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Scottish Medical Journal article

Florence Nightingale and Mary Seacole: Which the Forgotten Hero of Health Care and Why?

[Scott Med J, published online January 10, 2014]

Background and Aims:
This paper aims at correcting misinformation in circulation portraying Mary Seacole as a nurse, Crimean War heroine, and health care pioneer, even, for some, a replacement for Florence Nightingale, who really was a health care pioneer as well as being the major founder of the modern profession of nursing.

Methods and Results:
The article focuses on the claims for Seacole made by C. Short in Scottish Medical Journal, 2011. It reports, using primary sources, on what Seacole actually did--running a business for officers, with kind acts on the side--short of constituting heroism, pioneering health care or nursing.

Conclusion:
The article concludes with remarks on how Nightingale came to be forgotten as a health care pioneer, with comments on the two major sources that attacked her reputation, F.B. Smith in 1982, and Hugh Small in 1998. Detailed refutations in peer-reviewed sources are referenced. Finally, it is suggested that recent scandals in English hospital care, documented in the Francis Report, may provoke a revival of interest in Nightingale’s principles and methods.

Keywords: health care pioneers, Crimean War, history

The U.K. Department of Health in May 2013 announced new awards to be made in the names of four ‘health care pioneers’: Mary Seacole (1805-81), as Crimean War heroine, not Florence Nightingale (1820-1910), with Edward Jenner (smallpox vaccination), Elizabeth Garrett Anderson (first woman medical dean) and Aneurin Bevan (who brought in the National Health Service in 1948) (Andalo, D., ‘How to get ahead in … NHS leadership,’ Guardian 8 May 2013). Yet it was Nightingale who, as well as making nursing the profession of skilled patient care, was so visionary, in 1864, as to call for quality care for all, including the poor. She did much to bring that about, reforming the notorious ‘workhouse infirmaries,’ with their scarce medical attendance, minimal treatment, and bedsharing. The launch of the NHS in 1948 is unthinkable without those reforms.

The Department of Health did not say what Seacole did to be named a health service ‘pioneer,’ nor is any such achievement evident. She was a fine, decent person who ran a restaurant/bar/takeaway for officers during the Crimean War (1854-56). Her lively memoir, Wonderful Adventures of Mrs Seacole in Many Lands, 1857, gives full chapters to her meals and catering (page numbers in the text hereafter are to the 1988 edition (Oxford University Press, Oxford).

A substantial literature now promotes the replacement of Nightingale by Seacole, typically buttressed by citations of secondary sources, easily refuted by recourse to primary ones (for refutations see McDonald, 2012 and www.maryseacole.info/).

Christine Short, ‘Mary Seacole, forgotten hero?’ Scottish Medical Journal, 2011, is far from the worst example in its claims, but the article includes five major mistaken ‘facts,’1 here refuted with primary sources. A statement of Nightingale’s positive contribution and how it came to be forgotten follows.

What Seacole did not do

1. Seacole did not seek to go to the Crimean War ‘when Britain was still reeling from the shocking news of the Battle of the Alma.’ Her own memoir gives her motive for going to England to attend to her gold investments: ‘my share in the Palmilla Mine speculation’ (71). She described arriving ‘just after’ the Battle of the Alma, 20 September, but only abandoned her gold quest after ‘the fearful storm of the 14th of November,’ to apply to go to the war (74). Nightingale and her nurses had already left, on 21 October, and the second contingent was near departure, on 2 December. Seacole never applied in writing as prescribed (applications and letters of reference are at the National Archives, Kew). According to her memoir, she went around in person applying. She may have been refused on account of her race, but this is not clear, for, apart from starting late, she was old for nursing, lacked hospital experience, and never submitted the required documents.

This mis-representation is common in the Seacole literature, and some authors explicitly accuse Nightingale of discriminating against her. Seacole’s own memoir, however, describes their one meeting as perfectly cordial (90-91).

Short described Seacole giving her a letter of introduction from ‘a doctor with whom she had worked during an epidemic of yellow fever at Up-Park Camp.’ But the memoir refers only to ‘Dr F…a doctor who had known me in Kingston’ (85) and made clear than she did not work at the camp during the yellow fever epidemic (63).

Short had her store providing ‘desperately needed equipment,’ such as ‘mackintoshes, greatcoats, boots, caps, linen, bedding, and saddlery,’ but Seacole herself listed ‘linen and hosiery, saddlery, caps, boots and shoes,’ and meats, soups, tins of salmon, lobsters, and oyster, all officers’ fare (139). It was Nightingale who obtained the ‘desperately needed equipment.’

2. Short transmogrified Seacole’s business from the officers’ restaurant and store it was to one serving ordinary soldiers. She did help ordinary soldiers, especially when, for several weeks before her business opened, she served hot tea, lemonade, and cake to those waiting on the wharf for transport to the general hospitals (101). She did first aid work post-battle on three occasions.

Short, as other Seacole promoters, gave an exaggerated account of her treating ‘frostbite in winter, heatstroke in summer, typhus, scurvy, malnutrition, cholera, and the ubiquitous dysentery.’ She has her giving care at the Land Transport hospitals, where Nightingale provided the nursing and organized the kitchens. Short cites chef Alexis Soyer on visiting Seacole, neglecting to note his far more extensive comments on working with Nightingale, and his making clear that Seacole was running a business for officers (Soyer, A. Soyer’s Culinary Campaign: Being Historical Reminiscences of the Late War, G. Routledge, London, 1857).

According to Short, Seacole ‘was among the last to leave the Crimea, until then still caring for the sick and wounded, and visiting the trenches and graves.’ Yet, since the last battle took place on 8 September 1855, and she left in July 1856, one wonders what wounded there were to treat. Sickness was also scarce in the second year, thanks to improved conditions instituted by the Sanitary and Supply Commissions. Seacole’s memoir described visits to the graves of friends and former customers, but not trenches, which could not have been much used after the fall of Sebastopol. Nightingale stayed until the last soldier was discharged, but then her hospitals had the worst cases.

Short is wrong about Seacole’s post-war bankruptcy, on which there are numerous Times articles. Seacole and her partner unhappily overstocked late in the war, anticipating the army staying months longer than it did. The period after the fall of Sebastopol was lucrative: ‘Pleasure was hunted keenly. Cricket matches, picnics, dinner parties, races, theatricals…my restaurant was always full’ (178).

Short exaggerates Seacole’s ‘medical’ work: ‘she never charged poorer patients,’ but they were all relatively healthy walk-ins. The most serious cases went to the general hospitals, the less serious to the regimental hospitals. She missed entirely the first three, major, battles of the war and the worst of the siege.

Seacole did not give anything to the Russians before leaving, as Short claimed; indeed she cut buttons off dead Russians’ greatcoats and accepted looted goods from soldiers, (167), including a cut-up altar painting of a Madonna (176). In her memoir she described taking a hammer to cases of red wine, to keep the Russians from getting them (196).

3. Short has Seacole ‘determined’ to go to India in the 1857 Mutiny, to ‘provide a similar service to that which she had provided in the Crimea.’ But this was hardly possible as the mutiny was quickly put down. Short cited no source, and none is known, that she ‘was refused permission to travel to India.’ Her sister told Anthony Trollope, then staying at her boarding house in Kingston, that Queen Victoria did not want her to go as her life was too precious.2

4. Short has Seacole seeking to serve also in the Franco-Prussian War, that she returned from Jamaica ‘immediately’ to offer her services ‘at the outbreak of the Franco-Prussian War.’ But that war began in August 1870, while she returned to England on 13 October 1865 (‘The West India and Pacific Mails,’ Times 14 October 1865 p 10G).

‘Her enthusiasm met with the same response that it had sixteen years previously, although for different reasons.’ Here Short claimed that ‘both she and Florence Nightingale had helped to change’ the times, making nursing a ‘respectable’ profession. But that was Nightingale’s work (McDonald, 2009a and 2009b). Seacole never nursed in a hospital, trained or mentored a nurse, anywhere. Short is correct that there was ‘no shortage of women to staff the hospitals,’ but these were French and German nuns and deaconesses—neither the British government nor the voluntary National Aid Society sent any nurses.

According to Short, Seacole submitted an application to go to the war to Sir Harry Verney, Nightingale’s brother-in-law, who then consulted her. But there is no evidence of any application. The ‘great obstacle’ to her going, apart from her age and not speaking French or German, was that no British nurses were needed, not opposition from Nightingale. Nor were there were any British officers wanting to buy meals, tinned lobster, champagne, etc., as during the Crimean War.

Nightingale herself sent but one nurse to the Franco-Prussian War, Florence Lees, and that at the request of the crown princess of Prussia, Queen Victoria’s daughter. Lees was in France at the time, spoke both French and German, and had considerable hospital experience.

5. While Short recognized that Nightingale was a ‘reformer,’3 and Seacole was not, she nonetheless named her a ‘pioneer,’ without stating what she pioneered. Of her terms ‘sutler, nurse, doctor, and mother figure,’ only the first and last are correct. At no point did Short acknowledge, nor do other authors promoting Seacole, that she used toxic substances in her remedies, notably acetate of lead, ‘ten grains of sugar of lead’ and mercury chloride (31). In this she was no worse than the doctors of the day, but perhaps the term ‘healer’ should be avoided. In her memoir, she frankly acknowledged ‘lamentable blunders’ and trying remedies that later made her ‘shudder’ (31); she claimed few successes, none for yellow fever.

Short concluded by calling Nightingale and Seacole ‘two of the most outstanding women of the 19th century,’ without saying what the latter did that was ‘outstanding.’ Even what she apparently wanted to do—go to the Indian Mutiny and the Franco-Prussian War—reflects false information. Seacole led a worthy, remarkable, life, left a fine memoir, and made many friends thanks to her kindness, generosity, and warmth. There is much to commend in her and she deserves to be honoured, but she was never the hero or pioneer claimed, when relevant primary sources are consulted.

Nightingale as Pioneer of Health Care

How did Nightingale, who really was a health care and nursing pioneer, come to be so neglected? There is an sorry history of attacks, for iconoclasm is appreciated. The nursing union Unison even advocated a literal ‘toppling’ of Nightingale, with writers citing the destruction of Lenin statues as a pertinent example.4

Denunciations of Nightingale’s work and reputation go back to 1982, with the publication of historian F.B. Smith’s Florence Nightingale: Reputation and Power (Constable, London). His accusations of incompetence and dishonesty have been refuted in detail,5 although not by nurses, some of whom jumped on the bandwagon.6 In 1998 Hugh Small, a retired management consultant, accused Nightingale of responsibility for the high death rates of Crimean War hospitals,7 which she did so much to expose and correct. Refutations, using solid primary sources, again, are available,8 while Small used only rough estimates, without a table or chart.

With the Francis Report on excessive hospital deaths in Staffordhsire, the tide may be turning. Even some British nurses have begun to consider that Nightingale’s advice on compassion and patient care might yet have merit.9 So might her insistence on adequate supervision. At the very least, her methodological advice, which rates as early evidence-based health care, would ensure that bad care was found out in a more timely fashion.

Bibliography

Florence Nightingale On Public Health Care, ed., Lynn McDonald, Wilfrid Laurier University Press, Waterloo 2004,

Florence Nightingale And The Nightingale School, ed. Lynn McDonald, Wilfrid Laurier University Press, Waterloo, 2009.

Florence Nightingale On Extending Nursing, ed., Lynn McDonald, Wilfrid Laurier University Press, Waterloo, 2009.

Florence Nightingale At First Hand, Lynn McDonald, Continuum, London, 2010.

Florence Nightingale And The Crimean War, Wilfrid Laurier, ed., Lynn McDonald. Wilfrid Laurier University Press, Waterloo, 2010.

‘Nightingale and Seacole: Nursing’s Bitter Rivalry,’ Lynn McDonald, History Today 2,9 (September 2012):10-16.

Endnotes

1. For more extreme claims see: Davis, C, ‘Living Her Dream,’ Nursing Standard 18,32 (21 April 2004):12; Robinson, J., ‘On Her Own Terms,’ Nursing Standard 19,34 (4 May 2005), pp 16-17; Deane, E., ‘Campaign for Mary Seacole Memorial Is Stepped Up in the Face of Opposition,’ Nursing Standard 24,34 (28 April 2010), p 12; Anionwu, E., ‘A History that Lives on,’ Nursing Standard 26,5 (5 October 2011), pp 18-19; Smith, J.P., Editorial, ‘Mary Jane Seacole 1805-1881: A Black British Nurse,’ Journal of Advanced Nursing 9,5 (1984), pp 427-28; Watson, C., ‘Hidden From History,’ Nursing Times 80,41 (1984), pp 16-17; Crawford, P., ‘The Other Lady with the Lamp,’ Nursing Times 88,11 (1992), pp 56-58.

2. Trollope, A., The West Indies and the Spanish Main, Frank Cass, London 1868, p21.

3. On her workhouse reforms see McDonald, 2004; McDonald 2010a; and McDonald, L. ‘Florence Nightingale as a Social Reformer,’ History Today 56,1 (January 2006), pp 9-15.

4. Wheeler, W. and Walker, M., ‘Florence: Death of an icon?’ Nursing Times 25,19 (12 May 1999), p 24.

5. McDonald, L., ‘Florence Nightingale Revealed in her own Writings,’ Times Literary Supplement Dec. 6 2000:14-15; Appendix B, ‘The Rise and Fall of Florence Nightingale’s Reputation,’ in McDonald, L., ed., Florence Nightingale: An Introduction to her Life and Family, Wilfrid Laurier University Press, Waterloo ON, 2001 pp 843-47, ‘Secondary Sources on Nightingale and the Crimean War,’ in McDonald, 2010b, pp 32-40.

6. Dingwall, R,, Rafferty, A.M., and Webster, C., An Introduction to the Social History of Nursing, Routledge, London, 1991.

7. Small, H., Florence Nightingale: Avenging Angel, Constable, London, 1998.

8. McDonald, L., Florence Nightingale and the Crimean War, op. Cit., and McDonald, L., ‘Florence Nightingale, Statistics and the Crimean War,’ Journal of the Royal Statistical Society Series A 177, Part 3 (2014) pp 1-18.

9. Lee, G., Clark, A.M,, and Thompson, D.R., Editorial, ‘Florence Nightingale—Never More Relevant than Today,’ Journal of Advanced Nursing (2013):245-46.

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