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‘Creating new work and a new profession for women’: Florence Nightingale and the Rural Health Missioners of North Buckinghamshire 1891-1892

Linda Henderson, March 2021

Florence Nightingale 1920 reproduction for HERB, Library of Congress, Public domain, via Wikimedia Commons

In 1891 the North Bucks Technical Education Committee instigated the “Rural Health Missioners” (RHM) Health at Home scheme in collaboration with Florence Nightingale.
The scheme appears to be short lived and remained specific to North Buckinghamshire (although it was promoted elsewhere), with only one report, which is the focus of this blog, produced by the committee in 1892. The committee’s report can be viewed online at the Wellcome Library

It is within this report that Florence Nightingale writes that the RHMs must create ‘a new work and profession for women’ with the added caveat that ‘she [the RHM] must make this work acceptable to women of the labouring class’.  I would therefore like to explore what was new about this work, the women who were going to carry out the role of the RHM, and why it was needed. 

Firstly, some context to the scheme.   The committee’s chairman was Frederick Verney, Liberal Councillor for Buckinghamshire County Council since its inception in 1889 and Florence Nightingale’s nephew, the stepson of her sister Parthenope and Sir Harry Verney.  Florence had lived with them for some time at their Claydon estate in Buckinghamshire and knew the area well; she was affectionately referred to as Aunt Florence.  Sir Harry had established a strong link between the family and the health of the locality, especially the poor; most notably raising funds for the building of a hospital in Aylesbury following successive cholera outbreaks (pinpointed to the duck-breeders and fatteners of Aylesbury).  1891 was a difficult time for the Verney family with Frederick’s brother, Edmund, having fled the country following his conviction for procuring a girl under 21 for immoral purposes.  His wife Margaret was a member of the rural school board and co-opted onto the Buckinghamshire county education committee and contributed the section ‘Hints for the health-missioners’ to the report.  In his introduction to the committee’s report, Frederick emphasises the apparent neglect of the rural population by the government, who had, in his opinion, been spending too much money on urban sanitation schemes.  The women of the labouring classes who were the object of this new scheme of Rural Health Missioners were experiencing a sharp decline in employment opportunities due to the loss of the traditional female textile trades of lacemaking and straw-plaiting.  However, this decline was tempered by an increase in the activities of the Aylesbury duck industry as a response to the agricultural depression.

The RHM scheme was to be Nightingale’s last significant intervention on public health and one that represented a major shift in her pedagogical methods.  By now, Nightingale had realised that books were an inadequate medium for instructing poor, rural women about sanitation and health prevention, but that this need was imperative as it was in this very population that the future of the country resided.   To achieve this vision Nightingale deftly reversed the accepted and usual imperial knowledge flows by drawing on the experiences of similar schemes in India (which she had the opportunity to discuss at Claydon House with the Indian delegates attending the 7th International Congress of Hygiene and Demography).  The success of these schemes rested on women moving beyond campaigning to become the agents and authority in effecting a ‘real’ change in public health.  As she wrote in her paper ‘Rural Hygiene’ presented to the Leeds Conference of Women Workers in 1893:

Let not England lag behind – especially not in the conviction that nothing can be done without personal friendship with the woman to be taught.  It is a truism to say that the women who teach in India must know the languages, the religions, superstitions, and customs of the women to be taught in India.  It ought to be truism to say the very same for England.  We must not talk to them, or at them, but-with them. [italics original emphasis]

To overcome the limitations of book-learning, Nightingale proposed the creation of the RHMs. The RHMs would be middle-class women who would give interactive lectures to village women and visit their homes to offer personalised advice (This was the most important element). The scheme can be interpreted as a partial return to the traditions of the ‘Lady Bountiful’ described by Jessica Gerard where elite women, through charitable gifting and visiting the homes of the needy, cemented the structures of the rural hierarchy. However, there were significant differences; firstly, these women [RHM] did not already ‘exist’ in Nightingale’s opinion, but had to be found and trained, secondly, they had to be paid to avoid them being considered as ‘amateurs’, and thirdly, charitable giving to the village women was strictly forbidden. The RHM weekly wage (for working five days a week), once qualified and in post, was seven shillings a day plus travelling expenses as they moved from village to village, but they were always to remain in the immediate locality. For the village mothers, learning about managing the health of their family and home was not reliant on innate skills but was to become a ‘trade’ to be learnt the same as any other (dressmaking for example).

The report available at the Wellcome library is a later edition published after Nightingale’s death in 1910 which has the notable addition of a montage of photographs of Florence Nightingale and places that were associated with her (including St Thomas Hospital and her house in London). Drawing heavily on the iconography of ‘the ministering angel of the Crimean War’ the photographs assert Nightingale’s authority even though the RHM were not to be considered as, or trained as, nurses. The bulk of the report consists of letters from Florence Nightingale to the committee and the ‘village mothers’, instructions to potential missioners, syllabus of missioners training, a specimen lecture, template forms as well as reports on the scheme and the suitability of individual candidates for the role.

The committee wished to equip ‘certain ladies, who were willing to devote themselves to the work, with the knowledge indispensable for Health Missioners’. The RHMs were required to follow a syllabus of lectures, delivered by a local Medical Officer (the wonderfully named Dr De’ath) and pass examinations (oral and written) which were the ‘summary of the Science of Hygiene, and are to give the scientific basis, on which the popular familiar village teaching’ is to be founded. Although the committee agreed with Nightingale that only a man could teach the RHMs the knowledge they required, it was Nightingale herself who, in effect, interviewed and chose Dr De’ath for the role. Once trained the RHMs would give lectures to the village women on the ‘Sanitary condition of the Person, Clothes and Bedding, House, Management of Health Adults, Women before and after Confinements, Infants and Children’. The RHMs were required to ‘be of good character, good health, acceptable to village mothers, and have belief in and enthusiasm for the work’. It was important the RHMs were from the immediate locality as it was felt that urban women would not be able to understand the demands of rural life and work and would not be tolerated by the village women.

Nightingale herself was anxious not to follow in the footsteps of the Devonshire County Council who had earlier that year started a similar scheme which had failed to attract any local support or co-operation because the ladies came from the Sanitary Ladies Association in London at a cost of 5 guineas a week and had no understanding of rural life. The RHMs were not to have too much knowledge and to understand the limitations of that knowledge; they were not to try and be nurses or doctors. The RHMs were to be unmarried as work of this kind was considered incompatible with the responsibilities of looking after a house and family of their own. Twelve ladies were selected in response to the initial scheme. After the examinations, the three highest scoring candidates were named as Miss Deyns, Miss L Rowland, and Miss A Bartlett. I have been able to trace Miss Deyns on census returns and in newspaper reports which give an indication how this new work impacted her life. On the census of 1861 she is recorded in Norfolk as the new-born daughter of a surgeon, by 1891 she is living with her single brother (a local GP) in north Buckinghamshire and her sister (also single) who is a music teacher. Her familial connections and her interest in the role of the RHMs suggest that she had acquired a certain amount of vicarious medical knowledge but that her gender and status prevented her from pursuing this further. Miss Deyns has no occupation on the census and local newspaper reports only mention her name in connection with social and charitable events where she served tea or played the pianoforte. However, by 1894, she is reported as an energetic and popular teacher giving two ‘Health Course’ lectures a week at different locations in the Buckinghamshire town of Winslow as well as visiting cottage homes, strictly by invitation, afterwards. By 1896 she was the honorary secretary to the local Science and Arts Institute and on the committee for organising the annual Arts Industries and Loan Exhibition.

In the report Florence Nightingale addresses the “Village Mothers” directly in a letter, setting out the importance of their homes not just to them and their families but to the whole nation:

 ‘The Cottage Homes of England are after all, the most important of the homes of any class, that they should be pure in every sense, pure in body and mind’. 

As it was unequivocally the responsibility of the mother to cleanse the home of dirt and disease in was the role of the RHM to help them achieve this through ‘sympathy and friendliness’. This approach would enable the RHMs to show poor mothers and girls ‘better things without giving offence’ with village lectures being like a ‘picture book, with lively images to rouse the imagination, and retain the attention of the Village mother’. These colourful images were balanced by more practical advice that required the RHMs to be knowledgable about the prices and availability of utensils and equipment they were recommending (such as the prices of toothbrushes and towels)

Lectures were tailored to the local communities at a parish level; the specimen lecture entitled ‘Our Homes’ told women that illness was caused through ignorance and the breaking of God’s Laws. To make this point relevant the cases of cholera caused by the keeping of ducks in Aylesbury in Buckinghamshire was cited as a warning. It was therefore the duty of every woman to learn about health and so much more; the lectures on the ‘bedroom’ included whitewashing walls, filling holes in floorboards with sand and glaziers’ putty, making furniture out of old boxes and the folly of storing lumber and potatoes under the bed. But it was in the personalised visits to the cottage homes that the RHMs were at their most innovative – these visits were not for the acquisition of statistics on the state of the poor for a parliamentary commission but to apply the contents of the lectures to the living conditions of the individual women. Although some lectures covered aspects of rural life that would appear to beyond the remedy of the individual, such as choosing a healthy dwelling (avoid valleys because of fog, pick a southerly aspect) they did encourage and validate the women to complain to the relevant authorities and landlords about lack of sanitation, poor repairs etc by providing information on how to negotiate the bureaucratic process involved.

As Celia Davies identified when discussing the female health visitors of Manchester, the RHMs were pushing at the boundaries between the public and private spheres to identify a sphere of work that was only for women. However, unlike the health visitors, the RHMs were also disrupting class barriers by carrying out their work as a ‘friend’ to the village mothers, acknowledging that the learning/teaching was happening on both sides of the equation and that being poor did not relinquish the right to a private life. However, what is missing in the report is the voice of the female labouring class. Despite being portrayed as partners in the scheme they remained as the passive recipients of advice that increased their work and responsibilities.


Further Reading

Paul Crawford, Anna Greenwood, Richard Bates and Jonathan Memel, Florence Nightingale at Home (Cham: Palgrave Macmillan, 2020)

Celia Davies, ‘The Health Visitor as Mother’s Friend: A woman’s place in public health, 1900-1914’ Social History of Medicine, 1 (1988) 39-59.

Jessica Gerard, ‘Lady Bountiful: Women of the Landed Classes and Rural Philanthropy’, Victorian Studies, 30 (1987) 183-210

Jharna Gourlay, Florence Nightingale and the Heath of the Raj (London: Routledge, 2004)

Florence Nightingale, Rural Hygiene 1894

Florence Nightingale, Health and Local Government 1894 

Collected Works of Florence Nightingale: Florence Nightingale on Public Health Care, edited by Lynn McDonald, Wilfrid Laurier University Press, 2004

Dr. Gresswell's report to the Local Government Board on the general sanitary condition of the Buckingham rural sanitary district, 1889