Why Nightingale? Ashleigh Blackwood, Leverhulme Research Fellow in English Literature at Northumbria University, suggests that women’s medical history might help us understand the inequalities revealed by the current health crisis.

In just two months, the UK public, government, and health sector have been required to form new understandings of health protection. Since the arrival of Covid-19 in the UK, critical care health provision has been the lynchpin of a reactive response to the first global pandemic in living memory. Seven Nightingale hospitals have been established by NHS England in Birmingham, Bristol, Exeter, Harrogate, London, Manchester, and Washington, and similar facilities opened in Scotland, Wales, Northern Ireland, and Gibraltar. Project Nightingale, as these sites are referred to collectively in England, is aimed at ensuring that the NHS has sufficient capacity to meet increased critical care needs. As scientists and leading healthcare professionals express the belief that the UK has ‘passed the peak’ of Covid-19 (or at least the first peak, with apprehensions about future rises in figures), scrutiny regarding the validity and effectiveness of the Nightingale strategy has begun to emerge.  While the preservation of life remains the undoubted number one priority for all, the number of patients treated, or even the criteria of admissions to one of these facilities is not the only contribution Project Nightingale or associated initiatives, can make to the public today. The use of historical identities within the landscape of initiatives that are combatting against Covid-19 is an emerging pattern. What role, if any, do these historical identities play within the current health crisis? And what impact do these patterns have on women’s medical heritage and other equality groups that have for so long been lost to the shadows of cultural history?

Project Nightingale: History and Communication

The naming of Project Nightingale is, in itself, a choice that draws on the UK’s medical heritage and conveys an important message to the national public, as well as the wider world. Named for the celebrated English nurse Florence Nightingale (1820-1910), the name has long since served as a descriptor larger than her individual identity, carrying significant meaning about healthcare and healing for many. Through the national curriculum for history in key stages 1 and 2, children as young as 4 may find Nightingale in their lessons, as one of a number of ‘significant individuals in the past who have contributed to national and international achievements’. Even for those who did not study Nightingale at school, her name and achievements have been celebrated in other ways. Her achievements earned Nightingale the place of being the first woman whose image was used on the design of sterling currency in the form of the ten-pound note issued between 1975 and 1992. Her birthdate is used today to celebrate the nursing profession through International Nurses Day, and the year has also been utilised by the World Health Organisation (WHO)  in making 2020 the Year of the Nurse and Midwife. For roles so essential to the preservation and quality of life since well before Nightingale’s lifetime, this particular year would seem like poor repayment for such efforts, asking practitioners to go further, in the face of more risk, than they did before. In a similar spirit, Nightingale herself pushed the boundaries of what was expected of her and her role to transform nursing as a profession. The word ‘Nightingale’ is therefore a powerful signifier, becoming far more than a mere label through which to refer to these physical sites of care. But of what does it speak? In order to understand, therefore, the true meaning of Project Nightingale and its name, we need to take a closer look at how one woman’s name came to be so well recognised, and what this recognition might means for healthcare and the public amid a global pandemic taking place over a century after her death.

Florence Nightingale. Photogravure by E. Walker, 1887, after Sir W. Richmond. © Wellcome Collection.

Florence Nightingale was born in the Italian city from which her name was taken on 12th May 1820. Much of her young life was spent between the family’s homes of Lea Hurst, in Derbyshire, and Embley Park, Hampshire. While growing up in privileged surroundings, Nightingale’s is noted to have experienced periods of mental illness throughout much of her life.[1] Turning her attention to the possibility at the age of 24, Nightingale overcame a series of obstacles, including the strong objections of her family, to pursue nursing as a profession.[2] Among her many achievements were the modelling and establishment of nursing education, practice, and standards, as well as contributions to public health, social reform, and statistical analysis. Still best known for leading a delegation of nurses in running a barracks hospital at Scutari during the Crimean War (1853-6), the practices she implemented there, including increased handwashing.[3] Though individually and professionally successful in a way that no other woman had been, Nightingale did not lose sight of the everyday application of the skills she cultivated. In her Notes on Nursing (1860) Nightingale wrote, ‘every woman must, at some time or other of her life, must become a nurse, i.e. have charge of somebody’s health, how immense and how valuable would be the produce of her united experience if every woman would think how to nurse’.[4] Though our drive towards cultures of equality may have changed the gendered focus of who is now responsible for healthcare,  the spirit of these words, and Nightingale’s desire to improve healthcare all-round, mean that her name and work have come to represent hope, leadership, recovery, and healing.

Diversity within Nightingale’s Contemporaries: Mary Seacole and Betsi Cadwaladr

As with all seven of the temporary field hospitals, and other initiatives bearing her name, too often references to this remarkable woman stand alone, without any indication of the heritage that may have inspired Nightingale herself, or that she created for others. As the 1790 novel The Citizen noted, ‘a little good nursing does a great deal’.[5] Here, literature reflects truth, even decades before Nightingale sought to revolutionise the profession. If a ‘little good nursing’ had such value then, its value can only have increased since the interventions of Nightingale and many others who deserve to be represented.

Since the opening of the first NHS Nightingale in London, there have been public calls for more women’s stories and diversity to be represented within these names.  A petition, established by Patrick Vernon OBE, sought to name the NHS Nightingale in Birmingham NHS Mary Seacole, in honour of the Jamaican-born nurse (1805-81) who established her own nursing hospital in Crimea. Her memoirs recall her determination in looking for ways to travel to Crimea in support of military efforts, to ‘where the sword or bullet had been busiest and the pestilence most rife’.[6] Vernon’s cause was further supported by Yvonne Coghill, Director of the Workforce Race Equality Standard at NHS England, and resulted in a successful alternative resolution. The Government responded by naming the first Covid-19 rehabilitation centre, based in Surrey, NHS Mary Seacole. The petition, gathering over 145,000 signatures, explains that ‘[n]aming Mary Seacole as part of the fight against COVID-19 would be a major step forward highlighting the contribution of BAME staff who have worked tirelessly for the NHS since its creation in 1948 and highlight the collective spirit of the country to fight the pandemic and reduce the impact of infection.’

Seacole is further represented in the Midlands as Birmingham City University announced on 14th April the reopening of one of the university’s buildings, the Seacole building, as a Skills Hub ‘to help students nearing the end of their studies, current NHS staff, and returning employees to learn key techniques and skills needed in the frontline battle against coronavirus’. While the decision to keep all critical care hospitals in England under one name sits alongside the UK Government’s emphasis on single messages for all and shared experience, there has also been an additional call to name the temporary Dragon’s Heart Hospital in Cardiff in honour of Betsi Cadwaladr, a Welsh nurse who also volunteered in Crimea, eventually working in Nightingale’s hospital in Scutari.[7]

Lessons from WWI: Louisa Jordan, Elsie Inglis, Rachel Ferguson, and Katherine Hannan

While these issues of inclusivity for English and Welsh temporary hospitals were being debated, Scotland sought a separate identity in their Covid-19 response from the rest of the UK, diversifying from these labels.  On 7th April 2020 Scotland’s First Minister, Nicola Sturgeon revealed the creation of a temporary critical care hospital in Glasgow’s SEC Conference Centre. NHS Louisa Jordan recovers

Scotland’s women’s medical history by honouring one of their own foreign service nurses who was active during the first World War. Jordan nursed at Renfrewshire, Lanarkshire, and Manchester before joining the Scottish Women’s Hospital for Foreign Services (SWH), founded by another woman practitioner, Dr Elsie Maud Inglis (1864-1917), helping to set up and provide care at a hospital in Kragujevac, Serbia in the last weeks of 1914.[8] Not only were the staff challenged by the wounds of battle, but also by outbreaks of typhus during the winter months. Jordan nursed both patients and colleagues before succumbing to the disease herself in March 1915.

Photograph of Dr. Elsie Maud Inglis in uniform, 1916. © Wellcome Collection

Dr Inglis continued to offer healthcare across Europe beyond 1915 and was one of two women medical practitioners to feature in Danny Boyle’s Pages of the Sea public art engagement project for Armistice Day 2018, commemorating lives lost in the first World War.  Her photograph was chosen for reproduction on the beach at West Sands, Fife, alongside Staff Nurse Rachel Ferguson, a volunteer nurse who served in Queen Alexandra’s Imperial Military Nursing Service Reserve, whose image was also recreated on the coastline at Downhill, Londonderry.[9] Though Inglis’s name has been the best known of these women, the choice of the Scottish government and NHS to mark Jordan’s contribution is indicative of a growing need to recover a greater range of narratives from our heritage.[10] Scottish Health Secretary Jeane Freeman reflected that Jordan ‘is a person who has perhaps up until now been better remembered in Serbia than in Scotland. This hospital is a fitting tribute to her service and her courage.’ Freeman’s words highlight the lack of visibility women practitioners have traditionally been subjected to in historical studies within the UK, and the decision to change this in pandemic conditions suggests that these past omissions need rectifying within today’s medical and public culture.

Temporary hospitals are not the only Covid-19 efforts to mark women’s medical heritage. A collaboration between Northumbria and Newcastle universities is producing an essential PPE product, the Hannan Snap Visor, bearing a similar mark of the past. The visor, designed to protect clinical staff in treating patients in spaces where the risk of Covid-19 infection may be high, is named ‘[i]n honour of Katherine Hannan, a nurse [who] went out of her way to be at the very front lines of caring for the sick during the Spanish Flu pandemic’ through volunteering for the Red Cross, within the United States and Vladivostock, Siberia. Hannan’s story, that the team behind the product invokes with their brand, brings a human element to a product that has raised concerns about the depersonalisation of hospital care, offering a story the public can connect during the ongoing health crisis.[11]

The Past, Present, and Future

These decisions to draw upon women’s medical heritage form a specific moment that calls humanities scholars to action, to supply a greater, more diverse range of role models as part of creating a renewed health system, founded on equality and inclusivity. Efforts against Covid-19 alone, for all their scope and determination, will not resurrect these histories in their entirety, but they do offer a new impetus to maintain and develop historical and literary work within the field. People of all genders, ethnicities, and backgrounds are contributing to efforts to ensure the safety of the UK population through both clinical and professional support roles. Both NHS and BAME communities have experienced first-hand the great sacrifice made by individuals in their number risking their own health and, in some cases, giving their lives, to care for others. This is a willingness that has been displayed by generations of health workers that does not falter today. These efforts should not be forgotten, and an expanded heritage for all groups is a promising tool for the inclusion and empowerment of all in future healthcare. If preserved and cultivated, the rediscovery of these stories has the potential to create positive change in gender and ethnic inequalities in the post-Covid world.

*****

Dr Ashleigh Blackwood is a Leverhulme Research Fellow in English Literature at Northumbria University, UK. She leads on women’s writing and participation in healthcare as part of the major-funded project ‘Writing Doctors: Medical Representation and Personality, ca. 1660-1832’ (2018-21). She has published on maternity medicine, interactions between literature and wellbeing, and the relationship between sleep and stress in the long eighteenth century. Ashleigh is also Co-Investigator on the Wellcome-funded project ‘Thinking Through Things: Object Encounters in the Medical Humanities’ (2020-21). Twitter: @historylitmed

References:

[1] Lynn McDonald, Florence Nightingale at First Hand: Vision, Power, Legacy (London and New York: Continuum, 2010), 16; Elizabeth Wakely and Jerome Carson, ‘Historical recovery heroes – Florence Nightingale’

Mental Health and Social Inclusion;  Vol. 15, Iss. 1,  (2011): 24-28; Mark Bostridge, Florence Nightingale (2008; repr., London: Penguin Books, 2009), 108; Barbara M. Dossey, “Florence Nightingale: Her Crimean Fever and Chronic Illness,” Journal of Holistic Nursing 28, no. 1 (March 2010): 38-53.

[2] Mark Bostridge, Florence Nightingale (2008; repr., London: Penguin Books, 2009), 92.

[3] Florence Nightingale, Notes on Nursing: What it is and What it is Not, Revised Edition (London: Harrison, and Sons 1860),135.

[4] Florence Nightingale, Notes on Nursing: What it is and What it is Not, Revised Edition (London: Harrison and Sons, 1860), v-vi.

[5] Ann Gomersall, The Citizen, Vol. 1 of 2. (London: Scatcherd and Whittaker, 1790), 191.

[6] Mary Seacole, Wonderful Adventures of Mrs Seacole in Many Lands, ed. Sara Salih, Penguin Classics (London: Penguin Books, 2005), 70.

[7] Elizabeth Davis (Cadwaladr) to Elizabeth, Baroness Herbert of Lea, Letter of Application to nurse in Crimea, National Archives, WO 25/264.Cadwaladr’s name was also used to name the Cadwaladr Health Board, the primary organisation responsible for healthcare in North Wales.

[8] “Fife Nurse Dies in Serbia,” Fifeshire Advertiser (Fife, Scotland), March 13, 2005; Eva Shaw McLaren, A History of the Scottish Women’s Hospitals (London: Hodder and Stoughton, 1919), 360.

[9] Inglis died at the Station Hotel, Newcastle upon Tyne, of bowel cancer in November 1917. Ferguson contracted broncho-pneumonia and died in June 1918 while serving at Bordighera, Italy.

[10] As well as her efforts during a period of international conflict, Inglis is also noted for having attended Sophia Jex-Blake’s Edinburgh School of Medicine for Women before participating in a student rebellion which led to her subsequently establishing the competing Edinburgh College of Medicine for Women as well as contributing to the Scottish suffrage movement. See, Claire Brock, British Women Surgeons and their Patients, 1860-1918 (Cambridge: Cambridge University Press, 2017), 183; Shirley Roberts, Sophia Jex-Blake: A Woman Pioneer in Nineteenth-Century Medical Reform (1993; repr., London: Routledge, 2014), 179.

[11] My grateful thanks to Simon Scott-Harden, Northumbria lead developer for the Hannan Snap Visor, who kindly offered his time and reflections on the process of developing and naming the visor during a national lockdown.

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