In presenting this thesis in partial fulfillment of the require^ ments for an advanced degree at Montana State University, I agree that the Library shall make it freely available for inspection. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by my major professor, or, in his absence, by the Director of Libraries. It is understood that any copying or publica¬ tion of this thesis for financial gain shall not be allowed without my written permission. Signaturcy^L^/ Date THE INFLUENCE OF THE NIGHTINGALE PRINCIPLES ON FOUR MONTANA DEACONESS HOSPITAL TRAINING SCHOOLS 1902-1937 by RUTH STRANDNESS MCCULLOUGH A technical paper submitted to the Graduate Faculty in partial fulfillment of the requirements for the degree of MASTER OF NURSING Approved: Head, Major Department 'f- tioners. It had been difficult to -find young women of suitable character. The future of nursing, its reform and status, depended upon the behavior of these women. Those who were opposed to this new venture would watch eagerly for an opportunity to start a scandal about a Nightingale nurse. Every effort would be made to insure moral progress for the probationers during training. Miss Nightingale firmly believed that a good nurse must be a good woman. Mrs. Wardroper was required to prepare a detailed report on the pro¬ bationers every month, entitled "Personal Character and Acquirements". The part on "Moral Record" had six subdivisions - punctuality, quietness, trustworthiness, personal neatness, cleanliness, ward management, and order. She also wrote confidential personal reports about the probation¬ ers. Miss Nightingale felt she needed even more information than this. She wanted to know their very thoughts. To get this, she required them to keep daily diaries which she read every month. One rule that was intended to protect their reputations was that they were never to leave the home alone. An early proabationer is supposed to have said, "Of course we always parted as soon as we got to the corner." Flirtation was forbidden. This was reason for prompt dismissal. One probationer, caused Mrs. Wardroper and Miss Nightingale much concern because she "made eyes". They had conferences and wrote letters considering this -43- problem. They had no other reason for doubting her competency in nursing nor her morality. They finally concluded that she might grow out of this habit of "using her eyes unpleasantly". In addition to good character, Miss Nightingale wanted students to be mature and thus required them to be 25-35 years of age. (Not until long after the experimental stage was passed (1939) were any students under 20 admitted to the Nightingale School.) By 1896, they apparently accepted students at 24 years of age. Miss Nightingale wrote to a Miss Harrison who did not meet age requirements: I regret infinitely that we are quite decided for their own sakes not to admit Probationers at St. Thomas' Training School for Nurses under the age of 24. When the time comes, it might be possible to make the other arrangements you desire. At St. Marylebone Infirmary the Matron (who is one of ours) ad¬ mits them at 22, but, she tells me, that is too young. I strong¬ ly advise you to go on with the Nursing of Children for the pre¬ sent. I wish you every su^gess in persevering for the future. You are not losing time... Miss Nightingale also was concerned about who was too old to study nursing. During the first year of the school, she wrote to a nurse friend for advise regarding this and two other problems: 1. It is proppsed that an age be fixed for our Probationers at enr trance. Yours (at St. John's House) are, I see, "25-40". Do you approve this? Do you not find it difficult to teach a woman of near 40 anything like Nursing^ if she has not begun before? 2. It has been proposed that a form of testimonials, to be filled up, by each Probationer, before she can be received, shall be prepared. I think testimonials and proofs of character not worth the paper they are written on. What do you recommend? 16 Ibid. p. 51. -44- 3. It has been proposed not to admit deserted wives as Probationers. I think this is hard. Would you, requiring a certificate of mar¬ riage, refuse a wife whose husband had left her? Half the respect¬ able Nurses, certainly, I have ever had, have been deserted wives.^ Much of the time there was difficulty in securing enough young women for training. Miss Nightingale had more requests for graduate nurses than she could supply. She thought she might get more years of service from each nurse if she required them to either serve for at least five years or pay for their training. As time passed (1883), Miss Nightingale felt that the moral quality of young women was deteriorating in England. Other fields of work for women were opening. A feeling of independence in women seemed to her to influence home life in such a way that obedience was not being required. She thought that devotion to home duties was the best preparation for de¬ votion to nursing. Some of the gentlewomen who came, hoping for training, had as their primary motive, a means for making a living. This she attributed to the common practice in England of primogeniture (the custon of leaving the family inheritance to the oldest son). The number of students which could be in a class varied. At first there were 15 probationers in a class. While the hospital was temporarily at Surrey Gardens, the number was reduced to 10. When the new St. Thomas' Hospital, a much larger institution, was opened (1871), 31 probationers were admitted. This, apparently, meant that in the course of the year, 31 students were admitted, a few at the beginning of each quarter. They had 17 Ibid. p. 47. -45- no nurses to send out that year but added six sisters and 14 nurses to their staff. This is interpreted by the writer to mean that 14 probationers became staff nurses that year, after completing their year of training. Al¬ so, six staff nurses completed the required two years of experience under supervision. These were retained as head nurses (sisters) for the new hos¬ pital. Not only was a Nightingale nurse's employment pretty much controlled by her school but also the school was much like a guardian to her. Miss Nightingale felt that by keeping her in this relationship, she would always have a home where she would be exposed to good influences rather than to "the disintegrating influences of a nomadic existence".^ The term "colonise" was used in referring to the work done by a team of Nightingales who were sent to reform nursing in an established hospital. Miss Nightingale felt that it would be very difficult for a Nightingale to single handedly institute the reform of nursing in a hospital. A small community of nurses with common aims would give each other the moral sup¬ port needed to establish a good nursing system. By 1868, as many as nine or ten nurses were sent to colonise a hospital. By 1873, these groups of nurses were going beyond England to Scotland, Canada, New Zealand, and the United States. &n outstanding graduate, Miss Alice Fisher, assisted with the reform of four major hospitals. She died at the age of 49 years, at the post of matron at the Blockey Hospital, Philadelphia. The nurses were not at first given a certificate when their training 18 Nutting, Vol. II, o£. cit. , p. 187. -46- was completed. As nurses began to clamor for state registration, Miss Nightingale opposed this trend. Her reason was that examinations given from outside the school would not and could not examine for qualities of character. The successful candidates, she insisted, would be "the pert and the forward, not the best". The effort to prepare nurses to pass state examinations, she felt, would lead the school to lose sight of what she considered to be highly important, that of training the character. (State Registration was finally established in England in 1918). Not until 1928 (long after the first Montana Deaconess Hospital had formed their first alumnae associations) did the nurses who graduated from the Nightingale School have an organization to join. This organization, founded by the matron, Dame Alicia, was known as the Nightingale Fellowship. A certificate from the school was required for membership. The superinten¬ dent or matron of the Nightingale school is, according to its constitution, the president. The meetings were held twice a year. The organization published a journal and had a benevolent fund. Miss Nightingale lived to see, by the end of the century, a changed situation for students in nursing. It was no longer a disgrace to be a nurse. She had provided a school in which conditions for training were ap¬ proved by the strictest of parents. The graduates had not failed Miss Night¬ ingale, they had been well received, and society was recognizing nursing as a reputable vocation. They were being paid wages which were sufficient for them to live respectably. There were still a few of the old type nurses left at St. Thomas' Hospital; however, they were not in charge of any of the wards and were not working where they would influence the probationers. -47- III. CURRICULUM - The students were to be taught, by we1I-prepared nursing teachers, a thorough course in nursing. The program of study should in¬ clude personality development, supervised care of the sick (free from non¬ nursing tasks), and preparation to develop schools of nursing whenever they were needed. When Miss Nightingale defined nursing, she said, "Nursing is an art, an art requiring an organized practical and scientific training. For nurs¬ ing is the skilled servant of medicine, surgery and hygiene. When the Nightingale School was opened, there were no well-prepared nursing teachers in England except for Miss Nightingale. What would a thorough course in nursing include? The first annual report of the school included a list of the probationer's duties. These duties indicate the type of personality development hoped for and the skills which were taught (or learned by trial and error). DUTIES OF PROBATIONERS UNDER THE 'NIGHTINGALE FUND' You are required to be SOBER, HONEST, TRUTHFUL, TRUSTWORTHY, CLEANLY AND NEAT. PUNCTUAL, QUIET AND ORDERLY, 19 Ibid, p. 171. -48- You are expected to become skillful: 1. In the dressing of blisters, burns, sores, wounds, and in applying fomentations, poultices, and minor dressings. 2. In the application of leeches, externally and internally. 3. In the administration of enemas for men and women. 4. In the management of trusses, and appliances in uterine complaints. 5. In the best method of friction to the body and extremities. 6. In the management of helpless Patients, i.e., moving, change . ing, personal cleanliness of, feeding, keeping warm (or cool), preventing and dressing bed sores', managing position of. 7. In bandaging, making bandages, and rollers, lining of splints, etc. 8. In making the beds for the Patients, and removal of sheets whilst Patient is in bed. 9. You are required to attend at operations. 10. To be competent to cook gruel, arrowroot, egg flip, puddings, drinks, for the sick. 11. To understand ventilation, or keeping the Ward fresh by night as well as by day; you are to be careful that great cleanliness is oboerved in all the utensils; those used for the secretions as well as those required for cooking. 12. To make strict observation of the sick in the following parti¬ culars: The state of secretions, expectoration, pulse, skin, appetite; intelligence, as delirium or stupor; breathing, sleep, state of wounds, eruptions, formation of matter, effect of diet or of stimulants, and of medicines. 20 13. And to learn the management of convalescents. The School and Hospital were moved to temporary quarters after two years of its existence. A nurse who was a probationer in 1867 described ^The Nightingale Training School St. Thomas 1 Hospital 1860-1960, op. cit., pp. 6-7. -49- the teaching which she knew at the temporary hospital in Surrey Gardens: Very little was expected from us, as progress was slow in regard to organized teaching. Kindness, watchfulness, clean¬ liness, and guarding against bed-sores were well ingrained. A few stray lectures were given, one I remember especially. I think it was on the Chemistry of Life, or some such Title;... There was a dummy on which to practice bandaging and some lessons were given; also a skeleton, and some ancient medical books, one fortunately on Anatomy for those who attempted self-education. The more enterprising pupils provided them¬ selves with something more modern, Hoblyn's dictionary being a great favorite.... The directions on medicine bottles were given in Latin, therefore some Latin abbreviations had to be learned, which was not difficult. Mr. Whitfield, the principal Resident Medical Officer, took a great interest in the pupils, and would occasionally ask for notes to be taken of some parti¬ cular case, and from that would point out mistakes and omis¬ sions, which was excellent teaching. Temperature-taking and chart keeping were medical students' work, but from that time it gradually became the work of the nurses. The thermometer was in the form of the shepherd's crook, and had to be read in situ.... 21 A pupil was also told off now and then to trim the bonnets. In time, the course of instruction improved and took on a more defi¬ nite pattern. It was summarized in this way: Early in the history of the School, Florence Nightingale worked out an elaborate system for recording under various headings in a large register the Probationers' progress in the different branches of their work. Perhaps the most important of all was the instruction received from the Ward Sisters. So much' depended on the abilities of the individual sister, and even the best sis¬ ters were prevented by under-staffing from teaching the Probationers as much as they ..would have liked to do. There was a constant danger of a Probationer becoming involved in so many unskilled routine duties that she would have no time for the important business of learning to nurse. (Underscoring 21 Ibid. p. 8. -50- no t in the original.) The first Probationers attended the consultants' lectures and received instruction from Mr. Whitfield. They were also expected to keep written records in the form of lecture notes, diaries and case books. In her diary the Probationer had to write up in detail all the duties she had' performed in the ward on one particular day. This literary work involved con¬ siderable effort on the part of the less educated Probationers, and the keeping of a record of cases proved beyond the powers of some of them. The complete absence of suitable textbooks presented an¬ other problem. There were none written specifically for nurses and books intended for medical students had to be used instead. When Mr. Croft took over the teaching from Mr. Whitfield he found this lack of textbooks such a handicap that in 1873 he had his own lectures printed for the nurses' use. The appointment of Miss Machin as Home Sister in 1873 and of Miss Grossland in 1875 consolidated the form of teaching introduced by Mr. Croft. He established a more regular sys¬ tem of lectures and examinations than Mr. Whitfield' had used, but its efficacy depended largely on the Home Sister's zeal in checking what the Probationers had learnt, testing them in it and elucidating problems. In particular she guided them in the best use of the limited time they had for reading. Mr. Croft gave clinical lectures in the wards in addition to the lectures he gave in the Home, adapting his instruction carefully to the Probationers' requirements. By 1874 the teaching was established on the main lines which it would follow till the end of the century. It is set out in the Report of the Nightingale Fund for 1874. Mr. Croft, the Medical Instructor, reports that the course of Instruction during the year 1874 has varied considerably from that of 1873; the Twenty-five Lectures referred to in his last year's Report being in print, were available for class instruction, and while the "Home" Sister exercised the Proba¬ tioners on those Lectures which bear on Medical, Surgical and Sanitary Nursing, Demonstrations and Examinations on the appli¬ cations of Bandages and Splints were given. Seven lectures, with Demonstrations (some microscopical), were delivered on the Circulation of the Blood, on the Respiratory Organs, on the Heart and on the large Arteries. Dr. Bernays was so kind as to lecture on four occasions on the "Constituents of various articles of Food", and Dr. Peacock, -51- Senior Physician to the Hospital, delivered six lectures on the "Principles of Medicine." In addition to the above, a course of Monthly Examinations was commenced by Mr. Croft in November, by which the Lady and Nurse Probationers are tested with regard to their educational progress in the Wards. The sisters of the wards are first questioned on the usual written reports on their Probationers, and the Proba¬ tioners are then catechised and advised in the presence of Mrs. Wardroper and the "Home" Sister. The principal Subjects that have been taught in these Classes are as follows: Mr. Croft's printed Lectures. Elementary Classification of Medicines. Chief Poisons, and Treatment of. Concerning use of Stomach Pump, and Method of Cupping. Glossary of Medical Terms and Abbreviations. Review of Mr. Croft's Lectures on the Bones, with aid of Skeleton. The Special or Lady Probationers had kept diaries regularly, reported more Cases since the introduction of new Case papers, and contained their reading, study and practice of bandaging upon the alloted days.^ The importance of the sisters (head nurses) in teaching probationers is indicated by the following examples from a letter written in 1873. . . . Monday being bathing night there is such a stir. Every patient capable of being moved, the bathman wheels off in a big chair to the bathroom wrapped up in a blanket and scrubs them. I began on a Monday morning so at night the Sister said to me 'You shall wash Mr. So and So's leg (the other one was fractured), come and I shall show you how to proceed'. Accord¬ ingly a macintosh towel, soap and water was got and a jar with turpentine and oil was got ready. She tucked up her sleeves and took the clothes off his well leg, then scrubbed him up. She said, 'This is a new patient and he had not been properly washed when he came in, so to get off the dirt without wasting time rub in the turpentine,' it acted like magic. When wash¬ ing under the knee, she said 'This is the Popliteal space, you must remember, as the next time a new patient comes in with a fractured leg perhaps you may be sent to wash him, and I shall 22 Ibid. pp. 12-14. -52- direct you to wash well under the Popliteal space and expect you to understand me.' That is the sort of way we are in¬ structed, we are told a fomentation is wanted over the epi¬ gastrium, or a zinc dressing on the sacrum.^ . . o "Sister Edward" is a real born lady, very short with gentle kindly manners and both she and the staff nurse tell you what you are to do, in Alice it seemed just'to be found out, here it feels as if they meant to teach you though as there were two new nurse Probationers we:.were a little ber hindharid and Nurse said she could not show me this morning about the dressing of ther wounds but she would this evening. She is a pleasant spoken person but says they have dreadful hard work. 1 ... My Present "Sister" is a very comfortable lady of 46, Miss Hawthorne, who takes the world easy. Rachel (Williams) says fat and fair and 40 and that just describes her. I like Nurse Chapman the Staff Nurse and she likes me, I think . . . . . . Sister Elizabeth is very particular about her ward. There is a place for everything and everything has to be kept., in its place, the counterpanes have to be kept 6 inches from the ground and both sides exactly even together with a dozen other small minutiae which I am finding out or being told by degrees. I have had several long talks with Sister because she tells you what you are to do and does not expect you to find it out by instinct which is much pleasanter. She says she knows because she has herself proved it when she was a Probationer that the beds of a surgical ward can be kept tidy ... I think I shall soon be an embryo old maid, I find I do like order though I can't help smiling at some of the things and it bores the patients dreadfully to have their beds so often straightened but it is a must be.^ This same probationer wrote a few months later, about the sister who was helpful to her, when she was on special duty at night with a patient who had peritonitis following abdominal surgery. Sister is in here a great deal, and I have been giving her a lecture this morning most seriously, for actually last night she stayed up till 3 in the morning waiting for the Resident House Surgeon Mr. McKeller to come in. I tell her flesh and 23 24 Ibid, pp. 36-37. Ibid. p. 41. -53- blood can't stand it, but she is the most difficult person to influence that I know in that way. It is very happy working with her, and she is a most assiduous and as Miss Nightingale said of her a most conscientious Sister,, To have a nice dear Sister when you very much as it is pretty In spite of Miss Nightingale's high standards and the plan financed in such a way that students should not be exploited, there apparently were times when they were too busy to go to class. Miss Wilson, a lady proba¬ tioner wrote, "There was a lecture the other day which I could not be present at - on the liver and its diseases - they had a human liver to lec¬ ture upon."26 Another indication of this problem is the statement: "Through the years, St. Thomas' Hospital, in common with most others dn Great Brit- ian, had come to depend to a very great extent on student nurses to staff 27 the wards." When Miss D. S. Coode was appointed home sister in 1903 she knew, from her own student experience that some training should be given prior to clin¬ ical experience. . . . Miss Coode had suffered at the start of her training from being introduced to the wards with no preparation. Having been dependent on the patients' instructions for her early nursing treatments, she was determined that those following her should not be so handicapped. In the basement of the Nightingale Home was a room in which bandaging classes were held. Miss Coode arranged that the new probationers should enter at the quarter days in groups of three, and for their first two days she taught them some elements of nursing practice in this classroom. At first it was necessary to conceal the fact of their arrival un¬ til this instruction was over and they were ready to go to the wards, since the authorities were not vet converted to full re¬ cognition of the wisdom of this plan. ° you are on Special duty helps close work. ® 25Ibid. p. 43. 26Ibid. p. 39. 27Ibid. P* 30. 28t, . , Ibid. p. 20. -54- By 1910, the School was ready to organize instruction by adding the Preliminary Training School, financed by the hospital. Just how this eight weeks of preliminary training was organized was not found. (Two other hospitals in London already had Preliminary Training Schools.) In 1914, the home sister was relieved of her teaching load by the appointment of a sister to be in charge of the education of student nurses. This sister was given the title "sister tutor" and was paid by the Fund. This came at the time of World War I, when a military hospital was estab¬ lished in conjunction with the civil hospital. In spite of these new complications, a new syllabus was prepared, ward teaching was continued, planned teaching of staff nurses was started, and classroom teaching was improved. After the war, the struggle for state registration began. Soon, preparation for the statutory examinations became the chief aim of nursing education in British schools of nursing. In the Nightingale School, the "accent was always on: .preparation for more intelligent nursing than else¬ where. The tradition of teaching by the ward sisters was retained and fostered. The writer saw a gradual development in the curriculum offered at the Nightingale School. From the beginning, training in character develop¬ ment, learning to be observant, and learning to give good nursing care were stressed. Training in character development was the responsibility of the matron and home sister. (This was described in the section of The Home.) 29 Ibid. p. 23. -55- Learning to be observant was promoted by requiring the writing of case studies and of keeping daily diaries. The home sister was res¬ ponsible for checking the studies and the diaries before passing them on to the matron.. Learning to give good nursing care was encouraged by the ef¬ forts of the medical officer who gave some lectures, by doctors who gave some lectures (for the Lady probationers), and by the example and help of the ward sisters who were expected to teach probationers at the bedside and in ward classes. No mention was made of any special classes pertain¬ ing to "developing schools of nursing". Sisters apparently were expected to reproduce for students in other hospitals what they had experienced at St. Thomas' Hospital. IV. THE HOME - The hospital should provide a comfortable, attractive stu¬ dent residence where there is supervision of the students' intellectual, moral, and physical well-being. The Nightingale School was opened in 1860. The facilities prepared for housing the first class of fifteen students was the upper floor of a wing of the hospital. Each probationer had her own bedroom. The sister in charge had her own bedroom and living room. There was a common living room for the students. Miss Nightingale sent books, maps, prints, and flowers for this room. In 1862, the hospital buildings were sold to a railway company that was building a line that would need to cross part of the hospital property. The hospital was forced to move into temporary quarters until 1871. Miss Nightingale had arranged that in these buildings the. probationers would each have "a cubicle for sleeping, and a common dining room with, a neatly -56- O f) appointed table". u The new hospital, located across from the houses of Parliament, was built on the pavilion principle plan, a plan approved by Miss Nightingale. One block was set aside for the Nightingale Home in which the- probationers lived. This had been agreed' upon by the Nightingale Fund Council and the Hospital. In this building there was no provision for a classroom. The only common room was the dining room. (This home was used continuously by the Nightingale Training School until it was damaged by an air raid during the war in 1941.) At first, Mrs. Wardroper was not only the Hospital Matron and Superin¬ tendent of the Nightingale School, but was also home sister. After the new hospital and home were built, Mrs. Wardroper had a larger hospital to super¬ vise (600 beds) and a larger body of probationers under her care. It was necessary to find an assistant to the matron. Her duties as approved by Miss Nightingale were: 1. To take charge under the Matron of the Probationers' Home, of its servants, housekeeping, accounts, etc. 2. To take general charge under the Matron of the Probationers: to see to their preparing Notes of Lectures, Case books, Diaries, etc., and to verify and correct these previously to submitting them to the Matron. 3. To give such Classes whether religious or of general improvement as shall be from time to time arranged. ~^The Nightingale Training School St. Thomas 1 Hospital 1860-1960, op. cit., pp. 6-7. -57- 4. To read prayers when read in the Home. 5. To preside at meals, see to carrying out of rules, hours, etc. 6. To undertake all such correspondence concerning the Probationers as the Matron may desire. 7. To give such superintendence in the Wards or in such wards, as the *3 1 Matron may from time to time appoint. Between 1871 and 1875 there was a succession of three home sisters. Then Miss Cross land became Home Sister for a twenty-year term of office. She was described in these words. "Revered rather than loved by her Proba¬ tioners, and occasionally even at loggerheads with Miss Nightingale her¬ self, she ruled the home until 1896, when she was succeeded by Miss Haig- Brown, a completely contrasting personality."^ Miss Nightingale's feelings about the work of a home sister are shown in an exerpt from a letter to one of her Nightingales who had become a home sister in another school in 1888. The "Home" Sister has need to be so motherly, so disinterested in matters of sympathy:-giving so much, exacting so little - so impartial and generous - carrying all her charges on her heart before God. I often think it is the most trying and responsible position in the Hospital - more so than that of the Matron - because the "Home" Sister's charges change so continually. Few are the perfect Matrons but fewer still are the perfect "Home" Sisters.33 Miss Coode was home sister from 1903-1910. Her memories of life in the home as a probationer in 1899 were: New Probationers were admitted on, or near, each Quarter Day. 31Ibid. p. 12. 32Ibid. p. 12. 33 Ibid. p. 50. -58- When I arrived about tea-time on March 28th, 1899, I found my¬ self alone when the other Probationers went on duty at 6 P.M., but later discovered that at least one had preceded me on the previous evening and one (Baroness Mannerheim) followed next day. Soon the Home Sister (Miss Haig-Brown) gave me a small white tea-pot, and a tin of tea, and showed me where to keep them in a many tiered locker, and after a few more directions, I sat in the diningroom hear one of the long tables, sewing my name tapes on three Nightingale caps and four holland aprons (meant to supplement the white ones I had .been told to bring, and only used in emergency). Other directions as to uniform were to bring three cotton dresses (any colour). So I brought a light and dark blue and pink, and these were worn .-until, at the end of the. six or eight weeks we were seen by Matron and after talking to us our Contract was signed, and we were given the striped lilac uniform shawl (which later often proved of great comfort, being soft and warm). When the Probationers returned from the wards, we sat round the three long tables, and after Home Sister had read prayers, started supper (8:45). The next morning we rose with the call¬ ing bell, and after making our beds and tidying our rooms, went down, collected our teapots and make tea at two boilers in the Dormitory on the ground floor (Round this space were a few bed¬ rooms, occupied by Priscilla, the Head Maid, who was well liked by the Probationers, and a few other Maids, also a Linen room, where we deposited our linen bags for the laundry). At 7 a.m. we filed out from the first floor to go to the wards, and I was allotted to Leopold (later Nuffield) in Block 7, Male Surgical. Here I was received with a sigh, as my immedi¬ ate predecessor was only one month old, and Sister (Miss Smith) was away on holiday. The first duty given me was to wash No. 28. As I had little idea where to begin or end this, I had to ask him what was usual. Later I got into difficulties with hair comb¬ ing, and well remember the slow smile of the Night Staff Nurse, as she explained the use of a tooth comb. These early experiences made me determined that, if in the future I had the opportunity, no new Probationers should enter the wards without some previous instruction. . „ The new Probationer's time 'off-duty' was usually for two hours during the morning, but there was a free tea hour (5-6) which was much enjoyed, and enabled one to see other Pro. friends. There was also a greatly enjoyed hour after Sunday dinner, when tea could be made and taken to the bedrooms, and small 'tea parties' were rife. We were due to have one 'day off' a month. My first I spent with a relative at Epsom, and it is noted in the Diary as being more enjoyed than any previous experience. Altogether, -59- in spite of ups and downs, the year in the Nightingale Home had many happy hours.^ Each day was full from the time the probationer arose at 6 a.m. until bedtime. A Miss Wilson, who later was one of the ward sisters, had writ¬ ten in a letter in 1876: On Monday and Thursday we have class for an hour and a half so we only have from 10:30 until 11:30 for exercise except the time to spare at meal hours, but on other days we leave the wards at 9:30 a.m. for half an hour to get a rest and lunch and then on alternative days have from 11:30 until dinner time to walk out, or 3:30 till 5. But as that is the only time we have for studying you can imagine we are sometimes inclined to encroach upon it, or do any little tidying up jobs in our rooms, so that very often our exercise is confined to a promenade on the Terrace facing the river for half an hour after dinner. . . If the 'Home Sister' comes in and finds us in the study dur¬ ing exercise time however, we are told to go out and get an airing and not neglect our health. We are quite full in the 'Home' at present, and it is very enjoyable, I assure you, and there is so much change and variety that one does not get time to think of themselves at all, the time has passed like a week. The Probationers' time is fully occupied but their health and comfort is cared for in every respect, we are punctual to a minute in going to and fro from the wards, it does not matter what is in hand, the work is so arranged that when the time comes one set leaves and others come in off the regular staff to take our places, we are not overworked, and the work is not hindered.^ When other assignments were done there was always the diary to bring up to date: I have a diary of my work to keep now, it is such a bother.^ Probationers returned to the home at 8:30 p.m. to gather for prayers. After prayer time, the home sister corrected them for any deviant behavior ^Ibid. pp. 56-57. ~^Ibid. p. 38. 36 Ibid. p. 39. -60- which she had observed or heard about during the day. The hungry proba¬ tioners were then permitted to eat their supper. The food was wholesome, one plate for both courses. Some students chose to turn their plates over to have pudding on the underside. Day nurses were given one day off a month. Night nurses were on nights usually for two months and were then given two nights off during this time, if they were not too busy. At the end of the year of probation, the new nurse was given a month's holiday before she was expected to re¬ turn as a staff nurse to take up residence in the top floor of the block of the hospital in which she was assigned to work. V. CONTROL - The training of student nurses should be free from control by medical doctors or churches. The agreement made with the Governors of St. Thomas' Hospital was carried out so well that no comments were found that would indicate that doctors or clergymen interfered with the training of the probationers. The resident medical officer had certain responsibilities for which he was paid by the Nightingale Fund. Mr. Whitfield and those who followed him in this office were in sympathy with the Nightingale Plan and were most co¬ operative. (Mr. Whitfield was the apothecary and secretary to the Medical School as well as senior resident medical officer.) The senior physician and other staff doctors were helpful in giving occasional lectures. The probationers were taught to carry out doctors' orders implicitly. Even though the Nightingale School was not associated with any parti¬ cular church, there were religious influences which Miss Nightingale in¬ cluded in her provisions for "moral progress" and character building. -61- Prayers were read by the Home Sister before the evening meal. A student in the class of 1899, said, "In my early days a Scripture Lesson was given by a Hospitaller once a month before supper, at which the tired Pros were pretty inattentive."37 It might be assumed that the religious influence was Protestant. This fact about Miss Pringle, matron succeeding Mrs. Wardroper, is significant: Miss Pringle was 41 when she was appointed and it might have been expected that her term of office would be nearly as long as that of Mrs. Wardroper, but unforseen circumstances caused her to resign after less than three years. She became a Roman Cath¬ olic and after her change of faith she felt she could not con¬ scientiously retain her office. VI. FINANCES - The training school should be financially independent of the hospital in which the students are trained. The first financially independent training school for nurses came into existence as the result of an agreement between the Council of the Nightr ingale Fund and the Governors of St. Thomas' Hospital. It was approved by the Grand Committee of the Hospital on April 10, 1860. The terms were: On the part of the President, Treasurer and Governors of St. Thomas' Hospital 1. The President, Treasurer and Governors of St. Thomas' Hospital . will give facilities for the Training of Probationer:Nurses'" in the Hospital, being reimbursed from the Nightingale Fund for the extra expenses to which the Hospital is thereby put. 2. They will be prepared to receive into the Hospital, at first 15 Probationers, in connection with the Nightingale Fund. 3. They will allow their Officers, and in particular the Resident Medical Officer and the Matron, with such of the Sisters as may 37 38 Ibid. p. 57. Ibid. p. 17. -62- be nominated by the Matrom, to take part in the work of training the Probationers, and to receive remuneration for so doing from the Nightingale Fund. 4. They will provide the Probationers with board and separate lodging in the Hospital, under the charge of a Sister. 5. They will allow the Members of the Committee and their Secretary, with a lady visitor, to visit, in the company of the Resident Medical Officer or the Matron, the wards in which the Probationers are under training; the hours to be arranged by the Treasurer. 6. They will allow a certain number of the Nurses at present employed in the Hospital, to be selected by the Matron, with a view to their being registered as Nurses in connection with the Nightingale Fund after the satisfactory completion of a certain teriru of service. On the part of the Committee for Administering the Nightingale Fund 1. The(Committee engage to conduct the Training of their Proba¬ tioners at St. Thomas' Hospital under the direction of the Treasurer, and solely through the Resident Medical Officer, the Matron, and the Sisters appointed by the Matron of the Hospital. 2. They agree to remunerate the Officers of the Hospital for their services in Training the Probationers, and also to pay the Hospital for any extra expenses which it incurs in respect of the Probationers; such payments to be made through the Treasurer of the Hospital.^9 Up until this time, nothing comparable to tuition had been known to be paid for training in nursing. The Lady Probationers paid 30 pounds into the Fund and, in turn, had one less year as staff nurse required of them. The 10 pounds a year paid to probationers, the cost of the clothing provided for them, and the expenses involved in maintaining the home came 39 Ibid. pp. 4-5. -63- from the Fund. An interesting statement found in another source indicated that those nurses who had worked well for a year after completing training were given either "a first-class gratuity of 5 or a second-class gratuity of 3 pounds sterling." ® A letter written by a staff nurse, possibly in 1876, has this paragraph about receiving a gratuity: 'I saw Mrs. W. on Saturday and she paid me my wages and said "and here's something else you. don't expect and I found on open¬ ing it, it was two years gratuity with certificate from the Nightingale Committee which the ladies who pay for their training have not generally had. . . I thought of getting Dean Alford's on the New Testament and a case of instruments. . . When it was found that Mrs. Wardroper needed an assistant to assume responsibility under her for the home and for the instruction of the proba¬ tioners, Miss Nightingale and the secretary of the Nightingale Fund, found and hired the nurse for this position. The Nightingale Fund was used for the training of nurses in addition to that done at St. Thomas' Hospital, for workhouse infirmary nursing at both the Highgate (London) and Mary-lebone (Liverpool) Infirmaries. In a letter which William Rathbone wrote to Miss Nightingale, when he was planning with her for these schools (1871), he said "Now, what I want is simply that these two Workhouse hospitals should do for other Workhouse hospitals what the Nightingale School at St. Thomas' is doing for private hospitals."^2 Also, for a period of two years (1861-1863) the Nightingale Fund sponsored the Training School for Midwives in cooperation with the ^Cecil, ££. cit., p. 234. ^The Nightingale Training School St. Thomas' Hospital 1860-1960, op. cit., p. 44. 42 Ibid, p. 53. -64- authorities at King's College. It was a six months' course. The Nightingale Fund amounted to 45,000 pounds. More details about its use, other than the above, have not been found. It is recorded that the Preliminary Training School, started in 1910, was financed by the hos pital and not by the fund. In a description of the post World War II era this mention of the fund is made: In some sense the Nightingale School had lost its entity, and the great figures of the past had gone. Increased numbers and increased salaries made it impossible for the Nightingale Fund Council to continue to meet the expenses of the school. Thus the connection between the Nightingale Fund and the School depended on tradition and courtesy, rather than on finances, and the in¬ dependence of the school was largely lost, though, through the formation of Area Nurse Training Committees under the Nurses Act of 1949 a degree of financial independence was obtained by all Schools of Nursing within the National Health Service.^ 43 Ibid. p. 29. CHAPTER III THE INFLUENCE OF THE NIGHTINGALE PRINCIPLES This chapter consists of three sections: (1) The influence of the Nightingale principles on two models, (2) The influence of the Nightin¬ gale principles on the four Montana Deaconess Hospital Training Schools (1902-37), and (3) The influence of the Nightingale princi¬ ples on the curriculum guides used by the four Montana Deaconess Hospital Training Schools „ Ste Luke's Hospital, New York, and Johns Hopkins Hospital, Baltimore were the two training schools which Miss Ariss used as models when she or¬ ganized the early Deaconess Training Schools. Basic information was pre¬ sented about these two training schools and then, by means of a compari¬ son chart and the Nightingale principles, these two training schools were compared with the Nightingale School, in an effort to discover influences of the principles on them. Then, the history of the beginnings of each of the four Deaconess Hospital Training Schools were presented. Information discovered about them was organized according to the subjects of the Nightingale principles, to discover how the Deaconess Training Schools were influenced by the principles and the two models. Lastly, the recom¬ mended National League of Nursing Education curricula of 1917 and 1927 and the minimum standards set by the state, which were used as guides by the Deaconess Hospital Training Schools after 1915, were presented in such a way as to discover the influences of the Nightingale principles on them. -66- E. Augusta Ariss visited the Schools of Nursing at St„ Luke's Hospital, New York and Johns Hopkins, Baltimore where programs had followed the Florence Nightingale principles„ Miss Ariss patterned nursing education at Deaconess Hospitals in Montana after these two models„ -67- The -:Influence of the Nightingale Principles on Two Models The way in which Miss Ariss might have come to know about the St. Luke's and Johns Hopkins training schools were discussed before the begin¬ nings of the schools were described and the comparison chart was present¬ ed. The information about the training schools which was used pertained only to the earlier years of their history because Miss Ariss said, in her 1915-16 annual report, that "the curriculum outlined by the State Board was being followed." The information about the two models was obtained from a history of each of the schools. The history of the Johns Hopkins Training School is so much more comprehensive than that of St. Luke's that this presentation might not be entirely fair to the influence of the St. Luke's Training School. Miss E. Augusta Ariss, the first Deaconess Hospital Superintendent and Director of the Montana Deaconess Hospital Training School in Great Falls, Montana, said that the Training School was "based on the schools of Johns Hopkins Hospital of Baltimore and St. Luke's Hospital of New York, with which we were in frequent correspondence. Later, these schools were visited and their curriculum inspected and the features which supplied our needs were appropriated, thus laying a permanent basis for the education of our nurses."'*' Miss Ariss did not say how she became acquainted with these two schools. Miss Ariss had her deaconess training at the Chicago Training Class of 1937, Montana Deaconess Hospital School of Nursing, The White Caps (Great Falls, Montana) p.5. -68- School, founded by Lucy Rider Meyer in 1885. The Rev. and Mrs. R. Meyer had visited the Fliedners in Kaiserswerth. Dr. William Muhlenberg, found¬ er of the St. Luke's Hospital (1846) and the Sisterhood of the Church of the Holy Communion (1853), had been inspired to do this work, after hear¬ ing about the work of the Fliedners. The Meyers probably knew about Dr. Muhlenberg's work and taught deaconesses about him. Miss Ariss's interest in St. Luke's Hospital Training School must have been associated with her interest in the sisterhood of this hospital and Dr Muhlenberg's concept of a Christian hospital. In Miss Ariss's writings, she refers to the hospital as a Hotel Dieu, as Dr. Muhlen¬ berg did. In her 1914-15 annual report, she refers to non-paying patients in this gracious way, "During the year, we have been privileged to care for a number whom we are pleased to call 'guests'". Dr. Muhlenberg thought of the Christian hospital staff as a "Christian family entertaining their 2 guests, all of whom are sick." The only professional nursing journal available in 1902 was the American Journal of Nursing, founded in 1900. The nursing education pro¬ vided by the Johns Hopkins Training School was one of the most outstand¬ ing in the United States at that time. Miss Isabel Hampton, Miss Adelaide Nutting, and Miss Lavinia Dock, all of Johns Hopkins, were national lead¬ ers in nursing. They were involved in the professional organizations, the American Society of Superintendents of Training Schools (founded 1893) and * 2 Ethel Johns and Blanche Pfefferkorn, The Johns Hopkins Hospital School of Nursing 1889-1949 (Baltimore: The Johns Hopkins Press, 1954) p.31. -69- the Nurses Associated Alumnae of the United States and Canada (founded 1896). By means of this journal and these organizations, Miss Ariss could have become informed about the Johns Hopkins Training School and the thinking of its leaders. Miss Edith Lamb, a deaconess nurse friend of Miss Ariss said, "I would be inclined to say that professional organiza¬ tions and the journal provided information about the Johns Hopkins Train¬ ing School and its leaders. I am sure that Miss Ariss read the Journal in her conscientious efforts to establish the school. 4 The St. Luke s Hospital Training School The St. Luke's Hospital story began in 1845 when Dr. William Muhlen¬ berg, pastor of the Episcopalian Church, the Church of the Holy Communion, in New York City, began to make plans for a hospital. He felt that churches should feel a responsibility for providing care for the sick of their parishes. He had heard of the work of the Fliedners in Germany who were preparing deaconess nurses to work in hospitals. There were no Prot¬ estant Sisterhoods in the United States to come to his aid. He asked a member of his congregation, Ann Ayres, if she would consider dedicating her life to caring for the sick. After prayerful consideration, she ac¬ cepted the challenge. Miss Ayres became the first sister of the Sisterhood of the Church of the Holy Communion. Other dedicated, intelligent, educated women volun- ~*Letter from Edith Lamb '20, August 15, 1969. ^Marnelva W. Keller, History of the St. Luke's Hospital Training School for Nurses, May 28, 1888-May 28, 1938, pp. 1-76. -70- teered, became probationers and prepared for service under her guidance. They first cared for the sick in their homes, then in two rented apart¬ ments. A member of the congregation gave money for building a home for the sisters, in 1854. Their original home was then converted to a seven¬ teen-bed hospital. By 1858, a new hospital was built. Dr. Charles Hey¬ ward was the attending physician and instructor of the sisters, or dea¬ conesses, as they were often called. As time passed, the number of women who volunteered to become sisters did not keep pace with the increasing number of patients. More and more lay women were employed. Nursing was also becoming more complex. In 1888, the Training School for Nurses was started to meet these increasing nursing needs. The first superintendent of the St. Luke's Hospital Training School, Jessie Read, resigned in one year, to be married. Miss Anna C. Maxwell became the second Superintendent of Nurses (1889-1891). Formerly, she had been Superintendent of Nurses for seven years at the Massachusetts General Hospital in Boston. The training school at this hospital had been organ¬ ized according to the Nightingale Plan. Mrs. Lily Quintard (1896-1900), the sixth superintendent of nurses, was a graduate of and then director, for five years, of the Connecticut Training School, an endowed school, which became the famous Yale University School of Nursing. Annie Good¬ rich, the eighth superintendent of nurses (1900-1902), became the first dean of the Yale University School. These outstanding women must have -71- made noteworthy contributions to the St. Luke's Hospital Training School in its early years."* The only information found relative to the religious control exerted by the church over the training school was in the first prospectus of the school. Those who wished to enter the school were to apply to the pastor and superintendent of the hospital. At the end of a month of probation, this official determined whether or not students would be retained. He could also dismiss students at any time for misconduct or insufficiency. (Fortunately, he was a kind, warm-hearted and understanding person.) Stu¬ dents were expected to attend regularly the religious services at the hospital. The pastor and superintendent gave a course of religious in¬ struction each term. This same prospectus listed character requirements for students which were identical to and listed in the same order as those required in the Nightingale School. Students were to be sober, honest, truthful, trust¬ worthy, quiet, orderly, cleanly, and neat. Four additional requirements were that students be patient, kind, cheerful, and obedient to the rules of the institution. The Johns Hopkins Hospital Training School Johns Hopkins, the founder of Johns Hopkins University, Hospital and Training School for Nurses, died in 1873. After his death the Board of ^Deborah M. Jensen,, History and Trends of Professional Nursing. 4th Edition (St. Louis: .C.V. Mosby Co. 1959) pp. 232, 276. 6johns, ojx. cit., pp. .1-362. -72- Trustees of the Hospital moved slowly as they made thorough plans for the hospital building, nurses' home, and staffs for the hospital and training school, both of which were intended to be truly great institutions. Dr. John Billings was appointed by the trustees to supervise the construction of the hospital. Dr. Daniel Gilman, president of the University was asked to select the staff. Both of these men visited hospitals in Europe and the United States. Dr. Billings visited St-oThomas' Hospital in Lon¬ don. Mr. Francis King, president of the Board of Trustees, consulted with Florence Nightingale in London and had correspondence with her. Eighty nurses, many of whom were leaders in nursing education, ap¬ plied for the position of Superintendent of Nurses and Principal of the Training School. Miss Isabel Hampton, Superintendent of Nurses of the Illinois Training School, was selected for the position. The Johns Hop¬ kins Training School for Nurses opened in 1889. Miss Hampton led this new school for five years. Miss Lavinia Dock, in 1890, was appointed her assistant in charge of teaching the first-year students. In 1893, Miss Dock resigned to become superintendent of the Illinois Training School. Miss Adelaide Nutting, graduate of the first class of nurses, had been serving as a head nurse. She was appointed to take Miss Dock's place. Then Miss Hampton married Dr. Robb in 1894. Miss Nutting was appointed to be Acting Superintendent and then Superintendent, in Mrs. Robb's place. She served at the helm of this school from 1894 to 1907. These three leaders in nursing and their successors all made im¬ pressive contributions to the training school. From the beginning of the school, Miss Hampton wanted an eight-hour -73- day for student nurses. The leaders of the school had to keep striving toward this goal until 1938, when the forty-eight hour week was finally introduced. The forty-eight hour week was in effect in Montana Deaconess Hospital in 1931. Miss Nutting introduced a six-months preliminary peri¬ od in 1901, nine years before the eight-weeks preliminary school was started at the Nightingale School. In the early years of the Montana Deaconess Hospital Training School, when Miss Ariss was observing these two schools, she must have seen St. Luke's as a school which had high Christian standards and Johns Hopkins as a, school which had high educational standards. She wanted the best of what each of these schools was offering for the school she was organizing. CHART II A COMPARISON OF THREE TRAINING SCHOOLS FOR NURSES Information about these schools was organized according to the sub¬ ject matter of each of the Nightingale Principles. 1. MATRON - Nurses are to be trained under the direction of a matron edu¬ cated in nursing and leadership. The Nightingale Training School The first matron, (1860-1887) was "Mrs.- Wardroper, a lady of practical experience. 1887-1937 - The ma¬ trons were Nightin¬ gales who had had experience in lead¬ ership in other hos¬ pitals . All of the matrons were authoritarian. St. Luke's Hospital Training School The first housemother, (1853-1888) was Sis¬ ter Ann Ayres, a de¬ vout Christian woman who was untrained in nursing. She trained the first sisters or deaconesses. Superintendents of nurses were hired after the training of lay nurses began in 1888. At first, they were graduates of outstanding schools. Anna C. Maxwell (1889-1891) and Annie W. Good¬ rich (1900-1/902) be¬ came national lead¬ ers in nursing. Johns Hopkins Hospital Training School The first_£uperinten- dent of nurses of the training school was Isabel Hampton (1889- 1894), a graduate of Bellevue Training School for Nurses. She had been superin¬ tendent of nurses at the Illinois Training School for Nurses be¬ fore coming to Johns Hopkins. The three nurses who succeeded her were graduates of the Johns Hopkins Hospital Training School and had had experience in leader¬ ship positions in their home hospital. These nurses were all authoritarian leaders. -75- 2. STUDENTS - The students selected are to be refined young women, good character who possess aptitude for nursing. The Nightingale Training School Applicants were to be: Women of good moral character who had a basic education and good~h§alth, ladies or ordinary women. 1860-1896, 25-35 years of age, 1896-1938, 24-35 years of age. At first, students admitted at irre¬ gular times or at the beginning of each quarter and put to work imme¬ diately, on wards. It was usually diffi¬ cult to find enough qualified students. After graduation, nurses who were not retained at St. Thom¬ as' Hospital, were sent in groups to institute Nightingale Plan in hospitals throughout the world. St. Luke's Hospital Training School 1853-1888 - Women who were intelligent, educated, dedicated Episcopalians. 1888-Women of good character, whose doc¬ tors had provided a certificate of sound health, and 20-35 years of age. At first, students were admitted at ir¬ regular times and put to work immediately, on the wards. In 1920-1925, it was difficult to secure enough students to meet the hospital needs. After graduation, the majority of the nurs¬ es became private- duty nurses. of Johns Hopkins Hospital Training School Women of good moral character, sound health and of "supe¬ rior education and cultivation." 1889-6% were college graduates. 1910-19% were college graduates* 1889-1903, 22-35 years of age. 1903- 1922, 22, the minimum age. At first, students were admitted at ir¬ regular times and put to work immediately on the wards. More qualified women applied than could be accepted. Graduates were in de¬ mand for positions of leadership in nursing throughout the United States and in some foreign countries. -76- 3. CURRICULUM - The students are to be taught a thorough course in nurs¬ ing by well prepared teachers who are nurses. The program of study should include personality development, supervised care of the sick, (free from non-nursing tasks) and preparation to develop schools of nursing wherever they are needed. The Nightingale Training School Length of course: 1 year as probationers 2 years as staff nurs¬ es for paying proba¬ tioners. 3 years as staff nurses for non¬ paying probationers. Lady probationers were trained to be¬ come matrons and ward sisters (head nurses). Ordinary probationers were trained to work under the ward sis¬ ters . 1873 - A home sister was appointed in charge of probation¬ ers . Both groups were taught by the home sister, principle-med¬ ical officer and ward sisters. They were rotated through all the wards, except for isolation. St. Luke's Hospital Training School 1888- 1895 - 2 years, with 1-month proba¬ tion. 1889- 1920-3years, with 2 to 6-months probation. 1891- an affiliation in obstetrics was arranged. 1904 - Two nurses were appointed to assist with teaching and supervising in medical and surgical nursing. Students were taught by the superintendent of nurses, house phys¬ ician, house surgeon, pharmacist and staff doctors. They were ro¬ tated through all the wards of the hospital. Johns Hopkins Hospital Training School 1889-1896 - 2 years with 1-month pro¬ bation. 1896-1900-3years with 2-months pro¬ bation. 1901-3years with 6 months preliminary period. They were expected to take notes on lec¬ tures which were then checked by the in¬ structor. 1890 - The first as¬ sistant superinten¬ dent was appointed to teach first-year stu¬ dents . 1896 - The second as¬ sistant superinten¬ dent was appointed to do the extra teaching needed in the three- year course. Students were taught by the superintendent of nurses, her assis¬ tant, head, nurses arid doctors. They were rotated through all of the wards including isolation. -77- The Nightingale Training School At first there were no textbooks. 1873-Mr. Craft's 25 lectures were print¬ ed. Monthly exam¬ inations on ward experience were started. 1899-Student hours- 69 hours a week. Day duty-7:00 A.M. to 8:30 P.M. with three hours off. 7Ibid. p. 111. St. Luke's Hospital Training School 1896-First textbooks given to students. 1899 - 22 lectures given by doctors. Bandaging, anatomy and drugs were also taught. 1896-Student hours- 65 hours a week. Day duty-7:00 A.M.to 7:30 P.M. 2 hours off. Sunday 4 hours off. One afternoon 2:00 P.M. off. Two week vacation a year. 1896-Curriculum First year-Materia Medica-Potter. Ex¬ amination by Apothe¬ cary. Textbook of Nursing-Weeks. Anat¬ omy and Physiology- Kimber. First medical surgical examination. Second year-Anatomy and Physiology-Kimber. Medical Cases-Morris. Surgical Cases-Jones. Second medical-surg¬ ical examination. Third year-Dietetics, Practical and Theo- retical-Lincoln. Mas¬ sage, Practical and Theoretical. Child¬ ren's Diseases-Rhodes. Final examination. Johns Hopkins Hospital Training School 1889 - 68 lectures given by outstanding doctors: Dr. William Osier, Dr. Howard Kelly and Dr. William Welch. 1899 - Student hours- 7:30 A.M. to 7:00 P.M. with time off for rest and classes. Sundays A.M. or P.M. off. One afternoon a week off. Two week yacation a year. 1896-Curriculum First year-Elementary Materia.Medica, A- natomy and Physiology and Hygiene Cookery and Dietetics, prac¬ tice and theory. Intermediate year-Care of medical, surgical and gynecological pa¬ tients. Care of in¬ fectious diseases. Analysis of Urine- Massage . Senior ^ear-"Lectures and classes will fol¬ low the work of the n7 year1 -78- 4. THE HOME - The hospital shall provide a comfortable, attractive dent residence with supervision of the student's intellectual, and physical well-being. The Nightingale Training School 1860-1872-Temporary quarters were pro¬ vided, until the new hospital and home were built. 1872-The probationers lived at the home. Each stu¬ dent had a room of her own. Their study and off duty activities were supervised by the home sister. They ate their meals in the home dining room. Staff nurses and ward sisters each had a bedroom in the hospital. St. Luke's Hospital Training School 1854-The first home in the United States to be built for Protestant sis¬ ters was built adjoin¬ ing the Episcopalian Church of the Holy Communion. It was a fine home of the same architecture as the church. It was the gift of a donor. La¬ ter, an addition, the Vanderbut Pavilion, made it an adequate home for student nurs¬ es and graduate nurses. s tu¬ moral Johns Hopkins Hospital Training School 1889-The home was built before the opening of the school. It had 50 single rooms, dining room, lecture room and library. It soon be¬ came crowded so that two students were as¬ signed to a room. An "Annex" became avail¬ able. Then in 1926, luxurious Hampton House was built. It had many convenienc¬ es, lounges, kitchens and a gymnasium. -79- 5. CONTROL - The training of the student nurses shall be free from trol by medical doctors or churches. The Nightingale Training School St. Thomas' Hospital was a secular hospital. No religious group had any control in any way. Miss Nightingale, a devout Anglican Chris¬ tian, incorporated morning and evening prayers in the daily schedule of the pro¬ bationers . The Nightingale Fund Council was made up of nine distinguished men who always worked well with Miss Night¬ ingale. The two sec¬ retaries of the coun¬ cil were relatives of hers. Many of the doctors at St. Thomas' Hospi¬ tal were opposed to Miss Nightingale's Plan. The doctors who ap¬ proved the plan did the teaching. The medical doctors had no control of the school. St. Luke's Hospital Training School From 1846 to 1937, there were three hos¬ pital superintendents, all ministers. Dr. Mu¬ hlenberg, founder of the hospital and of the sisterhood, was hos¬ pital superintendent and pastor until 1877. He conducted daily wor¬ ship in the hospital and chapel. He worked very closely with the housemothers (matrons). In the first prospectus it was stated that the Pastor and Superinten¬ dent of the hospital would determine wheth¬ er students were dis¬ missed or retained. The. doctors on the staff were generous in their assistance as lecturers. The medical doctors had no control of the school. conr Johns Hopkins Hospital Training School Johns Hopkins, the founder of the train¬ ing school, did not want it to be associ¬ ated with any reli¬ gious group. The su¬ perintendent and her assistant conducted daily worship at breakfast each morn¬ ing. The training school, the medical school, and hospital were all under the direction of the Board of Trustees of the Johns Hopkins Hospital. All three institutions were very progressive, were com¬ peting for funds, and were limited in what they could do because of lack of funds. The two schools shar¬ ed class rooms. There were never e- nough class rooms. Doctors from the fac¬ ulty of the medical school gave lectures to the student nurses. Hospital and medicine received more finances than nursing educa¬ tion. -80- 6. FINANCES - The training school shall be financially independent of the hospital in which the students are trained. The Nightingale Training School The natron, the home sisters, and medical instructor were all paid for their ser¬ vices to the train¬ ing school by the Nightingale Fund. The expenses of the home were also paid from this fund. Lady Probationers paid 30 pounds (about $180) for their year of train¬ ing. Probationers were provided board, lodging, laundry, tea, sugar, some outer clothing, and an allow¬ ance of 10 pounds (about $60). St. Luke's Hospital Training School The only financial ob¬ ligation the hospital had for the sisters was to provide their board. Their other needs were met "by resources among themselves." In 1890, an endowment fund for the support of the training school was started but it was aban¬ doned after a few years. Student Allowances and expenses - 1888-1892, 1st year, $10 allowance per month. 2nd year, $14 allowance per month. Students paid for uniforms. 1893-1903, $10 allow¬ ance per month. Stu¬ dents paid for books and uniforms. 1904-1917-No more al¬ lowances, Uniforms and books provided. Pri¬ vate-duty nursing ser¬ vice given by student nurses in the hospital, supplemented the hos¬ pital budget. Johns Hopkins Hospital Training School In 1914, an Endowment Fund Committee was started by the Johns Hopkins Nurses Alum¬ nae Association. By 1936, the fund was $130,000. It was al¬ ways hoped that the training school might become financially in¬ dependent of the hos¬ pital . Student allowances and expenses - 1889-1896, 1st year, $8 allowance per month. 2nd year, $12 allowance per month. Textbooks and uniforms provided. 1896-Allow¬ ances discontinued. 1903, $50 entrance fee started. The doctor lecturer for the ana¬ tomy course was paid $300. Private-duty nursing service given by student nurses in the hospital supple¬ mented the hospital budget. -81- A summary of the contents of Chart II Before the training school was started in 1888 at St. Luke's, the pat¬ tern of the life and the spirit of the sisters were comparable to those at Kaiserswerth, their model. After the two training schools (St. Luke's and Johns Hopkins) began, their early superintendents of nurses met the re¬ quirements for matrons established by Miss Nightingale. Both schools tried to secure, as students, refined young women of good character. Johns Hop¬ kins succeeded in attracting young women of higher educational and cul¬ tural attainment than St. Luke's. Their aptitude for nursing was deter¬ mined, subjectively as at St. Thomas, by the superintendents of nurses who selected them. The curriculum of the Johns Hopkins Training School was in most respects more advanced than that of either St. Luke's or the Nightin¬ gale School. Neither of them were financially independent of the hospital; thus, students were, of necessity, exploited. This also happened at St. Thomas' Hospital where there was financial independence. Both hospitals tried to maintain nurses' homes which would meet Miss Nightingale's stan¬ dards. As the hospitals grew, more students were admitted and the homes were crowded for a time until more housing was acquired. There was con¬ siderable control of the training school, by the church in the early his¬ tory of St. Luke's and some control, financially, by doctors at Johns Hop¬ kins. Both training schools attempted to raise endowments in order to be financially independent. It appears that both schools were being guided by the principles established by Miss Nightingale. -82- The Influence of the Nightingale Principles on the Four Montana Deaconess Hospital Training Schools (1902 - 1937) The four Montana Deaconess Hospitals that had training schools and were studied for this paper are listed below with dates of openings, lo¬ cations, and the name of the deaconess superintendent who made the great¬ est contribution to each school. The years noted after each deaconess's name indicate her years of service at that hospital. Montana Deaconess Hospital - founded in 1902 - Great Falls Miss E. Augusta Ariss (1902-1931) Bozeman Deaconess Hospital - founded in 1911 - Bozeman Miss Edith Ackerman (1914-1929) Kennedy Deaconess Hospital - founded 1926 - Havre Miss Donna Watts (1926-1946) Billings Deaconess Hospital - founded in 1927 - Billings Miss Gertrude Buckles (1930-1948) A brief resume was given of the circumstances surrounding the begin¬ ning of each hospital. Then 4 study of the training schools in the four hospitals was reported. This information was organized according to the subject of each of the six Nightingale principles. The information relat¬ ing to curriculum pertains only to the years 1902-1915. The curricula of 1915 to 1937 was studied in the next section of this chapter. It should be noted that much sacrifice and struggle were associated with the founding and early years of each hospital. Except for the Boze¬ man hospital, these hospitals were established in communities where Roman -83- The four Montana Deaconess Hospital Training Schools were administered for many years by the above Deaconesses. -84- Catholic hospitals already existed. The Protestants in each community felt so strongly about having a Protestant hospital that they were willing to endure hardships to bring them into being. The Methodist ministers and their congregations, in each of the four communities and throughout the state, bore the major responsibility for organizing and financing the hos¬ pitals. The deaconesses gave of their lives to keep the hospitals open and growing. Their material remuneration was maintenance and a small monthly allowance. The Methodist Church obligated itself to care for them during their retirement years. The information which related to a specific training school, if not obvious by its context, was identified by abbreviations of the city in which it is located: Great Falls - G.F. Bozeman - B. Havre - H. Billings - Bigs. It may seem that more details are included than are necessary. The reason for including them was that, in most cases, they are bits of infor¬ mation that have not previously been brought together in any one written history of these training schools. g Montana's First Protestant Hospital - In 1896, the son of a Methodist minister, the Rev. F.A. Riggin, became very ill and there was no Protestant hospital in Great Falls. The Sisters of Charity started the Columbus hos- 0 -Mills, Edward Laird, Plains, Peaks and Pioneers (Portland, Oregon: Binfords and Mort, 1947). pp. 167-168. -85- pital . in 1892. It was not recorded whether or not Rev. Riggin brought his son to this Roman Catholic Hospital. However this incident led to plans for starting a Protestant hospital in Great Falls. In August of the same year, when the annual conference of the Montana Methodist Mission met at Sand Coulee, a committee of three ministers was given the authority to do what was needed to establish a hospital in Great Falls. This committee consisted of the Rev. F.A. Riggin, Rev. O.W. Mintzer, and Rev. W.W. Van Orsdel. Two years later, on June 16, 1898, a twenty-bed, red brick hospital, costing $10,000, opened its doors. It was incorporated with the name, The * Protestant Hospital . The lots on which it was built had been given by James J. Hill, president of the Great Northern Railway. Mr. L.H. Hamilton, a trustee of the hospital and a sheep rancher had made a substantial gift to the hospital. The first patient was admitted to the hospital on June 30. During the month of July, seventeen patients were reported. The in¬ come during the month was $287. During the first five years, there apparently was much coming and going of deaconesses who were depended upon for staffing and managing the hospital. During 1897, Miss Duetsche and Miss Sill were at work. In 1898, Miss Elizabeth Eicholds (or Erholtz) came to be superintendent. Other deaconesses who were associated with the hospital at this time were Misses Tage, Carlson, Peoples, and Walker. In 1900, Bishop I.W. Joyce and' Mrs. Lucy Rider Meyer of Chicago, who was in charge of the Training School *0n May 27, 1910, at a hospital board meeting, the name of the hos¬ pital was changed to Montana Deaconess Hospital. -86- for City, Home, and Foreign Missions, visited the hospital and gave the trustees some valuable suggestions. At the annual Methodist conference of 1900 and 1901, the Rev. W. Van Orsdel reported that the hospital had met with fair success. At a hospital board meeting in 1901, according to board minutes, Miss White resigned as superintendent of the hospital and Miss Hayward was e- lected to fill this position until another person could be secured. On September 17, a Miss Deimer came from Chicago to be head nurse. In just a few days, difficulties arose which resulted in both Miss Hayward and Miss Deimer leaving. In addition to staffing problems, there were financial problems. In the conference minutes of 1900, it was reported that indebtedness had risen to $8,000 and a financial agent was placed in the field to tide over the im¬ mediate danger. There seemed to be no alternative but to close the hospital in October, 1901. Did this first struggling hospital attempt to have a training school for nurses? The only clue to this is that, in 1942, Miss Ariss received a letter requesting verification of a Mrs. Eckman having graduated in nurs¬ ing during this period of the hospital's history. Miss Ariss answered that they had no records of a training school for that time. The only records that she had seen from the first hospital were two record books, one was a list of patieht admissions and another was a record book of income and. expenses. (From the letter Miss Ariss wrote to Mrs. Eckman.) The part of the history of this institution most pertinent to the history of training of nurses in the four Deaconess Hospitals begins with -87- the arrival of Miss E. Augusta Ariss, a deaconess, from Toronto, Ontario in June of 1902. After much cleaning, painting, and other repair work, the hospital was reopened on July 1, 1902. In looking back at this time, Dr. Mills said that the early ministers were overly optimistic when they started the original hospital and had pick¬ ed persons for leadership who were not equal to the difficult task in-. • volved. Before reopening the hospital, advice was sought from Mrs. Lucy Rider Meyers. She recommended Miss Ariss. "Neither the preachers nor trustees could have produced the desired results." Miss Ariss proved to be a "competent and sacrificial leader." She, together with the trustees and preachers, worked to bring about a hospital which functioned effect¬ ively. Bozeman Deaconess Hospital was incorporated in 1911. The story of the first hospital building goes back to 1896. It was a thirty-bed, three-story gabled sanatorium built by Dr. Henry W. Foster. After Dr. Foster's death in 1902, Dr. James Blair, a young doctor in Massachusetts, answered an ad which appeared in eastern papers offering the hospital for sale. It was described as being in a growing community which served an entire county. Dr. Blair bought the building and came to Bozeman to spend the rest of his life (31 years), serving the Bozeman community as a doctor and as a friend to everyone. When he came to Bozeman, transportation was largely by horse, and buggy. The streets were a mixture of gumbo and gravel. He struggled for eight years with the financial problems of operating his hospital and then decided to sell it to the community of Bozeman. The businessmen of Bozeman were hesitant about taking over a money- -88- losing venture. Dr. Charles D. Crouch, district superintendent of the Methodist Church, suggested that they might be able to get the services of deaconesses to run the hospital. This would eliminate a large part of the cost of salaries for hospital employees. It was decided to lease the hospital to Miss Ariss for six months. Two deaconess nurse graduates, of that year, Miss Violet Leach and Miss Amanda Olson, came from Great Falls to Bozeman. They were under Miss Ariss's supervision. They managed the hospital so well that when the lease expired, the Bozeman Chamber of Com¬ merce was willing to help raise funds for buying the building. Dr. Crouch as chairman of the finance committee, brought ministers from other towns to help collect the necessary funds. 9 At Havre, Kennedy Deaconess Hospital had a long, hard beginning. The first committee appointed to consider having a Deaconess Hospital in Havre was appointed at a Methodist Conference Meeting in 1909. Miss E. Augusta Ariss was on this committee. They were asked to discuss this possibility with the Havre Industrial Association. No action is record¬ ed again until 1916 when some Havre business men met with Miss Ariss, "Brother Van", (Dr. William Van Orsdel), and Rev. E.J. Huston, the local Methodist minister. Consequently, that year Mr. Meade Kennedy and Dr. J.A Wright gave the lots on which the hospital would be built and articles of incorporation were drawn up. The following year plans were made for raising money, bids were se¬ cured for construction, and a contract was let. A successful fund-raising 9 Mrs. L.E. Rhodes* Under God, Havre, Montana, 1965, Hill County Print ing Co. -89- campaign led them to proceed with building the concrete skeleton of the building in 1918. Then repeated crop failures occurred, construction was halted, and many who had signed pledges had difficulty merely supporting their families. Some who had made pledges moved away. In 1919, the local Methodist minister was appointed hospital manager. He supervised the building of a house in one corner of the donated lots. This was used as a parsonage until it was needed later as a nurses' home. In 1921 another financial drive was conducted which made it possible for a roof to be put on the skeleton of the building and to pay the archi¬ tect. Other actions were taken at conference meetings each year, until, in 1925, the conference authorized the Havre Hospital Board of Trustees, a- long with the Conference Deaconess Board, to complete the hospital. The Rev. Alexander Muirden was moved to Havre to be hospital manager. The goal of the trustees was to complete three of the four floors in such a way as to make it the best-equipped hospital on the main line of the Great North¬ ern Railway between Minot and Spokane. Miss Ariss recommended two deaconesses to come to Havre from the For¬ syth Deaconess Hospital which was closing its training school that year. Miss Ruth E. Robertson was assigned to be hospital superintendent and Miss Donna E. Watts to be principal of the Nurses' Training School. Students who had not completed the nursing course at Forsyth were transferred to Montana Deaconess Hospital. They completed their class work in Great Falls and their time in Havre. They have always been considered the first grad¬ uates of Kennedy Deaconess Hospital. The transfer students arrived at the hospital a few days before the grand opening to help get everything ready. -90- The Rev. A. Muirden had carried a very heavy burden during the year before the hospital was opened. The men on the board of trustees had made real sacrifices too. "There iwas a time when some of them were in danger of losing their homes because their names were on notes for this hospital. They were rewarded for their efforts when they saw this hospital lighted up at night and knew that sick people were being restored to health. It was a wonderful contrast to the windowless skeleton of a building that had "haunt¬ ed" them the previous eight years. The crop that year was quite average. The deaconesses shouldered much of the financial burden as time pass¬ ed. Two deaconesses were sent to collect pledges in the community. One of them stayed on and became the hospital treasurer. They worked and sacri¬ ficed to keep the doors of the hospital open. Much of the time they were opposed by what seemed unjust tactics used by the other hospital, which, no doubt, was having just as difficult a struggle. The years of the de¬ pression were followed by years of drouth. Dust storms in which the dust was so thick one could not see across the street were common. Farmers would try to pay on their bills by bringing in meat and produce. If pork or chickens were brought to the hospital, that would be the meat on the menu for both patients and nurses. A story is told by Ethyl Smyth Inman *29 about the produce which was brought in by those who went out to the farmers to try to collect outstand¬ ing accounts. Dr. Charles Houtz had given the hospital a new Ford for the deaconesses to use. Two young deaconesses went out one day to make 10 Ibid, p. 88. -91- collections. They had the car full of produce and chickens when they had an accident., "Their produce was strewn all over the place," (Personal in- 11 terview - 1969) 12 A Deaconess Hospital for Billings was first thought of in 1925. Dr. A.J. Movius and Dr. J.H. Bridenbaugh, prominent laymen in the local Metho¬ dist Church, were wondering what to do to secure better facilities for surgery. Should they build a hospital for themselves or should they ask the Methodist Church to help them get a hospital like the Montana Deaconess Hospital in Great Falls? The Protestants in the community wanted a Pro¬ testant hospital. With the help of the Deaconess Hospital Board and the local Methodist minister, the Rev. George Mecklenburg, a financial cam¬ paign was planned for June, 1917. Two weeks before the scheduled campaign was to take place, the money raiser who had been hired to conduct the campaign died. Even though Rev. Mecklenburg was young and inexperienced, he conducted the financial drive. By the end of the summer of 1917, they had reached their goal of $100,000. Construction of the building was started. Then World War I came, many of the pledges.were not paid, and construction had to stop. In 1922, Dr. Charles Crouch, who had been instrumental in starting Bozeman Deaconess Hospital, was appointed by the Methodist Bishop to super¬ intend the raising of funds and to complete the construction of the Bil¬ lings hospital. The General Deaconess Board paid his salary. The four- Personal Interview with Mrs. Inman, Jan., 1969 12 The Montana Methodist Conference Report, 1961. -92- story brick building was finally opened for service on June 25, 1927, after ten years of struggling through war and drouth. Dr. Crouch continued as administrator of the hospital until his retirement in 1930. The depres¬ sion years came next. Much free care had to be given to people in need and payments on indebtedness had to be postponed. During the years that Dr. Movius and Dr. Bridenbaugh waited for the Deaconess Hospital to open, they operated what was known as Park Hospital. It had been an old twenty-room boarding house. During the influenza epi¬ demic years, Dr. Bridenbaugh said that both Park Hospital and St. Vincent's Hospital were full. He brought obstetric patients to his home and other patients to the home of a practical nurse for care. Billings really need- 13 ed another hospital. The Billings Deaconess Hospital Training School began when the hos¬ pital opened. Miss Ethel Guilkey, a 1924 graduate of the Montana Deaconess Hospital Training School, was appointed by Miss Ariss to be the Superin¬ tendent of Nurses. The training school of the Deaconess Hospital in Syd¬ ney, Montana, had recently closed. Two third-year students and two sec¬ ond-year students transferred from Sydney. Miss Ariss asked the students in Great Falls if any of them would volunteer to transfer to Billings, "to help them out". Alta Henkle Hunter volunteered because her home was V in Billings. Nine new students had been enrolled for the first year class. 13 Personal Interview with Dr. Bridenbaugh in Powell, Wyoming, 1969 14 Telephone Interview with Mrs. Hunter, '29, (Bigs.), 1968. -93- A STUDY 05! THE TRAINING SCHOOLS IN THE FOUR DEACONESS HOSPITALS Matron - Nurses are to be trained under the direction of a matron, educated in nursing and leadership. The term matron, if used at all at the Deaconess Hospitals, referred to the person who was in charge of the nurses' home. This person was usu¬ ally a deaconess but not always a nurse. She lived at the nurses' home and helped to enforce the rules which were formulated by the superinten¬ dent. Miss Ariss's title the first few years was Superintendent. In the 1915-16 annual report, her title is listed as Superintendent and Principal of the Training School for Nurses. This is the title used by the heads of the Johns Hopkins Hospital Training School from 1889 to 1940. In 1917, Miss Donna Watts was appointed instructor of the students at Great Falls. Her title was Principal of the Training School. Miss Ariss's title then reverted to Superintendent. This terminology, Superintendent (for Matron) and Principal (for instructor) was usually used at the other Deaconess Hospitals. At Billings Hospital, however, Miss Guilkey's title was Superinten¬ dent, until Miss Buckles came. Then Miss Guilkey's title was Superinten¬ dent of the Hospital and Miss Buckles' title was Superintendent of Nurses. All of the deaconess superintendents lived in the hospital and were on call twenty-four hours a day. Miss E. Augusta Ariss was the first Montana Deaconess matron. June 6, 1902 was an important day in the history of nursing in Montana. It is the day when Miss E. Augusta Ariss arrived in Great Falls. She came to a -94- twenty-bed hospital which had closed its doors. It had been operated by deaconesses who could not keep it financially solvent. Miss Ariss was recommended to the Rev. W.W. Van Orsdel, president of the hospital board, by Mrs. Lucy Rider Meyer, of the Deaconess Train¬ ing School in Chicago, Illinois. Rev. Van Orsdel, ("Brother Van") went to Toronto to persuade her to come to Montana. She was loaned to the Northern Montana Mission of the Methodist Episcopal Church for two years, by the Mission in Toronto. She remained for 29 years, until she retired. This outstanding nurse was a graduate of the Guelph General Hospital Nurses' Training School of Guelph, Ontario, her hometown. She graduated in 1895 from a two-year course. She had two years of deaconess training in Chicago and five years experience doing "visiting nursing" for the Fred Victor Rescue Mission in Toronto, Canada. She made her calls for the Rescue Mission on a three-wheel cycle. Miss Bertha Wismer of Toronto, Miss Harriet Fritschle of Pittsburgh, and Miss Janet Burns of Kansas (or Missouri) were deaconesses who came at the same time to work with Miss Ariss. These humble, devoted women enter¬ ed whole’rheartedly in doing anything that needed to be done. Miss Ariss was known to do scrubbing, washing, cooking, tending of furnace, buying of supplies and bookkeeping. Miss Burns probably was the one who went out in¬ to the community and to churches of the state to represent the heeds of the hospital. At this time, deaconesses were given an allowance of eight dol¬ lars a month. This allowance was gradually increased as the years went by. Through all her years of professional work Miss Ariss lived on the deacon¬ ess allowance. -95- Wit h the support of divine guidance, Miss Ariss assumed what seemed to be an insurmountable task. Because the hospital was in debt for more than it had cost to be built, it was almost impossible for her to get cred¬ it. Six years after Miss Ariss came, the hospital was debt free and a new wing was dedicated. The original hospital had become too small to accom¬ modate the patients. Miss Ariss had often given up her own bed and slept in the office in order to accommodate one more patient. During these busy years, Miss Ariss was also conducting a training school for nurses. The students were all deaconesses from many eastern states who had been encouraged by Mrs. Meyer of Chicago to come to this school, in order to give their services in an area where they were sorely needed. Miss Ariss also visited the Chicago Training School nearly every year to recruit deaconess student nurses. In 1905, the first class was graduated. The teaching was done spas¬ modically by Miss Ariss at the patient's bedside, when time could be taken from her many responsibilities. The doctors assisted by giving a few lec¬ tures and by teaching at the bedside. In the class of 1908, there were also two students, Miss Ella Harris and Miss Edith Long. Miss Long, a jov¬ ial person, became a supervisor in the operating room and then assistant superintendent. Miss Long was Miss Ariss's faithful assistant in all of the work, especially in the delivery and operating rooms. Miss Long and Miss Ariss became lifetime friends. They shared a room in the hospital and were both on call twenty-four hours a day. Their per¬ sonalities were quite different. Apparently Miss Long could be quite brusque and could flare up easily. There were situations in which students -96- We have mentioned but a few of the Deaconesses who came to Montana and assisted the administrators of the four Deaconess Hospital Training School -97- feared her. And yet, in one of their annuals they described her as their "ideal nurse". She also was not as economical as Miss Ariss. When she was left in.charge of the hospital, Miss Ariss was known to take back some of Miss Long's purchases. An example of Miss Ariss's economy was her emphasis on turning off lights. Also, she had ten safety pins when the hospital opened. These she collected before the patients left the hospital and kept in the safe until needed again. The Montana Deaconess Hospital through Miss Ariss and the work of the Methodist Church bishops became the "Mother Hospital" for seven other Meth¬ odist Deaconess Hospitals, in Bozeman, Glasgow, Butte, Forsyth, Sidney, Havre, and Billings. In her obituary she was referred to as "The Florence Nightingale of the Northwest". In the 1906-07 annual report, she mentioned being away from the hos¬ pital for ten weeks. It was probably at that time that she visited hos¬ pitals in Toronto, St. Paul, Cincinnati, Chicago, and New York, in an at¬ tempt to be informed in what was happening in larger hospitals. As she used John's Hopkins and St. Luke's in New York as models for her school, she must have visited St. Luke's Hospital at this time. It is not known when she visited John's Hopkins Hospital. In one account in which she referred to the two schools she was using as models, she said, "We were in frequent correspondence. Later these schools were visited." ■* Miss Ariss had high ideals for the school of nursing. The one ideal that she added to high professional standards was that her nurses must ■^Class of 1937, o£. cit., p. 5. -98- also be growing in their Christian faith. To insure this she required church attendance, participation in prayer meetings at the nurses' home on Saturday evenings, attendance at morning prayers before going on duty at 7 a.m. each day and singing of hymns at 7 p.m. She said in the 1917-19 an¬ nual report, "The object of training schools in general may be said to be the training of nurses for service in their profession; the object of the Montana Deaconess Hospital is the training of Nurses for CHRISTIAN ser¬ vice." An alumnae association soon became an accepted organization for each training school. Miss Ariss was instrumental in organizing one for Mon¬ tana Deaconess Hospital Training School in 1914 when there were thirty-four graduates. She was the first president and was in this position continu¬ ously for seven years even though she was not an alumnus. She loved each one of the alumnae. Just as she referred to them as "the hospital family," they were truly her family. Her pride in the school and her students were evidenced when she wrote: Our School of Nursing has become the largest and most progress¬ ive in the State. Sixty students are enrolled and our gradu¬ ates have gone far and wide spreading the gospel of health. One of them is president of the California State Nurses' Asso¬ ciation and others are holding positions of trust and respon¬ sibility in institutions and organizations and still others are engaged in Missionary fields of India, China, Korea, Sumatra, Siam, and the Philippine Islands. Her Christian service is a boon to stricken humanity and an asset to civilization wher¬ ever she exercises her profession, in homes or hospitals, or in the vital work of health conservation and community welfare."1® Miss Ariss was very proud of the 1917 graduating class. They all 16 Ibid, p. 10. -99- volunteered for service with the Red Cross in the war theaters. She accom¬ panied this class as far as New York. Miss Edith Lamb, deaconess '20, wrote in a letter (April, 1969): She terminated her vacation at one time because she had been no¬ tified that one of the students was critically ill. Few of us will forget how quickly she appeared at the nurse.'s bedside and how she told those of us on duty how we must increase our dili¬ gence in the nursing care. This girl must not die. She re¬ covered and became an excellent nurse. Miss Ariss's influence went beyond the walls of the hospital not only through the lives of "her" alumnae but through her work in the Montana State Association of Graduate Nurses. In 1913 she was elected second vice- president of the Montana Association of Graduate Nurses, in 1914 counsel¬ or and in 1915 president. In 1915 the annual convention of this organiza¬ tion met in Great Falls. In the absence of the president, Miss Ariss pre¬ sided. It no doubt was she who influenced the delegation to vote "to open the convention with prayer hereafter." In 1920 she was again elected presi¬ dent of this organization and was sent to the American Nurses' Associa¬ tion meeting in Atlanta, Georgia, to represent Montana Nurses. As president she helped to raise the standards of nursing education in Montana, uni¬ fied the teaching program in the schools, brought to the state a much-need¬ ed executive secretary and aided in the establishment of a nursing head¬ quarters with an office in the capitol at Helena.^ Another important and demanding service to the nurses of Montana was her work on the State Board of Examiners for Nurses, which began in 1913. This involved help with preparing, administering, and grading state board 17 Ibid, p.7 -100- examinations each year for nurses who wanted to be registered and licensed to practice in Montana. In 1920 she was elected president of this board and served continuously in this office until 1933. After Miss Ariss retired, the Montana Nurses' Association honored her and Miss Long by sending them to the International Council of Nurses at Paris and Brussels in 1933 and by making her honorary member of District 16 of the Montana Nurses' Association. She gave her report of this trip to the Montana Nurses' Association following the banquet at the Glacier Park Hotel at the annual convention.in Kalispell. At the 1935 conven¬ tion of this Association she was^appointed to perform still another ser¬ vice for the organization, that of writing a history which became known as the Historical Sketch of the Montana State Association of Registered Nurses and Related Organizations. Two years later she was given a rising vote of thanks for writing this history. Miss Ariss was also an outstanding hospital manager. She worked dil¬ igently for improving the services of the hospital so that people would be given as much relief from suffering as possible. In each annual report it is obvious that she had received much joy each time a new service had been added. For example, on pages 7 and 8 of her 1922 annual report she said: This new feature of our hospital work is most gratifying. In 1921 the State Legislature passed a bill which provided for an appropriation of $25,000.00 for indigent and crippled children. Our hospital was one of the three institutions of the State selected to do this work. The children come to us in the most deplorable condition of deformity. One boy, 16 years old, had never been able to walk since babyhood. His faithful dog pulled him on sled and cart to school for years until he finished his grade work. Then the Orthopedic Commission made it possible for him to take six months treatment in the Hospital and the result is that this boy is now walking like other boys, taking a course in the Business College, and will soon be self-supporting. -101- The work of the maternity department seemed to be a special joy to her. She liked to have pictures of nurses holding babies in her annual reports. She was usually one of these nurses. In one report she had a picture of twenty-three nurses each holding a baby. The picture was labelled "A Scene in the Nursery." One cannot help but rejoice with her that the New Spencer Hospital became a reality while she was there to enjoy it. This is what it meant to her: The climax of the years came with the announcement that our good friend and benefactor, Samuel Spencer, had bequeathed almost his entire estate, the accumulation of a life time of this pioneer of Montana, to our hospital. Again our pulses quicken and our deepest emotions are stirred as we recall the gathering together of our staff and hospital family in an evening of praise and thanksgiving to our Heavenly Father for this "unspeakable gift." Our dreams had come true. Our visions of a hospital extending along the block had become a tangible thing. All our desires and imaginations had suddenly become a reality. The Giver of every good and perfect gift must get all the praise and the glory so we sang and prayed the evening away, rejoicing that we were counted worthy to share in such a marvelous legacy. No words of tongue or pen will ever describe the feelings of pride, devotion, and unutterable joy we experienced when we announced that his great, scientifically equipped and modernly appointed institution was ready for the care of the sick regard¬ less of race, color, or creed. As the years went by the Montana Deaconess Alumnae, as an organized group, recognized Miss Ariss in different ways. At the spring meeting in 1927, they honored her for twenty-five years of service in Great Falls. They presented her with a gift of one hundred dollars. One of her stu¬ dent friends, Madge Webster Rubens, '20, wrote a poem entitled "In Love 18 Ibid. p.10 -102- With Her Task.” 25 years of welcoming you.! 25 years of smiling through! 25 years of an upward climb! 25 years of keeping abreast of time! 25 years of sunshine and rain! 25 years of financial strain! 25 years of toil and grind! 25 years of asking records be signed! 25 years of smoothing the Dr.'s out! 25 years of quieting the nurses shout! 25 years listening to babies cry! 25 years watching people die! 25 years of hearing complaints! 25 years of cheering the Saints! 25 years of difficulties braved! 25 years of wanting 6th Avenue paved! 25 years of bearing the blame! 25 years of service, seeking no fame! 25 years - choosing nurses in the rough! and instilling into them the proper stuff! 25 years of inspiring the nurse! To help rid this world of disease's curse! 25 years of trying to keep 25 Doctors angelic and sweet! 25 years of aiding the sick! 25 years just filling her niche! And what is her reward you may ask! Why, she is simply in love with her task! Mrs. Rubens says, "This is the way I viewed her after being in her company for eleven years. Others presented their views of her as a Deaconess, as an instructor and as a Nurse." -103- The students quite generally characterized her as a strict discipli¬ narian who was always just, kind, and understanding. Her example as a Chrsitian is remembered by all. One student recall¬ ed that Miss Ariss always led them in prayer in the mornings before going on duty. She had the girls kneel by their chairs in the dining room. Some mornings, when there were many empty beds in the hospital, she would pray that the Lord would send in the suffering who needed care. "They seemed 19 to come in from all directions after she prayed." Madge Rubens said, "I didn't ever hear Miss Ariss pray that people would become sick but I did hear her pray that if people did become ill, they would decide to come to our hospital." Miss Lamb wrote the following: During "Bro Van's" last illness, 1919, I had the privilege of being his "special" nurse. Miss Ariss came in to inquire about his comfort and was somewhat surprised at his reply. "I am just fine, Edith fixed me up so nicely." She raised her eyebrows allow him to call you After her retirement in 1931 they furnished a room in her honor, The E. Augusta Ariss Alumnae Room. She tried to return for each annual meeting in the spring. She was toastmistress at the May 22, 1937 banquet. At the 1942 spring meeting they honored her on her Fiftieth Anniversary as a reg¬ istered nurse. It was also the year for honoring the classes of 1912, 1922 and 1932, The class of 1942 were their guests. One hundred and twenty nurses were in attendance. Before Miss Ariss's retirement, the doctors and members of the hos- 19 Telephone Interview - Mary Stevenson English, '23, - 1968 20 Letter from Edith Lamb'20, April, 1969 -104- pital board provided a cabin for her and Miss Long at Monarch. They had hoped it would be a home for them when they retired. They lived there only one full year. After that, they spent their winters in an apartment in California and summers at the Monarch cabin. She and Miss Long went to live permanently in Long Beach, California in 1940. She sold the cabin at this time. In Long Beach, Miss Ariss found that a local hospital was very short of nurses and appreciated her volunteer service for three years. She returned to Great Falls for the annual spring meeting of the alumnae whenever she could. The last mention in alumnae records of Miss Ariss's presence was in August 22, 1948 when a tea was held in her honor. At this time the Miss Edith L. Long Alumnae Room was dedicated to her long time friend and assistant. Miss Ariss kept up a correspondence with many alumnae. One example comes from Mrs. Rose Cheney who graduated late in 1905 and left the hos¬ pital in 1906 to return to Chicago. She said, "While I received Christ¬ mas messages from Miss Ariss through the years, I saw Miss Ariss and Miss Long only once after I left the hospital .... when they were on their way as delegates to the International Convention of Nurses in Germany." Just a couple of weeks before Miss Ariss died I received my last, beautiful Christmas card from her which I treasure. I will quote from it as follows: Christmas is so wonderful, and each year brings some inspiring thought to me - I am concentrating on the "Silence" of the Birth - So many in Bethlehem, but, amid the clatter and din of the streets no one knew of the very marvelous event occuring in the town. Many times the noise of our lives dulls the greatest thing in our days. ... I thank God I am enjoying His blessings day by day, take my insulin every morning and follow my diet closely so -105- keep pretty well. Passed by three score years and ten but don't feel that old. Am enjoying my church work, also am Secretary to the Goodwill Auxiliary and have made some very nice contacts. I have had several calls from many of the early day nurses this year. Two of our nurses work in one of the city hospitals. Mrs. Cheney concludes her letter by saying, "She was a wonderful person and 21 I am happy I had her for my friend through many years." Miss Ariss's family meant much to her. She had one brother and five sisters. She was the third girl. Her father was a farmer. She usually spent vacations in Canada with relatives. When she was spending winters in California, she would drive to Great Falls for the annual spring alumnae meeting and then drive on to Guelph, Ontario. After Miss Long's death, one of Miss Ariss's sisters lived with her in California. On her 1945 trip to Great Falls, she had an accident in which her Buick rolled over. Her dia¬ betes was diagnosed in 1949 in Guelph, when she was very tired after a long drive from Great Falls. During the years that Miss Ariss was working, she was generally in very good health. However, she did have two major operations. During her retirement, her friends discovered that she loved to cook and was a very good cook. She also enjoyed being free to participate in the activities of the church. Miss Ariss died of a heart attack in Long Beach, California - Jan¬ uary 9, 1952. Funeral services were held in the First Methodist Church in Great Falls. Entombment was in the Great Falls Mausoleum. When Miss Ariss wrote the story of the Montana Deaconess Hospital 21 Letter written by Mrs. Chaney, 1959. -106- Training School, she closed the story with the following paragraph: And what shall I say more? My story is ended, but the half has not been told. Would that someone had the ability to unfold the panorama of the years and show in reality all the deeds done, the words spoken, the love revealed, the prayers offered, the thousands of sick helped back to health again, and the lives of the young women awakened and quickened to higher ideals of ser¬ vice, and educated for life's great adventure among the sick and suffering of the world* (The White Caps 1937). This is appropriate also for closing the story of Miss Ariss's life. In the Montana Methodist Conference Report of August 21, 1928 there appeared an article written by Miss Ariss which is quoted here verbatim: Why I Remain a Deaconess My answer to this question is found in Mark, 10:28r30. "Then Peter began to say unto him,'Lo, We have left all, and have followed thee! and Jesus answered and said,'Verily I say unto you, there is no man that hath left house, or children, or lands, for my sake, and the gospel's. But he shall receive a hundredfold now in this time, houses, and brethren, and sisters, and mothers, and children, and lands, with persecutions: and in the world to come eternal life!. This has been true in my life and I have never made any sacrifice but what I have received a hundredfold in return. As I look over my thirty years of experience in Deaconess work, I can see several reasons for remaining in the work. First, is my love for folks. I have always loved people and the Deaconess work has brought three large groups of people into my life, whose associa¬ tion, fellowship, and Christian contact has meant much to me. The first group, at the Chicago Training School - splendid, eager, inter¬ ested young women - searching for their life investment, together with the faculty of finely developed Christian leaders. In this group we can find Mrs. Lucy Ryder Meyer and her husband, and many others who contributed much to my character. Next comes the group at Toronto, where I was associated with the Deaconess work for five years. Here I found congenial souls who were serving the church and kingdom in a large way, and who especially in Christian service, added much to my life. Next is the group in Montana, especially in Great Falls. Looking down -107- through the years of service spent here, I find such friends as Brother Van, "the Apostle of the West," the ministers and their wives of this great state. The deaconesses, the nurse deaconesses who have walked out from our hospital into the superintendency of other hospitals. In this group we find the body of student nurses, whose bright young lives and eager anti¬ cipations, have brought much to us to enjoy. The second reason is my opportunities for travel. Since I have been a deaconess I have travelled all over the continent. My journeys have taken me through most of the National Parks, into the White House, where I was introduced to the president. I have travelled and quite extensively by automobile, and next week I expect to fly over the Rocky Mountains into the city of Butte. The third reason, the privilege and the responsibility I have had in the handling of money. Since I have been in the Deaconess Hospital in Great Falls, there has been over two millions of actual cash pass through my hands. Money is power and we should not regard it lightly. I feel it is a sacred charge and we must use it with great care. Every Deaconess and every Christian worker ought to have a bank account. I have influenced many Ghristian women to do this, and feel that I have contributed some¬ thing worthwhile to their success in so doing. The fourth reason. I am a deaconess today because of the FAITH that is mine through my experience in the work. When one of our nurses was dying a few years ago, I bent over the bed and asked her if Jesus was near. She clung to my hand and made this reply: "That if she had known in health that he could have been such a 'friend,' she never would have doubted Him." This has kept me from doubting many times throughout the years. In Deaconess work I have learned to PRAY. I first learned to pray at my mother's knee. Next I learned to pray in the Chicago Training School. When it came my turn to lead the morning worship, I found my Episcopal Prayer Book and learned a prayer which I hoped to repeat at this service, but lest I should forget it, I decided to copy one and read it. Then I feared lest one of the Faculty should see me, so when the time came, I read the Bible and prayed aloud for the first time in my life. I next learned to pray in what we now call the Annex, the first small building of our hospital. When the days were dark and the obstacles seemingly unsurmountable I found relief in prayer. When we did not have very much to eat and the purse was empty and no patients coming in, again I prayed, and each time the Lord answered and opened his hand of blessing to us. Truly I can say with the Psalmist: "How precious are thy thoughts unto me 0 God! How great is the sum of them! If I should count them they were more in number than the sands of the sea." In this blessed work of ours I have developed a deep love for the Bible. It has been "a lamp to my feet and a light to my path." Many times I have rested upon its promises and found comfort in them. My heart is filled with love today because of this great work and I thank God that He ever -108- called me into Its services. I expect to remain a Deaconess so long as my life shall last and I will never cease to praise God for having called me into the work, and for the great company of blessed women who have been associated with me. I love the Deaconess work and the Deaconess Costume. I love the church of which I am privileged to be a part, and I feel that God has highly honored me, by set¬ ting me apart for this service. I look into the future with confidence and trust for "He Knoweth the Way that I take." Miss Edith Ackerman was the superintendent of Bozeman Deaconess Hos¬ pital and superintendent of nurses from 1914 to 1929. At the age of 80 years, she said in a letter to the writer, "The years spent at Bozeman Deaconess Hospital were among my happiest. They were pioneer days in the field of nursing and a part of the great deaconess movement in Europe and America." An outline of her life follows: 1887 - Born in Stanton, Nebraska. About 1902 - Family moved to Belle Fourche, S. Dak. She had her last three years of high school here. She taught four years in Butte County Schools. About 1910 - Entered Chicago Training School for City* Home and Foreign Missions. She did not finish the two-year course. 1911-1913 - In training at Montana Deaconess Hospital Training School. 1913- 1914 - Employed at Montana Deaconess Hospital. 1914- 1929 - Superintendent of Bozeman Deaconess Hospital. 1929-1931 - Private duty nurse in Missoula, Montana. 1931 - Night Superintendent of Torrence, California Memorial Hospital. 1934 - Surgical nurse at Kennedy Deaconess Hospital, Havre. -109- 1936-^939 (approx.) - Head nurse in Golden State Hospital, Los Angeles, Calif. 1940 - Unemployed because of surgery and convalescence. 1940-1942 - Night duty on surgical floor - Torrence California Memorial Hospital. 1942-1952 - Resident nurse at Thoburn Terrace, Alhambra, Cali¬ fornia - a retirement home of the Methodist Church. 1952-1957 - Retired and lived in Long Beach, California, in an apartment which was part of the home of her sister, the mother of Vern Shockley Keyes '27 of Bozeman. 1957 - Returned to Thoburn Terrace as a permanent resident. During the first eight years of Miss Ackerman's service in Bozeman, she had the handicap of working in a building which was too small and poorly arranged. The nurses did sterilizing in the basement and carried heavy vessels up long flights of steps. They used linen closets as dark rooms for developing x-rays. Obstetrics and pediatrics patients could not be separated from other patients. By 1918, it was necessary for probation¬ ers to live in private homes near the hospital. The new hospital was built in 1922. Miss Ackerman had high educational goals for Bozeman Deaconess Hos¬ pital Training School. Even though the Montana State Board of Nurses and the curriculum recommended by N.L.N.E. in 1917 permitted a minimum two years of high school as an entrance requirement, she very seldom admitted a student who was not a high school graduate. Girls interested in becom¬ ing nurses often were hired as tray girls in the hospital while they fin- -110- ished high school in Bozeman. It was not until 1930, that the goal of re¬ quiring high school graduation for admission to schools of nursing was a- chieved nationally. Miss Ackerman took advantage of community resources for enriching the students' curriculum. In her first annual report (1914-15) she said: Our State Course of Study is pursued with the addition of the study of Chemistry. The State Agricultural College of Bozeman supplies teachers in the subjects of Chemistry and Dietetics. We have equipped a Laboratory to make possible the experiments and tests in Chemistry and Bacteriology and aim to give our stu¬ dent nurses such training as will fully prepare them for the duties of the profession. The State Board of Examiners have ap¬ proved of our work and we are now a registered hospital; one of the first five registered in the state. She also had spiritual goals which were expressed in the same report: The Lord has prospered us and we desire to do our best for Him. We rejoice in the privilege of laboring in a Christian hospital service. When one tells us that the influence of our Christian nurses has brought them to a realization of their need of Christ in their lives or that they have caught a new vision of His love, we experience a thankfulness that cannot be expressed. When World War I came, she showed that she combined patriotism with high educational standards (1916-1918 Annual Report): We are glad to cooperate with the organization of Hospital Officials and Nurses and keep the standard as already attain¬ ed. We want to give to the men, serving our country in this war, the very best nursing care. No other motive should prompt us and no short course of nursing should be instituted that will lower the standard of nursing. However, we have been glad to accept the War Measures that call for intensive study, followed by two years' Hospital instruction and further study, for young women who go into Red Cross Service. (Underscoring added). The most original arrangement which Miss Ackerman made with Montana State College for the benefit of her students was that of making it possi¬ ble for the students to obtain three quarters, or one school year, of col¬ lege credit during their three-year course. It began in 1923 and was -Ill- continued until 1930. The students had to be high school graduates to be admitted to the college. Miss Ackerman planned the program so that the hospital would be adequately staffed with nurses, even though some were at¬ tending college. First year students attended college the first quarter of the school year, second-year students the second quarter, and third-year students the third quarter. While the students were going to college they lived at the nurses' home, carried sack lunches, and hiked to the campus. This affiliation with the college was discontinued the year after Miss Ack¬ erman left (1930). She had hoped to be able to bring into being an ar¬ rangement with the college for a baccalaureate degree course for her stu¬ dents . Miss Ackerman left Bozeman at a time when the depression was severe in Montana. The hospital had been giving much free care to needy people and had a policy of giving free care to all clergymen, Roman Catholic and Protestant, and to clergymen's families. As hospital superintendent, she had managed well to keep the hospital in good repair and well equipped. It was impossible to pay on hospital indebtedness from hospital income during such difficult times. As superintendent of nurses, she had the love and respect of all of "her girls". She had provided unusually well for the nursing education of her students. She now had to spend a few years work¬ ing as a nurse for salary in order to help provide for an elderly father. After his death in 1942, she returned to deaconess work. Her friends described Miss Ackerman as being firm but also kind and just. One incident which indicated this occurred in October or November of 1925. Dorothy Hillard Clark, '25, then on the staff,• recalls that Miss -112- Ackerman received a letter from the deaconesses (Miss Monta Bane and Miss Cora Meneley) in charge of the Sydney Deaconess Hospital. In this letter, they told her that the nurses there were bobbing their hair. She immedi¬ ately began to weep and said, "Have I been depriving my nurses of something that is vital to them?" She went to her room to think and pray about this. The next noon, when the nurses were in the dining room, she went to the blackboard,. which she used for messages to the nurses, and wrote,1 "Nurses may bob their hair when they wish." Within a month, all of the student 22 nurses including Mrs. Clark (faculty) had bobbed their hair. Miss Ackerman's motherly instinct came to the fore when a little boy about one and one-half years old, was admitted to the hospital. His mother had died when he was a baby and his father had not been able to cope with the care of his two sons. This little boy was very pale and malnour¬ ished. She decided to keep him. He lived with her in the hospital until he was eight years old. He became a sort of "mascot" for the student nurses. When he was eight, she decided it would be better for him to be at 23 the Methodist Deaconess Home in Helena and arranged for his care there. Miss Ackerman always lived in an apartment in the hospital and was on call 24 hours a day, especially for giving anesthetics. The subjects which she always taught were Materia Medica and Ethics. Her students said that she had a very retentive memory. When a young doctor who had just finished medical school began prac- 22 Personal Interview - Dorothy Hillard Clark, '25,.1968. 23 Alumnae - Alumnae Meeting in May, 1968. -113- tic ing in Bozeman, she often was able to give him help in prescribing for his patients. He did not mind giving her credit for helping him with de¬ cisions regarding many of his patients. Miss Ackerman had a very good friend who was a member of PEO. Miss Ackerman joined this secret sorority but often felt compelled to apologize for shirking hospital duties to participate in social functions for per- 24 sonal pleasure. According to the Alumnae Association minutes, in 1924 Miss Ackerman had served in Bozeman for ten years. The alumnae wanted to plan something very special for their annual meeting in June, in her honor. They thought of inviting Miss Belle L. James who had served for many years as secretary to Lucy Rider Meyer, the founder of the Methodist Deaconess Movement in the United States. It worked out that Mrs. Meyer herself came to teach a one month course on the Old Testament and to be here for Miss Ackerman's Anni¬ versary. Mrs. Dorothy Millard Fahy '29, had the opportunity to visit Miss Ack¬ erman in California in 1966. She said, "We found her to be a very cute, sweet and alert lady of 79. She could remember the name of every girl that had taken training under her, what year she graduated, and where she is 25 now." She is still (1968) remembering all of "her girls" every year at Christmas time with a card and a note. Miss Ruth Robertsen '19 (G.F.) was the first superintendent of Kennedy 24 Vern Shockley Keyes, '27, (B), Personal Interview, 1968 25 Letter from Mrs. Fahy '29, 1968 -114- Deaconess Hospital at Havre. She had had special training in anesthesia in Minneapolis and five years experience as hospital superintendent in Rosebud County Deaconess Hospital, Forsythe, Montana. She served in Havre from 1926-1931. She then resigned as superintendent and as deaconess and moved to Puyallup, Washington, to operate a fox ranch. Miss Robertsen was described as being: mannish, had short hair, a loud voice and took long strides when she walked. . . . she enjoyed driving the hospital car. . . . we liked Miss Robertsen but we were, also afraid of her. She was quite domineering. She expected us to know everything. When she would bring a patient down from surgery, we would hear the ele¬ vator stop and we would run to hide. One time when I was hiding I heard her call, 'Someone come. Anything in uniform will do.' Miss Robertsen' slather was a wealthy man who gave generously to our hospital. Miss Donna Watts '16 (G.F.) a mild, gentle person, was the deaconess superintendent in Havre who was much loved by the alumnae and who served there during the entire lifetime of the training school. Donna E. Watts was born January, 19, 1888, in Augusta, Illinois. She was a descendent of the hymn writer, Issac E. Watts. The five Watts child¬ ren grew up in a strict Methodist home. Donna had a lovely contralto voice and learned to play the organ well. After graduation from high school she worked as a dry goods clerk, until she decided to enter the Chicago Train¬ ing School to prepare for Christian service. In 1911 she. was consecrated as a deaconess, donned the deaconess, habit and began to work as Girls' Club worker at Halstead Street Settlement House, Chicago. She heard Miss Ariss plead for deaconesses (1913) to enroll as nurses in the small Montana 26 Telephone Interview - Laura Anderson Beatty '29, 1968 -115- Deaconess Hospital and she heeded the call. She graduated in 1916 and was promptly made principal of her alma mater. Miss Watts had five years experience as principal in Great Falls and five years as assistant to Miss Robertsen at the Deaconess Hospital in For¬ syth before going to Havre with Miss Robertsen. When Miss Robertsen re¬ signed, Miss Watts was promoted from assistant superintendent to superin¬ tendent of the hospital. During her years in Havre, she was active in the Van Orsdel Methodist church, particularly the choir. She was a frail, nervous person. In 1939, she was given a sabbatical leave which she spent in Spokane. It had been a great disappointment to her when' the training school had had to close in 1938. It could not meet the requirements of the State Board. The hospital daily average was about 35 when it should have been at least 50. Also, the nurses' home was most inadequate. In 1946, after 20 years of service in Havre, her frail health forced her to resign. Again she returned to Spokane but soon returned to Havre where she could mother two of her deaconess nurses, Agnes Wilder and Helen Marie Kraut. In Havre, she could also see many of the other alumnae and her "hospital grandchildren", as she called the children of her nurses. She had helped to teach thirteen classes of nurses or seventy-six nurses in all. In 1956 she left Havre to move with her "two girls" to Seattle for a year and then to a retirement home, Wesley Gardens in Des Moines, Washington. Miss Watts began writing annual spring letters to all of the alumnae in 1930. She has also remembered them with birthday and Christmas cards. In her letters she included: 1. the date and plans for the spring annual -116- alumnae reunion meeting which was held either in Havre or Great Falls, 2. the schedule of the monthly alumnae meetings for the coming year, 3. news about the latest improvement in the hospital which she referred to as "our beloved K.D.H.," 4. news about alumnae and their families, and 5. per¬ sonal comments about herself and other friends. In the 1946 letter she was still regretting the closing of their training school. She said, "Do you remember when we wanted to keep our school so badly and needed to have an average of fifty patients and how by counting babies and all we could never get over 35? In February this year we averaged 54. ... I have left until last the thing that is hard to tell. Owing to reasons of health, I have to hand in my resignation effect¬ ive June 1st. It is not easy to leave a place one has learned to love or that has become a part of you as K.D.H. and its alumnae have to me. But what must be must be." In 1968, at the age of 80, Miss Watts was still corresponding with the 66 of her 76 girls who are still living, through an annual spring let¬ ter , Ghrsitmas cards and birthday cards. She was rejoicing, particularly, in the years of service given by the three nurses who became deaconesses while they were at "K.D.H." Miss Wilder had given 42 years, Miss Kraut 35 years, and Miss Diefenbaugh 37 years of nursing service and they were still in active service. At Billings Deaconess Hospital, Miss Ethel Guilkey, '24, (G.F.) was the first superintendent (1927-1939). After she finished her deaconess training in Chicago in 1910, she served as a pastor's assistant for four years and in the business office of the Spokane Deaconess Hospital for -117- seven years. She graduated as a nurse in Great Falls in 1924, did post graduate work in Ohio, and worked at Kennedy Deaconess Hospital. She was respected as being a very efficient business manager, an excellent teacher in Materia Medica, and a good obstetrics nurse. The first ten thousand dollars given toward the Billings nurses' home was given by a patient who had appreciated Miss^ Guilkey's kindnesses to him. She had a good singing voice and often sang solos at the nurses' prayer meetings. Her person¬ ality was such that she did not relate as well to people as her successor did. Miss Gertrude Buckles, (the representative deaconess superintendent from the Billings Hospital), was born, May 15, 1886, near Le Roy, Illinois. The family moved to Iowa when she was six years old and to South Dakota, sixty miles from Belle Fourche,. when she was fourteen. Her father took a claim there. After teaching in rural schools for ten years, she decided to go to Great Falls to prepare to be a nurse, and she graduated in 1924. Miss Ariss recognized her teaching ability and appointed her principal of the Montana Deaconess Hospital Training School in 1925. She was particu¬ larly effective as a teacher of anatomy and physiology. From 1930 to 1.938, she was superintendent of nurses in Billings. Miss Guilkey was hospital superintendent. When Miss Guilkey resigned, Miss Buckles was made hospital superintendent and served in that position for ten years. She was made an associate deaconess in 1939. During the year 1943, she taught and supervised in the men's convalescent ward in Warm Springs, Montana State Hospital with Miss Edith Lamb. Miss Buckles did not spend the required two years of study in Chicago -118- to become a deaconess. It was suggested to her that she could do the re¬ quired studying by herself and pass examinations to become a deaconess. This she was ready to do. Then, the executive in charge of examinations suggested that she not bother taking the examinations because she was serv¬ ing just as effectively as any of the deaconesses as an associate deacon¬ ess. The one difference that it made to her was that when she was ready to retire she was not eligible for the retirement benefits which other 27 deaconesses receive. She had served as a deaconess for twenty-five years in the two Montana hospitals! The Billings Deaconess Hospital Board gives her a fifty dollar monthly pension. Some of the memories Miss Buckles' friends have of her are: "She was interested ineveryone. She wore a deaconess habit only occasionally, after one was given to her in 1939 . . . There were often five beds in the waiting room outside her office. She would come out and help the nurses wash and make up the beds when they were pressed for time! Sometimes she would come to get me and my two children to drive out to Laurel, Montana where we would spend the afternoon with her friend, a doctor's wife."28 "Miss Buckles had a warm personality and was a splendid nurse in¬ structor . . . One night when Dr. Bridenbaugh was hurt quite seriously he went to the Deaconess Hospital and it was full. Miss Buckles was irate that they had not called her. She said she would gladly have given doctor her bed."29 Nelda Mueller recalled going to the home of an aged lady with her to give the lady an enema. This was a favor requested by a doctor. Nelda Mueller's sister remembered helping Miss Buckles can vegetables 27 Personal letter - Miss Buckles - July, 1968. 28 Interview - Ethyl Smith Inman '29, (H) 29 Letter - Mrs. Bridenbaugh, Feb., 1969. -119- which farmers had brought for the hospital. Another student recalled pick- 30 ing cherries with her and of returning to the hospital to can them. Miss Buckles was active in the life of the church. In a letter writ¬ ten in March, 1969, she said that before she became hospital superinten¬ dent, she taught a Sunday School class of ten-year-old boys for three or four years and a class of high school girls for three years. In the same letter, she said that when she told the hospital board that she was leaving, they told her that she would have to find some one to take her place. She called Mr. Harry Wheeler who had worked in Montana Deaconess Hospital for nine years. He met with the committee and was hired as business manager. She stayed for another two years. She then took charge of the Nurses' Home at Spokane Deaconess Hospital until 1956, when she retired to Pasadena, California to live with her friend, Miss Ethel Guilkey for four years. They both went to a retirement home, Wesley Gar¬ dens, Seattle, Washington. Miss Buckles' friends do not recall when she began sending each of the Billings alumnae Christmas cards and letters. She was still remembering them in this way, Christmas of 1968 when she was 82 years old. The Students - The students selected are to be refined young women, of good character who possess aptitude for nursing. From 1902-1917, all of the student nurses at Great Falls were deacon¬ esses. Fifty-eight of them were graduated. Most of these students came from outside of Montana, as a result of Miss Ariss going to the Chicago 30 Telephone Interview - Nelda Mueller - 1968. -120- Training School nearly every year to speak to deaconesses about the need for nurses in Montana. Many of the deaconess student nurses whom she en¬ listed were not high school graduates. Some had had a few years of ex¬ perience working as deaconesses, after finishing their deaconess train¬ ing. Usually they were more than 18 or 19 years old at the time of admis¬ sion to nursing. From 1917 to 1927, one hundred and forty-two nurses were graduated, twenty-six of them were deaconesses. The last deaconess stu¬ dent nurse to graduate from Montana Deaconess was Mary Gordon in 1927. Some nurses became deaconesses after graduation as did three of the Kennedy Deaconess Alumnae: Agnes Wilder, Marie Kraut, and Lela Diefenr baugh. Bozeman Deaconess Hospital Training School had both deaconess and lay students from the beginning of the School. There were no deaconess student nurses at Havre or Billings. The deaconess movement gradually lost momentum as more vocations opened for women. Women no longer needed the help of the church to open fields of work for them. The requirements for admission to the two earliest Deaconess Hos¬ pital Training Schools were not identical. In Miss Ackerman's 1916-17-18 annual report for the Bozeman Hospital, the admission requirements were: 1. Good Christian character. 2. Age 19 to 35 years of age. 3. High School education or its equivalent. In Miss Ariss's annual report for 1915-16 the admission requirements in Great Falls were: 1. Good Christian character. 2. Age - 20 to 32 years of age. -121- 3. At least one year of high school or its equivalent. 4. Letters of recommendation from a reputable physician and her pastor. These requirements changed to 18 to 35 years of age and two years of high school in 1917-19 and to high school graduation in 1919-20. The 1919- 20 health requirements were a physician's letter testifying to the students physical and mental soundness, a vaccination scar from a vaccination given within three years of admission, a certificate from a dentist indicating that her teeth were in good condition, and a suggestion that if her ton¬ sils were enlarged, they should be removed. Miss Grace Linfield, principal in Bozeman, wrote a letter to Miss Alma Hill in 1924. She wrote: Montana State asks that student nurses have at least two years of high school, but to secure the benefit of our college work our young women must be high school graduates. We require that they be strong mentally, physically and a member of some protestant church. The admission requirements for schools of nursing of Montana were stated in this way in 1933: No school of nursing shall accept students under 18 years of age, nor students who have not graduated from an accredited high school. In 1935, Ellen Hagstrom Henry, '39, entered nursing in Havre and had been attending classes for six weeks when she received a letter from Edith L. Brown, secretary for the Montana State Board of Examiners for Nurses. She informed Miss Hagstrom that her lack of required courses in science in high school made her ineligible to take nursing. No compromise could be worked out whereby she could take a science course at Northern Montana College or the high school in Havre. She returned to her home in -122- Williston, N.D. , took a coarse in biology for a year, and then returned to 31 Kennedy Deaconess Training School the next year. After 1917, most of the students admitted to the deaconess training schools were Montana country girls who were 18 or 19 years of age; they were predominantly Methodists. Until 1937, it was required that students be members of a Protestant church and recommended by their pastors. Examples of how these young people decided to take nurses' training at these hospitals are: 1. Rose Cheney, '06, had planned to take nursing at Wesley Hospital in Chicago but had to wait to be admitted. When she heard of the need for nurses in Montana, she decided to go to Montana right away to take nurs- 32 mg. 2. Emil Christiansen applied to work as an orderly at Bozeman in 1915. When he came to work, Miss Ackerman persuaded him to enroll as a student nurse. He did not complete the course because he was called into 33 military service. 3. Agnes Henry Johnson, '19, Belt, Montana, was urged by her minister 34 to study nursing right after graduation from high school. 4. Madge Webster Rubens, '20, was 27 years old when her family moved from a farm to Great Falls. One day when she was relieving a private duty "^Letter - Ellen Hagstrom Henry '39, 1968. 32 Letter - Rose Cheney - 1959. "^Letter - Emil Christiansen - 1968 Personal Interview - Agnes Henry Johnson - 1968. -123- nurse who was caring for her sister in the hospital, the nurse suggested to Madge that she would make a good nurse. This was a new idea to her. She asked how she should go about enrolling. The nurse arranged for her to see Miss Ariss who gave her an annual report to study. This incident occurred in January, 1917. Miss Ariss admitted her right away to the class 35 that had started the previous fall. 5. Vern Shockley Keyes, '27 (B) lived in South Dakota. Her aunt, Miss Edith Ackerman, was superintendent of the Bozeman Deaconess Hospital. Vern wanted to go to college but her father could not afford to send her. She decided to study nursing at Bozeman where she would be able to earn O £ one year of college credits during the three-year course. 6. Rita Hansen Gilbert, '31, was a transfer student from Abbot Hos¬ pital, Minneapolis, Minnesota. She had been ill and was sent home to Syd¬ ney, Montana, to convalesce and rest. She did not want to stay out as long as was recommended. She found that the Bozeman Hospital would accept 37 her for the fall class. She transferred. The number of students who graduated in proportion to the number ad¬ mitted has not been studied. The alumnae interviewed have sometimes made statements such as, "Six of us started and six graduated." (Laura Ander¬ son Beatty, '29 H) or, "Ten started in our class but only two graduated." (Ada Millard Eahy , '29 B) Mary Stevenson English, '23, (G.F.) started in a 35 Telephone Interview - Madge Webster Rubens - 1968 ■^Personal Interview - Vern Shockley Keyes '27 - 1968 37 Personal Interview - Rita Hansen Gilbert '31 - 1968 -124- class of thirty and only fifteen graduated. In her class, many classmates married war veterans and left. At that time there was one floor of the hospital for war veterans. Miss Stevenson received seventeen boxes of 38 candy for Christmas at the time she worked on that floor. After graduation, nurses were free to seek their own employment. Many of the early deaconess nurses were asked to continue to serve in the hospitals from which they graduated. Others were asked by Miss Ariss to serve in another one of the deaconess hospitals which she knew had a spe¬ cial need. According to Deaconess Josephine Stout, '23, the deaconesses had a great respect for Miss Ariss and her judgement in placing them. How¬ ever, she said that deaconesses were always made to feel that the decision was theirs, to do what they felt was God's will for them, or what they con¬ sidered was the place of greatest need. A few of the graduates chose to be private-duty nurses. The deaconess superintendents rejoiced when any of "their girls" de¬ cided to become foreign missionaries. Miss Ariss promoted this cause by having deaconess missionaries speak to the students when they were on fur¬ lough and by encouraging the alumnae to keep in touch with "their mission¬ aries" through correspondence and by sending them money gifts. Miss Watts (H) regretted that none of "her girls" became missionaries. Miss Buckles (Bigs.) claimed one missionary for her school, Elizabeth Cole, '32, who served in South Africa for the Nazarene Church. The Alumnae of Montana Deaconess Training School who became missionaries were: 38 Telephone Interview - Mary Stevenson English '23 - 1968 -125- Naomi Anderson '10 Korea Clara Sauer * 10 China Agnes Dunn '13 India Lottie Swank Gottschall '19 - Philippines Bertha O'Dee '20 - Philippines Annie Vandenberg '23 China Fern Tillman '25 - West China Helena Newman '32 Thailand Letha Robinson '37 The nurses who married and lived in the community of their alma mater were often called upon to help when there was an emergency even though they did not want employment.. Ethel Smyth Inman '29, said that she was often called in,Havre. If she could possibly find a baby sitter for her 39 small children, she would respond to the call. It is certain that as deaconess superintendents selected students, their primary concern was to select young women of good character. Super¬ intendents depended upon minister's recommendations and upon the candi¬ date's church membership as their means for eliminating undesirable appli¬ cants. Very little information was found to indicate that those who quali¬ fied as having good character were ever denied admission because of lacking in "aptitude for nursing". One alumna remembered that there were students who were eliminated during the probationary period for not qualifying. One example was that of a girl who just could not conform to the nursing code 39 Personal Interview - Ethel Smyth Inman '29 - 1969 -126- of that time. She would do such things as greeting one of the very dignir fied doctors by saying, "Hi, Doc." or call nurses by their first names or last names rather than the accepted form of "Miss Jones".^ There was usually difficulty in securing as many students as were wanted. It is likely that they were willing "to take a chance" with any applicants who qualified as Protestant women of good character who also complied with the age, health and education requirements. Curriculum - The students are to be taught a thorough course in nurs¬ ing by well-prepared teachers who are nurses. The program of study shall include personality development, supervised care of the sick (free from non-nursing tasks), and preparation to develop schools of nursing wherever they are needed. Miss Ariss described the early teaching program in this way: During the first years, the teaching was done by the Hospital Superintendent, spasmodically of course, in time stolen from crowded hours of the day or night and a few lectures were given by the doctors. Most of the instruction was given at the bedside in the wards where conditions allowed demonstra¬ tions of technique and execution of nursing procedures.^1 The "Course of Study" which appeared in the first annual reports of the Great Falls and Bozeman training schools was the same in content until 1914. The subjects mentioned were not always listed as being given in the same year in the two schools. The year in which a course was listed is not significant because courses were often taught to two or even three classes at a time, especially when there were very few in a class. In this way, ^Personal Interview - Vern Shockley Keyes *27 - 1968 41 Class of 1937, o£. cit., p.5. -127- all of the courses would not have to be repeated each year. There was no correlation between student clinical experience and the time of teaching a particular course. The writer did not find a course of study from St. Lukes to use as a basis of comparison with the Deaconess Training School curriculum. The copies of early curricula of Johns Hopkins, which were sent to the writer by the secretary of the Johns Hopkins School of Nursing, included one for 1911. It will be used for comparison. It included the numbers of hours of lectures, classes, and demonstrations. This information was not preserved in the records of the early Deaconess Hospitals. (The State Board of Nurse Examiners did not require keeping these retords until 1,930.) The first minimum standards for registering training schools in Montana were written in 1913. The 1911 "Course of Study" must have been patterned from the curricula of the schools Miss Ariss used as models, as well as from the content of textbooks which, by this time, had been written for nurses. The textbooks used in both Great Falls and Bozeman in 1911 were: Principles and Practice of Nursing - Hampton Ethics of Nursing - Hampton Obstetrics - DeLee Materia Medica - Stoney Cooking for the Sick - Farmer Anatomy and Physiology - Kimber The first two textbooks listed ^bove were written by Isabel Hampton, the first Superintendent and Principal of the Johns Hopkins Hospital Train- -128- ing School. The list of textbooks used at Johns Hopkins in 1911 was not included with the curriculum information received. A comparison of the subjects taught and the years in which they were taught at Montana Deaconess and Johns shows many similarities: Montana Deaconess Year Medical Nursing 1 Anatomy 1 Ethics 1 Nursing Clinics 1 Hygiene 2 Materia Medica 2 .& 3 Obstetrics 2 Urinalysis 2 Massage 2 Dietetics 3 Surgical Nursing 3 Bacteriology 3 Lectures and Demonstrations* Surgery Nervous Diseases Eye and Ear Anatomy Surgery Hopkins Training Schools in 1911 Johns Hopkins Year General Nursing 1 & 2 Anatomy & Physiology 1 Elements of Nursing 1 Bandaging 1 Hygiene 1 Materia Medica 1 Obstetrics 3 Urine, Stomach con¬ tents and feces 2 Infectious Diseases 2 Dietetics 1 General Surgery 1 Bacteriology & Pathology 1 Gynecology 2 Orthopedics 2 The Nervous System 3 Skin, Eye, Ear, Nose and Throat 3 Infants and Children 3 -129- Bacteriology Special lectdres of interest to students of nursing. Obstetrics *Only one clue was found to explain the difference between the list of subjects taught and those subjects that were listed under lectures and demonstrations, in the annual reports. Miss Ariss once wrote: "In 1909 students studied: Principles and Practice, Anatomy . . . They attended 42 lectures in Anatomy, Medicine . . . The course of study offered by the two Deaconess Training Schools be¬ gan to differ in 1914-15. In this year, Bozeman added a course in chem¬ istry which was taught by Miss Edith Luther, B.S., a college professor. The next year, Montana Deaconess began to use people from the community to enrich the curriculum. Nurses from the state board gave lectures on tuber¬ culosis, Red Cross Nursing, national defense, and public health nursing. In 1916, both schools added a three-months elementary or probationary period and Bozeman had three more courses taught by college instructors: anatomy, bacteriology and dietetics. In Miss Ackerman's 1915-16 annual report she said. "There are so many demands, so many opportunities to add to a nurse's education that it takes constant planning to make the course of study the best." From this time on, each of these training schools devel¬ oped its own curriculum, depending on the resources of the hospital, medi¬ cal staff and community. The Great Falls hospital drew on high school teachers when more subjects were added. The Bozeman hospital sought more Julia Hamm, Montana Deaconess Hospital Nurses Alumnae Association History Constitution and By-Laws, Electric City Printing Co., Great Falls 1947. p. 4 -130- and more help from the college. Sometimes English Bible was included in the list of subjects taught. In 1917, 1918, and again in 1924, Mrs. Lucy Rider Meyers of Chicago was in Great Falls for a month, to teach the students a course in Bible. The work of the students on the wards in the first hospital building of twenty beds was pictured by Rose Fleet Cheney, '06, (G.F.): We were often overcrowded. Miss Ariss frequently slept in the office and our dining room was used as a nursery. We sometimes had to utilize rooms in the basement for patients. We had few conveniences. One time, our hot water heater failed and the nurses were propelling boilers of hot water on hand propelled elevators for tub baths, on the upper floor. I overheard one of the nurses operating the elevator fervently pray, '0, Lord, please send us conveniences 1^3 The most common nursing procedures before 1917 were probably those which were included in the practical examinations given as part of the first state board examinations in 1917. They were, bed making, making of poultices, plasters and fomentations, the use of the thermometer and the taking of vital signs. The written examinations were in three areas: fe¬ ver nursing, care of patients before and after operations, and care of the mother and child in normal and abnormal cases.^ Two nursing procedures which Josephine Stout, '20, recalled were still being used when she was a student, were for sterilizing water and for pre¬ paring horse hair sutures. She said: Miss Ariss used the best method she knew for sterilizing / *3 ^Letter to Agnes Johnson Henry '19, from Rose Fleet Cheney, '06, (G.F.), July, 1959: . Augusta Ariss, A His torical Sketch of the Montana S tate Assoc¬ iation of Registered Nurses and Related Organizations, 1937. -131- water for the operating room and other areas of the Montana Deaconess Hospital. The procedure for doing this was: Five or ten gallon tanks each of which had a spigot near the bottom, were filled with water arid put on the kitchen range. After the water in them had boiled for one to two hours it was strained through a clean pillow case. It was boiled again for one to two hours, strained through the pillow case and then boiled a third time for one to two hours. One tank would then be set on the back porch to cool and the other would be kept hot on the stove. The spigot was always sterilized by being wiped with a sponge soaked in carbolic acid. Student nurses would carry these tanks of water up the stairs to the operating room. There was no elevator. At Bozeman Deaconess Hospital we prepared our own horse hair sutures in the operating room. The steps of the procedure were: 1. Wash hair well in hot soapy water. 2. Soak in sodium bicarbonate solution to further dissolve grease. 3. Twist each hair into circles. 4. Boil it. 5. Preserve it in alcohol. 5 In addition to giving care to patients, the student nurses were ex¬ pected to keep their patients' rooms clean. When Miss Ackerman made daily rounds in the hospital, she used her handkerchief to check whether a bed, dresser or chair had been dusted. If :any dust was found the student was reprimanded (B). Cleaning duties also included cleaning the linen closets, diet kitchens, and any other cleaning that needed to be done. Students were never to be caught idle. There was always more cleaning to be done. The student nurses did not have much time to spend in the nurses' homes' because classes were held during their hours off duty in the after¬ noon or in the early evening hours. Their regular hours of duty were from 7 A.M.: to 7 P.M. with two-hours off, one afternoon a week off and onerhalf day off on Sundays, when possible. Night duty wass from 7 P.M. to 45 Josephine Stout, '20, (B), Personal Interview, Feb. 1968. -132- 7 A.M. They were required to attend the Saturday evening prayer meetings in the nurses' parlor when off duty, and were expected to attend the Wed¬ nesday evening prayer meeting at church. The nurses found it difficult to participate in community activities because hours were seldom posted more than twenty-four hours in advance. They seldom had much notice about assignments to twelve-hour night duty or other rotations. Service in the operating room and obstetrics required much overtime work and required being on call. During the influenza epi¬ demic in 1918, there were no classes for two or three months. During this emergency, all nurses were expected to serve whenever or wherever assigned This might mean assignment to private duty in the hospital or in homes, for twenty-four hour duty, seven days a week. The twenty-four hour pri¬ vate duty nurse would sleep on a cot in the patient's room and was sup¬ posed to have four hours off during the afternoon. Assignment of private duty nursing in homes was not uncommon in the earlier years. A graduate of 1906 did three months of private duty in homes (Lucille McRoberts ). A 1908 graduate did seven and one-half months (Edith Long) and a 1913 graduate did three months (Edith Ackerman) of this type of service (G.F.). The faculty of the first two deaconess training schools was made up entirely of nurse graduates of Montana Deaconess, at first, except for Mis Ariss and the doctors. New ideas were brought to the school as a result of Miss Ariss's visits to other hospitals and reading of professional literature. The first principal of the training school, in 1916, (G.F.) was Donna Watts who had just graduated that year. It was not uncommon -133- for senior students to teach younger students on the wards, to have senior students act as head nurses, or to be in charge of the hospital at night. The superintendent and her assistant were always on twenty-four hour call. When Agnes Johnson Henry, '19, (G.F.) graduated, she was sent to the Glasgow Deaconess Hospital to help with teaching students. She was not a deaconess. She first spent three or four days in Bozeman observing how A6 Miss Ackerman taught and supervised student nurses. In the 1919 annual report, Miss Ariss wrote: "This coming year, we have arranged to have graduate nurses from our own training school in charge in all departments." The departments she named were surgical ward, medical ward, obstetrics, x-ray, and pathology laboratory. For the period of 1902-1915, the curriculum or course of study of the two training schools was very similar to the curriculum of Johns Hopkins Training School. The students were taught and supervised by the deaconess nurses who were selected as being most qualified for the task. Their work was not free from non-nursing tasks but included much cleaning and any other housekeeping chores that needed to be done. This also occurred at the hospitals that were used as models. Deaconesses were trained or were expected, to be willing to develop schools of nursing in other deaconess hospitals in the state. The only mention of vacations in the annual re¬ ports of this period indicated four weeks of vacation each year. One month of vacation was given following the year of probation at the Night¬ ingale School and only in the second year at the Johns Hopkins School. 46 Agnes Johnson Henry '19 (G.F.), Telephone Interview, 1968. -134- This might have been given to make up, in some measure, for the large a- mount of overtime that was worked by the students at the deaconess hos¬ pitals. At Johns Hopkins it was given as a health measure. The Home - The hospital should provide a comfortable, attractive stu¬ dent residence with supervision of the students' intellectual, moral, and physical well-being. The early Deaconess Hospitals had financial struggles which were com¬ parable to those of Kaiserswerth. The needs of the patients always came first. The needs of the student nurses seemed to come second. The dea¬ conesses wanted to provide as well as possible for the students but they also expected sacrificial service from the students, most of whom were deaconesses during the years 1902-1917. The living quarters for the stu¬ dents in most cases were a part of the hospital, a near-by rented building, or the old hospital building when a new hospital was built. By 1937, Mon¬ tana Deaconess Hospital was the only one of the four hospitals which had a home that had been built specifically for the nurses. In Great Falls, the first student nurses (1902) were housed in one of the hospital wards of the twenty-bed hospital. In a very short time, that ward was needed for patients. Then a small upstairs apartment, which was two blocks from the hospital, was rented for their use. Later, a nearby cottage was willed to the hospital, and it served as the nurses' home un¬ til 1911 when the new Van Orsdel home was ready for use. Miss Ariss said that the discomforts of the crowded quarters "had been borne with Christ¬ ian fortitude." She felt that the new home provided "all of the accomoda- -135- tions and conveniences that a modern building affords.One outstanding feature of this new home was a gas hot water heater. An addition was built on this home in 1919. This home was a three-story brick building across the street from the hospital. It had a parlor, living room, classroom, and library on the first floor. Bozeman Deaconess Hospital was started as a 30-bed hospital in 1911. In the 1912 report of the first year's work, the hospital needs were men¬ tioned. Among these needs was a request for furnishings for the nurses' parlor "which stands bare and empty for the young women who give unreserv¬ edly of their time in service to the city." This appeal was repeated a year later. By 1915, the nurses' parlor had been furnished "through the generosity of friends, adding much to the comfort and pleasure of the fami¬ ly." "Skip" and the buggy, and a sleigh for winter use, provided the mode of local transportation for the hospital people until sometime in 1917. Skip was a beautiful black horse, which Dr. Blair had given, with a buggy, to the hospital. Miss Stout '20 and Grace Beach '20 were the last students to be met at the train by Skip and the buggy. Before Skip was retired to pasture, a good supply of horse hair was removed from his tail for prepar- 48 ing skin sutures. The barn was then sold and moved away. Instructions to new students included the suggestion that they bring their railroad checks for baggage to the hospital office where the secre- Class of 1937, op.cit., p. 6. 48 Josephine Stout, '20, (B), Personal Interview, Feb. 1968. -136- tary would see to their being brought to the nurse's home to save them "time and expense." The number of patients' increased each year, and the number of stu¬ dents to be housed also increased. There were twenty-three students in 1917. The probationers were living in residences near the hospital. In 1920, a new fifty-bed hospital was completed. The old sanatorium building was redecorated and used entirely for living quarters for nurses and other employees. What served as the nurses' home in Havre was originally built to be a minister's home. It had three bedrooms, a living room, a large screened- in porch, and basement. The housemother occupied one bedroom. All stu¬ dents slept on cots on the glassed-in porch. Snow sometimes blew into the porch in winter. The probationers or first-year class had their dressers (one to two students) in the living room. As they moved to the next year class, they were promoted to using one of the two bedrooms where there was a closet for their dresses. There was storage space in the basement. Laura Anderson Beatty, '29, recalled: There was no place in the nurses' home where we could entertain boy friends. A classmate and I made the mistake of inviting boys into the living room. Because of the other ways in which this room was used we should not have done this. We were punish¬ ed by having to live in a room in the hospital for three months. This we really liked because we had a closet all to ourselves and other advantages. When the time was up, we persuaded Miss Watts to let us stay there, so we wouldn't get into trouble again!^ When the Billings Deaconess Hospital opened in June, 1927, the fourth 49 Laura Anderson Beatty, '29, (H), Telephone Interview, 1968. -137- floor of the hospital was used as the residence for student nurses. When additional space was needed, a house diagonally across from the hospital was rented. The students who lived in the house claim that they had "more fun" than those who lived in the hospital. The housemother apparently lived in the hospital. The regulations which Miss Ariss formulated for the students at Monr tana Deaconess Hospital were the same as those used in Bozeman Deaconess Hospital and appeared in the annual reports of both hospitals until 1918. The rules were much the same in the other two Deaconess hospitals as they came into being. This, no doubt, is due to the fact that the superinten¬ dents and principals of the training schools had all had their nurses' training at Montana Deaconess Hospital and also because they met together once or twice a year to compare notes and to plan for their institutions together. These regulations were: Hours for Rising and Retiring. For rising - 5:30 A.M. For retirr ing - 10 P.M. All pupils are expected to be within doors at that hour, unless they have special permission to be absent, which per¬ mission can be obtained only from the superintendent. Rooms. Furniture in the rooms is never to be removed. Pins or tacks in plaster are not permitted. Nothing may be left on the floors, or placed on top of wardrobe. Money and valuables are kept in the nurse's room at the owner's risk. Such articles should be brought to the office. Thorough inspection of the rooms will be made at stated intervals. Before leaving the rooms for the hos¬ pital, each nurse must leave;her room in good order. On Friday mornings all beds should be left open to the air. The electric lights must be turned out when the nurse leaves the room for any length of time. A fine of five cents will be imposed upon any nurse who violates this rule. Duty. Day nurses are on duty in the hospital at 7:00 A.M. Night nurses are on duty at 7:00 P.M. Hours for Meals. Day Nurses: First breakfast, 6:30 A.M.; sec¬ ond breakfast, 7:15 A.M.; first dinner, 11:30 A.M.; second dinner 12 noon; first supper, 5:30 p.m.; second supper, 6:00 p.m. ; Night nurses: breakfast, 7:15 A.M.; supper, 5:30 P.M. Nurses must be prompt in coming to meals and not linger in dining room after meals. Nurses off duty must come to first dinner and first . -138- supper. No lunching between meals in dining room or kitchen will be permitted. Nurses are not to give orders to help. All such matters are to be referred to the matron. No visitors are in¬ vited to meals without permission. Laundry regulations. Clothes must be ready for the laundry at 6:30 A.M., Monday. The following articles are allowed each nurse per week: 1 uniform 1 colored skirt 6 aprons 6 pair cuffs 1 vest 1 drawers 2 stockings 1 corset cover 1 night gown 7 handkerchiefs Any clothing in excess of the specified number, and all elabor¬ ately embroidered garments will be returned unwashed. All clothing must be distinctly marked with indelible ink; under clothing on the bands, undervests to have name sewed on top of band, stockings to have tape with name sewed on top of each stocking, handkerchiefs to be marked on the hem, uniforms on bands at waist, aprons at end of strap, cuffs at the top on the inside. Pupils are allowed one uniform per week. If during the week, a nurse has an accident, she may, upon permission of the matron, put in an extra dress. White dresses, shirt waists, or white waists are never to be sent to the hospital laundry. General. Nurses are expected to observe at all times a quiet demeanor in halls, stairways and dining room. No noise, loud talking or laughing will be permitted anywhere in the hospital. Nurses are not allowed to remove any but their own mail from the letter box. The elevator will not be in use on Sundays unless in case of emergency, nor are the nurses allowed to use it on weekdays except when the duty of the hospital requires it. Jewelry or flowers are not permitted to. be worn with the uniform. Sickness. A sick nurse should report at once to the principal who will see that she is prescribed for, if necessary, by a physician. Nurses must not obtain medicine for their own use from the hospital without permission. When a nurse is off duty for illness, or leave of absence, she must not return to hospital duty without first reporting to the superintendent. They are not permitted to receive calls or telephone messages in the hospital from their friends, and should request their friends to observe this rule by calling upon them at the Home. Food, linen, silver or any property of the Hospital must not be carried to the Home. -139- Pupils will be excused from classes and lectures only on account of illness. Attendance upon church service is compulsory, opportunity is given the nurses to attend their respective churches. Prayer meetings led by students are held in the classroom of the Home one evening each week. These are very helpful and tend to promote a Christian spirit which is invaluable to a nurse in the pursuance of her daily duties. Students are required to attend vespers in the hospital each evening. Nurses from all of the Deaconess training schools who were interview¬ ed recall the fact that, among the economies that were stressed, turning off lights. A graduate of 1905 said that Miss Ariss did not per¬ mit the students to have dates because the shortage of nurses was so acute that she did not want them to marry. This same nurse commented that, in spite of the financial problems the hospital faced, Miss Ariss managed to 50 provide the nurses with good wholesome food. Edith Cox Christensen, '16, wrote in a letter, "The sleeping porches were in use the entire year, no matter how cold the weather was. There was considerable talking and laughing at bedtime. The story was told of some people living nearby who were having company one evening. The guests inquired about where all the noise and laughter was taking place. The hos¬ tess told them, 'It is just the nurses going to bed'."'^ One of the students in the Class of 1920 was the only student who had an alarm clock. She had the responsibility of awakening all of the other students each morning.^ ■^Rose Cheney, '06, (G.F.), Letter, 1959. ■^Edith Cox Christiansen, '16, (G.F.), Letter, 1968. 52josephine Stout', 20 (B), Personal Interview, Feb. 1968. -140- The reactions of the Bozeman students to the dormitory regulations were: We always had to be in by a certain hour. If the girls were caught sneaking in late, they were always punished by having privileges taken away. I was a quiet person so didn't get into any pranks. I can't remember that any of us became involved in community life, campus life, or church activities except for being required to attend the church of our choice each Sunday.^ We were always too busy to participate in life on campus. We were often called to 'fill in' in the hospital, in addition to our college work. (Bozeman students attended college one quar¬ ter a year.) We did have some dates with the college boys. 4 Life in the dormitory and hospital was like that of a convent. ' We were allowed out on Wednesday and Saturday evenings only to go to prayer meetings in some church in town. On Friday evening we could be out until 10 P.M. and occasionally until 11 P.M. for something very special. Card playing and dancing were not permitted. We would be put out of school if we were caught doing either of these. Of course, many of us did break rules without being caught. We were told that we must have plenty of rest because of the \ responsibility for life we had to carry. The inconsistency here was that we often worked a twenty-four hour shift in the operat¬ ing room. We would start at 5 A.M. sterilizing instruments. Then after the scheduled operations, there were often emergen¬ cies. There was no one to relieve us. After four hours of y sleep, we might go back on duty for another day. 1 The deaconesses were good sports and had a good sense of humor, in their special way. They were sort of other worldly.^ We had a phonograph in the nurse's home sitting room and each day as some of us came off duty we would have some music, but not on Sunday as that was forbidden. Also cards were not played al¬ though in later years, after their retirement, Miss Ariss and Miss Long did considerable playing of bridge at their cabin in Monarch and enjoyed it. I feel that they changed with the times and respect them for it. I think the students in the smaller ■^Ada Millard-Fahy, '29, (B), Letter, 1968. “^Vern Shockley Keyes, '27, (B), Personal Interview, 1968. -141- hospitals had more fun than we did. They were more like a fam¬ ily group. A student who transferred to Bozeman from a Minneapolis training school had this to say: It was so much smaller that we were like a family. There were only seventeen students in all three classes. The girls were more compatible. The rules of the deaconesses were pretty rigid but I did not resent them.56 Life in the dormitory was influenced for many years by two very fine 1 dorm1 mothers. First, there was Mrs. McAllister whom the girls called 'Mrs. Mac! She was not a deaconess. She was jolly and understanding. Then a deaconess, Miss Walther, came. She was quite elderly. She practically tucked each of us into bed each night. Lights were all off by 10:30 P.M. We loved her so much that we wouldn't want to do anything that might hurt her.57 Lillian Giddings, a deaconess, was housemother at Great Falls for twenty years (1911-1931). She is remembered affectionately for arranging for students who did not have to go on duty at 7 A.M. on Sundays, an in¬ formal breakfast in the home. Before examinations, she would often have coffee for them in the living room. Students were also thankful for her CO chronic cough which was a warning for them to get to bed. ° Miss Ackerman was very generous in permitting others to use her Model T and later, Model A Fords. However, they were also used when she was ■^Edith Cox Christiansen, '16, Letter, April, 1969. ■^Rita Hanson Gilbert, '31, (B), Personal Interview, 1968. -^Esther sime Matthews, '33, (B), Personal Interview, 1968. “*®Edith Lamb,. '20, (G.F.), Letter, April, 1969. -142- unaware of it. Very often, the students would take it to dances. They would push it away from the hospital during the night and when; it was far enough away so that she could not hear it start, they would drive it away. They would come back at about 2 A.M. The furnace man would cooperate and let them in. They would spend the rest of the night in the furnace room and then .manage to appear on duty, fresh as daisies at 7 A.M. The stu¬ dents in the dormitory had to cooperate, too, with the students who had left because the housemother would check each bed each evening when lights went out. When she had checked the first few rooms, girls would quickly go to the empty beds, crawl in, cover their heads and appear to be fast asleep when she arrived. In this way, the students managed to have it ap¬ pear as though all of the students were in their beds. One student claims that she smoked during the whole three-year period but was not caught because she would chew peanuts, after smoking, to re¬ move the odor from her breath. (B) The Bungalow was a place that was a block from the hospital where students would enjoy congregating with other teen-age young people of the community. (B) One Sunday evening, some of us made candy. One of the deaconess¬ es wasn't feeling well and had stayed home from the Sunday even¬ ing service. We brought her some of the candy. She appreciated our thoughtfulness but had to add 'You didn't make this on Sun¬ day, did you?' The doctors took a real interest in us. One, who had a real con¬ cern for us spiritually, would report us if he would see us going to a Sunday movie. Another doctor would look Miss Watts in the eye and lie to her saying, ' She could not have been at the movies. She was here helping me sew up an emergency patient's -143- cut finger'. It is not recorded just when the rules became more relaxed, but, by 1932, dancing was included in a school party. An alumni letter dated June 15, 1932, had the news that the juniors entertained the graduating class "when each girl and a gentleman friend were taken out to M. Lobdell's cabin twenty-five miles up the West Gallatin. The evening was enjoyed by dancing, after which a very delightful luncheon was served." The deaconesses tried to make holidays happy days for the students. Festive menus were planned for Thanksgiving, Christmas, and Easter.. Birthdays were remembered by having a birthday cake at the student's table on her birthday. One student who was particularly fond of pumpkin pie was n remembered with a pie instead of a cake. u At Christmas time, the usual procedure was that of accumulating the Christmas mail until Christmas morning. Early on Christmas morning, the students would gather around the tree in the home and open their gifts. They would then start singing Christmas carols as they proceeded to the hospital. In the hospital, they sang Christmas carols in the halls and en¬ joyed a special breakfast before going on duty. Occasionally, the deaconesses helped plan parties to which students could invite their friends. Such a party might be a costume party at which parlor games were played. Mock weddings were sometimes part of the fun. 59 Laura Anderson Beatty, '29, (H), Telephone Interview, 1968. ^Ada Millard Fahy, '29, (B), Letter, 1968. -144- In 1917, land in nearby Monarch, a very beautiful and popular summer resort spot in the mountains, was given to the hospital for a cabin for the nurses at Great Falls. The cabin was ready for use in 1920 and was named Kill Kare Kabin by the 1920 class (Johns Hopkins student nurses were given a cabin in 1916. Perhaps Miss Ariss got the idea of a cabin for students from them). At first, there was no road to Monarch, and the nurses had to take a train to get there. There was a period of several years when the Bozeman nurses had the use of cabins for outings. The deaconesses would often spend a day off or even a vacation at one of these cabins. The first cabin was one loaned to the hospital by the Simes family. This cabin was four or five miles from town. When the family sold the ranch, the cabin was no longer avail¬ able. Then the Women's Club of Bozeman arranged for them to use the Three Bear Inn which was beyond the fish hatchery up Bridger Canyon. After about a year, this was torn down to make room for a highway. The Bozeman Woman's Club then arranged for them to use the Middle Creek Cabin which was in Mid¬ dle Creek Canyon, thirteen or fourteen miles away. While Miss Ackerman was superintendent, her Model T. Ford, and later her Model A Ford, were at the disposal of the students. She would arrange for one of the college boys who worked at the hospital to do the driving. Later there was a young Hungarian, Steve Mladin, who came to work at the hospital as the engineer in charge of the heating plant. He came to the U.S. to avoid military service. He was well-educated, very fond of music, and from a family of wealth. He had a room in the basement of the hospital. Here he had his library of good records. The nurses who worked -145- in the diet kitchen enjoyed hearing good music coming from his Victrola. He had a car and was always happy to take the nurses any place they wanted to go. He often took them to the cabin. Steve worked at the hospital un¬ til his death. He was much loved by everyone. Memories of the dining room in Bozeman, and the food served can be summarized in this way: In the early years, the hospital had its own cows, chickens, and gar¬ den, to provide food for the patients and nurses. Each nurse had her own napkin ring and would use the same napkin for a week. Those who were off duty were expected to go to first dinner and first supper. Since the dining room was in the hospital, this rule applied: "Nurses are expected to observe at all times a quiet demeanor in halls, stairways, and dining room. No noise, loud talking or laughing will be permitted anywhere in the hospital." The food was usually quite uninteresting. The same menus were re¬ peated every week. Most evening meals included vegetable soup. The des¬ sert was usually sauce and a cookie, or, as one alumna described it, "a glob of plain jello." One day every week, an unpopular meal of boiled po¬ tatoes and boiled beans was served. Prunes were frequently the breakfast fruit. Brussels sprouts was always the special vegetable at the Christmas dinner. During the years that Cora Ekanger was cook, they had unusually good pies. Whenever grapefruit was served, the night nurses had the job of -146- • • u 61 sectioning them. The dining room was in the basement of the hospital in all four hos¬ pitals and not in the homes as Miss Nightingale recommended. The menus were planned by the hospital superintendent the first seven years at Billings. The students did not like the hospital policy of pro¬ viding better food for graduate nurses than for the students. An example given of this injustice was that graduate nurses were given whipped cream on their gingerbread. Students were given gingerbread plain or with milk. For nine years, beginning in 1928, the churches of the area had egg show¬ ers for the hospital at Easter time. The first year 900 dozen eggs, which 62 lasted for a few months, were collected and stored. After the egg showers, eggs were served in every conceivable way to both nurses and patients. They became very tired of eating eggs and learn- 63 ed to dislike them heartily. By 1914, the student nurses had a tennis court which had been provid¬ ed for them by the Alumnae Association, (G.F.) In 1935, they first organized a student government association,(G.F.^ A 1929 graduate said that the students did not have much money to spend in those years. They made their own fun. Her home was in Billings. The graduation dinner for her class was served in her home. She said, 1 "‘‘Reminiscences recorded at a coffee party of 4 alumnae, Jan., 1968. 62 63 Ethel Guilkey, '24', (G.F.), Letter written in 1929. Alumna, '35, Name withheld by request. 64 Montana Deaconess Hospital School of Nursing, Class of 1937, The White Caps, Great Falls, Montana. -147- "We had birthday parties and plenty of dates." A 1937 graduate said that the social life of the students was not very exciting. There was no student government. The fact that they were divided by being in two housing facilities hindered some activities. She remembered Miss Buckles as being the one who checked their rooms and often said, "Turn off the 66 lights, girls." Graduation time was a time when the graduates were entertained in a variety of ways. In Billings, the Deaconesses always honored them with a May breakfast. The junior class decorated the elevator and the dining room on commencement day. A doctor quite often entertained them for din¬ ner at his ranch. The alumnae and faculty entertained them at a banquet at the country club. Following the commencement program at a church, a reception would be provided by a local church organization. Graduation exercises included both a baccalaureate service and a com¬ mencement program, each held in a different Protestant Church. The com¬ mencement program usually was in the Methodist Church, with a Methodist minister giving the address and other ministers participating in other ways. The printed program would include the class,motto, class colors, class hymn, class flower. The charge to the class was given by the president of the medical staff, the class was presented by the hospital superinten¬ dent, and the diplomas were presented by the president of the board of trustees. ^“*Alta Bell Henkle Hunter, '29, (Bigs.) Telephone Interview, 1968. 66Evelyn Gilbert James, '37, (Bigs.) Telephone Interview, 1968. -148- An outstanding graduation event which was planned for the Bozeman stu¬ dents was a trip to the Lewis and Clark Caverns. They started as soon aft¬ er 7 a.m. as they could. At that time, it was necessary to hike up to the caverns from the highway. This exhausting hike came just about at noon of a very hot day. It was late in the afternoon when they returned to the hospital. One student had worked a 12-hour shift on night duty before the trip and had just a little time to rest before going on at 7 P.M. for an¬ other 12 hour shift. As she said, "We were young and full of energy. We could do it. The junior class entertained the senior class (of '26) at a breakfast at the Three Bear Inn. It was an unusually large class, ten in number* Because of the dependence of the hospital on student care of patients, there was always uncertainty about who and how many could attend these _ 68 events. In Great Falls, graduation-week activities had for several years in¬ cluded tree plantings. This program of graduation activities did not vary much from year to year no matter how many graduates there were. In the case of Billings, the number of graduates ranged from two to nine, in Havre, one to ten, Bozeman, one to nine, and Great Falls, one to twenty-nine. In 1917, state board examinations became an annual event in which those not involved empathized with those who had to take the examinations. £ -J Rita Hanson Gilbert, '31, (B), Personal Interview, 1968. 68 Vern Shockley Keyes, '27, (B) Personal Interview, 1968. -149- Miss Ariss described the event in this way: The year of 1917 was a banner year for our School. This class of ten graduates was the first to take the State Board Exam¬ inations, and obtain their State license. Our hearts are stirred with emotion as we recall the prayer service held with the class before their departure for Helena, and our thanksgiving and praise were equally responsive when we learned that each student had been successful in this final test given by the State.69 Miss Lamb a beginning student, recalled the event in these words: That enthusiastic class of 1917 was the first to write state examinations. With a great deal of fanfare they left in the undertaker's car for Helena. Not long after that, five of them entered overseas duty.70 The Bozeman students remember that Miss Grace Linfield, their dea¬ coness instructor, went with them when they took State Board Examinations because she was on the examining board. The deaconess superintendents were aware of the importance of and wanted for their student nurses the type of home Miss Nightingale recom¬ mended. Miss Ariss was most successful in securing these accomodations. They all tried to provide good supervision, particularly of student nurses' "moral well-being". Control - The training of student nurses shall be free from control by medical doctors or churches. The training of nurses in the Deaconess Hospital began at a time when medical schools were not well regulated. As a result of the Flexner Re¬ port in 1910, public opinion was aroused, proprietary diploma schools of ^Montana Deaconess Hospital School of Nursing, Class of 1937, The White Caps, Great Falls, Montana, p. 8 ^Edith Lamb, '20, (G.F.), Letter, April, 1969. -150- medicine were discontinued, and university medical schools were encouraged and strengthened. Before this happened, some nurses were better educated than some doctors. By 1914, when admission requirements for medical schools were being enforced, high school graduation was the minimum re¬ quirement for admission. In 1918, two years of college were required. As medical education improved, patient care improved and doctors needed more assistance from nurses. Procedures such as taking blood pressure and starting of intravenouses were turned over to the nurses by the doctors. In Montana hospitals, where there were no medical students or interns, the relationships between doctors and nurses were very close. Instead of controlling nurses’ training, they supported it by assisting with the teaching and by friendly acts such as entertaining student nurses at graduation time and transporting them in their cars on special occa¬ sions . The control of nurses' training in the Deaconess Hospitals by the Methodist Church was similar to the type of control practiced by the Flied- ners at Kaiserswerth and by Dr. Muhlenberg and Sister Ann at St. Luke's. The Rev. T. Fliedner and Dr. Muhlenberg were pastors both to the patients and the student nurses in their respective hospitals. In the Montana Deaconess Hospital, the students had great affection for the Rev. W. Van Orsdel, whom Miss Ariss considered the founder of that hospital. The early alumnae have pleasant memories of his visits to the hospital, his singing of hymns for the patients and with the nurses. In the other three deaconess hospitals and in Montana Deaconess, after Dr. Van Orsdel's death (1919), the students did not have a hospital pastor but -151- ins tead the pastor of the local church of their choice. Their fond memo¬ ries seem to be related to a deaconess rather than to a pastor. The rules regulating the personal lives of the students in the nurses' homes were comparable to those enforced by many strict Methodist parents in their homes. Parents desired that their daughters have that type of supervision away from home as well. A military type of discipline was com¬ mon to all nurses' training schools in the first decades of the century. Just as most young people have always rebelled against the limitations set by their parents, these students, rebelled and often actually had fun breaking the rules of the nurses' homes. The regulation which alumnae complained about consistently was the keeping of a book in each nurses' home, for signing each Sunday, to indicate that they had attended a ser¬ vice of worship. It did not serve as an incentive to worship but a temp¬ tation to sign and not attend worship. The requirement to attend weekly prayer meeting at the local Methodist Church in Bozeman was resented be¬ cause it was not attended by other young people of the church. However, weekly prayer meeting in the nurses' home was not generally resented. Some students found it difficult to lead the prayer meeting when it was their turn. What often happened on the evenings of church prayer meeting was that students used the hours going out for dates instead. Some of the annoying practices of the deaconess training schools were common also to secular training schools of the time. For example, the wearing of the black shoes and stockings and hair nets was still required of probationers at the University of Minnesota when the writer was a stu¬ dent, (1930-34). The practice of morning worship after breakfast each -152- day was a part of the routine of the Johns Hopkins Training School and the 1 l University of Minnesota School of Nursing, both secular schools. The prac¬ tice of singing hymns in the downstairs halls or hospital parlor at 7 P.M. for the enjoyment of the patients, and the requirement of attendance at a nurses' prayer meeting, one evening a week, were peculiar to the deacon¬ ess hospitals. Whether these were practices of Kaiserswerth Deaconesses or the Sisters at St. Luke's Hospital has not been found. At the Nightin¬ gale School, both morning and evening prayers were a part of the daily routine. As times changed, the deaconesses changed and rules were relaxed. Josephine Stout said, "The last two deaconesses in Bozeman even wore for- mals at Eastern Star meetings and played cards."71 In the study of the curricula of the Deaconess Training Schools and of her work as matron, the fact that Miss Ariss was a strong reli¬ gious leader did not, in anyway, hinder the progress of nursing education but contributed greatly to it. Her contributions were not only to the Deaconess Hospitals but to nursing education throughout Montana. She and Miss Ackerman of Bozeman, in 1917, made the first steps which eventually led to a university school of nursing. Finances* - The training school shall be financially independent of the hospital in which the students are trained. The Deaconess Hospital Training Schools were not financially inde¬ pendent of the hospitals in any way. The advantage that these training 7*-Josephine Stout, '20, (B) Personal Interview, Feb. 1968. -153- schools had was that the deaconess superintendents of the hospitals were nurses who had concern for the students: and the training school as well as for the patients and the hospitals. The hospitals were financed, in general, by two sources of income; payments for services made by patients and gifts or donations. How ex¬ tremely limited funds could best be allocated must have been an ever- pre¬ sent problem of the superintendents. The hospitals were financed, in general, by two sources of income; payments for services made by patients and gifts or donations. It appears that one reason for the first hospitals in Montana being church-related hospitals is that Christian people dared to start these ex¬ pensive ventures because they had sisters or deaconesses who did not re¬ quire salaries and who willingly gave of themselves beyond the call of duty. They were spurred on by their Christian faith and zeal. An example of this spirit was expressed by Miss Ariss when she told about the first year in Great Falls: The first year a Board of Directors was appointed and a school of nursing was organized. The year bristled with problems. We had no money, debts and difficulties stood out like huge spec¬ tres, on every side, but we worked and prayed, and stood amazed at the power of the Almighty, exerted in our behalf. We knew not by what methods rare, but, this we knew God answered prayer. The menial duties of scrubbing floors, firing the furnace, wash¬ ing the Hospital linen and relieving the cook and janitor brought rare joy to our hearts. Forgoing these tasks we heard the commendation of the Highest. The monthly allowance given to the deaconesses during the early years 7 ? Montana Deaconess Hospital School of Nursing, Class of 1937, The White Caps, Great Falls, Montana. -154- was eight dollars a month plus maintenance. This was gradually increased to thirty dollars a month by 1920 and to fifty dollars a month by 1930. The deaconesses did have a few privileges such as riding the street cars without paying. One reason for their wearing the deaconess habit when they went out was that this identified them for the street car conductors. Miss Watts (H) said, in response to a question about how their trips to state deaconess meetings were financed, that they were given passes to ride on the trains at first. Later, it was changed to half-fare passes. 7 3 Finally, they had to pay full fares. Madge Webster Rubens, '20, said of the deaconesses, "I never heard them complain although I roomed with one for a while. She did say once that when their allowance was fifteen dollars a month it would scarcely buy a pair of shoes." When Mrs. Rubens commented on how Miss Ariss stress ed economy she said, "Because the stores in town were extending credit to the hospital, when it was waiting for people to pay their bills, it help¬ ed the storekeepers to know that the hospital personnel were not being ex¬ travagant."^ The earnings of deaconess student nurses who were sent to homes to do private duty nursing were an additional source of income for the hospitals The patients sometimes expressed their gratitude for this service in their wills. These were the pioneer days of nursing in Montana and, as nurses ^Donna Watts, '16, (G.F.), Letter, 1968. 74 Madge Webster Rubens, '20, (G.F.), Personal Interview, 1968. -155- were scarce, our students were sent on many country cases to re¬ lieve distress among the sick. Through the pleading of our good friend, Dr. Ferguson, a nurse was sent to Helena to care for Pe¬ ter Larson, the lumber king- of the state. When his will was read a few months later he had bequeathed the hospital the sum of five thousand dollars, which was promptly applied on the new Hospital which was in the course of erection. We had now come to a Crisis in our building plan, the walls were up but there was no money for the roof. "Our Father is rich," oft repeated itself in our thinking, and, in direct answer to our prayers, came the prince¬ ly gift of ten thousand dollars from his Servants, the Reverend Jacob and Mrs. Mills of Helena. During Edith Lamb's student days she earned the money which paid for the lots on which the new hospital now stands, by service in homes of the sick and needy. During an epidemic of typhoid fever in Sand Coulee she nursed nine cases doing the housework, and preparing all the food for the sick. She brought every patient through to a perfect convalescence. Through her service in the home of Samuel Spencer the seed was sown which resulted, in his magnificent bequest of several thousand dollars to our hospital, which erected to his memory the splendid modern insti¬ tution we now have.75 The scrapbook of the Montana Deaconess Hospital Guild indicates that the guild was organized in 1904, jMiss Margaret Allen was its first presi¬ dent, and the membership was fifty-seven women. It "converted hundreds of bolts of materials into supplies." The guild members helped with mending the hospital linen and with providing some of the specific material needs. In 1908, the guild selected one room in the new hospital to furnish. In 1930, they "began to purchase more equipment and furnishings of a more lasting type." In 1931, draperies, curtains and carpets were bought for the nurses' home. In 1937, a portable x-ray maching was purchased by the guild. Each*of the other deaconess hospitals had similar guilds. The Nurses' Alumnae Association of the Montana Deaconess Hospital, 75 Class of 1937, o£. cit., p. 6 -156- organized in 1914, made gifts to the school. As all of the alumnae, until 1917, were deaconesses, it is obvious that their contributions were in ser¬ vice rather than in material gifts. However, they no doubt contributed their share of the first alumnae gift to the training school in 1918, a skeleton costing $100.00. In 1922, a tennis court was outfitted for the students at a cost of $200.00. In 1923, a loan fund was started for the use of the students. In 1936, a pledge of $1000.00 was made by the Nurses' Alumnae Association to help finance the beginning of the Consoli¬ dated Deaconess School of Nursing. Many gifts were also made to the hos¬ pital by the alumnae. The alumnae associations of the other deaconess hospitals made similar gifts to their alma maters except for Kennedy Deaconess alumnae. They did not have money-raising projects as did the other associations, to raise money to finance their gifts. Each>of the alumnae associations provided a special way of entertaining the graduating class each spring. The annual reports of the hospitals were circulated quite widely. The information in these reports were used to interest young women in entering the Deaconess Training Schools and to interest Protestant Christians in making donations to the hospitals. People and organizations which had made contributions to the hospitals were named in these reports. Sometimes there was a form included in the report for people to use to will money to the hospitals. The following is a sampling of the donations made to the Bozeman 76Hamm, o£. cit., p. 5 -157- Deaconess Hospital as reported in the 1914-15 Annual Report: LIST OF DONATIONS Ladies Aid M.E. Church, Bozeman, forty-eight quarts fruit, twelve glasses of jelly. Epworth League of M.E. Church, Flowers, hundred and fifty books for library, ten bars of soap, four tray cloths, two towels, one creamer, one sugar bowl, four quarts of jelly. Ladies Guild of Episcopal Church, Bozeman, thirteen sheets, twelve pair pillow cases, thirteen bath towels, four hand towels, six wash cloths, soap, cotton, one lap*sheet, two binders, twenty glasses of jelly, two pints fruit, four pints pickles, cash $3.45. Baptist Church, Bozeman, one sack potatoes, one box apples, vegetables, nuts, two pounds honey, seventeen glasses jelly, twenty-six quarts fruit, fifteen quarts pickles, rolled oats. Sisterhood Christian Church, Bozeman, three dozen towels, one pair pillow cases. W.C.T.U. Bozeman, flowers. Hospital Section Woman's Club, Bozeman, potted plants. Jewel Circle, 131 Women of Woodcraft, Bozeman, Twenty-five cakes toilet soap. Gallatin Lumber Company, coal. Mr. R.G. Gallop, two geese. Mrs. E.L. Houston, office desk. Mr. William Davis, parlor rug. Mr. and Mrs. F. Benepe, four sacks flour, two sacks potatoes, lard and meat. Dr. J.F. Blair, aseptic dressing cabinet, instrument case, shower bath, porch improvements. Ladies Aid, Clyde Park,M.E.„ Church, two sheets, two wash cloths, one dresser scarf, six bath towels, four linen towels, twelve pillow cases, sixty-six bars of soap. Ladies Aid, Wilsall, eighteen quarts of fruit. -158- Epworth League, Bridger, fourteen quarts of fruit. S.S. of M.E. Church, Missoula, three dozen bars soap, eight sheets, thirteen pillow cases, eleven bath towels, three hand towels, fourteen wash clothes, five papers of pins, eighteen cards safety pins, seventeen tray cloths, sixteen napkins, two doilies and six nursery cribs. M.E. Church, Stevensville, four sacks potatoes. Epworth League M.E. Church, Dillon, nine bath towels, two cloths, six bars soap, sixteen quarts fruit, two glasses jelly. Senior and Junior Epworth League, M.E. Church, Red Lodge, seven towels, three pillow cases, five wash clothes, five cards safety pins, twenty-seven bars soap, eleven packages breakfast food. In this same report Miss Ackerman said: "The nursery is a particu¬ larly interesting department of our work. It has been entirely refurnished during the year. The cribs were a donation from the Missoula Sunday School. We have, on several occasions, had to improvise a seventh crib to accomodate the number." A picture of a corner of the nursery showing the rack of six cribs was included in the report. The Methodist churches of each district were encouraged to have Har- v vest Home Festivals each fall at Thanksgiving time for the benefit of the ( hospitals. This was later referred to as White Cross Day. In Havre, the women of the protestant churches put on an annual silver tea and shower for Kennedy Deaconess Hospital. Prior to the tea, needs of the hospital were listed in the Havre Daily News. Minister's wives were asked to pour. Women's circles were asked to contribute fancy cookies and sandwiches. Other women were asked to take one-hour shifts of working in the kitchen. On the day of the tea, there were conducted tours of the hospital and gifts were displayed as they were brought in. The Roman Catholic women of Havre gave a similar tea each year for Sacred Heart -159- Hospital. There was always a little feeling about the devious means that were used for setting the dates of these teas. Apparently, the tea which came first received the most gifts. The finances of the hospitals were directly related to the economic problems of the times. In the Montana Methodist Conference Report of 1927, the Rev. A. Muirden, Manager of Kennedy Deaconess Hospital reported that "we had hoped to liquidate our indebtedness of equipment last fall, but unfortunately northern Montana had a crop failure, which was succeeded by one of the hardest winters in many years".'' Laura Anderson Beatty, '29, said, "As students we were much aware of the financial struggles of the hospital. After graduation, I worked at the hospital for one and one-half years. The hospital could not pay me in full. For quite a while after that Miss Watts sent me checks for small amounts until I was paid in full."^® In the period of 1902-1937, the nursing students of the Deaconess Hospitals paid no tuition. They paid for their uniforms and books. They also paid for thermometers and syringes which they broke and for rubber goods which they burned. These items were supposed to be paid for out of their allowances. Any nurse wishing to leave the hospital before the time of completing the course was required to pay the hospital the sum of ten dollars a month for the time she had been in training. (G.F.). For those students at Bozeman who took college work for credit, the ^The Montana Methodist Conference Report p. 372. 70 Laura Anderson Beatty, '29, (H) Personal Interview, 1968. -160- hospital paid the tuition ( $20.00 ) and the laboratory fees. The under¬ standing was that a student who left the hospital within any one year would refund to the hospital the tuition and lab.fees. The four hospitals did not give identical allowances. Each hospital maintained its own allowance schedule from the opening of their schools to about 1930. Why different allowances were paid by the different hospitals was not found. No allowances were paid during the probationary period. The monthly allowances paid in 1928, were as follows: Great Falls Bozeman Havre Billings First year $6.00 $8.00 $8.00 $5.00 Second year 7.00 8.00 10.00 8.00 Third year 8.00 8.00 12.00 10.00 Even though the N.L.N.E. and the Montana State Board of Examiners had been recommending that allowances not be paid to students and that the money be used for improving the education offered, the practice continued in the smaller hospitals through the depression years. In January, 1932, an applicant to the Bozeman Deaconess Hospital School of Nursing wrote to inquire about allowances: I have been informed that the State Board of Examiners decided that the training schools of Montana should discontinue the monthly allowances for incidental expenses. Is this correct? If the monthly allowances have not been discontinued I shall be able to commence training this month. However, if there is no allowance, I am afraid I shall have to enter the September class. The answer she received was: The State Board of Examiners has recommended a redistribution of the funds used in the training schools in the state ... we are, this year, giving an allowance of three dollars per month after the preliminary period of four months and then the allowance is increased each year. Board, room and laundry are all furnished free and we do not require an entrance fee or tuition. Every -161- nurse must pay for the thermomenters and special dishes she breaks, also for all rubber goods she burns. She entered January 29, 1932.^ Student nurses' allowances were discontinued at Johns Hopkins in 1896 and at St. Luke's in 1918. The discrepancy in timing of discontinuing al¬ lowances and charging tuition between the east and the west was due to the fact that those were still frontier days in Montana when most families were struggling to exist. The eastern training schools and the families, from which students were drawn, had been established there for many years. The Influence of the Nightingale Principles on the Curriculum Guides Used by the Four Montana Deaconess Hospital Training.Schools The curriculum guides used by the Deaconess Hospitals in Montana from 1915 to 1937, were: 1. First Rules for Montana Schools of Nursing (1915)80 These rules were adopted May 18, 1913. They became effec¬ tive June 1, 1915. The requirements set by the state are minimum requirements intended to protect both the patient and the student nurse. 2. Standard Curriculum for Schools of Nursing (1917) This curriculum was intended to raise standards of teaching and to bring about more uniformity in curricula of the nursing 79 Lucille Vaughn, '35, (B), Student Record. on These rules were one and a quarter typewritten pages of 12 rules. Q 1 The Committee on Education of the National League of Nursing Educa¬ tion, Standard Curriculum for Schools of Nursing, Third Edition, 1920. -162- schools in this country. 3. A Curriculum for Schools of Nursing (1927)^ This is a revision of the 1917 Standard Curriculum which endeavored to bring it in line with the new developments and ideas in nursing and nursing education. 4. Requirements and Curriculum for Schools of Nursing in Montana (1934).83 The four curriculum guides above were studied to discover influences of the Nightingale principles on them. To do this, the basic content of each guide was organized according to the subject matter of the Nightingale principles. This has been followed by two comparison tables which show to what degree the Deaconess Training Schools were adhering to these guides. These four guides were referred to as: 1. 1915 State Rules or 1915 S.R. 2. 1917 Curriculum Guide or 1917 C.G. 3. 1927 Curriculum Guide or 1927 C.G. 4. 1934 State Curriculum or 1934 S.C. Analysis of the guides: 1. Matron - nurses are to be trained under the direction of a matron, educated in nursing and leadership. 8 ^The Committee on Education of the National League of Nursing Edu¬ cation, A Curriculum for Schools of Nursing, Seventh Edition (New York: National League of Nursing Education, 1929). ^^ontana State Board of Examiners of Nurses, Requirements and Cur¬ riculum for SchooIs ,of Nursing of Montana and Nurse Practice Law, 1934, (Helena: Capitol Building) a pamphlet. -163- 1915 S.R.- The superintendent of nurses must be a registered nurse. She must make an annual report to the State Board of Examiners. 1917 C.G. - The superintendent of nurses must be an educated woman who as a broad point of view, is reliable, and trustworthy. She should have the ability to establish and maintain high standards and to develop new methods and educational policies as needs change. 1927 C.G. - Same as 1917 C.G. 122k ±L_c_. - The superintendent of nurses, employed after January 1, 1934, was required to be at least a high school graduate. She must have had experience as an assistant superintendent and be qualified to maintain high standards of nursing service and nursing education. She was required to make monthly as well as annual reports to the State Board. 2. Students - The students selected are to be refined young women of good character who possess aptitude for nursing. 1915 S.R.-The students were to have had at least one year’s work in high school. If not, the superintendent of nurses was expected to admin¬ ister a test in elementary studies to the applicant before admission. 1917 C.G. - The students should be graduates of an accredited high school or its equivalent. High school subjects which the applicants should have had were English, history,.mathematics, and science. Applic- cants who were college graduates could be allowed one year of credit to¬ wards the three-year course, providing their college work included a year of each of four subjects: chemistry, biology, sociology, and psychology. The age limit recommended was 20-35 years, with some exceptions for unusual maturity or ability in women younger than 20. -164- A character reference and, when possible, a personal interview should be required. The health requirements should include a recent certificate of health from a physician, a certificate from a dentist and, before acceptance, a thorough physical examination by the training school physician. 1927 C.G. - Same as 1917 C.G., except for more emphasis on the impor¬ tance of careful selection of students. 1934 S.C. - Applicants were to be high-school graduates from an ac¬ credited high school with three units of credit in English and two units of credit in each of three specified groups of subjects. Students were not to be admitted until their credentials had been checked by the State Board. 3. Curriculum - The students are to be taught a thorough course in nursing by well-prepared teachers who are nurses. The program of study shall include personality development supervised care of the sick (free from non-nursing tasks) and preparation to develop schools of nursing wher¬ ever they are needed. The course of study outlined by each of these guides will be given in Tables I and II in the next part of this section. The other requirements and recommendations were: 1915 S.R.- The hospital, in which the training school was a part, must be a general hospital having not less than twenty-beds and a daily * average of twelve patients. The course should be at least a two-year course. There should be no private duty experience away from the hospital during this course. Three months of private duty was permitted during the third year of a three-year -165- course, provided that neither the student nor the hospital were paid for the student's services. Accurate records of each student's experience and class work must be kept. The superintendent of nurses and all head nurses must be graduate, registered nurses. 1917 C.G. - A three-year course with a four-month preliminary period and a month of vacation each year were recommended. The hospital should have a daily average of at least 50 patients. A large, general hospital with a good variety of patients was preferred. A 52-hour week of practical work was recommended. This was broken down into an eight-hour day with a half day off on Sunday and one other half day off each week. For night duty, 8 hours a night was preferred. More than 10 hours a night should not be permitted. No more than four months of night duty in all nor more than two months at a time should be required of students. (The amount of time recommended for each clinical service is not included here because no records of length of service as¬ signed to students in the hospitals being studied, were found for this period) . University affiliations were recommended. A variety of teaching « methods were suggested, including ward teaching and case studies. A well-equipped demonstration room, laboratory, lecture room, and diet kitchen were suggested as necessary for good teaching. The recommended staff included a superintendent of nurses, day and night assistant superintendents, instructors, graduate nurses as heads of all departments, a dietitian, a librarian and a social director. -166- 1927 C.G. - The same things were being stressed and recommended ten years later. The marked changes were in the increased numbers of hours of classes recommended in each subject. (See Table III) There was also an increased emphasis on prevention of disease or health teaching. Two sub¬ jects, publich-health and social conditions, were combined in one course, Modern and Social Health Movements. The case method of assigning pa¬ tients was recommended. The recommended size of hospital was one with a daily average of at least 100 patients. Small hospitals were beginning to experiment with a plan of consolidating the teaching of theory for sev¬ eral small hospitals in a given area. Many schools were making progress in providing affiliations for student experience in care of patients with com¬ municable diseases, nervous, and mental diseases. 1934 S.C. - The minimum requirements for licensing a school included the following: The hospital must be a general hospital with high ethical and scientific standards. It must have a daily average of 25 patients. After the fall of 1935, if the daily patient average should fall below 30, the school must provide six months of affiliation in a larger school. There must be a minimum of 15 students in a school. The minimum faculty should consist of a superintendent of nurses, an assistant superintendent of nurses, an operating room supervisor, and a night supervisor. All faculty members were to be licensed and registered in Montana. The instructor must be a high school graduate who has had one year of preparation to teach or a record of several years of successful teaching experience. All heads of departments should have had special preparation or post-graduate work. There should be at least one graduate -167- nurse to each ten students. The hours of duty should be no more than two hours a day the first two months, four hours a day the next two months, and eight hours a day thereafter. The student clinical experience should be no more than 48 hours a week. If night duty is ten hours a night, two full days off should be given to the student after the night duty assignment. Four weeks of va¬ cation a year were recommended, with 3 weeks a year minimum. At least one well-equipped, well-lighted class-demonstration room and library were required. Each student should own the latest edition of the textbook used in each basic course taught. 4. The Home - The hospital shall provide a comfortable, attractive student residence with supervision of the students' intellectual, moral, and physical well-being. 1915 S.R. - A residence for students was not mentioned. 1917 C.G. - The home should be quiet, comfortable, orderly, and super¬ vised by a house mother or social director. Single rooms were recommended for all students. Student rooms should have good beds, writing tables, bookshelves, dressers, closets, good lighting. Double rooms were consid¬ ered a temporary arrangement only. Special arrangements should be made for students on night duty, if students do not have single rooms. Students whose homes are in the community might live at home to avoid crowding. 1927 C.G. - Same as 1917 C.G. 1934 S.C. - Students must be provided with suitable housing. Each student must have a single bed. Two students were permitted to a room if -168- the rooms were large. If dormitory sleeping were used, each bed should have curtains around it to allow for privacy. A quiet place should be pro¬ vided for night nurses to sleep. 5. Control - The training of student nurses shall be free from con¬ trol by medical doctors or churches. 1915 S.R. - This was not mentioned. 1917 C.G. - A training-school committee was recommended. This com¬ mittee should study the needs of the school as an educational institution and see that sound educational policies are established and maintained. It should help to prepare the budget and help to secure the finances need¬ ed by the school. 1927 C.G. - The same as 1917 C.G. 1934 S.C. - This was not mentioned. 6. Finances - The training school shall be financially independent of the hospital in which the students are trained. 1915 S.R. - Finances were not mentioned. 1917 C.G. - It was recommended that the head of the training school make out a budget for each year. The training-school committee should try to get the hospital to accept the proposed budgets. If the hospital can¬ not provide for the needs of the school, outside sources of funds should be sought. It was recommended that allowances be discontinued and the money di¬ verted to improving the quality of nursing education offered. Tuition fees were recommended in schools where hours of work were reduced and in¬ struction improved. -169- 1917 C.G. - Same as 1917 C.G. except for the added information that there were at that time four endowed schools in the 1,800 or more training schools in the United States. 1934 S,G. - Finances were not mentioned. In Table I which follows, the curricula of the two early Montana Dea¬ coness Training Schools were compared with the two curriculum guides they were using. The curriculum used for Montana Deaconess was found in Miss Ariss's 1922 annual report. No records for students of 1902-1937 classes were kept in Great Falls. The student records were kept in Bozeman but were stored in a basement where water from a leaky pipe caused them to be soaked. They were dried out but are crisp and blurred. The record of Esther Elene Johnson, '21, was chosen because it was least damaged. In her record, hours of class taught and hours of class attended were recorded. The year in which each course was taught was not recorded. (There was little concern about teach¬ ing a course prior to or during a clinical experience. Classes were often combined so that certain courses were taught only once in 2 or 3 years). It appears that the Montana Deaconess course of study was influenced by the high standards of the 1917 N.L.N.E. curriculum and that Bozeman Deaconess complied quite well with the Montana State Board minimum requirements. -170- TABLE I THE CURRICULA OF THE SCHOOLS COMPARED WITH TWO EARLY MONTANA DEACONESS THE TWO CURRICULUM GUIDES ! TRAINING THEY USED N.L.N.E. State Mont. Bozeman Board Deac. Deac. Curr. Curr. Curr. Curr. 1917 1915-16 1922 1918-21 Courses Hrs. Hrs. Hrs. Hrs. Anatomy and Physiology 60 34 60 40 Bacteriology 20 15 20 27 Personal Hygiene 10 10 20 16 Applied Chemistry 20 0 15 0 Nutrition and Cookery 40 24 (Biology 30) 3 Hospital Housekeeping 10 0 0 0 Drugs and Solutions 20 0 20 0 Elementary Nsg. & Bandaging 70 73 61 64 History of Nsg. & Ethics 15 15 25 27 Elementary Pathology 10 0 0 20 Nsg. in Medical Diseases 20 28 35 *27 Nsg. in Surgical Diseases 20 8 35 15 Mat. Medica & Therapeutics 20 24 20 32 Diet in Disease 10 12 20 32 Elements of Psychology 10 0 10 8 Nsg. in Communicable Diseases 20 8 * 0 0 Nsg. of Infants & Children 20 20 50 *18 Massage 10 0 12 *15 Principles of Ethics 10 14 25 0 Gynecological Nursing 10 0 0 0 Orthopedic Nursing 10 0 10 0 Operating Room Technique 10 0 0 *12 Obstetrical Nursing 20 18 35 *24 Nsg. in E.E.N.T. Diseases 10 6 17 10 Mental & Nervous Diseases 20 6 18 2 Occup., Venereal & Skin Diseases 10 2 10 0 Special Therapeutics 10 15 0 0 Public Sanitation 10 0 0 Survey of Nursing Field 10 0 7 Modern Social Conditions 10 15 0 * 8 Professional Problems 10 0 2 Emergency Nursing & First Aid 10 6 0 0 Electives Rel. to Specialty 30 0 0 0 585-595 329 548 409 Total Hours *Indicates number of hours student attended. -171- TABLE II - COMPARISON OF CURRICULA THE CURRICULA OF THE FOUR MONTANA DEACONESS TRAINING SCHOOLS COMPARED WITH THE TWO CURRICULUM GUIDES USED N .L.N. E. St, Bd. Deaconess Hosp itals Curriculum 1927 1934 G.F. B.z H. Bigs Anatomy & Physiology 90 75 90 61 60 80 Bacteriology 45 40 45 16 30 17 Gen. & Applied Chemistry 45 40 30 22 60 20 Personal Hygiene 15 15 15 5 12 15 Physical Training 15 0 0 0 0 0 Elem. Materia Medica 15 15 15 9 20 15 Nsg. Principles & Practice 90 75 90 16 30 30 Nsg. History & Ethics 30 45 30 43 60 20 Elements of Pathology 15 15 15 20 0 0 Dietetics 60 60 60 55 90 40 Advanced Materia Medica 30 30 27 9 60 38 Nsg..Ptinciples & Practice 30 30 30 0 0 0 Psychology 30 20 15 25 30 0 Case Study Methods 15 0 0 0 0 0 Gen. Med. Dis. Nsg. 30 30 30 20 60 40 Nsg. in Med. Specialities 30 30 15 0 0 0 Nsg. in Gen. Surg. Diseases 30 30 30 20 20 30 Nsg. in Surg. Specialities 30 30 15 15 20 10 Pediatric Nsg. & Feedings 30 30 30 20 60 40 Modern Soc. & Health 30 40 0 20 0 0 Obstetrical Nursing 30 30 30 20 60 30 Psychiatric Nursing 30 30 15 18 12 10 Nsg.. in Dis. of E.E.N.T. 15 15 15 15 12 9 Emergency Nursing 15 15 0 15 0 0 Survey of Nursing 30 30 15 24 15 30 Supplementary Courses 60 10 0 5 0 4 Total Hours 825 780 630 *496 736 508 This table indicates that the Montana State Board of Nurses had revised its requirements to comply with the recommendations of the N. L.N.E :.'s 1927 Curriculum. The Deaconess Training Schools were succeeding in complying with these guides, with varying degrees of success. Case Studies were not included as a part of their curriculum before 1932. A 1939 graduate from Havre said that she had to write case studies when she was in Great Falls for her affiliation. (Ellen Hagstrom Henry, '39) 1. Great Falls-- Montana Deaconess Hospital School for Nurses, Information for Applicants, date is apparently 1931. 2. Bozeman - St. Bd. of Nurses' Transcript, "Mary French Otto, '32* (The transcript for Myrtle Freburg Ferharty, '33, showed an increase, of 70 hrs. 3. Havre - St. Bd. of Nurses' Transcript, Gertrude Marie Finn, '31. 4. Billings - St. Bd. of Nurses' Transcript, Eugenia Hilderman, '32. TA BL E II I - FI N D IN G S O F TH E ST A TE BO AR D O F N U R SE S A T TH E FO U R D EA CO N ES S T R A IN IN G SC H O O LS W HE N TH EY W ER E IN SP EC TE D IN 19 28 AN D 19 30 CO M PA RE D W IT H TH E RE CO M M EN D A TI O N S O F TH E 19 27 N .L .N .E . 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CO CT1 pa 4-1 d > CU •H cu o 4-1 4-1 da CO da d •V •H • 34 CO o d • P4 • o PC dd • CO d 03 CO d 03 C CO 00 1 oi 03 d o oi CO 03 i 03 o d o3 1—1 d CO d cu •r-1 cu d CU •H CO £ •H cr1 d i-4 4J 03 M-l --4 O CU CO >-i P> O o cu 6 cu •H 00 O O da o CO 4-1 CU H Cl) CJ r—I d £ o H 4-1 O CU 4-1 O B y 1 93 4 b o t h B o z e m a n a n d H a v r e s t u d e n t s w e r e g o in g t o M o n t a n a D e a c o n e s s t h r e e m o n t h s (B ) a n d s ix m o n t h s (H ) fo r a f f il ia ti on s. -177- The Montana State Board of Nursing was very much aware of the inadequacies of the training schools in Montana in the 1920's. Montana State Board of Nursing, Part I., General Statement is a mimeographed report of licensure of nurses in Montana from 1913 to 1953. Comments made in this report regarding these years are: Following the publication of the report of the study of nursing by Josephine Goldmark in 1923, Nursing and Nursing Education in the United States, the minutes of the board reflect the efforts to initiate improvement in Montana schools of nursing. . . * In 1926 the National Committee on the Grading of Nursing Schools was formed. During the next eight years this committee made a comprehensive study of nursing schools throughout the United . States. Fourteen of Montana's schools participated in supplying information about themselves. These records show that in 1932 some student nurses in Montana were assigned to night duty for a total of 70 hours per week and only 5 of the fourteen schools reported a 48 hour week for "day duty". There were only 8 full time instructors in the 14 schools. Three schools reported that the superintendent of nurses alone taught from six to ten sub¬ jects! Only one school reported as many as 500 reference books in the library and only six schools had more than 100. Montana schools of nursing had a long way to go. Additional information that relates to the curriculum of the four Deaconess Training Schools (1915-1937). College affiliation efforts, according to the catalogs of Montana State College, began in the school year of 1917-18, to offer a Graduate Course for nurses; in 1918-1919 to offer a War Emergency Course; and from 1923-30 to offer a course for nurses worked out in response to a request from the Bozeman Deaconess Hospital. The registrar has no record of any one enrolling in these courses until 1923. In an effort to discover who made the first step relative to college courses for nurses at Montana State College, Vern Shockley Keyes, '27, (B) , -178- telephoned her aunt, Miss Ackerman, to ask her about this.®^ Miss Acker¬ man*, said that Miss Ariss made the first suggestion to M.S.C. President, Atkinson. She added that when Miss Grace Linfield was principal of the Bozeman Deaconess Training School she took some work at the college. She also made the arrangements necessary for the courses which began in 1923 for the student nurses. (Miss Ackerman was known to give others credit for what she did). As early as 1915-16 in her annual report Miss Ackerman said, "We are interested to note the conferring of degrees to nurses where affiliation of college and hospital exist." She was most likely referring to the Uni¬ versity of Minnesota where in 1909, the first college-based three-year nurs¬ ing program began and a baccalaureate degree course was offered there ten years later. The college program offered for the nurses in Bozeman in 1923 was: COURSE FOR NURSES A W S English Composition (Eng. 101, 102, 103)....: .3 3 3 General Chemistry (Chem. 101, 102, 103) 444 General Zoology (Zoo. 1 ) 4 Human Physiology (Zoo. 202) v 5 Elementary Bacteriology (Bact. 104) 4 Sanitary Bacteriology (Bact. 206) 3 Food (H.E. 112. 113) 3 3 Dietetics for Nurses (H.E. 114).... 4 Psychology (Ed. 30 ) 3 Sociology (Econ. 10 3 Housewifery (H.E. Ill) 2 The number of nursing students enrolled from Bozeman Deaconess Hospital each year varied from five to seventeen. ^Telephone call, August 24, 1969. -179- One student, Lee Bartholf Lange, '21, (B), enrolled in a War Emergency Course at Billings in 1918. She described it in a letter,this way: The year I graduated from High School at Park City they had this War Emergency special course which they were trying to get us all to take, because of World War I. They came there recruiting nurses. I was the only one from my class who attended the course at Billings. We were told by them that if we had certain credits in the subjects and had a passing grade in them from our high' school that we would not have to repeat those subjects. ...We were sent to Billings and paid our own board and room. There was no tuition charged for the school. They set-up a room for our classes in one of the buildings close to St. Vincent's Hospital and that is where we received our training and took our lessons. After we took this course it gave us thi advantage of one year's nurses training. According to Mrs. Lange's student record the subjects which she took. in two six week periods were: (1) Anatomy and physiology, nursing history, bacteriology, hygiene, chemistry, domestic science, and (2) ethics, hygiene, sociology, physiology, mathematics, and English. In 1930 college courses, for credit, were discontinued in Bozeman. However, students did take two courses on campus, foods and chemistry. An affiliation of three months with Great Falls was arranged for experience in pediatrics, pharmacy, and general ward practice. The faculty after 1915. In the 1920's, Miss Ariss and Miss Ackerman began to arrange for post-graduate training or experience for members of their faculties. Examples of this from the Great Falls faculty were: Edith Lamb, '20 (G.F.) had additional experience in obstetrics at the Dea¬ coness Hospital, Wenatchee, Washington, right after graduation and then was made head nurse in obstetrics. In 1928, she was sent to Columbia University, 85 'Lee Bartholf Lange, '21, (B), letter, 1968. -180- New York, for a summer session, to take courses in educational psychology, hospital economics, and supervision in schools of nursing. Anna Mecum, '15, (G.F.) had been head nurse in obstetrics for several years and was then sent to the University of Minnesota for a three-year course in x-ray and medical technology. She became a registered laboratory technician and was put in charge of the x-ray department. She was also an assistant in the laboratory. Opportunities were also provided for the Bozeman faculty, Miss Acker¬ man, and the other members of her faculty, attended evening courses taught by college professors at the hospital for the student nurses (1916-23) in chemistry, psychology, etc., whenever they could spare the time to do so. Josephine Stout, '20 (B) was on the staff as surgery supervisor from 1920-1926 and Grace Linfield, '18, (B) was principal from about 1922-1929. Both of these deaconesses took college courses for credit. The probationary period at Great Fanils was described in the 1920-21 annual report thus: During the Probationary period practical instruction will be given in general nursing and nursing topics. Duty is also assigned them in the hospital. This period gives the student the opportunity of deciding whether she wishes to pursue her course of training and also give the school the means of determining the capacity of the student for the profession of nursing. The student should always be provided with means for incidental expenses and to re¬ turn home in case of non-acceptance. A transcript of the personality or character record of a student at Great Falls (1918-1921)^ for two school years indicated an average of 977,. ^Transcript of record of Effie Ely. -181- The monthly grades in one year were: Efficiency VO „ o o S e p t 4J o o 98 > o 98 o