The Racist Lady with the Lamp

Nursing historiography is centered on whiteness. Even worse, nursing history revolves largely around a single white nurse: Florence Nightingale. This, unfortunately, doesn’t mean nurses understand who Nightingale was. There are nurse historians doing incredible and diverse work, but in general, nursing, both as a profession and as an academic discipline, promotes a view of Nightingale based in a culture of white supremacy rather than historical facts. Here, I make explicit Nightingale’s role in British colonial violence by analyzing some of her writings on the British colonies. This history allows us to better discuss the consequences of her legacy in nursing.

Nightingale and colonialism

What is rarely discussed in nursing history is Nightingale’s racism and her political role in the genocide of Indigenous people under British rule. She counseled many key political figures and her writings on the subject show that she was a staunch supporter of British colonialism, even with the knowledge of the death and destruction left in its wake. She believed Indigenous lives were a small price to pay for the expansion of the British Empire. Although some of her contemporaries recognized the brutality of the colonial system, Nightingale believed imposing British culture to be necessary. Anything else, she believed, “would be simply preserving their barbarism for the sake of preserving their lives.”1

Florence Nightingale in 1870. (Courtesy Wikimedia

This racist statement by Florence Nightingale is one of many. Thanks to digitization efforts, her writings are now accessible, and it’s easy to find sources that reveal Nightingale’s racism. She was steadfast in her belief of the supremacy of white Christian culture. By her own accounts, Nightingale considered Indigenous peoples to be inferior, and the British state to be a “civilizing” force. The quote above is from Nightingale’s Sanitary Statistics of Native Colonial Schools and Hospitals, published in 1863, a report commissioned by the Colonial Office of the British government. In it, she concluded that the high death rates of Indigenous people in colonial schools and hospitals reflected the haste of British authorities to assimilate them. She felt assimilation should be more gradual in order to minimize the death toll, but she had no issue with the death toll itself: “Every society which has been formed has had to sacrifice large proportions of its earlier generation to the new conditions of life arising out of the mere fact of change.”2

In the report, Nightingale defended the deaths of Indigenous children in the Canadian precursors to residential schools: “There is nothing in the school education as described in the returns, sufficient to account for the special prevalence of tubercular diseases in these schools. The causes must probably be looked for in the close foul atmosphere of the native dwelling.”3 Her comments on the Canadian situation were indicative of her larger position: that the deaths of Indigenous people was due to habits of Indigenous people themselves, and that British rule catalyzed a process of “decay” already in motion.

Victorian “Cleanliness” and Miasma Theory as Ideological Weapons

It is important to understand the meaning of cleanliness within the Victorian era and for Nightingale. Cleanliness was a synonym for purity, and the Victorian rituals attached to it came with a sense of godly supremacy.4 It is beyond the scope of this article to discuss the ideological roots of the term, but it went hand in hand with the miasma theory of disease, which Nightingale believed until the end of her life. Miasma theory held that bad smells and filth generated disease. Filth was not just physical, it was also moral. For example, under miasma theory, Nightingale believed sex workers embodied evil that spontaneously generated disease. As Nightingale explained: “When we obey all God’s laws as to cleanliness,…, health is the result. When we disobey, sickness.”5

Indigenous traditions offended the “cleanliness” ideal of Victorian Britain. Miasma theory conveniently supported British supremacy and was a pillar of public health until the end of the 19th century. More importantly, it was a political weapon to destroy Indigenous health and wellness traditions, as it labelled anything non-British or non-Christian as “filthy.” It is inaccurate to assume that when Nightingale speaks of “cleanliness” it is somehow detached from its ideological roots. When she speaks of cleanliness, filth, or foulness, there is always an implicit Christian bias. She could never have supported any form Indigenous health practices because they were not based in Christian values.

The New Zealand Nursing Organization’s Reframing of the Nightingale Legacy

From 1861 to 1868, Nightingale was advisor to George Grey, Governor of New Zealand. Her role in advising the governor during a brutal era of repression against Maori anti-colonial uprisings is part of the reason the New Zealand Nurses’ Organization (NZNO) has decided not to celebrate Nightingale’s birthday in 2020.6

Why 2020? The World Health Organization declared the year of Nightingale’s 200th birthday to be the International Year of the Nurse and the Midwife. For the nurses of the NZNO, however, “Raising her as the beacon for nursing globally causes trauma and re-ignites the history and pain of colonization.”7 They explain that the Eurocentric campaign for the year of the nurse is harmful and disrespectful to Indigenous nurses and call her legacy “dangerous.”

The NZNO’s statement is the only article I’ve found that explicitly discusses Nightingale’s racist heritage. Critical writings are buried by the hagiographies, despite the abundance and accessibility of Nightingale’s own writings.

“She’s a product of her time” is a racist excuse I’ve often heard from colleagues when discussing less appealing aspects of Nightingale’s canon. Her “time” was the Victorian epoch, named after Queen Victoria, who ascended to the British throne in 1837. It was a time of brutal capitalist expansion, an era that saw the rise of the suffragettes, countless working-class uprisings, and anti-colonial revolts. Nightingale was not just a product of her time; she was a product of her social class and its conservative values, which she actively embraced. Her racist discourse was part of the upper classes’ reaction to some of the anti-colonial movements rocking the British empire. The Great Indian Revolt of 1857 sent shockwaves throughout the empire, as did the New Zealand wars. Nightingale was an active participant in British colonialism. Excusing racism or any type of discrimination by claiming it as normal in a particular era is never ok, and as is the case with Nightingale, it also reveals ignorance about the era itself.

History or Cult?

Despite the clarity of Nightingale’s writings, nursing academia continues to produce hagiographies venerating her. While some nurse scholars have offered critical perspectives on Nightingale, her body of work is largely unchallenged within the nursing profession.8 Countless nursing schools, awards, hospital wings and more are named after her. The International Committee of the Red Cross grants a Nightingale medal. Many of the professional nursing colleges and associations in Canada where I live have Nightingale awards, as do most North American nursing schools and faculties. Nursing students around the world recite the Nightingale pledge in solemn ceremonies. In 1971, the International Council of Nurses (ICN) declared International Nursing Day as May 12, in honor of her birthday.

The weight of Nightingale seems to smother our capacity as a profession to celebrate other historical nursing leaders, especially Black and Indigenous women. One in particular stands out; Mary Seacole, a Black nurse from the same era, who also served in areas where Nightingale worked, such as Crimea, and for much longer. She achieved fame in her own right because of the selflessness and grit with which she treated wounded soldiers.

Edith Monture was the first Indigenous nurse in Canada and a pioneer in maternal and Indigenous health. Emma Goldman, a Jewish nurse in addition to an anarchist activist, was an advocate for women’s health and fought against the devastating impacts of capitalist industrialization on the health of working people. None of these trailblazing women fit within the Nightingale “ideal” of the nurse; they were willful and rebellious, and by their very existence, challenged racist and sexist norms.

Nursing academia often uses Nightingale’s writings on public health and education to champion her as a defender of human rights; she’s credited with coming up with the social determinants of health, described as an expert in peacekeeping, and an advocate for the good of humankind.9 I would argue that there is little in her writings to support these claims.

As the NZNO points out, “The historical figures we choose to venerate say a lot about who we are.” The continued veneration of Nightingale tells a story of racism and exclusion within nursing. We cannot claim to teach nursing advocacy and leadership when our model for these concepts was a Victorian bigot. The goal of this article is not to erase Nightingale from our history books; on the contrary, I’m proposing that we get to actually know her and what her legacy means for nursing.

We lose nothing by relegating Nightingale to her rightful place in history. We gain critical insight, growth, and a richer understanding of what nursing is.

Notes

  1. Florence Nightingale, Sanitary Statistics of Native Colonial Schools and Hospitals (1863), 16. Return to text.
  2. Nightingale, Sanitary Statistics, 18. Return to text.
  3. Nightingale, Sanitary Statistics. Return to text.
  4. Anne McClintock, Imperial Leather: Race, Gender and Sexuality in the Colonial Contest (Routledge, 1995), 216. Alison Bashford, Purity and Pollution: Gender, Embodiment, and Victorian Medicine (Palgrave Macmillan, 1998), 36-37 Return to text.
  5. Florence Nightingale, Florence Nightingale to Her Nurses (MacMillan and Co., 1914), 120. Return to text.
  6. Grant Brooks and kaiwhakahaere Kerri Nuku, “Why We Aren’t Celebrating Florence’s Birthday,” Kai Tiaki Nursing New Zealand 26, no. 3 (2020): 34–35. Return to text.
  7. Grant and Nuku, “Why We Aren’t Celebrating Florence’s Birthday,” 34. Return to text.
  8. Roberta Waite and Deena Nardi, “Nursing Colonialism in America: Implications for Nursing Leadership,” Journal of Professional Nursing 35, no. 1 (2019): 18–25; Jessica Dillard-Wright, Jane Hopkins Walsh, and Brandon Blaine Brown, “We Have Never Been Nurses: Nursing in the Anthropocene, Undoing the Capitalocene,” Advances in Nursing Science 43, no. 2 (2020): 132–46. Return to text.
  9. D.-M. Beck, “A Brief History of the United Nations and Nursing: A Healthy World Is Our Common Future,” in A New Era in Global Health, ed. W. Rosa (Springer, 2017). Barbara M. Dossey, William E. Rosa, and Deva-Marie Beck, “Nursing and the Sustainable Development Goals: From Nightingale to Now,” AJN The American Journal of Nursing 119, no. 5 (2019): 44-49. Return to text.

About the Author

19 Comments

Lynn Seaver-Forsey PhD RN

Excellent article. Thank you for your scholarship around this topic. We absolutely need to invest in a deeper understanding of Nightingale and to broaden our knowledge of other great historical nurse figures.

Martin Schiavenato PhD, RN

Here’s to the continued eradication of our figurative sacred cows!

Debbie

Excellent article. I had the opportunity to go to England for an exchange program for my ASN. It was while I was there that I heard the English nurse ask why we would honor Nightengale. I realized then that she was as flawed as we all are. Celebrate so many incredible nurses that have paved the way for us.

Dr. Patrick J Dean

As a product of her time, FN held ideals that are easy to challenge in retrospect. It behooves us, as the most trusted profession, to constantly evaluate our present day ideals as to their future scrutiny by historians.

Martin Schiavenato PhD, RN

I believe the point of the article is that it is Not easy to challenge Ms. Nightingale; in fact, this is the first occasion that I’ve ever seen it done. It is much easier to stand by and let the impetus of tradition and the weight of authority prevail.

David Harley

Among the English, it is easy to criticize her. Standard practice. As a cultural hero,m she has been eclipsed by Mary Seacole, whose standing as a battlefield nurse is somewhat uncertain. However, Nightingale’s detestation of Seacole (race? class? lack of formal training?) has been inherited by N’s devotees.

David Harley

It’s less easy to explain that miasma theory, central since ancient times, was at the root of public heath reform. Plague, gaol fever, cholera, all spurred cleansing of the cities. Contagion was seen as a purely individual and proximate cause. Hence the bitter opposition of N.

Umar Razaq

It is easy to excuse a historical figure’s racism and genocidal tendencies as being products of the historical context of their environment. However, do those who defend her in this light suggest they aught to defend the actions of Hitler?

Thomas Cox PhD RN

While I think I understand your general concern, in that an extremely small portion of Nightingale’s writings are certainly of concern with the extraordinary benefit of 160 years of hind sight. But, I also think that comparing Nightingale to Hitler is a bit of a stretch historically and ethically.

First, and most obvious, Nightingale was not her nation’s official leader. Unlike Hitler, Nightingale did not play a significant policy role in promoting and facilitating genocide, or authorizing the development of genocidal programs. She was a consultant to the governor of New Zealand, but I have yet to find anything to suggest that she even visited New Zealand during the period of her consultancy. I’d be happy to be corrected on this issue because I am curious.

Was she wrong about the miasma theory, and did she land on the wrong side of attributing the cause of illnesses to the practices of indigenous peoples, rather than the transport of disease to those lands? Yes. Do some people continue to die from improperly prepared pork, even today? Yes.

We, on the other hand, have the benefit of a well-tested theory of communicable disease spread. But despite this, the US leads the world in Covid-19 cases, deaths, and debilities. We are failing, in our own time, despite our knowledge of communicable disease prevention and control. Most of my colleagues are too busy fighting to save lives to spend time writing about their resistance to poor public health policy. Are we just willing abettors to the spread of disease because we didn’t write enough? Should we blame epidemiologists a few decades from now because they thoughtlessly compiled and analysed data, but didn’t take care to make sure that every report they wrote fully described the political and social causes of the spread of the epidemic? Rebekah Jones tried to be a stand up data analyst and has paid an extraordinary price for it, and no tangible impact on the policies of reckless ron desantis.

Nightingale, unlike Hitler, didn’t hire people to design, develop, and run concentration camps and extermination facilities. Nightingale apparently never visited genocidal facilities, in person, to ensure that extermination goals were being more efficiently met, which Hitler did. Nightingale didn’t hold large political rallies encouraging people to commit genocide, which Hitler did. Clearly the list of differences between Nightingale and Hitler are extensive.

The more appropriate comparison, at best, would be that Nightingale was a minor bureaucratic functionary, removed from the front lines of genocidal activity, who processed information provided from afar, and did so dispassionately, with a perspective that while deeply flawed through the lens of 2020 was accepted “truth” by most people in her own time.

She most certainly wrote some materials, a minuscule portion of her total collected writings, that I have little doubt she would correct with the perspective of living in 2020, and quite likely would have done so long before 2020.

Could she have been a better person? Certainly. But most of us rely on carbon-based energy at the moment, and I suspect that people will look back on our decisions, and our flippant use of cars, and our climate controlled homes, with little in our writings to suggest that we moved to renewable energy sources as quickly as we should have to protect our habitat, and the habitats of indigenous people all over the globe. I suspect our children and grandchildren will be horrified by our thoughtless complicity in destroying planet earth, and that they will find precious little in any of our voluminous writings, for them to see us as anything but thoughtless products of our time, and unredeemable eco-terrorists.

Bad 2020 PC yes, Hitleresque, not even remotely.

Hélène Rondeau Houle

Thank you for contributing to the effort to portraying this true face of FN. Hélène Houle RN Leominster Ma

Hobo_Yoda

Not for nothing but there are no womem of color on the Nursing Clio editorial board

Don’t get me wrong, I was deeply moved by what I just learned about Nightingale, just another verdict on the evils of colonialism. I intend to follow the sources for further research.

Having just this morning come across this blog, I feel somehow more enriched and added its button to my homescreen

Cynthia Cain

Very interesting viewpoint. Very much appreciated the acknowledgement of the contributions of diverse nurses from the same time period. I think having a realistic and true view of history is vital. I think it is also vital to remember that we all have feet of clay including people who do extraordinary work. We are all very human and have made mistakes we don’t want remembered in history but would not want our entire life’s work judged by those mistakes.

Thomas Cox PhD RN

I wrote a rather lengthy response several weeks ago – but the effort was lost because I apparently wasn’t properly linked – This one may come to naught as well, so I will keep it short and if it appears I will expand on it.

Like most nursing students, I had to come to some resolution of my relationship with Nightingale. As a second semester nursing student, with a rather unusual background (Mathematician, statistician, biostatistician, risk theorist, actuary, and engineer) I was thinking I would find little in common with Nightingale.

Of course, I was wrong. In the course of trying to resolve the relationship, I came upon the term “passionate statistician” which forever changed the dynamic. What I discovered, was that Nightingale was a single handshake removed from one of the greatest mathematicians of all time, Carl Friedrich Gauss, through her relationship with Quetelet, one of the luminaries in the founding of social physics – the precursor to modern social statistics. Sadly, I have not been able to acces Nightingales copies of mathematical and statistical texts, which would put yet another face on Nightingale and her career and importance in understanding health dispariities.

So, the short and sweet version is that Nightingale, through her voluminous writings, is a Rorschach ink blot. We see in her writings what we want, for better or worse. Had she written less, there would be far less analysis, far fewer interpretations, less evidence to support what we want to think is the true Nightingale. But she wrote so much that one can easily amass an academically strong argument for almost any vision one would have of her.

Was Nightingale a product of her times? Indubitably. But she was also at the forefront of the understanding of the human experience, and absent her contributions, nursing would be a much weaker profession.

Rorry Zahourek, PhD, RN

First, I had never heard of this blog and was delighted to read this article on FB ( delighted is the wrong word! I was actually shocked by the article)
I have always venerated Nightingale and her pioneering perseverance to change what at the time was not health care but illness promoting care. And I was really impressed with the article in Scientific American many years ago on her accomplishments as a statistician. But —- I and small group of my graduating nursing class in 1965 from Skidmore College decided the Nightingale pledge was sexist and put nurses in a subservient tole with physicians. We wrote our own.
On another occasion my 7 year old granddaughter who lives in London informed me that Nightingale was not the first nurse but Mary Seacole, a black woman. I was shocked and had never heard of her before!
I appreciate this article and it’s scholarship, it should be published in a major nursing journal.I also agree with many of the comments that she was a reflection of her time, her class and upbringing and have to take her accomplishments and short sighted failing into that context. I wonder what trai blazing she would be doing today?

Thomas Cox PhD RN

Hi Rorry, Hope you are enjoying the sun and sand.

We should first remember that Mary Seacole was not the first battlefield nurse by hundreds, even thousands, of years. The first battlefield nurses were men, and nursing has systematically ignored the roles of male nurses, marginalized men in nursing, and cleansed the nursing history books of the far longer roles of men in nursing. While Hobo Yoda appears to be correct, notes that there are no women of color among the named editorial team, there are also no men, as far as I can tell. Of course race, gender identity, ethnicity, and religion are hard to tell just from names and pictures. I am Hispanic, but who would think that?

All that said, NOBODY but Nightingale left behind such an extraordinary, multi-dimensional, body of written work covering so many facets of nursing and health care, society, spirituality, scientific management, and dedicated research, as Nightingale. Despite her very contextualized racism and sexism, and her embrace of a now failed theory of disease, ignoring and belittling her positives does nursing little good.

Nursing is already a marginalized profession, and some of Nightingale’s legacy of failing to promote the intellectual development of nurses is certainly still alive today. As I have often said, academic nursing confuses possession of PhDs, with the skills normally associated with having PhDs, in other disciplines. We constantly struggle with the anti-intellectualism, and suspicion of advanced degrees of many bedside nurses and other health professionals and nursing, continues to be an unwanted step-child in many academic institutions.

But, I have little doubt that if Nightingale were alive today, Nightingale would be a much different person, and would have corrected/never written much of the writing she did, that is now used to diminish her. I think she would have embraced people’s of color, the LGBTQ community, and her work in health disparities would make our decades long failures in that area look amateurish.

I have often seen the evidence for nursing eating its young – Let’s try to avoid eating our long gone, as well. We can venerate, and elevate, other nurses without having to discredit Nightingale, because especially in academia, and in the broader context of nursing practice, we already struggle to be heard, seen, and have a place at the decision-making table. Criticizing our own is a losing proposition, when our real problem is criticism from without. Some justified, much not. Please note, I am not saying there is no foundation at all for concern, merely that the foundation represents a minuscule portion of her written work.

As David’s thoughts suggest, here we are in the 21st century and large swaths of the American population are still rejecting the germ/virus/contaminant theories of disease. We can’t get people to wear masks, we can’t get them to stop smoking, we can’t get them to stop drinking, we can’t stop polluters, we cannot get employers to operate safe working environments, we can’t get people to stop taking licit/illicit drugs that are killing them, and we can’t get them to eat in a healthy manner. We have more sophisticated understandings of why people get sick, debilitated, and die, but we are losing the war against the dark, self-destructive, forces of human nature.

We have a political system, that much like the political system Nightingale railed against, couldn’t even manage to get hungry people food/resources in a pandemic, on Christmas Eve, yet most people think of the US as a Christian/Religious nation.

While we count many successes, and we are certainly a large part of the success stories in the fight against Covid, we also have many failures, and all too much of academic nursing literature, is devoid of the rich intellectual, spiritual, and statistical content of Nightingale’s vast body of work.

We can acknowledge Nightingale’s flaws, and elevate other nurses, without cutting our own legs off above the knees.

Rorry

Your comments are well taken and bear a great deal of thought. I think the paper that began this discussion and the discussion that followed is healthy and vibrant. Re men in nursing, Walt Whitman, famous poet (Leaves of Grass) was a heroic nurse In the civil war before he became a famous American Poet. The American civil war was just after the Crimean war. I wonder of he knew of Nightingale and her work ( yes we are enjoying sun and sand, Bear a relief !)

David Harley

As Dr Anne Summers of Birkbeck College, London, has pointed out, the early history of nursing institutions in the UK is best understood in denominational terms, especially Elizabeth Fry and the Quakers, or the High Church Anglicans,m such as John Henry Newman’s mother.

Nightingale founded the first secular nursing school in England, which is now part of King’s College, London. Among international schools of nursing, it is ranked #2, after U.Penn and above Johns Hopkins

Dame Anne Marie Rafferty CBE FRCN, President of the Royal College of Nursing, is Professor of Nursing Policy at the Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care at King’s College London.

Both Summers and Rafferty were among the surprisingly large group at the Oxford Wellcome Unit who undertook the social history of the lower ranks of medical practitioners, such as nurses, midwives, herbwomen, and so on. Ornella Moscucci, Irvine Loudun, and Hilary Marland are notable examples.

Nightingale might not have been a nurse or an especially early champion of nursing, although an influential one, but she was an early advocate of handwashing, discovered by US health authorities in the 1980s and by most doctors and nurses more recently. However, they wash their hands AFTER touching the patient, but not BEFORE. Like the freedom-loving opponents of facemasks, they don’t seem to understand who it is that is to be protected.

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