Florence Nightingale and the Christian Origins of Public Health Care
A Sermon given at St John’s Anglican Church, Elora, Ontario
23 July 2000
Fond as she was of ancient Greek and Roman society and civilization, Nightingale recognized that the care of the sick was peculiarly a Christian contribution. “The old Romans were in some respects, I think, superior to us,” she wrote, “but they had no idea of being good to the sick and weak. That came in with Christianity.” The Romans left the sick on the banks of the great rivers, to starve or drown themselves. Lepers were kept apart and “the nation did not try to avert or to cure leprosy.” The call to Christians to relieve suffering was such that we “dishonour Christ when we do not do our best to relieve suffering, even in the meanest creature. Kindness to sick man, woman and child came in with Christ.”1
Her own interest in nursing was prompted by a religious “call” experienced as a “call to service” on Feb. 7 1837, when she was age sixteen. Yet Nightingale was not allowed to act on this calling for many years, for her wealthy and privileged family took the conventional view that a nurse was rather like a kitchen maid in status. Nightingale was allowed to travel, and so she visited hospitals all over Europe, workhouses in England and Roman Catholic nursing orders on the Continent. It was not until she was thirty-one that she could even spend three months, at the Deaconess Institution at Kaiserswerth, Germany, where the diaconate for women was revived in the Lutheran Church. It was not until she was thirty-three that she was permitted to take a position as a nurse, superintending an institution for ill governesses in Upper Harley St., London. The timing is akin to that of St Paul’s wait, for it was fifteen years after his encounter on the road to Damascus to his first preaching tour. Nightingale would later see this long delay as God’s timing, that she was not ready for the work.
In 1854-56, at age thirty-four she led the nursing team for the British Army in the Crimean War, and returned a national heroine for saving lives and reforming many practices, all against tremendous odds. She then began her long career as a “nurse and social reformer” as our prayer book calls it, when she saved even more lives.
“I was sick and you visited me” we read in Matt 25:36. Nightingale rephrased this passage to “I was sick and you nursed me.” For her, merely visiting was not enough, but it is significant that a great process of reform, that took many decades to achieve, began with Nightingale’s following of the admonition merely to visit the sick. In the period when she was not permitted to nurse she visited several workhouse infirmaries. Later she said that visiting workhouses served only to “break the visitor’s heart.”2 So she stopped, but it seems resolved to reform workhouse infirmaries.
To understand how bad they were think of Charles Dickens’ description of these vast institutions of misery, with the aged, infirm, physically and mentally disabled, psychiatrically ill and destitute all lumped together. There was occasional medical attendance but the only “nursing” that provided by so-called “pauper nurses” or other inmates who were not ill, who were entirely untrained, often desperate women, notorious for stealing their patients’ food and gin. Yet these were the only hospitals for the great mass of people who could not afford to go to a fee-paying hospitals, the “real hospitals” of the sick poor.
It is clear from correspondence that Nightingale was considering how reform might be achieved even while she was working at her genteel institution in Harley St., and even while very pressed and ill in the Crimean War. Yet she realized that even on her return from Crimea with the status of a heroine and a fund raised in her name by her follow citizens (which she used to train nurses) she could do nothing about workhouse reform.
It was only in 1864, when Nightingale was age forty-four, that the window of opportunity opened: a Christian philanthropist in Liverpool, William Rathbone, wrote her deploring the existence of such “hopeless dreary” places in a “Christian land” and proposing a “lady visitor” to gradually introduce a “better system,” offering to fund it himself as the Poor Law authorities would have to raise taxes to do so, which they were not likely to do. “If the thing succeeds it would probably extend to other places. At any rate 700 or more patients would be brought under the influence of love and religion instead of despair.” He asked her if she knew anyone with “tact, power and Christianity to undertake such a work” and closed “if you do not know anyone do not trouble yourself to write. We must bide God’s time.”3
Nightingale responded with alacrity. Clearly she had a scheme now in mind, the A, B and C of workhouse reform as subsequent briefs and memoranda have it, and thought God had waited long enough. She insisted that a “lady visitor” would not do but “efficient nursing.” “There is no reason whatever why workhouse infirmaries should not be nursed and the sick cared for as efficiently as in the best nursed hospital.”4 No two-tier system, but the best care, for, as she explained to the President of the Poor Law Board, “when the poor pauper becomes sick, from that moment he ceases to be a pauper and becomes brother to the best of us and as a brother he should be cared for. I would make this a cardinal distinction in Poor Law relief.”5 A later statement with a fuller description of her plan explains that the sick poor are “poor and in affliction.” Society certainly owes them, if it owes anything, every necessary care for recovery.6 So high quality health care becomes the goal, and the family is the entire family of God.
Guiding the process of thinking through the reforms needed was Nightingale’s conceptualization of God as Creator, who runs the world by laws. It is our responsibility and privilege to study God’s world, using the best methods of quantitative, statistical research, to learn how we can best intervene for good. We then become God’s co-workers, or συvεργoί. God was always the gracious, all-wise, all-good Initiator. We get to second His work.
Nightingale’s training school for nurses took women regardless of denomination—she abhorred the prevalent sectarian practice of converting patients on their deathbed to another denomination. But her school was hardly secular. Student nurses were required to attend chapel and nurses read prayers in the wards. Nightingale believed that nurses needed spiritual resources to do their difficult work. Her letters to nurses are full of biblical quotations and examples from the lives of notable, especially heroic, Christians like Dr Livingstone and General Gordon.
To nurse Elizabeth Torrance she wrote, “If there is one thing more than another that our great Master strives to steer us, by his life as well as by his gospels, it is that he considers it an honour to serve the poorest and the meanest, that he will not give his crown except to those who have borne his cross…that patient courage, the fighting the good fight through life—enduring hardship is what he encourages and rewards.
As his greatest follower, St Paul, said and did, to run with patience our appointed course—that is our calling. Now what is our nurses’ ‘appointed course’? Evidently to bring the nursing of the poorest sick to perfection. And how are they to ‘run it’ By ‘looking unto Jesus….’
When we are told expressly that we are to give ‘glory to God on high’ by showing ‘good will towards men’ in the persons of His poor, His sick, His wretched, forsaken, sinful and degraded creatures. It was to these Christ came, and he came in humility of heart, in poverty of spirit. It is only to the humble, not to the conceited or grasping that he gives his strength and his help.”7
On the completion of the Highgate Workhouse Infirmary Nightingale wrote the same nurse about the “remembrance of our Lord’s communion,” asking nurses when they received communion to think “that we should try to be like him whose sacrament is a promise from us that we will live and die as he did, to the utmost of our power, with God’s help. To be ‘like him’ is to live for theirs and not for ourselves…to consecrate our plan of life to the service of our Father in heaven as he did.
Christ has expressly pointed out some services (and of these the nursing service is so fortunate as to be one) in which he not only promises us ‘communion’ with him, if we strive to do our part, as he did, but actually says that he feels as if those services were done to him personally and he were once more on earth receiving them. When we are nursing the sick we may actually be sure that he says to us, “I was sick and ye nursed me.”8
The first superintendent of nursing at the Liverpool Workhouse Infirmary was another Christian, Agnes Jones, an evangelical church member, trained at the Nightingale Training School and at the Deaconess Institution at Kaiswerswerth. She died of typhus on the job in 1868. In her tribute to her after her death Nightingale used the hymn “The Son of God Goes Forth in War,” asking for other to “follow in his train.” This hymn was used also while Nightingale was being lowered into the grave in the church yard of her home church in Hampshire.
Jesus’ life of service and sacrifice was Nightingale’s model from young womanhood, through her own work in the Crimean War to the end of her days. The night she left for the Crimean War she recorded a prayer in her devotional reading, Thomas à Kempis’ Imitation of Christ. By Mme Elisabeth, sister of Louis XVI, who was also executed in the French Revolution, the prayer states that nothing happens but what God has foreordained from all eternity. It offers God “everything,” joining “my sacrifice with that of Jesus Christ my Saviour.”9 Nightingale had indeed been taught at Kaiserswerth that it was a “privilege” to nurse in a cholera ward.10
Nightingale’s approach to health care was always holistic. Chemicals don’t cure, but God or nature. The nurse’s role was to supply the right conditions for that healing work to be done. “Go to God’s infirmary and rest awhile” was advice she gave.
She believed that the life of the spirit should nourish the practical life of service. She translated and commented on the medieval mystics, attracted by the strength of their dedication to God, but disagreeing with their remaining in cloisters. One should when refreshed get back into the fray.
Nightingale was appalled when people used prayer as a substitute for practical activity. The litany was particularly abhorrent, for asking God not to do things only an ogre or tyrant would do anyway. Moreover, prayer was for God to tell us what to do, not for us to tell Him what to do.
“It did strike me as odd, sometimes, that we prayed to be delivered from plague, pestilence and famine when all the common sewers run into the Thames.” She thought that God want us to clean up the sewer system rather than pray to be delivered from the known consequences of unsanitary practices. She prayed instead “God deliver us from unconscientious work.”
Nightingale loved the exchange between Moses and God in Exodus 33, where Moses asked God to “show him His glory.” God replied, “I will make my goodness pass before you.” Nightingale brought the two thoughts together: His goodness is His glory.
God did not delight in burnt offerings and sacrifices. “ [God] does not want to be praised, to be adored, to have his glory sung. We can scarcely conceive a good man…wishing it. How inappropriate, then, to Him all this praise!”11 Instead, God wants us to act, to do His work in the world. Nightingale lived her life sacrifically, prepared to give all to follow the way of the cross.
Let us give thanks for the life and work of this servant of God, handmaid of the Lord, co-worker with God in bringing health and healing to God’s world, Florence Nightingale.
1 Letter to Nurses 28 May 1900, Archives of Ontario.
2 Letter to Mary Clare Moore 3 September 1864, Convent of Mercy, Bermondsey and letter to Dr Henry Bence Jones 13 October 1864, Cambridge University Manuscripts and Archives, Add 8546/I/170.
3 Letter from William Rathbone to Nightingale 31 January 1864, Add Mss 47753 ff23-26.
4 Draft letter to William Rathbone circa 8 February 1864, Add Mss 47753 f27.
5 Copy of letter/draft to C.P. Villiers 30 December 1864, Add Mss 45787 ff54-56.
6 Draft note on principles of Poor Law reform 1 July 1865, Add Mss 45787 ff61-67.
7 Letter to Elizabeth Torrance, matron of Highgate Infirmary, 6 January 1870, London Metropolitan Archives St Thomas’ 2.
8 Letter to Elizabeth Torrance 4 November 1879, London Metropolitan Archives 2.
9 Inscription in Thomas à Kempis, Imitation of Christ 20 October 1854, Florence Nightingale Museum.
10 Letter to Mary Jones 11 August 1866, London Metropolitan Archives St Thomas’ Hospital 1.
11 Suggestions for Thought, ed. Mary Poovey:54.