Beyond Florence
African Americans, Slavery, and Nursing in the US South

African Americans, Slavery, and Nursing in the US South

R.J. Knight

In 2016, a statue of Jamaican-born nurse and businesswoman Mary Seacole was erected outside St Thomas’ Hospital in London. Seacole’s contribution to the war effort in the Crimea and to British life is well-known. Yet, the tribute – the first statue of a named Black woman in the UK – gathered vocal opposition from The Nightingale Society, which assembled to oppose the decision and “defend” Florence Nightingale’s reputation as Britain’s premier nurse. In essence, its members do not view Seacole as a “proper” nurse.

The opposition speaks to a persistently narrow view of the history of nursing. Nursing has been expansive, encompassing many forms of work, knowledge, and experience. It has been practiced in many settings. It has also been racialized, as well as gendered, work. In numerous historical contexts, women of color have experienced barriers to opportunities, inclusion, and advancement in nursing, and at the same time, have performed the bulk of nursing work and played key roles in developing nursing knowledge and practices. These complexities in the history of nursing are made especially clear by centering enslaved African American women. Indeed, while Seacole and Nightingale were in Crimea, around four million African Americans were enslaved in the American South. They labored in every capacity imaginable, including as nurses.

In the nineteenth century, while enslaved people were increasingly treated in medical institutions in towns and cities, many slaveholders established hospitals or “sick houses” on their own plantations. A “good” sick house was one that allowed for “attendants to lock the patients in,” and in these settings enslaved people confronted at once their enslavers’ economic interests, coercive power, and racist beliefs around their capacity for pain.[1] Most notoriously, in a purpose-built hospital on a farm in Montgomery, Alabama, physician and surgeon James Marion Sims experimented with the repair of vesicovaginal fistula on about twelve enslaved women, including Anarcha, Betsey, and Lucy. He operated without anesthetic. Historian Deirdre Cooper Owens has shown how these women continued to “perform the duties slaves were expected to complete” during the five-year “experiment.”[2] Enslaved women cared for Sims’s sick child and, as skilled medical workers, served as Sims’s surgical nurses. Hospitals were at once sites of enslaved people’s struggle for autonomy over their bodies and their forced labor.

Houses where enslaved people were forced to live
Houses created for enslaved people, preserved at the Bergendal heritage village. (Wikimedia Commons)

Physicians generally visited sick houses as slaveholders requested, and hospitals were supervised by overseers and slaveholders. White female slaveholders also took roles in enslaved people’s healthcare. Victoria Adams described to a Federal Writers Project interviewer in the 1930s how her “mistress” used to “look after de slaves good when they was sick” in Cedar Creek, South Carolina, using medicines made from herbs, leaves, and roots.[3] Caregiving was a vehicle for their economic interests. As formerly enslaved woman Sarah Douglas described: “If I got sick old miss would give me plenty of medicine because she wanted me to stay well in order to work.”[4] Nursing was not interchangeable with nurturing, and female slaveholders regularly complained of the burdens of caring for those they characterized as incompetent and irresponsible shirkers and malingerers.

It was enslaved women who supplied the bulk of the daily nursing work on plantations. Some received their training from white doctors. When Clara Walker was thirteen years old, her “mistress” sent her to a doctor “who learned me how to be a midwife” over five years during her enslavement in Arkansas. Clara “made a lot o’ money for old miss,” delivering white and Black children.[5] Few received such apprenticeships. Treatments, practices, and beliefs were passed down from older community members, and enslaved women merged African, Caribbean, Indigenous, and European medical knowledge in their work. Women were particularly renowned for their expertise in the reproductive realm, and “grannies” and midwives helped to manage pregnancy, childbirth, and childrearing within the “female slave network.”[6] As skilled medical practitioners, and nurturing caregivers, enslaved women were highly valued in their families and communities. Bacchus White conveyed enslaved people’s conviction in their female healers: “anything Aunt Judy couldn’t do ‘hit won’t wurth doin’.”[7] Enslaved women sustained life, eased pains, and healed.

Whites, on the other hand, found themselves reliant on the medical skills of enslaved people but skeptical of – or reluctant to recognize – their abilities. They often characterized enslaved women as superstitious, uninformed, and injurious. Enslaved people’s expertise troubled racist constructions of African Americans’ intellectual capacities, and slaveholders’ denigration and recognition went hand-in-hand. In Georgia in the 1830s, for instance, plantation mistress Fanny Kemble debased enslaved people’s medicine as the “simple remedies” of “ignorant” “savages,” yet noted these were “generally approved by experience, and sometimes condescendingly adopted by science” and physicians.[8] The work of nurses was also the “fatiguing, repetitive, and dirty” work of caring for the sick, and thus, as historian Sharla Fett writes, enslaved people’s roles in healthcare exhibited “contradictions between skill and servitude.”[9]

In slaveholding households, nursing was equally expansive and beset with contradictions. Enslaved women performed elder-care, nursed white women through childbirth, and cared for those suffering all manners of disease and injury. Enslaved women fed and washed patients, administered medicines, dressed wounds, and changed beds. In the domestic realm “nurse” was a noun, as well as a verb, and commonly referred to an enslaved person who cared for white children. These nurses were chosen from slaveholders’ existing laborers, or women could be bought or hired explicitly for this work. They watched, fed, bathed, dressed, held and played with children, and cared for them in illness. Enslaved women’s experience and talents were valued by their enslavers. White women remarked on their children’s affection for their Black caregivers, and their abilities to soothe fretful babies.

Painting of an enslaved black woman breastfeeding a white infant while a black infant is on the floor at her feet.
Mae preta. (African Globe)

Slaveholders simultaneously complained about nurses’ shortcomings and were quick to punish perceived transgressions.[10] Value did not necessarily equate to privilege: nurses worked in close confines with abusive slaveholders, frequently changed hands, and experienced separation from their families. They were called upon to do all manner of household tasks, worked day and night, and were often forced to travel with whites. While this posed particular challenges for adult women with families, many enslaved nurses were just children. Sylvia Cannon was “just a little small girl” when Earlie Hatchel bought her for a nurse. Hatchel put the baby in Cannon’s lap and instructed her “don’ drop him.” While the infant slept, Cannon did other work in the house.[11] In turn, enslaved children themselves became experienced nurses. That nursing children could be both specialized labor and part of wider working responsibilities, required much and little experience, complicates the definitions of skilled and unskilled work.

Another common use of the term “nurse” was in reference to breastfeeding. It was not unusual for enslaved women to wet-nurse their enslavers’ infants. This form of nursing demanded intimate bodily and emotional labor. Many enslaved wet-nurses were actually bereaved of their own babies when forced to take on this work.[12] Other Black women coerced into breastfeeding white infants had to balance their enslavers’ demands against feeding their own children, or relinquish them to other caregivers.[13] Indeed, to allow enslaved women in their “prime” years to labor unhindered by their infants, many slaveholders instituted collective forms of childcare, whereby a plantation “nurse” would take charge of all the enslaved children. In Georgia, Lina Hunter described how her great-granny Rose looked after the enslaved children while their parents worked, with the assistance of the older children. Rose “had ‘em all day, and she had to “see dat dey had de right sort of victuals to make chillun grow fast and strong.”[14]

Slavery was an intricate web of care and capital, and from the hospital to the household, it depended on enslaved women’s nursing to sustain Black and white lives. And yet, in their medical knowledge, as medical practitioners and caregivers, women also threatened the system of slavery. Enslaved women appreciated that certain substances had abortive and contraceptive properties, and “king cotton” itself could be consumed to control reproduction and deprive slaveholders of chattel. Colonial laws acknowledged that medicine could be used to malicious ends: a 1748 Virginia law recognized “poisonous medicines” might be administered under the “pretence of practicing physic.”[15] These legal provisions implicitly acknowledged the power of enslaved people, but also rendered them vulnerable to accusations that had serious and even deadly consequences. In 1860, for instance, one enslaved woman called Fanny was accused of poisoning the white child she was hired to nurse by the Luck family in Richmond, Virginia. Fanny, they alleged, had attempted to fashion a pill from blister salve and force it “down the babe’s throat” after an altercation with Mrs Luck. The Daily Dispatch thought Fanny would surely be executed, but – valued at a sum of $1000 – she was instead sentenced to transportation outside of the U.S.[16] Fanny maintained her innocence.

The varied dimensions of nursing under slavery highlight that this work has encompassed exploitation and power as much as intimacy and care, forced labor as well as free, and has served both communities and regimes. This work has been both valued and unrecognized, construed as skilled and unskilled. A narrow view of nursing’s history does not allow for this expansive and complicated past, nor the unique contributions and experiences of Black women nurses.


    1. A. P. Merrill quoted in Stephen Kenny, ‘“A Dictate of Both Interest and Mercy?’ Slave Hospitals in the Antebellum South,” Journal of the History of Medicine 65, no. 1 (2010): 5.
    2. Deirdre Cooper Owens, Medical Bondage: Race, Gender, and the Origins of American Gynecology (University of Georgia Press, 2017), 1–2.
    3. Victoria Adams in Federal Writers Project, Slave Narratives: A Folk History of Slavery in the United States from Interviews with Former Slaves (Library of Congress, 1941), vol. XIV, South Carolina, part 1, 12.
    4. Sarah Douglas, Slave Narratives, vol. II, Arkansas, part 6, 189. Emphasis mine.
    5. Clara Walker, Slave Narratives, vol. II, Arkansas, part 7, 21.
    6. Deborah Gray White, Ar’n’t I a Woman?: Female Slaves in the Plantation South (W.W. Norton, 1985).
    7. Quoted in Todd Savitt, Medicine and Slavery: The Diseases and Health Care of Blacks in Antebellum Virginia (University of Illinois Press, 2002), 180.
    8. Frances Anne Kemble, Journal of Residence on a Georgian Plantation, 1838–1839 (Harper and Bros., 1863). Project Gutenberg.
    9. Sharla Fett, Working Cures: Healing, Health, and Power on Southern Slave Plantations (University of North Carolina Press, 2002), 112.
    10. See Thavolia Glymph, Out of the House of Bondage, The Transformation of the Plantation Household (Cambridge University Press, 2008); and Stephanie Jones-Rogers, They Were Her Property: White Women as Slave Owners in the American South (Yale University Press, 2019).
    11. Sylvia Cannon, Slave Narratives, vol. XIV, South Carolina, part 1, 188.
    12. Stephanie Jones-Rogers, “‘[S]he could…spare one ample breast for the profit of her owner’: White Mothers and Enslaved Wet Nurses’ Invisible Labor in American Slave Markets,” Slavery and Abolition 38, no. 2 (2017): 337–55.
    13. Emily West and R.J. Knight, “Mother’s Milk: Slavery, Wet-Nursing, and Black and White Women in the Antebellum South,” Journal of Southern History 83, no. 1 (2017): 37–68.
    14. Lina Hunter, Slave Narratives, vol. IV, Georgia, part 2, 255.
    15. An Act Directing the Trial of Slaves Committing Capital Crimes, 1748. Geography of Slavery in Virginia.
    16. Daily Dispatch, Richmond, Virginia, Jan. 21, Jan. 23, Feb. 16, 1860. Chronicling America.

Featured image caption: Statue of Mary Seacole by Martin Jennings in front of St Thomas’ Hospital, London. (Courtesy Sumit Surai/Wikimedia Commons)

Rosie Knight is a historian of enslaved women, children, and female slaveholders in the antebellum US south and a Lecturer in American History at the University of Sheffield.

1 thought on “African Americans, Slavery, and Nursing in the US South

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      To set the record straight, the Nightingale Society has never objected to their being a statue of Mary Seacole, a fine person worthy of recognition, but to its being placed at St Thomas’ Hospital, home for more than a century of the Nightingale School of Nursing, and to describing her as a “Crimean War nurse” It is not that she was not a “proper” nurse, but she was not a nurse at all. She never nursed in any hospital in any country and called herself a “doctress” rather than nurse, as she sold herbal remedies, to which, however, she added lead and mercury.
      Mrs Seacole ran a restaurant/bar/catering service for officers, which they greatly appreciated, and distributed free magazines at the Land Transport Corps Hospital near her business, but it is quite an exaggeration to call these kindnesses as a “contribution to the war effort.”
      A Nightingale Society co-founder who lives close to St Thomas’ Hospital recommended several suitable, alternative, sites for the statue. Lynn McDonald, PhD, co-founder, Nightingale Society

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