By Patricia D’Antonio PhD, RN, FAAN, Director, Barbara Bates Center for the Study of the History of Nursing
The following was originally published in The Chronicle in Fall 2003.
The Bates Center’s collections highlight the boundaries women as nurses crossed as well as the empowerment they created for themselves and for the profession. The basic idea of hiring nurses raised profound anxiety about class systems and private versus public spaces. Philadelphia’s nursing pioneers changed the idea of hiring nurses for quality care both at home and in hospitals. The history of nursing, and of healthcare, demonstrates the intersections of race, economics, and society, particularly in the decades leading to the ratification of the 19th Amendment.
Nurses have always recognized the work of its historical innovators, pioneers, visionaries, and distinguished leaders. The profession has also celebrated the contributions of its clinical practitioners, although, since many of their names and stories have been lost over the time, as a group rather than as individuals. The diaries, training school lecture notes, and many of the letters of Chloe Cudsworth Littlefield, an 1883 graduate of the Woman’s Hospital of Philadelphia Nurses’ Training School, allows us to document the personality and the practice of one heretofore unknown practitioner. And they challenge some of our assumptions about the work of our historical predecessors. Miss Littlefield strenuously objected to anyone -patient, physician, or colleagues -addressing her by her first name. As she wrote to her sister of one particularly impertinent private patient, “she has no right & I shall not allow it.” We, therefore, will continue to respect Miss Littlefield’s preference, in our review of her life and her work.
Chloe Cudsworth Littlefield was born in 1850 in the small, upstate New York town of Troy. Her interest in nursing was sparked by a physician who had trained at the Woman’s Hospital of Philadelphia, one of the few institutions in the United States dedicated to the education of female physicians, and was, in 1861, the site of one of the first training schools for nurses. Miss Littlefield arrived in Philadelphia in 1881 to train in a fairly extensive and well-grounded two-year nursing program at the Woman’s Hospital that also promised a 10-month rotation at the Pennsylvania Hospital, 6 months in private duty, and one month on the insane wards of the Norristown Asylum in nearby Norristown, Pennsylvania. When finally awarded her nursing diploma in 1883, Miss Littlefield wrote her sister, “I know I have a better means of support than at one time I was likely ever to have …. ” Miss Littlefield briefly considered an opportunity to nurse in China because of its promise of “stead employment.” Ultimately, she decided to remain close to her family and returned to Troy, New York, after graduation. Miss Littlefield ultimately settled in Springfield, Massachusetts, in 1887 to be with her widowed, sister, Ellen, and her niece, Marion.
Miss Littlefield’s papers, however, do more than document a life. They also provide a deeply layered perspective on 19th century nursing training and private duty practice that challenges some dearly held historical assumptions. We believe, for example, that pupil nurses’ bartered two or three years of arduous work for their diplomas. Miss Littlefield certainly worked hard (and she particularly disliked the demands of night duty), but she, as often, had times of real pleasure as she and other nurses sewed or trimmed hats with their patients, walked with them to surrounding parks and gardens, or visited the then exciting new department store that had recently opened in downtown Philadelphia. We also believe that 19th century pupil nurses’ had little recourse but to accept the rigid and hierarchical structure of their training school experiences. But Miss Littlefield’s papers suggest that in our search for more organized forms of resistance, we may have overlooked the power and the efficacy of pupil nurses’ individual self-assertion. Miss Littlefield, for example, refused night duty if she felt too tired; and she threatened resignation and, one might presume, to move on to another training school if the educational offerings advertised by the Woman’s Hospital failed to materialize.
We also believe in the loneliness of nineteenth century private duty practice. But unless a patient seemed critically ill, Miss Littlefield visited her own friends and family almost each day of a private duty assignment. And the fact that Miss Littlefield frequently visited patients to inquire about their health after her private duty assignments had ended suggests continuity in 19th century nursing care that we have not yet imagined. Miss Littlefield practiced within a world of mutual family connections, obligations, support, and pleasures that characterized the life and the work of one 19th century private duty nurse.
For the best description of late 19th century private duty nursing practice, see Susan Reverby’ s Ordered to Care: The Dilemma of American Nursing, 1860-1945 (New York And Cambridge: Cambridge University Pres., 1987) and Patricia D’Antonio’s American nursing: a history of knowledge, authority and the meaning of work. (Baltimore: The Johns Hopkins University Press, 2010).
Chloe Cudsworth Littlefield’s papers are held at the Barbara Bates Center for the Study of History of Nursing at the University of Pennsylvania, School of Nursing and are online: http://openn.library.upenn.edu/html/0024.html .