Seacole, Nightingale and Ingenuity
The reputations of Mary Seacole and Florence Nightingale may have fluctuated over the years, but their distinct yet complementary achievements were fundamental to the development of the modern hospital environment, writes Ann-Marie Akehurst
Martin Jennings, Mary Seacole, St Thomas' Hospital, 2016. Photo: Owen Blacker. Creative Commons CC0 1.0 Universal Public Domain Dedication.
During his recent hospital stay, Boris Johnson almost certainly will not have had the time to admire the two statues dedicated to the nursing pioneers Mary Seacole (1805–1881) and Florence Nightingale (1820–1910) at London’s St Thomas’ Hospital. You’ll recognise the names of these two women more immediately from the news, commemorated in the temporary ‘field hospitals’ established by the NHS to increase capacity for critical and community care during the current pandemic. Florence has pride of place in the Central Hall – her statue is a plaster cast of Arthur George Walker’s statue on Waterloo Place, made shortly after the latter’s erection in 1915. The statue of Mary was unveiled a century later in 2016 in the hospital grounds facing the Palace of Westminster. These women knew each other and both played a critical role in attending to wounded soldiers during the Crimean War, a very different ‘campaign’ from today’s. The current overuse of the war metaphor to describe present times has been criticised but perhaps has some validity: wars are crucibles stimulating innovation born of the need for ingenious responses to rapidly shifting events and circumstances. In the past few months, gin distillers have turned to making hand-sanitiser; 3D printers have been pressed into service to make ventilators and PPE; and buildings have been repurposed to expand capacity in the NHS.
Most prominently, ‘Nightingales’ have been established as critical-care field hospitals by NHS England. The first of these was NHS Nightingale London, opened on 3 April 2020, a conspicuous symbol of the Government’s intention that NHS resources should not be overwhelmed. Named for the well-connected nurse and epidemiologist who rejected her privileged life in favour of revolutionising nursing, it is an appropriate designation as field hospitals are temporary structures addressing medical emergencies, often during wartime, and Nightingale’s formative experience was in the theatre of war.
The Crimean War (1853–56) proved a laboratory for salubrious hospital design, stimulating both Nightingale’s gift for planning and organisation, and the engineering understanding of Isambard Kingdom Brunel (1806–1859). The mortality rate at Üscüdar (Scutari) field hospital from infectious diseases such as typhus and dysentery was 42.7% until Nightingale arrived in 1854 and imposed a regime of rigorous cleaning. She demonstrated the impact of hygienic infection control within the constraints of a converted barracks, but her understanding of spatial planning was reinforced by the short-lived prefabricated hospital she encountered at Erenköy (Renkioi), six miles away. This hospital was built to a design by Brunel in England, and then shipped to Turkey to receive wounded soldiers. Renkioi’s separate wards, connected by a spine corridor, comprised separate pavilions, an idea imported to England in the 1730s by James Gibbs (1682–1754), with his rebuilding of St Bartholomew’s, London. By impeding the spread of infection, they reduced the mortality rate from disease to just 3%.
Returning to England, Florence established a new nursing school at St Thomas’, inspiring protégées across Europe and North America. Leveraging her networks, she published advice and experiences, transforming hospital design. Notes on Nursing (1859) was her manifesto for creating a healthy environment, effectively comparing poor ventilation in wards to the murder of patients through negligence. Her key requirements for healthy buildings were pure water, efficient drainage, cleanliness, light and pure air. It is especially appropriate then that NHS Nightingale beds are equipped with ventilators alleviating the respiratory crises of Coronavirus patients.
Nightingale was politically engaged, and extended her authority to hospital design. Notes on Hospitals (1858) characterised the role of the hospital as active spaces ‘to restore the sick to health’ in the shortest time and with the lowest mortality rate. She established principles of hospital construction and improved hospital plans. Her critique was persuasive because she supported her arguments with statistics and demonstrated familiarity with European models, arguing for ‘the most healthy structure of the pavilion’. She criticised the Royal Victoria Military Hospital, Netley, because its ventilation and planning contaminated pure air, even convincing the prime minister, Lord Palmerston, of its inadequacies.
T. Sulman, Saint Thomas’ Hospital, Lambeth, 1871. Credit: Wellcome Collection. Attribution 4.0 International (CC BY 4.0).
Nightingale was keen that misplaced ‘received wisdom’ should not be repeated at the New St Thomas’. While the architect and surveyor Henry Currey (1820–1900) designed fashionable Italianate elevations and towers whose massing responded to the Palace of Westminster directly across the Thames, it was Nightingale who influenced the planning. Echoing Brunel’s Renkioi, and its salubrious ‘pavilion principle’, St Thomas’ was built with separate ward buildings linked by low corridors, intended to improve ventilation and segregate infectious patients. She recommended Parian cement walls that were impervious to effluent; specially designed sash windows; and an artificial ventilation system with air extraction pipes, all intended to create a health-giving environment. Upon completion in 1868, despite its ruinous price tag, the medical press declared St Thomas’ to be ‘one of the finest hospitals in the world’. The hospital buildings were replaced in the 20th century, but Nightingale’s institutional, scientific and scholarly contributions are acknowledged by the commemorative statue in the Central Hall.
Outside, in the gardens of St Thomas’, is Martin Jennings’ sculpture of Mary Seacole, completed in 2016 and inscribed with words written in 1857 by The Times’s Crimean War correspondent, Sir William Howard Russell: ‘I trust that England will not forget one who nursed her sick, who sought out her wounded to aid and succour them, and who performed the last offices for some of her illustrious dead’. It is Britain’s first sculptural memorialisation of a named woman of colour. On 4 May 2020, the NHS Seacole Centre opened at Headley Court in Surrey in a repurposed rehabilitation centre for injured soldiers. Equally appropriate to its dedicatee, it will be used as a convalescent centre for patients recovering from COVID-19. This naming recognises the contribution that Seacole in particular, but people of colour in general, have made to healthcare in Britain over the centuries. Though BAME people comprise 14% of the population in 2020, approximately 20% of the entire NHS workforce is from an ethnic minority background, including 44% of medical staff in England and Wales. And yet a recent study by the Office for National Statistics revealed black people in England and Wales were nearly twice as likely to die from Coronavirus. Opening NHS Seacole, the NHS chief executive Simon Stevens said: ‘Recalling the pioneering work of Mary Seacole rightly pays tribute to our BAME nurses and other staff at the forefront of the extraordinary NHS response to this terrible COVID-19 pandemic ... It also serves as a timely reminder that it is their contribution over the past seven decades that has been a foundation for the very success and continuation of the NHS itself.’
Mary Jane Seacole [née Grant] (1805–1881) was born in Kingston, Jamaica, the daughter of a Scottish soldier and the mixed-heritage proprietress of a boarding-house for officers and their families. She acquired nursing skills and knowledge of the Creole herbal-medical tradition from her mother. In 1836, Seacole married Edwin Horatio Seacole, a godson of Horatio Nelson, but she was soon widowed. She ran the family boarding-house for several years, supervising its reconstruction after Kingston’s great fire in 1843, an experience that was to prove useful in Turkey. She nursed cases of cholera and yellow fever in Jamaica and in Panama where, for more than two years, she helped her brother manage a hotel. On returning to Jamaica she was briefly nursing superintendent at Up-Park Military Camp, the headquarters of the British army in Jamaica.
Seacole sailed to England to support Nightingale during the Crimean War, but her offer of help was rejected, possibly because of underlying racist attitudes then prevalent. Not dissuaded, she travelled to the Crimea at her own expense, settling at Balaklava in 1855. Mary demonstrated great ingenuity in developing care provision for soldiers, recognising that combatants would benefit from a space to recuperate – albeit briefly – from the stresses of war. On a site at Kadikoi, renamed Spring Hill, Seacole, a team of local men and her husband’s kinsman Thomas Day improvised, repurposed and upcycled available materials. They created ‘Seacole & Day’ or ‘The British Hotel’, which offered material comforts necessary for soldiers’ wellbeing; an officers’ club; and a good, clean canteen for the men.
Seacole recorded: ‘It cost no less than £800. The buildings in the yard took up at least an acre of ground, and were as perfect as we could make them. The hotel and storehouse consisted of a long iron room, with counters, closet and shelves; above it was another low room, used by us for storing our goods, and above this floated a large Union Jack. Attached to this building was a little kitchen, not unlike a ship’s caboose – all stoves and shelves. In addition to the iron house with two wooden houses with sleeping apartments for myself and Mr Day, outhouses for servants, a canteen for the soldiery and a large enclosed yard for our stock, full of stables, low huts and sties. Everything, although rough and unpolished, was comfortable and warm; and there was a completeness about the whole which won general admiration.’ For a woman whose prose style was distinctly matter of fact, Seacole poetically encapsulated the warmth she had engendered in the place: ‘Where there was no sun elsewhere, some few gleams – so its grateful visitor said – always seemed to have stayed behind, to cheer the weary soldiers that gathered in the British Hotel.’ It is evidence of the psychological importance of care as much as cure.
Seacole’s popular autobiography The Wonderful Adventures of Mrs Seacole in Many Lands (1857) includes testimonials from many grateful patients attesting her approach was to nursing centred around the recuperative benefits of sustenance and social care. She was proactively responsive, showing great personal courage in the face of adversity by independently bringing medicine, food and wine to the front line on accompanying mules. When allied troops entered Sevastopol, she secured special permission to become the first woman to enter the burning city: ‘Every step had a score of dangers,’ she later wrote, ‘and yet curiosity and excitement carried us on and on. I was often stopped to give refreshments to officers and men, who had been fasting for hours.’ She brought medical comfort to the maimed and dying after the Battle of the Great Redan, in which a quarter of the British force was killed or wounded, and two months later she tended Italian, French and Russian casualties at Chernaya, miraculously laying on ‘a capital lunch on the ground’ for a cricket match between the guards division and other regiments on the day after the battle.
Seacole’s Crimean War experience, like Nightingale’s, drew on her background and demonstrated her courageous, resilient and selfless capacity for personal care in improvised settings. Her generosity left her personally indebted at the end of the conflict. Back in England and bankrupt, she was reimbursed through popular support, and her services to ‘the Army, Navy and British Nation’ were recognized by a Seacole fund, established with royal approval.
Nightingale’s reputation was subsequently distorted by Henrietta Rae’s painting Miss Nightingale at Scutari, 1854 (1891), which romanticised her wartime experiences. ‘The Lady with the Lamp’ – as Nightingale became known – embodied benign the domestic femininity expected by late Victorian standards. A broad approach to architectural history means that we can now appreciate her formidable intellectual grasp and body of work, and – in the context of saving lives – that aesthetic considerations are subordinate to planning and massing.
The uncomfortable truth, recorded in Seacole’s memoir, is that despite her relevant experience, as a woman of colour her Jamaican origins marginalised her from received histories of the British campaign in the Crimea – and they continue to do so. Despite recognition in the field and on return to England, her reputation proved as temporary as the British Hotel she constructed. Largely thanks to the recent exertions of Elizabeth Anionwu – herself a nurse of mixed heritage – Seacole’s ingenious, adaptable and flexible responses to crisis have been acknowledged.
At the outset of this emergency, Government accounts focused exclusively on technology and on hospitals, but in a crisis we re-evaluate priorities and reassess what is valuable. The rising death toll is making apparent that people of colour are both over-represented among NHS staff and among the dead. This bravery and personal sacrifice in continuing to tend to patients is now being acknowledged and, where necessary, mourned. Such fresh understandings have elevated public appreciation that essential work is equally conducted in care homes, and that social care is an equal and necessary complement to hospitalisation: just as Seacole’s contribution is equal and complementary to that of Nightingale.