Monday, August 8, 2011

The VNA of Boston story continues... and finds its way to Boston!

If you've been following along, you know that the VNA of Boston story started far away from here (in Europe, in fact).  Here's where it gets interesting... as we've now made our way to Boston.  Here's Rebecca's post:

Today we arrive in Boston, about a quarter century after the founding of district nursing in England. In 1884 Abbie Crowell Howes, the unmarried daughter of a well-to-do Boston family, travelled to Liverpool to learn about Rathbone’s system of district nursing for the sick poor with hopes of establishing a similar program in Boston.

The period of reconstruction following the end of the Civil War in 1865 ushered in an era of rapid industrial, economic and population growth often referred to as the “Gilded Age”, a term coined by Mark Twain. During the 1870s and 1880s, the U.S. economy grew at the fastest rate in its history, and northern coastal cities were quickly transformed as new industries flourished and people flooded in to fill the need for workers. As in Liverpool of the mid-1800s, these new residents, in the over-crowded and poverty-stricken inner cities, often succumbed to sickness and disease leaving their families without income and threatening the social fabric of the community. At the same time, the professional and business classes became very wealthy, and many women pursued charitable activities to ease the suffering of the working classes and to promote improvements in education and health.

One such group in Boston was the Women’s Education Association (WEA). In 1871, Mrs. Charles Pierce and Mrs. B F Brooks sent out a circular proposing the establishment of an organization to support the expansion and quality of educational opportunities for women. At the first meeting, 75 women joined as charter members. Members would propose ideas for promoting the education of women, form committees with other ladies who had similar interests, and receive small grants from the Association to help jumpstart their project. The Association would remain involved for one or two years, with the expectation that the project would either take root in the community and become self-supporting or would fold. Several of the organizations started by members of the WEA include Radcliffe College, the MIT Women’s Laboratory, The Boston Training School for Nurses (the second oldest nursing school in the US based on the Nightingale model), The Boston Cooking School (where a scientific approach to food preparation was taught and where Fanny Farmer trained), the Marine Biological Laboratory at Wood’s Hole (a place where both men and women could conduct research and women were encouraged to be a part of the community of scientists – Rachel Carson formed many of her ideas at the MBL), and the Boston Children’s Museum.

Abbie Howes and her friend Phebe Adam were members of the WEA and upon Howes' return from Liverpool; she approached Adam to propose they request a grant from the WEA to start a program of district nursing in Boston. In her book, The Evolution of Public Health Nursing, Annie Brainard describes Howes as finding satisfaction and happiness in service to others. “As a social worker she had no interest in any personal rewards such as office or leadership for herself, but with rare persistence and tireless enthusiasm gave herself, at all times to the service of the poor and needy.” She describes Adam as “a lady of dominating personality” who “to some seemed stiff and forbidding, though to those who knew her better was a loved and revered leader. She had intellectual tastes and had taught school for some years. At the time of which we speak she was connected with the Shaw Day Nursery in Boston and, having already realized the need of nursing care in the homes of many of her little charges, quickly became interested in Miss Howes’ suggestion.” (For more on the Shaw Day Nurseries see

In addition to learning all they could about the Liverpool organization through visits and an active correspondence with Rathbone and his nursing superintendents, Howes and Adam also studied the situation in Boston. Howes proposed collaborating with the Boston Dispensary, an organization of physicians who had served the poor of the city since 1796. They approached Dr. W. H. H. Hastings, the Superintendent of the Dispensary and he happily agreed to the partnership. Hastings wrote “No one knows better than a Dispensary physician, how hard it is to treat a patient when there is but little to do with, and no one to properly carry out his instructions. He feels powerless, and perhaps suggests a hospital; but that recommendation is declined for fear that it may lead to the breaking up of the home and the scattering of its members. It is in such cases as these that the work of your nurses is needed to complete the efforts of the medical adviser, and accomplish the greatest amount of good for the suffering poor.” (

In 1885 Adam became the chairperson of the WEA’s Committee on Industrial Education – and shortly thereafter proposed the idea for District Nursing. Brainard notes that “at first it was necessary to convince the Committee that the work, which at first sight, seemed to partake only of charity, was, in fact largely educational. In this they succeeded, although at first assistance was reluctantly given, and the name “Instructive District Nursing” was adopted in order to ally the work with other educational efforts. By the end of the first year, however, ample proof having been obtained that teaching, as well as nursing, was a large part of the work, the undertaking was heartily endorsed.“

In her report on the activities of the Industrial Education Committee for the year 1885, Adam writes “In concluding our report we desire to express our gratification at the assent of the Association to work we hope to begin with the New Year, and which, for lack of a better name, we call ‘Instructive District Nursing’. It is too early for us to give details of what we propose and hope to accomplish, but, to those who question the acceptance of this work as not within the scope of an Education Association, we desire to say that one of the important portions of the work of a nurse thus employed is as a teacher, and largely consists in the instruction she is able to impart to the family and friends of the patient. Whatever may be the value of lectures on health and on the care of the sick, given to the poor and ignorant, it cannot be doubted that their practical usefulness and assistance must be vastly increased by direct lessons in a sick-room. The skillful application of a simple bandage or poultice at the bedside of a patient reaches at once even the lowest intelligence, and a competent nurse can give instruction of the greatest value in all matters of diet, ventilation, etc – lessons not confined to the immediate sick room, but spreading their beneficial influence throughout the neighborhood in which she works. We ask the interest and cooperation of all the members of the Association, and any suggestions or information bearing upon our work will be gladly received.“

In her April of 1887 report to the WEA Adam, now President of the Instructive District Nursing Association writes – “you will remember that our Association undertook the work of Instructive District Nursing in February 1886, and reports have been read at each meeting of its continued success and the growing interest in the work. At the meeting last April the Committee thought it best to withdraw from the Association, as has been the custom in the past whenever any enterprise had reached the stage when it could stand alone. The President of the new Instructive District Nursing Association reports that it continues to prosper.” 

Board of Managers
IDNA – 1887 – Second Year of Operation

Miss Phebe G. Adam
Mrs. F. W. Chandler
Miss A. E. Wheelwright

Miss Hannah A. Adam (sister of Phebe)
Mrs. J.W. Andrews
Mrs. Wm. Appleton
Miss Anne P. Cary
Miss Clara T. Endicott
Mrs. J.S. Copley Green
Miss Margaret Greene
Miss Abbie C. Howes
Miss C.I. Ireland
Miss Mary Minot
Mrs. Oits Norcorss
Miss Mary Russell

Advisory Board
Mr. Wm Endicott, Jr.
Dr. Francis Minot
Mrs. Chas D. Homans
Mrs. S. T. Hooper
Dr. Vincent Y. Bowditch
Mr. Lewis Wm. Tappan, Jr.
Mr. George Wigglesworth

First 4 IDNA Nurses Employed By the WEA (7,182 visits to 707 patients were done in the first year)
Amelia Hodgkiss Hired Feb 8, 1886 New England Hospital for Women & Children
(left in November of 1886 after finding the work too stressful)
Elizabeth Rinkler Hired June 15, 1886 Boston City Hospital Training School
Calina E. M. Somerville Hired Nov 1, 1886 Boston City Hospital Training School (went on to become Superintendent of Nurses Lawrence General Hospital)
Emma Gordon Hired May 1, 1887 Boston City Hospital Training School (also travelled to study with Rathbone/Nightingale District Nurses in London)

Boston Medical Center and the VNA of Boston working together...