey Gardens event (24 July 1857, 1).

“Festival at the Royal Surrey Gardens”: “Mrs Seacole sat in state in front of the centre gallery, supported by Lord Rokeby on one side, by Lord George Paget on the other, and surrounded by the members of her committee….[she was] the first to give a new character to the trade of sutler and rescue it from the imputation of worthlessness and plunder” (28 July 1857, 10).

Failure of the fundraising to provide much money (27 August 1857 8).

“City of London Theatre”: “an actress played Mrs Seacole as vivandière…and freely handed glasses of cordial about” (28 December 1857, 9).

1859: “Military and Naval Intelligence”: “Mrs Seacole, of Crimean celebrity, visited several of the military and naval heroes doing duty at Sheerness on Friday and Saturday last. She received a hearty and kind welcome from the garrison officers whose quarters she made her home during her stay. She purposes in a few days paying a visit to the officers of the navy, many of whom now in part partook of her creature comforts while in the Crimea” (1 February 1859, 10).

Her return to Jamaica: Royal Mail steamer Shannon listed “Mrs Seacole, and seven Sisters of Charity”(18 October 1859, 6).

1865: Seacole arrives at Southampton from Jamaica on the Atrato (14 October 1865, 10).

1866: “Mansion House Cholera Relief Fund” lists donation by her, 100 bottles of anti-cholera medicine and 100 boxes of pills” (31 August 1866, 6).

1867: New Seacole Fund Formed “a Committee to carry out a scheme to ensure for Mrs Seacole, in her declining years, the means of obtaining remunerative employment,” lists patrons and donations (30 January 1867, 5).

“The Jamaica Prosecutions” Mrs Seacole in court, she sat “behind the witness box” (30 January 1867, 5).

“portrait of Mrs Seacole” on sale by auction (29 March 1867, 16).

“The Wandering Thespians” A performance in aid of Seacole Fund,” lists patrons (18 July 1867, 8).

1869: Review of a book, Letters from the Levant, “past the scenes of the Balaclava charges and the heaps of broken bottles by Mrs Seacole’s store” (3 May 1869).

1871: Miniature bust of the famous Mrs Seacole adorned with her Crimean medals at studio (21 July 1871, 4).

1881: “Obituary” (21 May 1881, 7).

Legal notice to creditors “Mary Seacole deceased” (21 July 1881, 14).

Mentions in other newspapers

1856: Installation of Order of the Bath, Balaclava, Seacole attended (Daily News 7 June 1856).

1858: “Promotion of Mrs Seacole” she “arrived yesterday at Antwerp having on board Lady Seacole who has been decorated with the order of the Legion of Honour, the English Crimean medal and the Medjidie. This lady was the companion of the celebrated Miss Nightingale who had gone to the East during the war in the Crimea to carry aid and consolation to the wounded and dying. On the arrival of the vessel, Lady Seacole was adorned with all her decorations” (Morning Chronicle 17 June 1858).

1862: “Mrs Seacole, the famous Crimean camp follower, is now living at Panama” (Sheffield & Rotherham Independent 18 April 1862, 3).

Seacole’s will: Her estate was valued at £2500 total, including two houses; in addition to money bequests, she left such household items as a bedstead, bedding, furniture, linen sheets, calico sheets, counterpane, her watch, her husband’s ring, other jewellery, trinkets and ornaments, pictures, prints, engravings, plate and china, but no medals or letters (Probate Office, will of Mary Seacole, 11 July 1881).

Mentions in published memoirs, letters, etc., of officers

Chef Alexis Soyer on meeting her: “God bless you my son, are you Monsieur Soyer of whom I heard so much in Jamaica? Well, to be sure! I have sold many and many a score of your British and other sauces–God knows how many” …Come down, my son, and take a glass of champagne with my old friend, Sir John Campbell….No sooner had we entered than the old lady expressed her desire to consult me about what she should do to make money in her new speculation” (Soyer, Soyer’s Culinary Campaign, 231-33).

“She had a store at Kadikoi, near Balaclava, gave hot tea to soldiers waiting to board ship “out of the goodness of her heart and at her own expense” (V. Bonham-Carter, ed. Surgeon in the Crimea, 157).

“she had wisely pitched her tent equally close to it on the opposite side or the line being used for the transport of goods and material from the port to the front….Mrs Seacole kept a perfect Omnibus Shop, which was greatly frequented.” Also, she “freely giving to such as could not pay” (Lady Alicia Blackwood, Narrative of Personal Experiences and Impressions during a Residence on the Bosphorus throughout the Crimean War, 262).

Met the “very well known… Mrs Seacole, who lived near the railway below Kadikoi and kept a sort of general store. She was a wonderful woman, a native of the West Indies and had travelled over half the world. All the men swore by her, and in case of any malady would seek her advice and use her herbal medicines” (Vieth, Recollections of the Crimean Campaign, 73).

Seacole “kept a store at Kadikoi, two or three miles from British headquarter, where, in an emergency, one could obtain some kind of a meal” (Buzzard, With the Turkish Army in the Crimea and Asia Minor, 179).

“The officers were to keep the men in sight the whole time, and not to refresh themselves at Mrs Seacole’s store” (Pollock, United Service Magazine, 1857, 360).

“On the afternoon of the 16th of June, when returning from a ride to Balaclava, we stopped at a store kept by an old black woman, whom we used to call Mother Seacole, and bought some bottled fruit, which we laughingly agreed should be kept for the survivors of the assault” (Wood, The Crimea in 1854 and 1894, 294).

Saw Mrs Seacole “an elderly mulatto woman from Jamaica, was a well-known character in the Crimea, all the soldiers and sailors knew her. She had a taste for nursing and doctoring, but she added to this a business as a sutler” (Eyre-Todd, ed. The Autobiography of William Simpson, 57).

She was spotted in Panama by a traveller: “we saw the sunny face of Mrs Seacole of Crimean renown, gadding about with naval officers on leave from the frigate Orlando” (‘A Trip to Vancouver Island,’ United Service Magazine, No [July 1863]:383).

Seacole was decidedly a celebrity, did press mentions of her are not about nursing or health care, but fund raising for her post-Crimea and her travels. Nightingale’s coverage was on substantive matters, from her Crimean War work, the reports on it afterwards, the founding of her school, publication of her Notes on Nursing, agitation for social reforms, in the Poor Law, the establishment of district nursing and the extension of nursing to other countries, her Notes on Hospitals and its application in many places.

Secondary sources propagating the myths

Nursing journals

• Nursing Standard (numerous)
• Nursing Times (numerous)
• British Journal of Nursing (several, 2011, 2015, 2018)
• British Journal of Healthcare Assistants, 2010
• British Journal of Perioperative Nursing, 2005
• Journal of Advanced Nursing, 1984, 1999, 2015
• American Journal of Nursing, 1984, 2016
• Journal of Nursing Management, 2010 (she “far outdid Nightingale’s experience of hands on nursing”) Nursing Mirror, 1983
• Reflections (Sigma Theta Tau International), 1996
• Nursing History Review, 1998
• Contemporary Nurse, 2007
• Journal of Orthopaedic Nursing
• Christian Nurse International, 1996
• Paediatric Nursing, 2008
• Clinical Excellence for Nurse Practitioners, 1998
• “Mary Seacole Exhibition,” British Journal of Perioperative Nursing, 2005: re her “caring for the military garrison at Kingston” responded to the same call to go to the Crimean War as Nightingale.
• Santy and Knight, “Nurses in War,” Journal of Orthopaedic Nursing, 2008: “While Florence Nightingale, it could be argued, was more of a nurse administrator, Mary Seacole was a true trauma nurse”.

Medical journals

• Mathiasen, “Black Nurse, White Nurse: Heroines and the Horrors of the Crimean War,” American Journal of Cardiology, 2010.
• Scottish Medical Journal, 2011 (Short, “Mary Seacole: Forgotten Hero?”); her store had “desperately needed equipment, mackintoshes, greatcoats, boots, caps, linen, bedding”; in her clinics “she treated frostbite in winter, heatstroke in summer, typhus, scurvy, malnutrition, cholera and the ubiquitous dysentery.”
• Ellis, “Mary Seacole: Self-Taught Nurse and Heroine of the Crimean War,” Journal of Perioperative Practice, 2009: (in Kingston, many of her residents were disabled British soldiers and sailors; in Panama epidemic, her therapy comprised tender loving care, mustard poultices, calomel; she helped organise the nursing at Kingston hospital during a severe outbreak of yellow fever).

Military journals

• Military History. “Women at War” 2016: “Jamaican caretaker of the wounded at Balaclava”

Other journals

• Philological Quarterly, 1997, 2004
• Jamaican Historical Review, 1991, 2006
• History Today, 1981, 2005
• New Yorker, 2001
• Feminist Studies, 1994
• African American Review, 1992
• Victorian Literature and Culture
• History Compass, 2007
• Women’s Studies, 1997
• Ariel: A Review of International English Literature, 2008
• Journal of Women in Educational Leadership, 2005.
• Harmer, “Women in History–Mary Seacole”: invited to assume the supervision of Nursing Services at the Kingston headquarters of the British Army; “Reading reports of the tremendous number of deaths due to cholera and dysentery, Seacole was certain she could be of service. Using her own funds, she crossed the Atlantic to offer her assistance. Seacole’s request to join the campaign in Crimea were refused by Br officials on four separate occasions, including once by the young novice nurse who had been appointed to head the nursing services in the Crimea–Florence Nightingale.”

Nursing textbooks

• Pharris, et al,, eds. Transforming Nursing Education: The Culturally Inclusive Environment, 2009
• Mortimer and McGann. New Directions in the History of Nursing: International Perspectives, 2005
• Williamson et al., Contexts of Contemporary Nursing, 2010
• Hill and Howlett, Success in Practical/Vocational Nursing, 2013
• Polifko Harris, Practice Environment of Nursing: Issues and Trends, 2009
• Cherry and Jacob, Contemporary Nursing: Issues, Trends and Management, 1999-2017 (subsequently omitted, 2019)
• McAllister and Lowe, eds. The Resilient Nurse: Empowering Your Practice, 2011
• Peate, et al., Nursing Practice: Knowledge and Care, 2014
• Peate, Nursing Care and the Activities of Living, 2009
• Klainberg, et al., Today’s Nursing Leader: Managing, Succeeding, Excelling, 2010. (Pre-Crimea, she traveled to Cuba and Panama and worked during cholera and yellow fever, yet refused an interview because of her race and ethnicity, funded her own trip to the Crimea, brought supplies, established a hospital and respite home for wounded and fatigued soldiers in Balaclava)

Encyclopedias

Encyclopedia Britannica

(academic ed.), 2014
• Orlando: Women’s Writing in the British Isles from the Beginnings to the Present, 2006
• Africana: The Encyclopedia of the African and African-American Experience, 1999
• Andrews, et al. eds. Oxford Companion to African and American Literature, 1997
• Historical Encyclopedia of Nursing, 1999
• Dictionary of Caribbean and Afro-Latin American Biography
• Biographies of Jamaican Personalities
• Oxford Companion to Black British History
• Encyclopedia of African-American Culture and History
• Encyclopedia of African American Women Writers
• Third World Women’s Literatures: A Dictionary and Guide to Materials in English, 1995
• Fister, “The Wonderful Adventures of Mrs Seacole in Many Lands.”: in the war, “her contribution was in many ways as notable as that of Florence Nightingale”)
• Dictionary of Medical Biography, 2007
• Reeves. “Seacole, Mary Jane,” (went to war after Britain declared war, refused).
• The Macmillan Dictionary of Women’s Biography, 1998 (“She used her nursing skills more directly than did Florence Nightingale, whom she met several times” “tended wounds on the battlefields under gunfire”)
• Women in Medicine: An Encyclopedia (Served with the British in the Crimean War, “made a significant contribution to the war effort”)

Doctoral Dissertations: (up to 2014): 21 American, 3 British, 1 each Canada, Poland and Netherlands

Children’s books: (14 at least)

National institutions

• Department of Health
• NHS and NHS Employers
• NHS Leadership Academy
• Unions: Unison and RCN
• BBC (2 films, websites); “Horrible Histories”
• Channel Four
• National Portrait Gallery
• National Science Museum
• National Army Museum
• Department of Education
• OCR (Oxford, Cambridge, Royal Society of Arts) examinations

The National Army Museum currently has a (free) programme on for children. It previously had a greatly fallacious description of Seacole on its website: “Civilian supplier of food/medical care to British Expeditionary Forces.” lists 3 medals.

NHS Leadership Academy: On the 70th anniversary of the founding of the NHS, a senior official published a list of the “great leaders of nursing,” topped by Mary Seacole. She gave not one example of nursing leadership by Seacole, but repeated the fallacious statement that Seacole was twice turned down by the British government to go to the Crimean War, got there herself and cared for the “wounded and sick” (Price-Dowd, “The changing face of nursing: from the pioneers to the future of leadership,” British Journal of Nursing, 2018).

African-American Nurse and Author: Seacole “the Black British nurse whose fame equalled Florence Nightingale in the mid nineteenth century; she is one of the inaugural writers in a burgeoning African-American literary canon” (Salih, “‘A Gallant Heart to the Empire.’ Autoethnography and Imperial Identity in Mary Seacole’s Wonderful Adventures.” Philological Quarterly 83,2 (spring 2004).

Military histories

• Royle, Trevor. Crimea: The Great Crimean War 1854-1856, 2000
• Ponting, Clive. The Crimean War: The Truth behind the Myth, 2004
• McLoughlin, Authoring War: The Literary Representation of War from the Iliad, 2011.
• Donald, Loose Cannons: 101 Myths, Mishaps and Misadventures of Military History, 2009.
• Figes, Crimea: The Last Crusade, 2010: “At the start of the Crimean War she travelled to England and attempted to get herself recruited as a nurse with Florence Nightingale, but she was rejected several times, no doubt partly because of the colour of her skin.”

General histories

• Wilson, A.N. The Victorians, 2002 Schama, A History of Britain, 2002: “another heroine of the Crimea whose work was unknown”; “If you had been sick or wounded and managed to get taken to her ‘British Hotel,’ you stood a decent chance of surviving. It was not so at Scutari.”

Back-up Quotations (from The Wonderful Adventures of Mrs. Seacole in Many Lands)

Intention to open a “British Hotel” as “a mess table and comfortable quarters for sick and convalescent officers” (WA 81), but became instead a restaurant, store, takeaway, catering services. For ordinary soldiers: “a canteen for the soldiery” (WA 114)

On cholera: “I have no doubt that at first I made some lamentable blunders, and, may be, lost patients which a little later I could have saved.” “One stubborn attack succumbed to an additional dose of ten grains of sugar of lead, mixed in a pint of water, given in doses of a tablespoonful every quarter of an hour.” By then, reviewing her “cholera medicines” made her “shudder” (31).

Yellow fever: “The groans of the sufferers and the anxiety and fear of their comrades were so painful to hear and witness…. I found the worst cases sinking fast, one of the others had relapsed, while fear had paralysed the efforts of the rest. ….At last I restored some order and, with the help of the bravest of the women, fixed up rude screens around the dying men. But no screens could shut out from the others their awful groans and cries for the aid that no mortal power could give them. So the long night passed away; first a deathlike stillness behind one screen, and then a sudden silence behind the other, showing that the fierce battle with death was over, and who had been the victor” (28-29).

In her kitchen: “The officers, full of fun and high spirits, used to crowd into the little kitchen…would carry off the tarts hot from the oven, while the good-for-nothing black cooks…would stand by and laugh with all their teeth.” (WA 140-41).

Battlefield: “My first experience of battle was pleasant enough…. one fine morning they [Omar Pasha and Turks] were marched away towards the Russian outposts on the road to Baidar. I accompanied them on horseback, and enjoyed the sight amazingly” (WA 146-47).

After the fighting: “Pleasure was hunted keenly. Cricket matches, picnics, dinner parties, races, theatrics, all found their admirers. My restaurant was always full, and once more merry laughter was heard and many a dinner party was held beneath the iron roof of the British Hotel. Several were given in compliment to our allies, and many distinguished Frenchmen have tested my powers of cooking” (WA, 178)

For New Year’s Day, 1856, Seacole made plum puddings and mince pies for the Land Transport Corps Hospital (WA, 187).

References on Seacole

Biography: The best is Jane Robinson, Mary Seacole: The Black Woman Who Invented Modern Nursing, 2004.

For a refutation of the myths see Lynn McDonald, Mary Seacole: The Making of the Myth (Toronto: Iguana 2014). Website: www.maryseacole.info/

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Kofoworola Abeni Pratt

In our April lecture at King’s College, we introduced the Nigerian-born Mrs “Rola” Pratt — who began her nurse training at the Nightingale School in 1946 — as the first black nurse in the NHS, when it was launched in 1948.

by Lynn McDonald, for the Nightingale Society

Women’s Rights: Given the great disabilities women suffered, as women, in Victorian society, it will come as no surprise that Nightingale was a keen supporter of women’s rights, in education, political life, employment and the professions.

The Vote: Nightingale was an advocate for the vote for women, signed the petitions, paid her dues, but did not make suffrage a major concern, in terms of time commitments. She did not join the executive of any suffrage organization, but did write a pamphlet for the cause. Suffrage organizations, in fact, had excellent leaders (one was a cousin of Nightingale’s, Barbara Bodichon, who also worked on education and employment for women). Nightingale, instead, gave her time to establishing a well-paying profession for women and safer childbirth. A midwifery nursing training school was the second project of the Nightingale Fund, based at King’s College Hospital.

The Contagious Diseases Acts: This legislation was aimed at reducing syphilis in the army and navy, by targeting women suspected of being prostitutes for inspection and compulsory treatment in “lock hospitals.” The men? Not a concern. Nightingale’s opposition probably delayed the passing of the first act, in 1862. She next led the opposition to it, documenting the lack of effect in reducing syphilis, and protesting its unfairness to women.

The acts (two more were adopted to strengthen the measures) were repealed on only in 1886. Harriet Martineau was the next leader after Nightingale, then Josephine Butler took over (Nightingale assisted behind the scenes).

Men in Nursing: It is commonly said that Nightingale opposed the entry of men into nursing, and/or thought they could not be good nurses, but neither is accurate. Her training school took only women, but that was for practical reasons. At that time, women were not allowed in ANY profession—medicine, law, clergy, architecture, engineering, accounting, the armed forces, or civil service. They were not admitted into any university; nor could they sit in Parliament or hold any municipal office.

Nightingale never thought that being a woman was in any way a qualification for nursing—training and ongoing experience were. She knew men she considered to be good nurses. The famous Colonel Gordon, “Gordon of Khartoum” after his assassination there, is a prime example. Gordon told her that he won his men to him because of his care for them when sick or wounded, and continually visiting the hospitals. Nightingale considered that his “love for the sick made him of the same profession as I.” She was in touch with men who gave (untrained) nursing services to relatives, and complimented them on their skills of observation.

Nightingale also believed that army and navy nursing would have to be done by men, and wanted them to have better training, working conditions, and supervision.

In today’s circumstances, with women able to join (almost) every profession, and with nearly all occupations open to women as well as men, the situation is very different. Certainly Nightingale had no principled opposition to men in nursing.

Women in Medicine: Nightingale’s priority, of course, was the creation of the nursing profession, not medicine. She did give support to early women medical doctors, notably Elizabeth Blackwell, the first woman to qualify as a doctor (Blackwell credited Nightingale with acquainting her with sanitary issues). However, Nightingale did not believe that the entry of women into medicine would in any way improve or change the practice of medicine.

Women in India: Indian women, Hindu and Muslim, did not allow a man to see or touch their bodies; hence, many died untreated, or after treatment by an untrained woman. Queen Victoria took leadership on this issue, commissioning Lady Dufferin, vicereine of India, to organize the provision of medical aid for women in India. Nightingale gave considerable assistance in this work, also in the establishment of hospitals for women.

She well aware, also, of the terrible burden Hindu women, especially women of high caste, suffered. A widow, even a child whose marriage was never consummated, was held morally responsible for the husband’s death. She was to atone for it by fasting (a diet of cold rice and water), giving up her jewellery and fine clothes, and leading a life of seclusion. Nightingale supported Indian nationals who opposed child marriage, but the problem remained. A complication: many leaders in the India independence movement supported child marriage.

Nightingale supported the opposition to enforced consummation of marriage by Rukhmabai, an Indian whose husband sued her for her refusal. Ironically, although the initial provision was Hindu, British law was available to men to coerce a wife who refused to comply. Rukhmabai later trained in medicine in England and practised for years in India.

by Lynn McDonald, for the Nightingale Society

Nightingale was a pioneer not only of nurse training but health promotion, disease prevention and hospital safety. The bold ideas she set out in Notes on Nursing, Notes on Hospitals and later writings influenced health care policy in the U.K. and indeed throughout the world. Herewith some examples:

Integrating health promotion and disease prevention with treatment: Nightingale called for this in her 1860 Notes on Nursing. The principle was finally enshrined, years later, in the National Health Service Act of 1946. It called for a comprehensive health service, to “secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness.”

Access to health care for the poor: Nightingale was the first person, in 1866, to call for quality hospital care for all, specifically that workhouse infirmaries, the only recourse for 80% of the population, should provide as good care as the best hospitals in the suburbs (workhouses were not in the suburbs). Governments, with Nightingale prodding, made piecemeal improvements over many years. The National Health Service Act of 1946 set up the comprehensive, single-payer system. Canada’s medicare system was based on the British model.

An independent, centrally administered system. Nightingale saw the importance of removing the stigma of “the workhouse.” In 1866, she called for removing the workhouse infirmaries from the Poor Law, to manage them centrally, under Parliament, paid for by tax money. The legislation adopted in the U.K. in 1867, the Metropolitan Poor Bill, was only permissive: it made it possible for workhouse infirmaries to make improvements, even start a nursing school, but it did not require them to, which Nightingale wanted.

The Nightingale School: Improvements were made gradually in the old workhouse infirmaries, thanks to the School providing teams of rained nurses with a matron. The Metropolitan Asylums Board established state-run hospitals without the name “workhouse.” The Poor Law Board was renamed the Local Government Board.

Abolition of the Poor Law: Nightingale, in 1866, called for the end of the harsh provisions of the Poor Law itself, for the aged, disabled, mentally ill and children, in favour of agencies to provide care instead. The National Assistance Act, 1948, did this in Section I: “The existing Poor Law shall cease to have effect.”

Health as a Human Right: Nightingale never used “rights” language, but rather stressed the obligation to provide quality health care services. Using her knowledge of statistics, she showed that this was doable–statistics to save lives. As countries increasingly made health care accessible to all, the idea of health as a “right” took hold.

The World Health Organization: The WHO Constitution was adopted in 1946. It makes “the highest attainable standard of health as one of the fundamental rights of every human being, without distinction of religion, political belief, economic or social condition.” This came into force in 1948.

Disease prevention and health care-acquired infections. As early as her 1860 Notes on Nursing, Nightingale explained the importance of handwashing: “Every nurse ought to be careful to wash her hands very frequently during the day. If her face, too, so much the better.” Details followed, the specifics becoming more stringent as knowledge increased.

Handwashing is now recognized as the primary means of avoiding cross-infection. Said Dr. A. Gawande, “Proper hand hygiene is the primary method for reducing infections” (“Notes of a Surgeon: On Washing Hands,” New England Journal of Medicine, 2004). So says the WHO: “Health-care associated infection is a major problem for patient safety and its surveillance and prevention must be a first priority” (World Alliance for Patient Safety, WHO Guidelines on hand hygiene in health care, 2009).

Celebrating the 2020 Nightingale Bicentenary: Nightingale’s far-seeing vision and solid understanding of health concerns are among the many reasons to celebrate her Bicentenary, 2020, also designated (not a coincidence!) The Year of the Nurse. The Nightingale Society invites nursing, medical and health care faculties and other organizations to feature Nightingale’s groundbreaking work–not as a nod to the past, but inspiration for the future. We encourage the establishment of annual Nightingale lectures, for example, on evidence-based health care, innovation (and its assessment!) in nursing and health care.

Nightingale had a way with words. Here are some fine examples:

On heath and healing

“It is Nature that cures, not the physician or nurse” (“Nursing the sick,” 1883)

“It is much cheaper to promote health than to maintain people in sickness” (Health and Local Government, 1894).

“To make the people’s dwellings fit for sick, or rather such as will not make sickness…is of course our first duty” (1872).

On nursing

“The physician prescribes for supplying the vital force, but the nurse supplies it” (“Sick nursing and health nursing,” 1893).

“A nurse must not be a scrubber. And a scrubber cannot be a nurse” (Notes on Hospitals, 1863).

On hospitals

“In building or extending a hospital, it is to be taken for granted that the object in view is to benefit and not injure the sick” (1859).

“Let us reform our hospitals now, and as we improve our cities and towns, they will be less required.” (‘Hospital construction: wards,’ The Builder, 1858).

“I know no class of murderers who have killed so many people as hospital architects” (letter, 1877).

“It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm” (Preface, Notes on Hospitals, 1863).

On child care and pediatric nursing

“Children require the most observing and best nursing because they cannot tell you what they feel…. Love for children is a necessity in a children’s ward….They must be either ‘those dear little souls’ or ‘those tiresome dirty things’” (address to nurses, 1897).

“keep no child an hour longer in hospital than is positively needful” (undated note, Add Mss 45820 f112).

“No child can be well who is not bright and merry and brought up in fresh air and sunshine and surrounded by love—the sunshine of the soul” (Rural Hygiene, 1894).

On infant care

“The life duration of babies is the most delicate test of health conditions” (“Sick-Nursing and Heath-nursing,” 1893).

Nightingale’s ideas used by the World Health Organization

Her definition of health, 1883: “Health is not only to be well, but to be able to use well every power we have to use” (“Nursing the Sick,” Quain, Dictionary of Medicine).

World Health Organization, 1948: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

Nightingale’s advice on handwashing, 1860: “Every nurse ought to be careful to wash her hands very frequently during the day. If her face, too, so much the better” (Notes on Nursing, “Personal Cleanliness”).

World Health Organization, 2009: “Hand hygiene is the primary measure to reduce infections” (World Alliance for Patient Safety. WHO Guidelines on hand hygiene in health care).

On unreformed nursing

“The cardinal sin of paid nurses, of all classes, of all nations, is taking petty bribes and making petty advantages (of many different sorts and sizes) out of the patients” (Notes on Hospitals, 186).

“Doctors little knew how nurses hoodwinked them: the bad woman, the clever nurse, must be a idiot if she cannot hoodwink the doctor” (letter 17 March 1879).

God

“God is to have a church or chapel to Himself, but He is to have nothing to do with political economy or with government administration or House of Commons legislation. Most curious of all, He is to have nothing to do with fighting and bloodshed and murder, by wholesale, in war” (from an unpublished essay).

“It is not His will for people to have cholera, or rather it is His will for people to learn how to prevent cholera for themselves” (unpublished note).

“Can God have created this world merely to forgive it?” (unpublished essay).

Activism

From an interview with a hospital philanthropist in 1897:
“She warned me against ever being discouraged by the snubs of government officials: “Keep what you know is right before you, and never cease trying to get it. Aim high and people will follow you in the end.”

“No, no, no one can be neutral in this life; you are either doing good or bad, and the very fact of not trying to do good is bad in itself” (Sydney Holland, In Black and White, 154).

Nightingale was the major founder of the modern profession of nursing, a health care pioneer, originally famous for leading the first team of British women to nurse in war, the Crimean War of 1854-56.

The Bicentenary of her birth (May 12, 1820) will be celebrated in 2020, we hope not just during Nursing Week, but throughout the year, with a new look at her key ideas and their relevance today.

While Nightingale was well known in her lifetime, and for a long time after it, she is now often mis-represented. Her best-known book, Notes on Nursing, came out in 1860, the same year that her training school opened. She wrote many books and reports, on nursing, hospital safety, and health care more broadly.

She is also a major pioneer of evidence-based health care. She was instrumental in getting professional nursing into the workhouse infirmaries, the first step towards their becoming regular hospitals. The National Health Service could hardly have begun operations in 1948 without the great improvements made in the old workhouses, when 80% of hospital patients went to them. Nightingale believed in quality care for all, regardless of ability to pay.

She was instrumental in making nursing an attractive, well-paid career, when “nurses” had been disreputable hospital employees, mainly cleaners, and often drunk. However, she considered that the “cardinal sin” of unreformed nursing was demanding bribes from patients. She worked mightily also for improved hospital safety, for nurses, doctors and patients.

“A nurse must not be a scrubber. And a scrubber cannot be a nurse” (Nightingale, Notes on Hospitals).

Scotland: Nightingale knew it from travels as a child and young person. In 1856, after her return from the Crimean War, she was invited to Balmoral Castle to meet with Queen Victoria, Prince Albert and the war minister, Lord Panmure. Panmure commissioned her to write a report on the war hospitals, and what went wrong (they had very high death rates, which were brought down). She was in touch with leading Scottish doctors and was instrumental in founding nurse training in Scotland.

Collaborators in research and policy. Two of Nightingale’s closest allies were Scottish-trained doctors sent to the Crimean War to clean up the hospitals: Dr. John Sutherland, head of the Sanitary Commission, and Sir John McNeill, head of the Supply Commission. Post-Crimea, Dr. Sutherland became, in effect, her research associate, providing medical information and drafting material for her.

Edinburgh surgeon James Syme was a pioneer in the use of chloroform, probably Nightingale’s source for the supplies she took to the Crimean War.

She corresponded with Sir James Y. Simpson on “hospitalism,” or health care-acquired infections. Edinburgh nutrition expert, Sir Robert Christison was her collaborator in improving food in the army.

Edinburgh Royal Infirmary: This large and famous hospital, with its highly regarded medical school, was notorious for sanitary defects and disreputable “nurses.” It was a “beastly den of thieves.” This changed when a new director was appointed: C.H. Fasson, who had practiced in army hospitals, both without and with trained nurses. He asked Nightingale to get them trained nurses, which she did. They started in late 1872.

It became, in effect, a second “Nightingale school,” and, as the first, in London, sent out trained nurses and matrons to introduce professional nursing elsewhere. Angelique-Lucille Pringle, its second trained matron, led the nursing there from 1873 to 1887, when she accepted appointment as matron at St. Thomas’ Hospital, London.

In 1879, its new, pavilion-style, building was opened, with excellent ventilation, 2300 to 2500 cubic feet per bed. It remained in operation until 2002. Late in her life, Nightingale called the Edinburgh Royal Infirmary “the best hospital” in the United Kingdom, both for nursing and organization. She regularly sent doctors and nurses visiting from other countries to see it.

Glasgow Royal Infirmary. Professional nursing was started there by Rebecca Strong, a “Nightingale nurse,” meaning one who trained at the Nightingale School at St. Thomas’. Nightingale was not as involved with the Glasgow infirmary as she had been with Edinburgh, but she is recognized there with a fine marble statue in the vestibule, next to a bronze relief of Joseph Lister (who pioneered antiseptic surgery there) and Rebecca Strong, the first trained matron. Strong earlier had been the first trained matron at the Royal Dundee Infirmary.

by Lynn McDonald, for the Nightingale Society

Florence Nightingale (1820-1910) is well known as the founder of the modern profession of nursing—her training school, the first in the world, opened in 1860. She was already famous then as the heroine of the Crimean War (1854-56), leader of the first team of British nurses to nurse in war.

What she did for the United States is now little known, but she was famous there in her lifetime—the Crimean War and her own work were well covered by the press. Poet Henry Wadsworth Longfellow celebrated her in a poem, “Santa Filomena”:

Lo, in that house of misery
A lady with a lamp I see
Pass through the glimmering gloom
And flit from room to room.

Her example inspired women to volunteer, on both sides, to nurse in the American Civil War.

In 1860, Nightingale published her most famous book, Notes on Nursing, which was promptly re-published in the U.S., and serialized in the Saturday Evening Post. She had begun publishing on hospital reform in 1858, to bring out a full book-length account, Notes on Hospitals, in 1863. They were used by both the Northern and the Confederate Armies during the Civil War. Her hospital forms were sent to the Northern Army—she thought that if they had been better used, the death rate would have been lower. The largest Confederate hospital, Chimborazo, outside Richmond, VA, the capital of the confederacy, was built on her principles—huts with good ventilation and well spaced.

While many women nursed during the Civil War, this did not lead to the founding of a nursing school or profession, as Crimean War nursing had in England. In 1872, Nightingale was approached for advice by a doctor at the Bellevue Hospital, New York—a committee had condemned the hospital for its numerous defects. She worked out a detailed plan for how to set up a school and introduce trained nursing into the hospital. The first three schools in the U.S. opened around 1873, all based on her principles, but not her nurses: the New York Training School, at Bellevue; the New England Hospital for Women and Children Training School in New Haven, Conn., and the Boston Training School at Massachusetts General Hospital.

Roman Catholic nuns had been giving nursing services before the Civil War, and had founded many hospitals, but they did not require nurse training or found training schools until late in the 19th century.

Hospital Design: Nightingale was an advocate of the “pavilion” model of hospital design, as a means to minimize cross-infection. She gave extensive advice on the design of Johns Hopkins University hospital, which opened in 1879.

Cholera: In 1883, when a cholera epidemic was expected, Nightingale was approached for advice by the New York Herald. She produced “Scavenge! Scavenge! Scavenge!” which urged vigorous clean-up measures. Her advice was repeated in British newspapers and American and British public health journals. It was revived in 1892 when another cholera epidemic was expected.

Advances in Nursing: Nightingale was asked to send a paper to the world congress on charities held in Chicago in 1893. Her “Sick-nursing and Health-nursing” was an important statement on the state of nursing in the early 1890s, or 30 years after her school opened and Notes on Nursing appeared. It shows how much the technical requirements of nursing had advanced. It also shows continuity on the core principle of environmental influences on health: air and water quality, ventilation, hygiene, nutrition. The paper gives Nightingale’s much-cited, definition of health as “not only to be well, but to be able to use well every power we have.”

That paper also continues Nightingale’s theme that the goal for both “sick” nursing and “heath” nursing is “to put us in the best possible conditions for Nature to restore or to preserve health. The congress also facilitated nursing organization—meetings held at it led to the formation of the American Nurses Association. Also in 1893, the New Jersey Training School for Nurses awarded Nightingale its first degree in nursing, MSN.

Universal Access to Health Care: Nightingale did not play any role in the United States in debates over who should pay for health care and what role government should play. She did in her own country, and this influenced policy elsewhere. As early as 1866, she set out as a goal that the poorest sick should have access to quality care, as good as in the best civil hospitals in the suburbs. She did much to improve access in the transformation of the dreaded workhouse infirmaries into real hospitals—getting them professional nurses and (for some) a training school, and a well-designed building.

The single-payer system for hospital and medical care in the U.K. dates to 1948, when the National Health Service came into effect. The Poor Law itself, the foundation of the old workhouse system, was also abolished then—Nightingale had advocated its effective end in 1866.

Some further connections between Nightingale and the U.S.A.

The faith connection: Nightingale’s nursing was based on a “call to service,” which she believed to have come from God. That call, in turn, followed from an earlier sense of conversion, or commitment, influenced by a book by an American minister and educator, Jacob Abbott, The Corner-stone, “the book that converted me in 1836,” as she described it to a friend late in life.

Nightingale Nurses in the United States: “Nightingale nurses,” meaning those trained at the Nightingale School in London, were important in starting professional nursing in the U.S. and training schools for it. Alice Fisher did this in 1885 at the Blockley Hospital, Philadelphia (later the Philadelphia General Hospital). Louisa Parsons, in 1889, became the first (trained) superintendent of nursing at the University of Maryland Hospital; she nursed later in the Spanish-American War and the Boer War.

Influential Americans Nightingale knew:

• Samuel Gridley Howe, an expert on the blind, and Julia Ward Howe, author of Battle Hymn of the Republic, named their first daughter after her, in 1845 (before she was well known).
• Harriet Beecher Stowe, author of Uncle Tom’s Cabin, wrote Nightingale in 1872 on nursing issues.
• John Shaw Billings, Civil War doctor and designer of Johns Hopkins University Hospital, sought her advice on the plans.
• Linda Richards, first American trained nurse, met with her in 1877, got English nursing experience, then introduced trained nursing into numerous American hospitals, then later in Japan—she learned Japanese and spent 5 years there.
• Canadian-born Isabel Hampton (later Robb), the first superintendent of nursing at Johns Hopkins, sought Nightingale’s advice and met with her in England. Robb later wrote several of the most influential books on nursing of the 20th century.
• Edward Jarvis, president of the American Statistical Association, met with her in 1861 in London, when there for the International Statistical Congress.
• Joseph M. Toner, president of the American Medical Association, met with her in London in 1881.
• Alfred Worcester, first professor of hygiene at Harvard University, and founder of the Waltham Training School, near Boston, author of two books on nursing, sought her assistance. Worcester was instrumental in convincing doctors in Ottawa to accept district nursing in 1897.
• Canadian-born Charlotte Macleod, trained in nursing in the U.S., became the first principal of the Waltham Training School, and later a nursing leader in Canada.

Nightingale was the major founder of the modern profession of nursing, and health care pioneer, who became famous for leading the first team of British women to nurse in war–the Crimean War of 1854-56.

The Bicentenary of her birth (May 20, 1820) was celebrated in 2020, we hope not just for Nursing Week, but throughout the year, with a new look at her key ideas and the relevance today.

While Nightingale was famous in her lifetime, and for a long time after it, she is little known today and often mis-represented. She wrote a lot! Not just her most famous book, Notes on Nursing; published in 1860, the same year that her training school opened.

So, here are some key points on her work and legacy:

• Nightingale wanted nursing to be an independent profession; nurses would take medical instructions from doctors, but no doctor would hire, fire, discipline or promote a nurse, decisions for senior nurses.
• Her vision for the profession included a career path, with increases in salary and responsibility, and made nursing a well-paying profession. Giving superintendents power to hire, discipline, etc., was to remove it from doctors, then 100% male when nurses were 100% female, and an unspoken measure to prevent sexual harassment of vulnerable women nurses.
• Nightingale consistently argued for good salaries and working conditions for nurses, holidays of at least a month per year; decent pensions; good living conditions during training; and hospital design to save nurses’ energy for patient care. Hospitals should hire cleaners, and nurses ensure that the job was done.
• “Army nurses,” before Nightingale’s time, were recruited from among the wives and widows of privates and non-commissioned officers (doctors were always officers), were paid less than cooks and laundresses, and reported to a sergeant. They did not even speak to a doctor. The belief that Nightingale wanted nurses to be “subordinate to doctors” misses the point, for when her nursing school started, in 1860, women lacked even a high school education, let alone university. Doctors had university/medical qualifications.)
• Nightingale succeeded in improving the status of nurses, from being a “domestic” service occupation in the 1861 Census, to being grouped with “medicine” in 1901 In the army, nurses became “officers,” like doctors.
• She did pioneering work on occupational health and safety as early as 1858. In 1871, she published a pioneering study of maternal mortality post-childbirth, Introductory Notes on Lying-in Institutions. Throughout her life, she worked with doctors, architects, engineers and statisticians to achieve great reforms.
• Nightingale worked to turn the terrible workhouse infirmaries into real hospitals, calling for the same quality of care available to the rich also for the poor.
• Hand washing is the single most effective means of infection control known–Nightingale began urging it in 1860. Hospital architects are turning back to Nightingale for her insights on sunlight and gardens in healing.
• Her writing is now available in a 16-volume Collected Works of Florence Nightingale, collected from more than 200 archives world wide.

Don’t want a 16-volume series? See the 200-page paperback with highlights: Lynn McDonald, Florence Nightingale at First Hand (London: Bloomsbury 2010) and Florence Nightingale, Nursing and Health Care Today (New York: Springer, 2018) 267 pages.

For short articles on what Nightingale actually said and wrote see: https://cwfn.uoguelph.ca/short-papers-excerpts/.

For backgrounders, links, and other resources, see www.nightingalesociety.com.