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Beyond Nightingale

Mary Hitchcock's nursing school closed its doors 25 years ago. But—as alumni of the school and administrators at DHMC attest—nursing education and practice are thriving today at Hitchcock.

By Laura Stephenson Carter

It's with a sly chuckle that DHMC nurse Peter Nolette, B.S.N., R.N., notes that the earliest nurses were men—monks and other males in religious orders. It's not surprising that as one of only 11 male nurses to graduate from the now-defunct Mary Hitchcock Memorial Hospital School of Nursing (SON), Nolette would look for male roots in the profession that he loves.

"The beginning of nursing—we think of Florence Nightingale," Nolette says, admitting that "she may have started the first formal nursing program." One of history's most famous nurses, she established the Nightingale Training School for Nurses at St. Thomas's Hospital in England in 1860. Soon, nursing schools began popping up all over the U.S. The earliest ones were in Boston, Philadelphia, and New York. By 1893, when the Mary Hitchcock Memorial Hospital Training School for Nurses—and Mary Hitchcock Memorial Hospital itself—opened, there were about 200 such schools in the country.

Nolette, who graduated from the SON in 1977, has immersed himself in its history and remains an active alumnus. It was exactly 25 years ago that the Hitchcock School closed its doors, but its impact is still very much in evidence.

In the early days, hospital-based diploma nursing schools, like Mary Hitchcock's, had little formal instruction, no standardized curriculum, and no accreditation, but they provided on-the-job training. In 1893, the 36-bed MHMH was staffed by three doctors, two nurses, and two nursing students. An early application form specified that "candidates for admission to the Training School should be between the ages of 21 and 35"; explained that "instruction will be given by lectures and recitations, at the bedside in the Hospital and in the homes of patients, in contagious and non-contagious diseases"; and warned that "the profession of a nurse . . . calls for the exercise of self-denial, patience, gentleness, and good temper."

Students typically worked six and a half days a week in 12-hour shifts, including at night; took classes; and, if they were seniors, managed whole wards of patients. In the early years, students also worked in private homes in the Hanover area, caring for patients with typhoid fever, grippe, fractures,

MHMH nursing students, in the operating theater with two of their instructors, circa 1910.

peritonitis, and heart disease. Students were treated like family, so they didn't seem to mind living in dorms supervised by housemothers, following strict rules, working hard, and wearing uniforms and caps. New student nurses were called "probies" because they served a two- to four-month probationary period before being accepted as first-year students. As student nurses toiled away, receiving only small stipends for their work, established nurses nationwide were forming professional organizations that fought to set standards for nursing schools.

But in the late 1800s and early 1900s, MHMH student nurses were oblivious to early efforts to improve nursing education. They were too busy preparing breakfast trays for patients; washing dishes on the maid's day off; making beds; stoking the ward fireplaces; polishing silver; dusting floors; cleaning bathrooms; and even arranging patients' flowers. And too focused on preparing mustard and flaxseed plasters to treat pneumonia or infection; giving patients cool baths to reduce fevers; administering enemas; and dispensing medications such as morphine, phenacetin (a sedative), mercury ointment (for syphilitic sores), and oil of wintergreen. Students had responsibilities in the operating rooms, too: sterilizing equipment, gloves, and gowns; making sponges and dressings;

keeping the OR clean; and assisting during surgery by handing instruments to the physician.

The two-year program was changed to three years in 1905. The amount of time spent in classrooms increased, but students still worked long hours in the wards and operating rooms. They were supervised by senior nurses but were capable of handling things on their own when necessary.

During the 1918 flu epidemic, classes were suspended because so many flu patients were hospitalized that every nurse was needed. "Beds were placed in corridors, sunrooms, anywhere there was space," wrote Loretta Land in Hiram Hitchcock's Legacy. The nursing students "provided such good care that one report indicates that no person hospitalized for other reasons caught the flu. At times, though, the nurse could do little more than go from one patient to the next, giving fluids and trying to reduce fevers. . . . Very few nurses became ill, and those who did were not seriously afflicted."

However, "the following year, 1919, brought severe cases of influenza to the nursing school and hospital. Many students and hospital workers were stricken at once. When Miss Shepard and the head nurse were both ill, the hospital's

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Laura Carter is the associate editor of Dartmouth Medicine.

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