International Journal of Nursing Studies 48 (2011) 1155–1162

(Author)ity abroad: The life writing of colonial nurses

Jessica Howell a,*, Anne Marie Rafferty b,1, Anna Snaith c,2

a Centre for the Humanities and Health, Florence Nightingale School of Nursing and Midwifery, King’s College London, United Kingdomb Florence Nightingale School of Nursing and Midwifery, King’s College London, United Kingdomc Twentieth-Century Literature, Department of English, King’s College London, United Kingdom

A R T I C L E I N F O

Article history:

Received 9 December 2010

Received in revised form 15 March 2011

Accepted 22 March 2011

Keywords:

Attitude of health personnel [N05.300.100]

Biography as topic [K01.517.211]

Colonialism

Medicine in literature [K01.517.584]

Nurse’s role [F01.829.316.616.625.450]

A B S T R A C T

Objectives: This paper asserts the significance of nurses’ writing within the developing

field of life writing studies. It closely examines selected letters written by nurses in the

Colonial Nursing Association (CNA) and models pertinent methods of literary analysis, in

order to illuminate nurses’ experiences and their skills of self-authorship. The figure of the

CNA nurse is an especially rich subject for study: while these women travelled across

political and geographical boundaries, they also demonstrated especially flexible and

multifaceted ‘travelling’ identities. This essay’s subject holds relevance for scholars of

healthcare and the humanities, nursing educators, literary critics and medical historians.

Designs: This is a discussion article that first establishes the value of narrative analysis in a

health care context, specifically in the context of nursing scholarship and practice, and

then introduces the relevant history of the CNA. Subsequently, the article analyzes primary

texts, in the form of nurses’ letters, demonstrating how CNA nurses participated in and

changed ideologies of gender, nation, and empire.

Data sources: A range of historical and contemporary sources is used to support the goals

of this paper, including primary texts such as letters and speeches and secondary material

such as literary criticism and colonial histories. The essay is based on research into the first

twenty years of the CNA, from approximately 1896 to 1914, with a particular focus on

nurses posted to Africa and the Caribbean.

Review methods: The article uses methods of literary and cultural analysis in order to

prove that the study of nurses’ writing has contemporary cross-disciplinary significance.

Conclusions: Women employed by the CNA drew upon traditional forms of colonial

rhetoric in depicting their experiences, but also adapted these forms in order to reflect

their own personal and professional experiences as nurses abroad. Many CNA nurses

embraced adventure, independence and professional and physical challenges. For these

traits to be accepted and celebrated within the late nineteenth and early twentieth century

cultural imagination indicates that the CNA nurse may have revised concepts of female

propriety in her own time, which may cause us to question some of our current

assumptions about historical gender roles.

� 2011 Elsevier Ltd. All rights reserved.

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International Journal of Nursing Studies

journal homepage: www.elsevier.com/ijns

* Corresponding author. Tel.: +44 0207 848 3230.

E-mail addresses: Jessica.howell@kcl.ac.uk (J. Howell),

anne_marie.rafferty@kcl.ac.uk (A.M. Rafferty), anna.snaith@kcl.ac.uk

(A. Snaith).1 Tel.: +44 0207 848 3561.2 Tel.: +44 0207 848 2174.

0020-7489/$ – see front matter � 2011 Elsevier Ltd. All rights reserved.

doi:10.1016/j.ijnurstu.2011.03.010

What is already known about this topic?

� C

ritics have established that the historical figure of thenurse provides insight into issues of gender ideology andwomen’s professionalization.

J. Howell et al. / International Journal of Nursing Studies 48 (2011) 1155–11621156

� W

ithin the field of Healthcare and the Humanities,doctors’ and patients’ narratives are used to shed light onexperiences of illness and recovery.

What this paper adds

� A

lthough the figure of the nurse has received consider-able attention from scholars interested in the politics ofrepresentation, her role as author and authorising herown identity has not. � L ife writing and travel writing studies allow us to

examine how nurses formulated identities for them-selves, drawing upon discourses not only of gender butalso of colonial politics and medicine.

� N urses’ self-representation has relevance outside of a

purely domestic context—they were also key figures inBritain’s colonial endeavors.

� A better understanding of nurses’ past perceptions and

roles may illuminate current nursing practice.

1. Introduction and background

In order to encourage empathy as well as a greaterunderstanding of cultural difference, educators in health-care and the humanities guide medical and nursingstudents through attentive encounters with art andliterature (Shapiro et al., 2009). In the past, however,more effort has been dedicated to discussing the experi-ences of doctors and, more recently, of patients, than theexperiences of nurses and midwives. A growing body ofscholarship in the history of nursing is correcting thisimbalance. In order to contribute to such progress, thisessay presents original research into nurses’ life writing,outlining certain significant themes in their letters.

The words ‘author’ and ‘authority’ come from the sameLatin root, auctor, meaning ‘‘creator’’ or ‘‘originator’’(University of Norte Dame ‘‘Latin Dictionary,’’ http://www.archives.nd.edu). Through writing letters, CNAnurses authored their own lives, claimed professionaland personal authority, and helped authorize the imperialproject. Though these women originally were sent in orderto recreate a sense of home for British citizens stationedabroad—a seemingly traditionalist and delimited job—theyalso encountered new experiences and cultures and tookon new professional responsibilities. In this sense, nursesnot only travelled across national boundaries but alsoadapted and changed boundaries of propriety and genderexpectations. By studying their correspondence, one mayobserve how these ‘travelling’ nurses reinvented them-selves in the colonial setting.

2. Previous scholarship

Scholarship concerned with the figure of the nurse tendsto fall into certain categories, which may sometimesoverlap: research on wartime nursing, anthologies andliterary analyses of contemporary nurses’ poetry and prose,gender criticism, and Nightingale studies. Florence Night-ingale had an intriguing and multifaceted personality; shealso wrote a prodigious amount, including letters, books andtracts; further, her theories and plans strongly influenced

modern nursing. It is no surprise that the work of such a keyfigure should be much studied. The Collected Works of

Florence Nightingale edited by Lynn McDonald, as well asMark Bostridge’s biography Florence Nightingale: The Woman

and Her Legend (2008), both attest to an ongoing interest inFlorence Nightingale scholarship. Critical discourse has alsoacknowledged the importance of Nightingale in literatureand culture, as shown in Mary Poovey’s 1988 Uneven

Developments: the Ideological Work of Gender in Mid-Victorian

England and Catherine Judd’s 1998 Bedside Seductions:

Nursing and the Victorian Imagination 1840–1880, just toname two. By examining Nightingale scholarship from theperspective of life writing, however, we can begin tounderstand how biography and autobiography are bothdriven by the discursive imperatives of the day.

In order to better understand what life writing analysishas to offer in studying the figure of the nurse, let us brieflyconsider past biographies of Florence Nightingale, many ofwhich over-simplified her personality. Even while she wasstill serving in the Crimean War, Florence Nightingale’sreputation was growing to mythic proportions, bolsteredby reports of her good deeds from family and friends,colleagues and patients. Deemed an angel, titled ‘‘The Ladywith the Lamp,’’ Nightingale became one of the Victorianera’s biggest celebrities. She was memorialized even beforeher death (Poovey, 1988), and since her death has been thesubject of a steady stream of biographies. Many of thesehave sought to reconcile or explain the contradictoryimpulses manifested in Nightingale’s life and work. Themajority of biographers or historians seem to have acertain unified theory about her identity. One may oftenguess by the title what each book’s focus will be: Florence

Nightingale: Mystic, Visionary, Healer; Florence Nightingale:

Avenging Angel; Florence Nightingale: Reputation and Power;

or Creative Malady.As Ania Loomba explains, ‘‘historians and critics’’ are

‘‘part of a discursive order rather than outsiders—whatthey say, indeed what they can say, is also determined andshaped by their circumstances’’ (1998). Thus, eachbiography’s own historical moment influences its tone.Early biographies such as Cook’s Life of Florence Nightingale

(1914) seem anxious to rescue Nightingale from anyaccusations of unfeminine character—[Along with] ‘‘Theimpelling power of a brain and a will’’ she ‘‘brought to hermission the tenderness of a woman’s heart.’’ However,mid-century biographies bring this ‘flaw’ to the fore:‘‘There was something about Florence that chilled. . . Shedid not know what personal feelings were, in a private noteshe wrote that never in her life did she recollect beingswayed by a personal consideration. She lived on adifferent plane, out of reach, frighteningly, but alsoinfuriatingly, remote’’ (Woodham-Smith, 1955).

Though outside the scope of this essay, an importantlarger project will be to historicize the Nightingalehistoriography itself: for example, one could productivelyanalyze the foregoing quotation in light of the 1950scultural obsession with unreachable women. However,from a literary perspective, for the purposes of this paper itis most useful to notice Woodham-Smith’s passingreference to ‘‘a private letter.’’ Not only does he fail toquote the letter directly, he also neglects to tell us anything

J. Howell et al. / International Journal of Nursing Studies 48 (2011) 1155–1162 1157

about its context. For example, imagine how differently wewould perceive this letter and the author’s resulting claimsif we learned that it had been written to a colleague whoaccused Nightingale of favoritism, or as a reply to a familymember who complained about her absence from aholiday function. By not letting Nightingale’s words speakfor themselves and by not acknowledging other relevantcontextual factors, the biographer is able to portrayNightingale’s identity in a one-sided manner that supportshis theory of her personality. More recent biographers haveacknowledged more shades of gray to Nightingale’sidentity. However, they often still use over-archingcharacterizations, calling her ‘‘stringent and complicated’’or ‘‘a puzzle’’, contrasted with other figures who have‘‘relatively unified’’ personalities, whose ‘‘actions, wordsand feelings tend in the same direction, complementingeach other’’ (Boyd, 1982). Life writing critics would arguethat there are often nuances to be found in the language ofeven the most straightforward authors.

The over-simplified treatment of Nightingale’s life andpersonality may be following in the spirit of nineteenth-century essentialisms regarding nurses in general. The‘‘character’’ of a good nurse—pious, sober, nurturing yetfirm—was partly inculcated by Nightingale herself. Not onlydid she use pamphlets and tracts to set out the ideal behaviorand characteristics of nurses, she also practiced quickjudgment of other women, assessing their ability to succeedin the profession. As one may observe from her notes onprobationers’ reports, Nightingale terms the hapless AnneCororan ‘‘Deficient in both management and steadiness, acoarse, low sort of woman.’’ In contrast, Elizabeth Ford‘‘under strict supervision may yet do well‘‘, in spite of‘‘defects.’’ Mary Yarnley is deemed ‘‘A clever woman but of avulgar mind, somewhat inclined to hobnobbing where shelikes and spitefulness where she does not. Too much on thelevel of the nurses she has to superintend’’. Nightingaleasserts that Ellen Sparks is ‘‘Not to be trusted in a generalhospital for her own sake; light in her conduct with men’’(Baly, 1982). Nightingale evaluates nurses’ characters inorder to assess their professional promise. One notes certainsocial values encoded in these comments, which dictate thatwomen, especially nurses, should be chaste and notencourage male attention; they should be refined andladylike; and finally, they must differentiate themselvesfrom their inferiors. These excerpts demonstrate howhistorical values and priorities affect written discourse,and that writers often reinforce one-sided perceptions ofidentity.

Our research attempts to counterbalance this trend inhistorical and literary nursing studies, whereby the idealcharacter of nurses is pinned down, and the identities ofindividual nurses are stabilized or summarized for thepurpose of argument. Studying the representatives of theColonial Nursing Association provides us the opportunity forthis important corrective. CNA nurses travelled to far-flungcolonies of their own accord, seeking novelty, adventure,professional opportunity, to give service, or all of thesetogether, and their writing reflects these myriad motiva-tions. Rather than defining them by one dominant, stablecharacteristic, we may consider these nurses as mobile or‘travelling’ both physically and in their self-representation.

3. Methods of analysis for nurses’ life writing

One takes into account several key considerations whenstudying life writing. First, one must reflect on the genre ofthe text, as each has different structures and conventions.Genres that fall under the label of ‘‘life writing’’ mayinclude ‘‘autobiographies, biographies, case studies, dia-ries, memoirs, autobiographical novels, ethnography,blogs, profiles, and numerous other forms’’ (Lynch inBradford, 2010). Next, one must be careful not tooversimplify the writer’s identity and its influence onher writing. For example, a reader would be best served bytaking into account the multiplicity of perspectivesrepresented within women’s writing, and nurses’ writingin particular. As Linda Peterson explains in Traditions of

Victorian Women’s Autobiography, one should acknowledge‘‘that gender may not be the crucial factor in someautobiography, that other allegiances (religious, regional,political or social) may be equally important, that somewomen may deliberately avoid a female literary tradition,or that some women’s accounts may self-consciouslyinvoke multiple traditions’’ (2001).

In order to remain alert for these subtleties, it may helpto think of the context and situation in which the text wasproduced. To this end, Smith and Watson suggest oneapproach the writing as an autobiographical ‘‘act.’’Autobiographical ‘‘acts’’ are made up of the occasions(what caused the author to begin); sites (both historicaland spatial); the ‘‘I’’, or speaker; the others of the ‘‘I’’ (maybe other characters with whom the narrator relates, or the‘absent other’, such as a beloved); patterns of emplotment(narrative strategies and storytelling); media; and con-sumers/audiences (2002). None of these elements areideologically neutral. An author is both created by andparticipates in creating his or her culture. For example,‘‘What is recollected and what is obscured’’ by the narratorcreates our ‘‘knowledge about the past.’’ In turn, a narratoris shaped by his or her own cultural background: ‘‘As wetell our stories discursive patterns guide, or compel, us totell stories about ourselves in particular ways.’’

If ‘‘autobiographers incorporate and reproduce modelsof identity in their narratives as ways to representthemselves to the reader’’ (Smith and Watson, 2001), thento analyze nurses’ writings one must identify the historicaland political models of identity available to them. Nursesmay draw upon and deploy any number of these models ata time—a reader should not necessarily look for one mouldinto which a nurse falls. In fact, nurses may have evolved tobe particularly flexible in their self-representation. In‘‘Reimagining Nursing’s Place in the History of ClinicalPractice,’’ Fairman and D’Antonio argue that ‘‘Nurses’. . .

class and gendered, structural place and authority hasalways made it necessary. . . to negotiate and formalliances to achieve ends, necessitating a positionalitythat is always shifting in response to the needs of patientsand nurses themselves’’ (2008). This dynamic was nodoubt heightened by the shifting political and economicpower structures of the colonial setting. Also, CNA nursesnecessarily improvised and adapted in response to theentirely new healthcare situations in which they foundsthemselves.

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In the late nineteenth century, nurses could draw uponseveral models of identity when representing themselvesto others. One was the ‘‘heroic nurse,’’ made popular byFlorence Nightingale and others who served in wartime.The heroic nurse was portrayed as bringing ‘‘morality andpurification’’ from the domestic realm to ‘‘the taintedpublic domain’’ (Judd, 1998). One may immediatelyobserve how such a goal would be relevant in the colonialsetting. Florence Nightingale herself linked hygiene andrace when she said ‘‘On women we must depend, first andlast, for personal and household hygiene—for preventingthe race from degeneration’’ (quoted in Judd, 1998). In thecolonial context, then, nurses might have perceived theirrole as two-fold—their mission was not simply to teachindigenous peoples ‘good hygiene’ but to prevent membersof their own race from losing the civilised health practicesof home and thus become like ‘natives’ themselves.Nightingale’s model of wartime nursing service alsoblended the ‘‘Domestic narrative of maternal nurturingand self-sacrifice’’ with the ‘‘military narrative of indivi-dual assertion and will’’ (Poovey, 1988). This model seemsespecially relevant for nursing in the colonies, as imperi-alism uses the rhetoric of duty—the ‘‘white man’sburden’’—to mask underlying drives for profit andexploration.

At the same time, one would be well served to keep inmind both the ‘‘occasion’’ and ‘‘consumer’’ of the CNAnurses’ letters home. Many of the letters to which we haveaccess were written to the CNA secretary, an officialrepresentative of the nurses’ employer. Only a very few ofthese letters were then chosen for publication in Nursing

Notes (the magazine that ran 1888 through the 1940s andwas comprised of letters, reports and advertisements ofinterest to fellow nurses). Therefore, it is perhaps notsurprising when one comes across a letter espousingopinions exactly in line with both the CNA philosophy andthe values of imperialism. In fact, though women’s travelwriting may seem ‘‘largely supportive of the imperialorder, even though the voice and the tone may be morenuanced,’’ censorship greatly ‘‘restricted what travelwriting became available in print’’ (Travel Writing, Formand Empire Introduction, 2009).

CNA nurses recorded their impressions of the foreignlands and peoples they encountered; therefore, one mayproductively study their letters as a form of colonial travelwriting. The over-arching purpose of ‘colonial discoursestudies’ is to understand ‘‘how stereotypes, images and‘knowledge’ of colonial subjects and cultures tie in withinstitutions of economic, administrative and biomedicalcontact’’ (Spurr, 1993). In other words, how does acolonist’s perception of ‘natives’ reinforce colonial policy,and vice versa? As hospitals and clinics must surely beconsidered institutions of ‘‘biomedical contact,’’ and asCNA nurses were sent to support the economic andadministrative functioning of empire, their writtenimpressions may be considered as valuable examples ofcolonial discourse.

When examining the letters from this perspective, onebecomes especially attuned to representations of inter-cultural friction or misunderstanding. As Mary Louise Prattargues in Imperial Eyes, much of colonial travel writing was

written in the ‘‘contact zones’’ of empire–‘‘social spaceswhere disparate cultures meet, clash and grapple witheach other, often in highly asymmetrical relations ofdomination and subordination’’ (1992). Reading thesetexts, one must be alive to how ‘‘subjects are constituted inand by their relations to each other.’’ When producingwritten texts, colonists commonly attempt to exert theirsuperiority by expressing mastery over landscapes andbodies. For example, many explorers describe foreignlandscape in three steps: first they estheticize it, painting apicture with their words and taking ‘‘esthetic pleasure’’ inthe sights they encounter; then they imbue the landscapewith ‘‘density of meaning’’, making it ‘‘rich in material andsemantic substance’’. At the third stage, ‘‘mastery’’, theexplorers ‘‘judge and appreciate’’ their environment andproduce their ‘‘own vision of it for the readers (Pratt)’’.

In addition to the environment, it is common to findtexts of exploration and travel that engage with the body asa ‘‘focal point of colonialist interest’’—either its ‘‘materialvalue as labor supply, esthetic value as object of artisticrepresentation, ethical value as a mark of innocence ordegradation, scientific value as evidence of racial differ-ence or inferiority, humanitarian value of the sign ofsuffering,’’ or ‘‘its erotic value as the object of desire’’(Spurr, 1993). Instances appear where colonial nursesinvoke bodies—their own, as well as both their white andnative patients’—on all of these semantic levels except theerotic. For example, a nurse may mend a colonist’s brokenbody so he can continue to labor in mines; she may judge a‘native’s’ level of civilisation and morality by his or hermedical practices; but at the same time, she may feel it isher duty to relieve the suffering of members of both races.She may also depict the physical discomforts of life in thecolonies, but downplay her own suffering out of a sense ofduty. These are some of the key elements to which lifewriting and travel writing analysis draw our attention, tokeep in mind when examining the letters themselves.

4. The Colonial Nursing Association

The Colonial Nursing Association began in 1896. Itsupplied over 8400 trained nurses to care for the sick andwounded abroad between 1896 and its termination in1966. The Association was suggested by Mrs. FrancisPiggott, who observed British subjects in need of adequatemedical care in Mauritius, where her husband was posted.In her proposal letter to the Colonial Office in 1895, shewrote that ‘‘Recent experiences in this Colony and amongthe European Community in Japan, have brought home tome most forcibly and distressingly the utter impossibilitywhich exists in these places of obtaining any skillednursing in serious cases of illness.’’ She continues byemphasizing the difficulties of life in the colonies, assertingthat ‘‘men, delicate women and small children’’ must face‘‘terrible risks and trials’’ because their ‘‘duties andavocations lead them year by year to these far-awaytropical and often unhealthy climates.’’ She creates a senseof urgency through dramatic diction—‘‘forcibly, distress-ingly, utter impossibility, serious’’—as well as by char-acterizing the colonial setting as threatening and foreign

J. Howell et al. / International Journal of Nursing Studies 48 (2011) 1155–1162 1159

(‘‘delicate,’’ ‘‘small,’’ ‘‘terrible risks,’’ ‘‘far-away,’’ ‘‘tropical,’’‘‘unhealthy’’).

The letter portrays nurses as able to counteract negativeattributes of the colonial environment by recreating themore civilised standards of medical care available at home,which will allow for the natural relationship betweenwhite men and women to be reestablished. Mrs. Piggotdwells most on examples of what she melodramaticallyterms ‘‘young married women to whom their hour of trialcomes,’’ or mothers in labor. She describes with distasteinstances when it becomes necessary to engage a nativenurse, such as ‘‘a helpless old China-woman’’, or for thehusband to step in to assist with his wife’s care. The nurse’spresence can prevent these undesirable situations fromoccurring. Joseph Chamberlain, in his address at the 1899annual CNA meeting, echoes these values: ‘‘hitherto oursick fellow countrymen have been left almost entirely tothe tender mercies of the dirty, ignorant, and of courseindifferent natives,’’ he says, but now they can depend onwholesome, English women to care for them.

The Association’s work was depicted as beneficial toboth the project of empire and the professional develop-ment of nurses. Sir Alfred Jones, during the 1905 annualmeeting, said, ‘‘Speaking from the point of view of abusiness man, he considered it wise economy to supportthe Association, as it was certainly diminishing the greatwaste of life in the tropical Colonies.’’ In 1909, Mrs. CharlesRobinson, a member of the CNA committee, wrote ‘‘TheStory of the Colonial Nursing Association’’, in which sheasserted that ‘‘Professionally, it is exceedingly rare for anurse to fail, and certain of them develop qualities whichnot only double their value, but largely increase theirpersonal happiness.’’ Both of these excerpts are notable fortheir characterization of human life in terms of investmentand ‘‘waste,’’ reminding the reader that CNA nurses werehired to support colonialism, which was purportedly amoral but also fundamentally an economic venture.Similarly, nurses are encouraged to think of their ownprofessional development as a commodity, which can bevaluated, and which is enhanced by experience abroad.

Nurses were selected carefully for service in the CNA(later called the Overseas Nursing Association), as it wasunderstood that their performance affected not only theirpersonal reputations but also the reputation of the CNAand of British colonialism itself. Women who fell betweenthe ages of twenty-five and forty were chosen. They weremost often middle class or from ‘‘the new skilled workingclass.’’ This selection process targeted spinsters and‘‘ladies,’’ who would ‘‘aim to replicate their sense ofpropriety abroad’’; this demographic would perhapsbenefit from opportunities beyond the domestic realm,and would (it was hoped) enhance the reputation of theCNA through good behavior (Rafferty, 2005).

Certain personality characteristics were also desired bythe CNA: ‘‘The greatest qualifications for nursing abroadare cheerfulness and tact.’’ Cheerfulness was considerednecessary in the face of the challenges of climate, culturaldifference and travel, and tact in the face of ‘‘awkward’’ orunexpected incidents. The same author appeals to nurses’sense of duty and heroism when he says, ‘‘The need is sogreat, the difference made by her service so incalculable in

the lives of those whose lot is cast in a far country.’’ A nursewho answers the call to serve in the colonies ‘‘can feel thatshe is not only fulfilling the highest aim of her career inhelping the sick and suffering, but also doing her share ascitizen of a great Empire in preserving the health of thepioneers and patient lonely workers.’’

The letters of those who served in the Colonial NursingAssociation provide a rich resource for exploring nurses’life writing. In particular, one may analyze their self-representations in order to see to what extent they alignedwith the expectations outlined by the CNA. Also, thecolonial environment sometimes provided nurses withmore opportunities for professional initiative and inde-pendence than they might have received at home, and it isuseful to see what they did with their newfound freedoms.Of course, the letters provide a fascinating window into theday-to-day realities of colonial life. Perhaps most impor-tantly, however, one may gain insight into these earlynursing ‘‘pioneers’’’ values and emotions by examiningwhat they chose to include in their letters home.

5. Letters by CNA nurses

Held by Rhodes House library at Oxford University is asubstantial archive of documents related to the ColonialNursing Association, including transcripts of annual meet-ings, official recruitment publications, and nurses’ indivi-dual files, with their applications and letters to the CNAsecretary (Colonial Nursing Association archives, Mss BritEmp s400, hereafter CNAA, Rhodes House, Oxford). Thisarticle will concentrate mainly on the models of identitycreated and adapted by nurses in their own writings.Excerpts from four letters are analyzed—one unpublished,three published—from Central Africa and the West Indies.

Though the entire history of the CNA is relevant to thefields of life writing studies, colonial and nursing history,this article considers letters written before World War I,because during wartime, well-rehearsed rhetoric ofpatriotism and service can dominate cultural discourseand block out other key considerations. This article focuseson Africa and the West Indies, colonial sites with complexlegacies left over from slavery and the slave trade, in orderto better understand CNA nurses’ relationship to race andracial difference. Paul Gilroy suggests we consider thedynamics of cultural migration and contact betweenAfrica, America and the Caribbean. He says that suchstudy should not focus only on one strictly defined nationor ethnicity at a time, but instead on the whole regionthrough which black bodies were transported for slavelabor. He calls this region the ‘‘Black Atlantic’’ (1993). TheCNA nurses could not help but participate in the legacy ofthe Black Atlantic, as they treated and trained the sons anddaughters of former slaves. Though legally emancipated,these subjects were often still exploited—as Kevin Grantclaims in A Civilised Savagery, ‘‘Slavery and freedomremained blurred even after emancipation, which com-monly gave way to what abolitionists called ‘slaveries indisguise’’’ such as indentured servitude, unfair wages andpoor living conditions (3). The CNA nurses faced limita-tions posed by inadequate medical supplies and staff, aswell as from poverty surrounding their stations. In Africa

J. Howell et al. / International Journal of Nursing Studies 48 (2011) 1155–11621160

and the West Indies, they were often posted to struggling,former slave- and plantation-based colonies. Further, thenurses themselves were also transported back and forthacross the Atlantic in the service of Empire; their travel wasdictated by routes of colonial trade and economic demand.

Miss Alice E. Drewe is a useful subject of study becauseshe served in the CNA for an extended period of time—from1898 to 1923—and in many different locations, includingCeylon, Eastern Rhodesia, Sierra Leone, Southern Nigeria,the Gold Coast, British East Africa and Cyprus. She wrotethe first letter under scrutiny here from North EasternRhodesia in 1906. Britain was interested in Rhodesia for itsminerals and precious gems. From the late 1800s, Britishworkers were sent to construct a railway system connect-ing South Africa with Rhodesia, in the interest of ‘‘colonialcapitalism’’ (Lunn, 1997). It was hoped that the railwaysystem would eventually stretch ‘‘Cape to Cairo’’ in orderto make exporting more efficient. White Britons whoarrived to work on the railways or in the mines often hadlimited previous knowledge of or contact with other races.As historian John Lunn explains, unfortunately, ‘‘Whiterailway workers were not slow to resort to ideas of ‘nativestupidity’ and ‘inferiority’ to justify their relative privi-lege.’’ In analyzing nurses’ letters, then, let us remainattuned to the degree of influence such common colonialrhetoric may have had on their writing.

Miss Drewe begins by telling Secretary Miss DalrympleHay that she meant to write earlier, but has been too busybecause there has been ‘‘no other nurse here besidesmyself’’ (CNAA). Her journey took three months. Nurseswho served in Central Africa often had long treks beforearriving at their final destination, as was Miss Drewe’sexperience: ‘‘On my arrival in Chinde I had to wait severaldays for the river steamer + the journey up the Zambesitook three weeks, twelve days of which were spent in ahouseboat. The weather was hot + extremely dry + wewere continuously landing on sandbanks which madeour progress up the river very slow.’’ She documents thepractical difficulties of such a journey, as the party ran outof all provisions ‘‘except tinned salmon’’ several daysbefore arriving on shore and then travelled over land for afurther fourteen days while sleeping in tents. They lackedclean water: ‘‘The rivers + streams being very low therewas scarcely any water to be had + it was usuallythick + muddy + sometimes almost black.’’ While thesediscomforts would be trying for any traveler, Miss Drewestates the problems matter-of-factly and does not dwell orexpress self-pity.

She explains further challenges of the job, includingpurchasing household supplies and paying for privateservants out of her own wages, and often working doubleshifts: ‘‘There is only one nurse in the place + when I firstcame I did night + day work, but now in bad cases some ofthe officials relieve me in turn at night.’’ While some of thepatients she is called upon to treat are routine maternitycases, some are unique to the colonial environment:‘‘There have been several patients in from the gold mines atNussale (30 miles from here) one of them was a poor fellowwho had been tossed by a buffalo. He had five ribs brokenand four large wounds which were in a terrible state as hehad travelled nearly 100 miles in a machilla. I am glad to

say he is well again now and at work’’ (CNAA). While thisnarrative underscores the Miss Drewe’s own professionalcompetence and strong work ethic, it must also remind thereader of the over-arching purpose of her position, which isto maintain colonists’ bodies, and their ability to workextruding natural resources for the profit of Empire.

In letters, nurses often describe their own homes,including details of the natural setting. While some, suchas Miss Drewe, seem to take comfort in reproducing abotanical version of home—‘‘I have made a garden since Icame + have rose trees honeysuckle + other creepers roundthe verandah’’—still others revel in the exotic quality ofnative plant life and the tropical environment, as demon-strated in the letter from Costa Rica. Miss Dreweemphasizes the elements of Fort Jameson that remindher of home, and judges it livable according to thesestandards: ‘‘There are generally about ten ladies in FortJameson + it is quite a sociable little place. There is a niceclub + library also a sports and golf club + a Ladies tennisclub.’’ In her free time, she chooses to socialize in thisinsular simulated-Europe.

In contrast, in a letter published in February 1904sNursing Notes, a nurse posted to Costa Rica emphasizes thedelight she finds in her new circumstances. She travelledduring a brief interim period of prosperity in the WestIndies and adjoining countries, after the 1896 RoyalCommission had investigated the status of these coloniesand then pumped over three million pounds into the localeconomies and the trade infrastructure in order to makethem profitable. Sugar cane and coffee exports were on therise, supplemented by tropical fruits. However, uprisingsover poor labor conditions in the 1920s and 1930s, andmid-century struggles for independence, had yet to occur(Dookhan, 1988). One may observe in the followingexcerpts a sharp contrast in perspective regarding theWest Indies between the pre-War years and mid-century.In the first excerpt, from The British West Indies (1912),author Algernon E. Aspinall enthuses, ‘‘By Englishmen allthe world over the very name West Indies should be helddear, for it was in those colonies that the foundations of theBritish Empire were laid.’’ He states ‘‘The scenery of theWest Indies is exquisitely beautiful. That will be admittedby everyone who has been privileged to visit thosecolonies. . . [They are] Clothed with a wealth of tropicalvegetation in which creepers and ferns of infinite varietypredominate.’’ By 1951, when W.L. Burn writes his History

of the West Indies, cynicism and disgust have replaced theearlier enthusiasm and optimism: ‘‘An observer of theEnglish mind on the eve of the last war must have found ithard to believe that the West Indies could ever have beenobjects of ambition and desire. . . Their wealth, once sosplendidly tangible, which had built great families andaltered the course of national politics, had been replaced bya dreary indigence.’’

However, in 1904, optimism still dominates. Our CNAnurse travelling to Costa Rica enjoys the Caribbeanenvironment, noting, ‘‘We had a most pleasant voyageout, good weather all the time, and we touched inBarbados, Trinidad and Jamaica.’’ She disliked the enclosedenvironment of the ship, so set out with a fellow traveler to‘‘the Constant Spring Hotel’’, ‘‘nearly seven miles out of

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Kingston, near the Hills.’’ She states, ‘‘We had a delightfullycool room and pineapples for breakfast, and we took backsome lovely flowers to the boat. There were hummingbirdsin the garden and clouds of butterflies.’’ This tropical Edencontinues ‘‘all the way up’’ to the post, as she passes ‘‘firstbananas and then coffee plantations; rivers and waterfallson either side and trees growing close to the line with allkinds of wonderful creepers hanging from them.’’

This nurse imbues her journey with a sense ofadventure and happiness, related to the luxuriant, sensualbeauty of the natural landscape. As previously mentioned,such themes are often found in colonial travel narrativeswherein the writer ‘‘estheticizes’’ the tropical environ-ments in order to make order and sense of it. In addition,one notes the mention of coffee and banana plantations,which indicates the colonial economy that the nurse’slabor is intended to support.

Finally, whereas male explorers earlier in the nine-teenth-century might have added to their descriptions ofthe landscape ‘‘density of meaning’’, namely references tothe rich natural resources they hoped to mine, here thenurse invokes her professional role by listing her ‘‘cases’’.She leads with her professional accomplishments, speak-ing with a voice of authority and self-confidence: ‘‘I am atmy second typhoid case already. The first was a little girlwith typhoid, quite a mild case, but there is a great deal oftyphoid about here, and always will be till they have abetter water supply and drainage. I am now at a maternitycase.’’ Her tone is matter-of-fact and upbeat. She seemsunfazed by the possibility that the winds of the dry seasonwill be ‘‘rather trying’’—she says that in her previous post ‘‘Ihad plenty of that before.’’ This early published letterpaints an appealing example indeed of life as a CNA nurse.

Some nurses go even further, to the extent that theyprofess a preference for the colonial to the domesticenvironment. In the next letter, from the May 1904 editionof Nursing Notes, a different nurse claims ‘‘One feels quitehelpless in civilisation after living two years in the jungle. Ilove the jungle and am already longing to return and leavethis terrible English cold. Life in Central Africa is just onelong summer day, with a shower in the middle and a longcool evening after the rain.’’ By saying she ‘‘feels quitehelpless in civilisation’’ and longs to return to the jungle,the nurse allies herself with the colony, and, one couldargue, depicts herself as an honorary native. She hascompletely acculturated to the new setting. This is aninteresting rhetorical move practiced by many generationsof colonial explorers whereby the colonist exerts super-iority over her readers through having more intimateknowledge of an intimidating foreign locale than they do.However, her experience is dependent upon the speaker’sposition of privilege—she may revisit England whenevershe wants, and she never encounters colonial lifeunfiltered or unprotected by her circumstance as a whitewoman.

This letter demonstrates the nurse’s adventuresomeand intrepid spirit. She enthuses, ‘‘We had a wonderfullyentertaining journey coming out of the country’’:

The river was too low for a boat to come up, and we hadto travel overland nearly all the way to Chinde, almost a

three weeks’ journey through jungle where very fewwhite women had ever been. The natives were mostinterested to see the ‘Donas,’ some of them neverhaving seen white people before. We travelled thegreater part of the way by night as it was too hot for theboys to carry us by day. We came through the big gamecountry, and the natives told us they had been veryfrightened by hearing lions. We had not heard them Iam glad to say, but the boys know the sound too welland are terribly afraid.

The nurse’s experience takes on the romanticism andexcitement of bushwhacking, even though she is in fact onan established trade route to a colonial outpost, beingcarried by native ‘boys’ so as not to overly exert herself. Sheeven includes the scintillating detail of lions roaring in ‘‘biggame country’’, hearkening back to Henry Morton Stanleyand other hyper-masculinist discourses of African explora-tion.

Within the ‘‘contact zones’’ of the colonial environment,travelers often cement their superior status through theirrepresentation of natives. The CNA nurses expressfrustration with native ‘superstitions’ and traditions, asthey feel such practices interfere with the work they aretrying to accomplish. Ania Loomba, in her book Colonial-

ism/Postcolonialism, explains that this is not an uncommonperspective: ‘‘Many nineteenth and twentieth centurywriters equated the advance of European colonization withthe triumph of science and reason over the forces ofsuperstition’’ (2005). Miss Drewe, the nurse posted toCentral Africa, remarks ‘‘The natives here are extremelylazy + usually leave off work as soon as one’s back is turned.I do a good deal of cooking myself as they are not to betrusted with invalid food neither are they to be trustedwith patients who are very ill at night as they invariably goto sleep + it is sometimes difficult to wake them.’’ Thisrepresentation of locals as not trustworthy and lazy iscommon in colonial texts. Here, it emphasizes the dividebetween the nurse (competent) and the native (incompe-tent; in fact, a liability). It rests upon characterization ofblacks, in this case, as immature or childish, inferior insense as well as in training to their white counterparts.Such rhetoric also creates for the nurse a position ofmedical authority as distinguished from backward Others,who must be taught, punished or supervised.

As a further example, a nurse stationed in the WestIndies wrote in June of 1904 ‘‘I have trained one woman, orperhaps ‘trained’ is too big a word for it. She is a middle-aged Carib woman and I have taught her that absolutecleanliness is necessary and that interference with any butnormal cases is punishable’’ (Nursing Notes). Not only inAfrica and the Caribbean but in other colonies as well, CNAnurses often recount forcefully displacing native nursesfrom caregiving situations in order to protect the health ofthe patient from their well-meaning but damagingministrations. In this quotation, the native nurse isrepresented as incapable of true training; rather, she canonly comprehend punishment and reward. It is not thepurpose of this paper to question the merits of hygienicmeasures implemented by early twentieth-century Britishnurses in the colonial context, which doubtless saved lives,

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but rather to turn our attention to the identities thesenurses forged, sometimes through contrast or oppositionwith other subjects.

6. Findings and future research

The colonial nurse, though ostensibly employed tocreate an ordered, hygienic and traditionally ‘‘British’’treatment environment within the colony, was also apotentially transgressive figure—a single woman travellingto the outposts of empire and encountering unusualchallenges and trials due to her situation. She blendedcharacteristics of bravery and nurturing, kindness andambition, service and self-interest, all of which can be beststudied through careful consideration of her writings.Women who demonstrated such complex motivations andcharacteristics challenged the ‘‘angel in the house’’stereotype. Coventry Patmore’s 1854 narrative poem ofthe same name had introduced a popular ideal offemininity that was influential in the later Victorian periodand early twentieth-century, whereby a woman should beangelic, innocent and submissive to her husband (‘‘Manmust be pleased; but him to please/Is woman’s pleasure’’).For the CNA nurse to be accepted and celebrated for herstrength and professional capability indicates that the frailand self-sacrificing ‘angel in the house’ was a model thatcould be broken or revised depending on context and theneeds of the nation. In this sense, CNA nurses built uponthe precedent set by Florence Nightingale and otherwartime nurses, who breached the domestic settingthought to be most appropriate for women while stillmaintaining an air of propriety. Therefore, the CNA nurses’popularity should cause us to further reassess some of ourcurrent assumptions about the pervasiveness of historicalgender limitations.

When studying nurses’ writing, it is productive toemploy methods of life writing analysis more generally,and specifically to consider their letters as colonial travelnarratives. These approaches allow one to remain alive tothe political as well as personal implications of autobio-graphical texts. The findings produced by such studyenhance our understanding of nursing and colonial history.In addition, we gain insight into nurses’ multivalent self-fashioning and identity formation. Namely, we observethat, in writing their own stories, nurses claim forthemselves medical, cultural and narrative authority.

Our future research plans include seeking outunpublished and unofficial correspondence by CNAnurses posted to the West Indies and Africa. Fellowresearchers at King’s College are investigating CNAnurses’ experience in Asia and during the World Wars.Collaboration with scholars who study the history ofdistrict nursing, or the writings of nurses travelling forwork in a domestic context, would be valuable indetermining the differences between the rhetoricalmethods nurses used at home and abroad. It also wouldbe desirable to further investigate nurses’ historicalrelationship to race and racial difference within health-

care environments, especially in traditionally segregatedsocieties such as those found in colonial and slave-basedeconomies. More fundamentally, however, this essaycontributes to an ongoing and growing project ofreclaiming and listening to nurses’ voices, letting theirown words speak for themselves.

Conflict of interest: None declared.

Funding: Wellcome Foundation. Funders played no role in the

conduct of research.

Ethical approval: None.

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