“A Marvel of Perfection”

Wednesday, June 9, 1909

They labored, as one scholar has deemed it, “on the edge of exploitation,” working 12 hours a day, five days a week – initially for no pay, and later on for little more than a pittance.



They put up with a lack of respect from male physicians, while residing in cramped quarters and enduring the strict limitations that early twentieth-century societal norms placed on the private lives of unmarried women.



On top of all this, they were expected to maintain a perpetually cheerful disposition and “give special attention to their personal appearance at all times.”



Beyond their primary care responsibilities – everything from giving baths to patients to administering medications – they were also required to cook and serve food, make beds, scrub floors, do laundry, prepare dressings and sterilize medical equipment.



And if all this wasn’t enough for these young women enrolled in what was then called the Training School for Nurses at the University of Kansas School of Medicine, there were six weekly hours of classroom instruction in such subjects as anatomy, chemistry, pathology, hydrotherapy and dietetics.



But at the end of this grueling three-year regimen was an achievement that presumably made the entire experience worthwhile – a diploma that would qualify these women as “graduate nurses” and serve as their passport to a bona fide career.



Formally established on July 1, 1906, this earliest iteration of the present-day KU School of Nursing began offering classes in October of that year in the KU School of Medicine’s first Eleanor Taylor Bell Memorial Hospital atop “Goat Hill” in Rosedale (now part of Kansas City, Kansas). Some three years later, the first four women who had met the nascent nursing school’s manifold requirements received their diplomas at the University-wide Commencement ceremonies held on June 9, 1909, in Lawrence.



Their names were Myrtle Gragg, Nellie Taylor, Anna Hemphill, and Elizabeth Rogers, and their accomplishment propelled the editors of that year’s Jayhawker yearbook into rhetorical overdrive. “Arising from the depths of obscurity with no light to guide,” as the Jayhawker put it, “the first and most illustrious class ever to be graduated” from the Training School for Nurses “stands as a marvel of perfection.”



But perhaps the greatest marvel of all was that this class – as well as the ones that would follow over the next few decades – provided the unsung and lowly compensated essential services that helped keep the KU School of Medicine’s Bell Memorial teaching hospital in operating condition during its early years of meager funding and lukewarm legislative support.



The roots of nursing education at the University of Kansas trace back to Florence Nightingale, the British nurse who had gained fame during the Crimean War. In 1860, following the end of this conflict, she opened the Nightingale Training School at St. Thomas Hospital in London.



Based on the precepts of the Florence Nightingale Pledge – “With loyalty will I endeavor to aid the physician in his work and devote myself to the welfare of those committed to my care” – this school is considered the first systematized training program for nurses. It combined practical nursing instruction with a broad-based coursework curriculum. By the mid-1870s, this system had begun to migrate to the United States, albeit with one significant modification.



As Shirley Veith has observed in her 1988 KU doctoral dissertation, “The Development of the Nursing Profession at the University of Kansas: 1906-1941,” whereas the Nightingale School was an autonomous entity, associated with but not subordinate to St. Thomas Hospital, the vast majority of American nursing schools were “organized and controlled” by the hospitals themselves. Student nurses were taught under a straight apprenticeship program, usually three years in duration, with only a minimal emphasis on academic learning.



Nursing trainees were “inculcated with [the] qualities of helping, caring, and passivity,” wrote Veith, and “tasks were learned through constant repetition and adherence to the individual hospital’s standards for correct performance.” As many hospital administrators saw it, any efforts to alter this arrangement and move towards the greater professionalization of nursing would have deprived them of an important source of “non-wage labor” since the unpaid nursing students received little more than room and board in return for the education they gained and the services they performed.



This situation was largely unchanged as the twentieth century dawned, although the number of US hospitals, along with their affiliated training schools for nurses, had increased tremendously. In Kansas and elsewhere, nursing was most often regarded either as strictly humanitarian work or, in Veith’s words, as a “menial occupation whose members were submissive and dependent on the medical profession.”



Nonetheless, at this time, nursing represented one of the few viable vocational opportunities for women who desired careers of their own outside the home. Fortunately for those Kansas women so inclined, the early 1900s saw a plethora of new hospitals established statewide, no less than 24 from 1900-1910 alone.



Among these, perhaps the most prominent was the one affiliated with the University of Kansas School of Medicine. Erected during 1905-06, this 35-bed facility known as the Eleanor Taylor Bell Memorial Hospital was made possible by a $100,000 benefaction from Wyandotte County physician and real estate investor Dr. Simeon Bishop Bell. It was named in honor of Bell’s late wife and situated in his hometown of Rosedale. This new hospital had enabled the KU School of Medicine to grow from a two-year program into a full four-year MD-granting institution.



One thing the Eleanor Taylor Bell Hospital did not come with were nurses to staff it. Recognizing this need, yet knowing that funds simply did not exist to hire a full nursing complement outright, in 1905 the KU Board of Regents recommended that “a hospital school for training nurses be established under the newly-organized School of Medicine.” As the Med School’s Clinical Department Dean George H. Hoxie later put it, “We had to train our own nurses if we were to have our own hospital.”



This necessitated the creation of the Training School for Nurses. The product of negotiations between the Board of Regents, University Chancellor Frank Strong and Dean Hoxie – who also served as superintendent of Bell Memorial Hospital – it was organized in time for fall semester 1906 classes. (Although also referred to as the Department of Nursing, according to the KU course catalogue it was technically considered “a sub-department of the School of Medicine of the University of Kansas and as such subject to the general oversight of the Dean of the Clinical Department.” This was in keeping with the national trend, followed by most hospitals and universities alike, to maintain strict administrative control over their nurse training programs.)



To run KU’s Training School for Nurses on a day-to-day basis, the Regents selected Miss Pearl L. Laptad. She was a Lawrence resident who not only held a “graduate nurse” diploma from Christ’s Hospital in Topeka, but had also done postgraduate work at Chicago’s Presbyterian Hospital. At Rosedale, she was named lecturer on nursing and the School’s principal (or head nurse). This title was more than fitting. Laptad was the only trained nurse on staff and, in fact, was the Training School’s only female, only non-physician faculty member.



Nine MDs – out of the 100-plus men listed as full-time and part-time Medical School faculty members – had agreed to give classes for nursing students as well. The subjects ranged widely, from pathology, physiology and pediatrics to massage, hydrotherapy and dietetics. The bulk of the nursing education program, however, was conducted on an apprentice basis – a learning-by-doing approach under the direction of Principal Laptad.



Among Laptad’s primary responsibilities in preparation for the three-year Training School’s inaugural 1906-07 academic year was to choose those students she felt best met the Board of Regents’ admissions requirements. These prerequisites, it should be noted, were somewhat ambiguous and were only loosely connected with grades and prior academic performance.



Applicants had to be between 20 and 30 years of age. Each prospective nurse was asked to submit a letter describing the “educational advantages which she has enjoyed and the manner in which her life has been spent.”



Two additional letters, one a “testimonial as to her character from a clergyman” and another from a doctor declaring her to be in “good health,” were also required. In the selection process, preference was given to “women of superior education and refinement.” (The former criterion reflected a desire for applicants who had something resembling a high school education; the latter was most likely judgment call based on each woman’s overall background.)



In the end, six young women made the cut. They were welcomed as KU’s first nursing students when classes began on October 1, 1906. Their admission, however, was conditional. Continued enrollment was contingent upon surviving a three-month probationary period.



During this time, Laptad closely evaluated the women to see whether they could handle the workload. Just as important was their ability to conform to the Training School’s stringent rules and regulations. Doing all this was no mean feat, and two of the original six did not complete the program.



Indeed, as the members of this initial class discovered, their time at Bell Memorial Hospital involved far more than mastering the skills essential to the nursing profession. These included applying bandages and dressings, taking temperatures, administering medications, making careful observations of symptoms, and above all, helping ensure the physical and emotional comfort of their patients at all times.



Beyond this, noted Veith, KU’s nursing students, “as in other diploma schools,” were obliged to perform “many housekeeping tasks. Nurses were occupied with maintaining an appropriate sickroom environment and preparing, cooking and serving food to patients. Mending supplies, cleaning, scrubbing, making dressings, sterilizing equipment and other similar tasks,” she added, “were also in the nurses’ domain, and many hours were spent in these duties.”



In fact, when both their medical and “domestic” duties were combined, KU’s early nursing students worked approximately 60 hours a week. In keeping with the apprentice model, these services were unpaid at first.



This was changed in 1908-09 – the inaugural class’ final year – when each of the four women began receiving a monthly stipend of $15. (First-year KU nursing students began earning $8 a month at this point and second-years were paid $10. Adjusted for inflation, the $15 allowance would equate to just under $300 in early twenty-first century terms.)



In addition to their tuition-free education, these early nursing students also received room and board at no cost. The former was in exceedingly modest accommodations remembered by Dean Hoxie as “a house on College Avenue about two blocks from the hospital.”



There were, however, other expenses that students at the Training School for Nurses were expected to cover themselves. Each incoming trainee had to purchase a variety of medical implements, including a hypo syringe, a pair of bandage scissors, and a clinical thermometer. Furthermore, during the probationary period, the women had to furnish their own uniforms. These elaborate sartorial ensembles, which the University catalogue meticulously described, consisted of “brown gingham dresses,” “large bleached muslin aprons,” “bleached muslin sleeve protectors from wrist to elbow,” and linen “Bishop style” collars.



At least as far as the University was concerned, these were but “trifling expenses.” Once they became full-fledged “pupil nurses,” the catalogue hastened to remind them, their regular Training School uniforms would be supplied gratis, as would their textbooks. What’s more, “Since the demand for trained nurses is so great and the remuneration so generous, no young, ambitious woman, qualified for the profession, should feel herself barred by poverty.”



It was by no means a foregone conclusion, however, that the Training School’s pupil nurses would successfully complete the probationary period or remain in good standing throughout the entire three years. Those who failed to follow the “house rules” explicitly could be dismissed immediately by majority vote of the hospital administration. These dictums governed the permitted and prohibited activities of the nurses’ daily existence.



Day-shift students were instructed that “The hour for rising is 5:45 a.m.” Additionally, “Before going on duty, each nurse must leave her room in good order, ready for inspection at any time.” Lights-out was 10:30 p.m., no exceptions.



Pupil nurses were expected to arrive promptly for meal times and “not linger in the dining-room” afterwards. To further ensure adherence to these rules, nurses were reminded that “no food is provided out of the appointed times.” There was a provision for the occasional dinner guest, but this could hardly be a spur-of-the-moment thing, as “no visitors are to be invited to meals without permission of the principal.”



Still other regulations restricted the nurses’ freedom of movement and effectively crimped any social lives they may have hoped to enjoy. When on-duty, they could “not leave their wards without permission.” During off-duty periods, however, “nurses must not visit the wards of other departments” without the principal’s permission. There were also prohibitions against any unauthorized telephone use, and during the nighttime hours, day-shift nurses were confined to their quarters. Naturally, “No visitors may be entertained overnight.”



For those pupil nurses who pulled the 12-hour night shift (7:00 p.m. to 7:00 a.m.), they were required to be in their rooms from 9:00 a.m. to 4:00 p.m. and were not “permitted to go out between these hours without permission from the principal.”



Other serious infractions involved obtaining medication or seeking medical advice from physicians without the principal’s consent.



While some activities were proscribed, others were required. As the 1906-07 University catalogue noted, “Nurses will … be expected to show the greatest consideration for the comfort, welfare and happiness of patients.” Additionally, they were to be “quiet and gentle in attending to their duties” and “courteous in their manners to one another.”



According to Veith, strictures such as these were perfectly in keeping with the early twentieth-century social mindset that “conceptualized the nurse’s role as feminine, i.e., nurturant, obedient [and] altruistic. Diagnosis and treatment of disease,” she further noted, “was assumed to be a male function, while personal care and empathy seemed female.”



One man who doubtless felt this was the self-evident natural order of things was Dr. George Hoxie, the Clinical Department’s dean from 1905-11. Referring to the differing attributes of the (male) physician and the (female) nurse, he once observed that “His is more of the mental, and hers of the manual labor in the treatment of the sick.” Though inarguably a man of his times, Hoxie was hardly an irredeemable sexist, as Veith has testified to. “In the first years of the training school’s existence,” she observed, “Dr. Hoxie emerged as an advocate of nursing.”



Dean Hoxie repeatedly petitioned Chancellor Strong and the Board of Regents to, in his words, “make the training school an integral department of the University, with adequate courses of study, competent instructors, and a university atmosphere.” (Increasing faculty quality, it should be noted, was one of Hoxie’s hot buttons on the Med School side as well.) What’s more, he also edited and largely authored the Training School’s first nursing textbook, titled The Practice of Medicine for Nurses and Students of Domestic Science.



Its chapters covered such diverse topics as “Health and Disease,” “Emergencies,” “Intestinal Parasites,” “Surgical Nursing” and “Care of the Patient and Sick Room.” Pearl Laptad wrote the chapter on the “Technic of Nursing.” Hoxie even personally designed the Training School’s pin. Featuring the University seal with a Red Cross superimposed over it, the pin was awarded to graduate nurses when they completed the three-year program. It is still used by the KU School of Nursing to this day.



Yet despite Hoxie’s best and seemingly sincere efforts, he was unable ultimately to convince University administrators to grant the Training School for Nurses independent departmental status. In terms of at least arranging “adequate courses of study” for nursing students and providing them with “competent instructors,” Hoxie enjoyed greater success, but here, too, his effectiveness was limited.



“Teaching was often slipshod,” Veith noted, “because it was done at the physician’s convenience, so class times were changed or canceled frequently.” Moreover, considering the trainees were already putting in some 60 grueling hours of regular hospital work each week, the six additional classroom hours they were required to attend were, for many, of marginal value.



Finally, to his admitted chagrin, Hoxie failed to "work out any [baccalaureate] degree for the graduates." Indeed, before the 1913 passage of the Kansas Nurse Practice Act, which began licensing registered nurses (or RNs), students had to content themselves with diplomas signifying them as "graduate nurses."



This appears, however, not to have bothered the Training School’s first four nursing students when they became the University’s first four nursing graduates on June 9, 1909. Presented their diplomas at KU’s annual Commencement ceremonies on Mount Oread, they were recognized alongside 16 newly minted MDs from the School of Medicine’s Class of 1909.



Not on hand, unfortunately, to witness the festivities and share in her students’ achievements was Pearl Laptad. She had resigned her position as principal of the Training School for Nurses the year before, a decision attributed variously to health problems or, as Dean Hoxie recalled, to just plain “exhaustion.” Hoxie himself, though, was present and accounted for – although some may have wished he’d stayed in Rosedale.



As related by Hester I. Thurston, RN, in a 1982 article titled “The Kansas University School of Nursing: An Historical Perspective,” the Clinical Department faculty members were “very proud of these first four nurse graduates, but when they were presented at the Commencement exercises in Lawrence, Hoxie forgot to read their names and [Chancellor Strong] had to remind him to do so.” Hoxie’s unintended omission apparently did not go undetected, for the audience reportedly “tittered” when the dean attempted to redress his error.



Reminiscing years after the event, Hoxie himself retained fond and pleasant memories in spite of his faux pas. “It was a great day,” Hoxie recalled, “when the first class was graduated at the Commencement services in Lawrence. We were always so proud of [them]. They were imbued with the spirit of service.”



Little is known on an individual basis about the Training School’s pioneer nursing graduates, both during and after they completed their studies in Rosedale. Yet according to Veith, if their experiences were like those of other early twentieth-century nurses whom she had investigated – and in some cases personally interviewed – they had uncomplainingly done everything that was asked of them, to the best of their abilities, during their training. Having “endured its discipline,” perhaps they, like many, “went on to make their livings as private duty nurses,” thankful for the education they received, fulfilled by the independence it granted them and rewarded by the good work they were thus able to do.



As for KU’s Training School for Nurses itself, the years 1906-09 set it upon a long and circuitous, but ultimately successful road to recognized professional stature. Not surprisingly, the first couple of decades were the most difficult.



As nursing classes began to grow in size, the students quickly outgrew their original University-rented home. What followed were a succession of ad-hoc housing accommodations, including one stint in the original Bell Memorial Hospital building which, in 1911, was reorganized as the Training School’s headquarters after a second (and larger) Eleanor Taylor Bell Memorial Hospital was built, also on Goat Hill.



Then in 1928, by which time the third Bell Memorial Hospital and most of the KU School of Medicine had moved to the present-day location at 39th and Rainbow in Kansas City, Kansas, Hinch Hall was opened as a permanent nurses’ home. This structure acceptably addressed the perennial problems of overcrowding and lack of privacy.



The nursing program also endured – and after a fashion, addressed – other problems and growing pains. These included a series of doubtlessly well meaning, but less than entirely successful principals, and several instances of pupil nurses resorting to strikes in order to protest what they felt were intolerable work requirements and rampant “abuse of power” by hospital and School of Medicine administrators.



Gradually, though, the overall educational and working environment began to improve. In 1929, the University finally carried out Dean Hoxie’s early wishes by establishing an independent Department of Nursing Education within the Medical School. The new department offered an academic degree – the Bachelor of Science in Nursing – and began slowly phasing out the diploma program.



Beginning in 1941, a long-standing vestige of the Training School’s Victorian-era code of conduct was swept aside when the prohibition on married student nurses was abolished. And the very next year, 52 nurses (along with 47 doctors) – volunteers recruited mainly from KU’s Bell Memorial Hospital – were activated as part of the US Army’s 77th Evacuation Hospital, a unit that served valorously during World War II in both the North African and European Theaters.



In 1959, the Department of Nursing Education obtained full and formal accreditation from the National League of Nursing. Fifteen years after that, in April 1974, the department finally achieved independent School status as the University of Kansas School of Nursing.



Editors

KUhistory.com

 

[Source Notes: The documents and materials consulted for this article can be found in the University of Kansas Medical Center Archives. They include the following: Shirley Veith, “The Development of the Nursing Profession at the University of Kansas, 1906-1941,” (PhD dissertation, University of Kansas, 1988); Hester I. Thurston, RN, “The Kansas University School of Nursing: An Historical Perspective” (paper presented at the Nursing Perspectives Workshop, May 15, 1982); Sara A. Patterson, “Out of Our Past” (paper presented at the Inter-Century (KU 1866-1966) Day in Nursing); Dr. George H. Hoxie, “The Training School for Nurses of the University of Kansas (undated reminiscences); Ralph H. Major, MD, An Account of the University of Kansas School of Medicine (University of Kansas Medical Alumni Association, 1968), pp. 1-58; Lawrence H. Larsen and Nancy J. Hulston, The University of Kansas Medical Center: A Pictorial History, (University Press of Kansas, 1992), pp. 3-76.]