Anne Marie Rafferty

The Seductions of History and the Nursing Diaspora^*

From 1896 to 1966, more than 8,400 British nurses applied to the Colonial Nursing Association (CNA) for work in the colonies, lured by the seductions of empire, adventure, and independence. The CNA's pristine and uniform image of the British nurse as a beacon of the empire fails to capture the nature of these multi-layered subjects, which defies simple stereotypes of nurse, woman, spinster, colonial officer, and expatriate. Today, the legacy of nurses travelling through the empire has been replaced by a migration of nurses into the United Kingdom. By developing a deeper historical understanding of British nurses in the empire we can begin to understand the impact of these newer immigrations on nursing care in Britain today.

In paying tribute to the memory of Ben Haneman—a remarkable physician, ethicist, and historian by all accounts—I was struck by his major contribution to the Indigenous Health archive in Australia. I wondered then what he would make of the British nurses sent out to work in the colonies in Victorian and Edwardian Britain. Would he judge them, as a physician and clinician, in terms of how well they worked with their medical colleagues and adapted their clinical skills to the new and challenging environments of the tropics? Or would he consider them from the view-point of an ethicist, noting how sensitively they dealt with cultural difference? Perhaps, donning his historian's hat, he would have regarded them very much as a subset of the social group to which they belonged—judging them in the context of the standards, norms, and values of Victorian and Edwardian society. Most likely, he would have seen them in all three dimensions—multi-layered subjects with different sets of overlapping identities. In this article, I would like to explore how the image of nursing was transformed by the reform of nursing in the late–nineteenth century and how this image was transported and further altered through the diaspora of nurses who worked in the British colonies.

Nurses and historians

First of all, I would like to reflect briefly upon what historians and nurses might have in common. There is a sense in which they share a desire for intimacy—intimacy in the sense of a desire to get close to one's sources and subject. To be a good historian, one has to enter the world of the 'other' and understand his or her world, based on what the evidence suggests. The historian acts as an intimate confidante, privy to the stories and secrets from the past. For the nurse, intimacy comes from being privileged to share in the patient's encounter with illness. In nursing, intimacy is the touchstone of quality patient care, as well as being a source of job satisfaction. There is something about the prospect of the relationship that the historian has with his or her sources and the nurse with his or her patient that lures us into libraries, or hails us into the hospital, the home, and other settings where health care is delivered. One could take the argument further. If the historical archive is a site for intimacy and seduction, then the sickroom was also feared as one. The sickroom was a site that elicited ambivalent responses from those who crossed its threshold; atmosphere, attitudes, and accoutrements set the scenes for seductive encounters. The sumptuous surroundings of the Mitchell Library in Sydney, and the rules and rituals of the cultural space of the reading room impart a reverence to the authority of the stories that wait to be discovered. Just as it is the historian's role to fashion their accounts by working with agreed professional methods that assist them to portray the past with verisimilitude, based on verifiable archival evidence, so the nurse's role to protect and defend the patient with whom he or she is engaged in the therapeutic relationship is governed by professional codes of practice. The nurse legitimately transgresses socially-inscribed boundaries of intimacy and the body by following practice guidelines and by adopting a professional persona that mediates the intimacy of the close, personal encounter. Similarly, the historian, privileged with intimate personal sources of evidence from the past, adopts a professional stance that guides interpretation of that documentary evidence, bringing the voice of the author to life with veracity, by using the methods of their profession.

Nurses in history

Intimacy and seduction are themes that feature in the early records about nurses in the archives. These are not, however, the archives of a state library but fictional accounts—novels of the mid-to-late Victorian period. Indeed, what is generally regarded as the first novel, Daniel Defoe's A Journal of the Plague Year, features nurses as miscreants.¹ They are not the pristine paragons of Christian virtue, promulgated by nurse propagandists, but nasty, nefarious nurses plying their pernicious trade, thieving from patients, and even murdering them for personal gain. Perhaps the most famous portrayal is that of Sairey Gamp—a comic–cruel creation of Charles Dickens. This watcher of the sick and canny practitioner caused havoc in the households of the sick, with only cursory regard for the patients' welfare, provided it did not interfere with her own.

These social novels reflect, above all, the anxieties of the middle classes rubbing shoulders with women of working-class origins; their crude cultural practices contaminating the sickroom and disrupting the smooth running of the Victorian household.² What reformers objected to was not just the identification of the 'old-style' nurse with working-class culture, but also the unsupervised nature of her practice and its commercial success in the growing market. They disliked her autonomy, referral networks, nostrums and remedies, and, most of all, her scant regard for medical authority. But it was the very success of the 'Gamp types' that stimulated reformers to try to squeeze her ilk out of the market and introduce a programme of reform. Making nursing respectable would expand employment opportunities for middle-class women, legitimising their work by aligning it with the gentrifying aspirations to a religious devotion to duty and philanthropy.

The second theme evident in the fictional literature that is relevant to this analysis, is that of the nurse as seductress. The nurse is portrayed as the sexual spider preying on the sick male heads of households, or upon the unsuspecting doctor, diverting him from his vocation.³ Nurses, in these accounts, are cast either as husband huntresses or hypocrites inveigling their way into the wills of besotted patriarchal figures. Again, the theme is one of the patient's vulnerability, when the necessary intimacy of their encounter is consequently exploited and betrayed by the grasping, unscrupulous nurse. Reform, in this context, meant reconstructing the class basis of nursing, creating distance from working-class culture. Aspirant nurses, doctors, and managers conspired to move the locus of care from the private, domestic setting of the home to the more public space of the hospital where the new nurses and patients could be supervised and subjected to surveillance. This was necessary in order to reform the morals and mores of working-class patients, seen increasingly as a threat to stability in the social ferment of burgeoning cities in Victorian England.⁴

The new nurse who emerged from this purification process was the antithesis of the old; she was her polar opposite. Above and beyond reproach, the new nurse's crystalline character became a beacon of Christian piety and virtue, and her demeanour and deportment were signifiers of her class. The new nurse's domain was that of the hospital, in contrast to her domiciliary counterpart.⁵ As the new nurse was charged with a 'civilising' mission at home, nurses who went to work in the colonies were to become bearers of that same mission across the great expanse of the empire.

British nurses in the colonial context

Existing studies based on the archives of the Colonial Nursing Association (CNA) in Oxford and the British National Archives in London, present nurses in colonial history in terms of the historians' concerns to expose race, class, and gender politics as seen through the experiences of coloniser nurses in colonial contexts. Historians have attempted to challenge the image of the British nurse as 'heroine of the empire' and reveal the range of nurses' attitudes to the relationship between themselves as colonisers and the colonised, mostly in a specific colony context.⁶ The primary sources of evidence in the archive of the Colonial Nursing Association provide a unique and rich resource that invites investigation along multi-disciplinary lines of inquiry. They expose the complexity of the British nurses' positions in specific colonies, factors that motivated them to apply for overseas posts, the range of their attitudes to their colonial experiences, perceptions of their place in the imperial mission, and the eventual decline in their status and the effects on the nursing profession.⁷ Apart from reappraising existing scholarship on British nurses in the colonies, engaging broader thematic concerns may reveal commonalities with migrant nurses' experiences today, and change the way nurse migration is understood within the profession and by the public.

The beginnings of the Colonial Nursing Association (CNA)

The Colonial Nursing Association was established in 1896 by a coterie of friends in London, connected with the Colonial Office (CO), who saw the need to send nurses to look after British expatriates in what they regarded as 'primitive' colonial habitats. In 1895 a proposal to form the CNA was made to the CO by Mrs Francis Piggott, wife of the procureur general in Mauritius, who would later become the association's first secretary. Although the scheme operated independently from the British government, Joseph Chamberlain, secretary of state for the colonies, took a personal interest in its establishment.⁸ The CNA operated at arms length from the CO and was self-funded from voluntary contributions. The first English nurse to be selected by the CNA sailed for Mauritius early in 1896. For the next seventy years, the association effectively operated as a recruitment agency for the CO—in 1919, the name was changed to the Overseas Nursing Association (ONA)—sending some 8,400 trained nurses to the colonies throughout the years of its operation until its closure in 1966.

The CNA's primary raison d'être was service to the empire. Its 'circle of patrons' included royalty, titled peers, and colonial officials—who, like Dr Gage Brown, Medical Adviser to the CO, saw the Association as 'a great philanthropic movement'.⁹ The first nurses were needed to help save the lives of colonial officials and 'heroes of commerce' throughout the empire.¹⁰ The Victorian upper-class and middle-class foundations of the Association characterised its recruitment principles. The CNA emphasized the nurse's character and social background; they selected lady nurses, whose religious dedication to duty would stand them in good stead in the colonies. Undoubtedly, some nurses were seduced by the promise of adventure, the exotic natural and cultural worlds, and the scenic landscapes—it was the ultimate travel opportunity in the service of the empire. But the reality of life in many colonies was to prove challenging for these mostly middle-class nurses, who could not have anticipated the isolation and loneliness that was a feature of many posts.

The emblematic nature of a nurse's behaviour

The image of the ideal nurse that the CNA promoted was dependent upon the recruits coming from a very specific target population. It was stipulated that, ideally, the nurse should be older than twenty-five but younger than forty, effectively defining spinsters as their target group. Nurse recruits were mostly from the middle class or the new skilled working class, the greatest numbers being unmarried daughters of engineers, professionals, and commercial traders, as well as a significant group whose fathers were landowners.¹¹ The youngest applicants were twenty-three years old, and the oldest forty-four years; the average age was thirty years.¹² The census records reveal that approximately one-third of British women between the ages of twenty-five to thirty-five were unmarried in the late–nineteenth century, and throughout the Edwardian years there was a sustained surplus of women in England and Wales.¹³ Nursing in the colonies presented an alternative role for unmarried middle-class ladies. A successful CNA recruit had the benefit of being associated with a respectable organisation with social kudos at home. Provided they followed the CNA's social prescriptions for the lady nursing sister, they would be given an opportunity to be part of the civilising mission across the empire.

That nurses sent out to the colonies should be 'ladies' who aimed to replicate their sense of propriety abroad was accepted without question by the CNA. What was meant by lady was clear: secular middle-class nurses were expected to be 'religious, modest, gentle, patient, compassionate, and self-sacrificing, always placing the needs of other members of their families ahead of their own needs or wishes.'¹⁴ In an open letter circulated to the nurses and their friends and families, the CNA stated that a nurse who is a 'pleasant, capable woman, with some tact, and of good private reputation' was considered 'invaluable.'¹⁵ The nurse's behaviour reflected the authority of the colonising power, and, at the same time, it could so easily undermine that power. The CNA instructed their recruits accordingly:

A nurse's success is her own, but her failure is not her failure only, and no nurse should leave England without realising this, and having a distinct standard of right and wrong on which she means to base her life.¹⁶

The distinct standard of right and wrong applied to her behaviour, her uniform, and her social and work habits. She was expected to be obedient to her medical officers and uncritically accepting of her place in the hierarchy.¹⁷

The Association called for moderation in social activities, which were clearly of secondary importance in the life of a lady nurse. It was advised that a lady should not be too knowledgeable, worldly, or independent; her actions and behaviour would be criticised 'more than in England,' especially by those 'whom she thinks in all innocence, are greatly admiring both her savoir faire and knowledge of the world.'¹⁸ The contrast with their Religious Nursing Sister predecessors, who were working in several of the colonies, is clear.

The seduction of the colonies

There were many 'push' and 'pull' factors that enticed nurses to respond to the CNA's recruitment drive. Whilst some nurses had colonial connections through their fathers or brothers who had served as colonial officials, army officers, or missionaries, many other nurses without such connections chose the uncertainty of a life overseas. Nurses wrote about their expectations of a better life abroad, the variety of work and the unique challenge it entailed, and the sense of responsibility that could only be experienced in the service of the empire, where, for example, the nearest doctor might be seventy-five miles away.¹⁹ Many nurses relished the sense of autonomy and the certainty that a tour of duty in the colonies would furnish them with unforgettable memories: 'Life, conditions, climate, food, in fact everything is so different from what one has been used to, that on arrival, especially as a first experience, one feels as though one has been dumped into a new world,' one nurse reminisced.²⁰ Life among the expatriate and indigenous colonial community provided accommodation, reasonable pay, a pension for those who stayed long enough, and a sense of contributing to the imperial project of bringing western health care to the expatriate communities they served. Mary Johnson, for example, was a thirty-year-old nurse who chose to devote her working life to colonial nursing. She trained at Manchester St Mary's Children's hospital in the late-nineteenth century and also earned her qualification as a midwife with the Central Midwives Board. She was interviewed by the CNA on 13 June 1901 and her first tour was to Cyprus as Matron of the Government Hospital. She was then appointed as a Nursing Sister for the Government hospital in the Federated Malay States in August 1901, where she worked until she retired in 1913.

The expatriate community also offered social opportunities for these British ladies; undoubtedly, the nurses' marriage prospects in the colonies were far greater than if they had stayed in Britain. Unfortunately for the CO there was a significant consequence of this fact. Not only was there an increased chance that any eligible bachelor they met through the colonial services was of their equal or higher social standing, the nurses were in any case subordinate to men in the hierarchy of the service: lower in rank and earnings. They were often willing—indeed many expected—to give up nursing in favour of the social status that marriage offered. One-fifth of the first one hundred recruits married.²¹ Clara Watson from Dublin was among them; she had completed three years' training at King's College Hospital and held a qualification from the Obstetrical Society. The CNA committee interviewed her on 4 March 1904 and she was posted to British Central Africa, although the documents record her preference for Venice. She did not complete her tour, resigning in October 1904 because she was about to get married.²²

Colonial community

For others, who perhaps did not aspire to marriage, the sorority of their nursing colleagues abroad was important; several nurses applied to the CNA in pairs, requesting to be posted to the colonies together. Emma Dark, of Brixton Hill, was thirty-eight years old when she applied to the CNA with her friend, Sarah Watson, who was thirty-two. They had completed the three-year training course at Guy's Hospital in London, where, as the evidence suggests, they met. Subsequently, they had worked together at the South East Fever Hospital for five years, and were therefore very experienced nurses and well qualified for colonial work. Watson also completed the midwifery qualification with the Central Midwives Board. The nurses were interviewed on the same day in June 1899, and the records show that they expressed their wish to be posted together. The CNA supported these requests. Their first tour of duty was to Northern Nigeria from 1900 to 1903. After this tour, however, the pair withdrew their names from the CNA register, but it is not clear why they decided not to pursue further colonial work.²³

For some nurses, the isolation and loneliness of their posts proved intolerable. Jeanie Stewart applied to the CNA in January 1929 when she was thirty-seven years old, and was sent to the Government Hospital in the Virgin Islands in May of that year. By December she had written to the Secretary of the CNA, advising of her resignation:

Acknowledging the debt I owe to the Association for their assistance I would wish to let you know of my resignation of the position of Nurse Matron of the above hospital and that my principal reason is that I find the awful lonliness [sic] unendurable, so much so that it is telling on my nervous system. I wrote Miss Adams after I had been here a short time and told her how I found things also that I was prepared to give it a trial. After six months trial I think it wiser to give it up.²⁴

Indeed, the challenging and shockingly difficult nature of the job can be understood, not just via the individual stories of those for whom it did not suit, but also from crude statistics. Many recruits, for example, were susceptible to tropical diseases, especially during their first tour of duty. Of the first one hundred nurse applicants, 16 percent—mostly serving in the tropics—succumbed to illness; of these, 7 percent died and 9 percent were sent home to England as invalids.²⁵ In addition, of these first one hundred recruits, 20 percent resigned before their tour was completed, and many others completed one tour and resigned from the colony and from the CNA. Nearly one-third of the first one hundred applicants withdrew their applications after the initial interview.

Nevertheless, those who stayed in the service for the long-term and wrote about their experiences painted a picture of personal achievement gained from overcoming challenges and adversity, 'battling with primitive surroundings, conquering apathy and prejudice, learning a variety of languages and dialects, [and] making important decisions without help or advice.'²⁶ There were personal, as well as professional, aspects of overcoming challenges and adapting to the strange surroundings. Many reported on the niceties of their newly-won status as a British colonial nurse. Vivian Dargan, for example, wrote of her achievement in being awarded the Silver Badge for meritorious long service, and in making her home in Zanzibar in 1927:

I had my Silver Medal presented to me yesterday, with due form & ceremony ...
I am up in Weti Pemba and have a nice new bungalow, it is really a dear little house with 3 large rooms, 2 large verandahs, bathroom, boy's pantry kitchen, storeroom and Boy's room ... I have a garden full of flowers ... with zeinias, petunias, phlox, sweet williams, balsams and really a lovely show. I also have a vegetable garden and keep myself supplied with beans, lettuce, carrots, onions, tomatoes, cucumbers etc. These we cannot buy and it is so good for one out here to have fresh vegetables.²⁷

Evidently, the seduction of the exotic destinations was ultimately to be redesigned in the image of Britain, in a bungalow with a cottage garden.

Many nurses saw themselves as 'women pioneers ... blazing civilisation's trail in the far corners of the world.'²⁸ The challenge of working in the colonies gave them the opportunity to test their resolve: '[H]owever well equipped a nurse may be with technical knowledge and experience, many other qualities—superlative ingenuity, serenity in the face of incredible difficulties, and untold perseverance—are necessary for success in this work.'²⁹ Gertrude Merriman's account of working in Uganda illustrates her pioneering spirit. She was born in 1892 and applied to the CNA in 1929 when she was thirty-seven years old. She was sent to the Government Hospital in Uganda and worked for two years before she succumbed to illness and was forced to resign her post. She contested the assertion that her health was unable to cope with the tropical climate, and, having survived a severe attack of malaria, she argued the case for keeping her position:

During the last 13 months I was in Uganda I was in charge of the Native hospital Jinja. When I went to Jinja I found that the Native Orderlies were untrained with the exception of two. The interior of the wards were like ill kept stables in appearance; men and women were being nursed together, and there was no discipline whatever. Patients died through lack of attention. I was told that I would be responsible for the cleanliness, and discipline of the Hospital, also for all equipment of the Hospital, and clothing of patients, orderlies, nurses, also for the teaching of the latter ...The linen was needing renewing, and I had one Native boy to help to keep the linen for 104 beds in repair, also coats for the native male nurses, and to make the usual bandages etc. We also opened a women's ward, and altogether it was a very busy place. The African nurse had to be taught to read the patients' prescriptions, and symbols etc. All this took time, apart from trying to teach them how to nurse. ... I quite enjoyed teaching them; and I saw much progress, but one must not relax for one minute; the trouble was, one had not sufficient time to spend on one branch of the Hospital; also the young Medical men, fresh from the London Schools, found it difficult to be always improvising, and so were always complaining they had nothing to work with. ... I am not complaining, and I loved it all.³⁰

Work in the faraway colonies of the empire could be unusually demanding and difficult, but for those who persevered and succeeded, it was also unusually rewarding.

The perspective of the Colonial Office

From the CO's point of view the nurse was a crucial conduit into the local population and a means of winning the confidence of indigenous communities. It was expected that the decorum and demeanour of the nurse, as well as her class and status, would convey her capacity to exert her authority over the 'native personnel.' Correspondence from nurses mention the need to learn languages motivated not by a desire to interact with her indigenous patients and nursing counterparts, but by the necessity to communicate orders to the ward staff and to teach them British nursing practice. In 1928 Nurse Gracie Holmes wrote from Uganda about her role as teacher in a busy 'Native Hospital':

we are on the go all the time, added to that myself & one other sister gives instruction classes each morning for 1 hr to the Native Orderleys [sic]. These lectures are a series of Lectures on Practical Nursing, 36 lectures in all and are quite good and we hope to teach the Orderleys Nursing on a very different scale to what has been done up to the present. This is the Native Training School & from here the Orderleys are draughted [sic] all over "Uganda" so that we have to keep our wits about us and endeavour to make them learn.³¹

By the 1930s the tenor of CO policy itself was beginning to change. Spurred on by the threat of independence, a more conciliatory, development-oriented, and enlightened self-interested approach had to be adopted. Colonial policy in East Africa, in particular, was recommending the spread of education as a means of promoting the economic advancement of the country:

As in the political sphere so in the social, it should be the aim to train the natives themselves to take on an ever increasing part, not only in the work of the educational, medical, administrative and other services alike, by filling in such services any posts for which individuals may increasingly become qualified, but also in the local direction of these services through the native councils already referred to'.³²

Such councils were the professional registration bodies responsible for the regulation of training standards and the vehicle for reciprocal recognition of qualifications between Britain and its colonies. However, it was not until the eve of World War II that the CO began to pay serious attention to nursing. It recognised the benefits for Britain. Ultimately, the CNA's role evolved into providing nurse training for the indigenous populations in the colonies with the aim of creating a workforce capable of contributing to the British National Health Service.

Conclusion

In this article, I have sketched the beginning of the diaspora of nurses from Britain to the colonies. Nurses were lured by the seductions of empire, the spirit of adventure, and a newfound independence. But invariably their experiences tested their resourcefulness, resilience, and indeed their physical and emotional resolve. The highly regulated and scrutinised order of their lives as representatives of the empire meant that any breach of the codes of conduct were met with stern criticism at best, and at worst the termination of their position as a CNA nurse. The image of the British nurse, according to the CNA, had to remain intact for the benefit of the empire. But it was not transported in an unblemished form. The significance of the position of nurses, as the first women to serve in the colonial service (albeit not as fully-fledged officers with full pension rights), is that they adopted a range of attitudes to colonial life, from loyal complicity to active resistance and rejection of their 'imperial mission.' There is little evidence that they were standard bearers of universal ethics, but some nurses displayed sensitivity to the cultural significance of their roles. Certainly, there were cases of more radical nursing sisters challenging medical authority as well as those whose behaviour was more consistent with conventions central to the imperial project.

Interestingly, the paradoxical legacy of the nurses travelling through the empire today has been the reverse: a rising trend in inward migration of colonial nurses to the United Kingdom beginning at the moment that the National Health Service began to expand its demand for labour. The training of overseas nurses in Britain is a characteristic of the contemporary nursing workforce in Britain. Recruitment of registered nurses from overseas provides approximately one third of all new registrants joining the Nursing and Midwifery Council's register. The greatest numbers of overseas nurses come to the United Kingdom from India, the Philippines, Australia, and South Africa, followed by Nigeria, West Indies, Zimbabwe, New Zealand, Ghana, Pakistan and Zambia.³³

One thing that is certain is that both the experiences of yesterday's nurses serving the empire as well as current policy encouraging nurses from the former empire to migrate to the United Kingdom need to be evaluated in their historical context. The current drain of nurses from skill-depleted countries to richer destination countries is an ethical and economic dilemma for policy makers and health systems throughout the world. Current migration patterns do seem to correlate with colonial connections. But the relationship now, as in the past, is far from being a simple one. What the historical evidence begins to show us is that these women nurses were multi-layered subjects operating with complex motives in pursuit of multiple agendas. They defy any simple classification into stereotypes of the categories nurse, woman, spinster, colonial officer, and expatriate. Equally, there was no uniform way of exporting a British 'model' of nursing, if indeed such a model existed.

Perhaps what is important is the realm of the imagination, the 'fantasies' of empire that these nurses carried with them, which are likely to have been powerful motors of motivation. Thus literary as well as oral sources of evidence are important in developing a composite and complex view of the lives of these women as well as the settings in which they lived and worked. Diaries, letters, memoirs, fictional accounts, and travel writing all add to the rich repertoire of sources we can draw on. Moreover, conceiving of these groups and generations of British nurses in the colonies as 'exporters' of British nursing practice enables us to explore the extent to which the ideals of nursing practice and education that they promoted gained currency across the empire. How was the model of British nursing translated into the many and varied outposts of the British Empire? How were the rituals, routines and norms associated with practice invented and reinvented in the process? These are all questions of interest to the historian as much as to the nurse. Given the prominence of international recruitment to governments and NGOs internationally, questions of the impact of such immigration upon the conduct of care and interactions with patients, their carers, and their families are crucial. The Filipino nurse caring for the patient in a nursing home in the small towns and villages of Scotland are as much a feature of care delivery today as is the nurse recruit from West Africa training in a major London teaching hospital. Both these processes represent different consequences of the legacy of the nurses who ventured forth to work in those early training schools. For it was these schools which provided an important link in the supply chain and infrastructure to underpin the reciprocal regulatory mechanisms and career trajectories that remain very much with us today.

King's College London

Acknowledgements

The author wishes to thank Diana Solano for superb research support in the conduct of this project and the two referees for their excellent suggestions.

Notes

^* An earlier version of this paper was given on 23 August 2005 as the Ben Haneman Memorial Lecture at the Mitchell Library, Sydney. The lecture was jointly sponsored by the New South Wales Society of the History of Medicine and The State Library of New South Wales Foundation. Dr Ben Haneman (1923–2001) was an executive member of the New South Wales Society for the History of Medicine, president of the Australian Society of the History of Medicine, and active supporter of the State Library. The Ben Haneman Memorial Lecture is given annually by distinguished invited lecturers on topics that reflect his broad interests and commitment to social reform.

^1. Daniel Defoe, A Journal of the Plague Year (London: Blackwell, 1974).

^2. Anne Marie Rafferty, The Politics of Nursing Knowledge (London: Routledge, 1996), 13.

^3. Christopher Maggs, The origins of General Nursing (Beckenham: Croom Helm, 1983), 187–90.

^4. Rafferty, 10.

^5. Ibid., 21.

^6. Helen Callaway, Gender, Culture and Empire: European Women in Colonial Nigeria (Basingstoke and London: Palgrave, Macmillan, 1987); Megan Vaughan, Curing their Ills: Colonial Power and African Illness (London: Polity Press, 1991); Dea Birkett, "The "White Woman's Burden" in the "White Man's Grave": The Introduction of British Nurses in Colonial West Africa," in Western Women and Imperialism: Complicity and Resistance, edited by N. Chaudhuri and M. Strobel (Bloomington: Indiana University Press, 1992); Helen Sweet, ""Wanted: 16 Nurses of the Better Educated Type": Provision of Nurses to South Africa in the Late Nineteenth and Early Twentieth Centuries," Nursing Inquiry 11, no. 3 (2004): 176–84.

^7. Shula Marks, Divided Sisterhood: Race, Class and Gender in the South African Nursing Profession (Basingstoke and London: Macmillan Press, 1994); Margaret Jones, "Heroines of Lonely Outposts or Tools of the Empire? British Nurses in Britain's Model Colony: Ceylon, 1878–1948," Nursing Inquiry 11, no. 3 (2004): 148–60.

^8. "Colonial Nursing Association," Times, 16 July 1896, 12.

^9. Ibid.

^10. "Colonial Nursing Association" Times, 2 December 1898, 2.

^11. "Files of Individual Nurses", Colonial Nursing Association archives, Mss Brit Emp s400 (hereafter CNAA), Boxes 128–30, Rhodes House, Oxford.

^12. Ibid.; based on a sample of 231 CNA applicants during the period 1897–1939.

^13. Pat Jalland, Women, Marriage and Politics 1860–1914 (Oxford: Clarendon Press, 1986), 254–5.

^14. Carol Helmstadter "From the Private to the Public Sphere: The First Generation of Lady Nurses in England," Nursing History Review 9 (2001): 127–40.

^15. Open Letter to Nurses, 1909," Box 133, item 6, CNAA, Rhodes House, Oxford.

^16. Ibid.

^17. Ibid.

^18. Ibid.

^19. H.P. Dickson, The Badge of Britannia: The History and Reminiscences of the Queen Elizabeth's Overseas Nursing Service, 1886–1966 (Edinburgh: Pentland Press, 1990), 13.

^20. Ibid., 19.

^21. "Register of Nurses," Bound Volume 100, CNAA, Rhodes House, Oxford.

^22. Ibid.

^23. Ibid.

^24. "Letter, Jean Stewart to the CNA Secretary, 9 December 1929," box 140/item 1, CNAA, Rhodes House, Oxford.

^25. "Register of Nurses", Bound volume 100, CNAA, Rhodes House, Oxford.

^26. Dickson, 29.

^27. "Letter, Vivian Dargan to the CNA Secretary, 12 October 1927," box 140/item 1, CNAA, Rhodes House, Oxford, 130.

^28. Dickson, 29.

^29. Ibid.

^30. "Letter, Gertrude Merriman to the Chair of the Nursing Committee, 17 February 1933," box 140/item 1, CNAA, Rhodes House, Oxford.

^31. "Letter, Gracie Holmes to the Secretary, 18 January 1928," box 140/item 1, CNAA, Rhodes House, Oxford.

^32. "Memo on Native Policy in East Africa, 1930," cited by Janet Welch in "Nursing Education Related to the Cultural Background in East and Southeast African Colonies," box 140/item 1, CNAA, Rhodes House, Oxford.

^33. The Nursing and Midwifery Council, "Statistical Analysis of the Register, 1 April 2004–31 March 2005 and August 2005," Nursing and Midwifery Council. Available at http://www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=856 (accessed 2 May 2006), 10.

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The Seductions of History and the Nursing Diaspora*