A Document Answers Some Questions (and Raises New Ones)

Lenoir NC, 1874. Caldwell Heritage Museum.

Lenoir NC, 1874. Caldwell County Heritage Museum. Ella Austin Whisnant was born just outside of Lenoir, on Lower Creek, in 1869.

In writing this blog so far, I have consulted and presented many kinds of documents: photographs, census records, newspaper articles and advertisements, printed catalogs,

Western North Carolina Insane Asylum, Inebriate Admission form ca. 1885.  Morganton Public Library

Western North Carolina Insane Asylum, Inebriate Admission form, ca. 1885. Morganton Public Library

maps, postcards, government reports–whatever I have been able to find that seemed useful.

Much of the time, a document ties down some fact or answers some question.  Not infrequently, however, it can be opaque, misleading, tantalizing but unyielding, frustrating in its incompleteness.  It can raise more questions than it answers.

This is a brief account of a single document sent to me recently by a member of the Whisnant family, and my effort to understand what it says (or does not) and what questions it answers (or does not).

Here is the document.  Click to enlarge it, and take a look:

Ella Austin's "Nurse's Certificate of Registration," December 19, 1903. Private collection.

Ella Austin’s “Nurse’s Certificate of Registration,” December 19, 1903. Collection of Sarah McGinnis.

My first reaction to receiving this 100+ year-old piece of paper was “Great!”  It seemed to answer a question I had wrestled with for months: Was my grandmother Ella Austin trained–and did she work–as a nurse at the State Hospital at Morganton sometime around the turn of the century (maybe between 1880-something and 1907)?  Its answer to that question, posed in that way, was a simple “yes.”  But there was, it turned out, much more (and less) to it than that.

Nurses' training class, State Hospital at Morganton, probably 1895 (note on back says "first" class, 1905; almost certainly in error). Patrick L. Murphy Papers, Southern Historical Collection, UNC Chapel Hill.

Nurses’ training class, State Hospital at Morganton. Note on back says “first” class, 1905.  Even before seeing the certificate under consideration here, I was almost certain that “first” and the date were in error. By comparing this photograph with others of Ella, I am confident that she is fourth from the left in the second row.

Patrick L. Murphy Papers, Southern Historical Collection, UNC Chapel Hill.

Where the Blog Stood When the Document Came to Me

By the time this document came to me, I had already written about my grandmother Ella Austin [Whisnant] several times:

  • Her and Asbury’s years at State Hospital [for the Insane, it was originally called] at Morganton.

    Asbury and Ella Whisnant with children, ca. 1916

    Asbury and Ella Whisnant with children, ca. 1916.  Nurse’s watch pinned to bodice of dress.  Click for larger image.

What I Had Already Learned About Early Professional Nursing, and Nursing at the  State Hospital

Not a whole lot.  Mostly I had learned some things about the nursing program as a whole:

  • The hospital itself opened in February 1883, when Ella was fourteen years old.  It (and consequently its staff) grew very quickly.
  • A nurse-training program that combined lectures and clinical practice was established  in October 1895, when Ella was twenty-six (Streeter thesis, p. 86).  On March 3, 1896, the Morganton Herald mentioned (in a weekly series “At the State Hospital”) that eight (unnamed) nurses were in training.  Thus the 1896 class, and not the “1905” one in the photograph above, was likely the first one.
  • Early training of nurses included at least “bathing, use and effects of medicines, control of hemorrhages, applications of surgical dressings, and use of the catheter and clinical thermometer” (Streeter thesis, pp. 91-92)  Mental asylum nurses were also trained to identify and treat mental disease. What additional training they may have had is unclear.
  • The 1900 manuscript census of Burke County listed the occupation of Ella and 51 other women and men at the State Hospital as “nurse,” but (as Streeter notes) this census did not distinguish between trained and untrained nurses.  The 1910 census did so, but by then Ella was living in Asheville.

    Federal census of 1900, Burke County NC, State Hospital at Morganton

    Federal census of 1900, Burke County NC, State Hospital at Morganton

What I Did Not Know

  • When Ella first came to the hospital.  A Lenoir Topic article of August 21, 1895  said she was returning after a visit home to Lenoir, and another of March 30, 1897 says she had been “employed at the hospital for some time.”  Born in 1869, she could perhaps have been there as early as 1887, when she was eighteen years old. At least one eighteen year-old nurse was listed in the 1900 census; the oldest was sixty-eight. Ella was then  thirty-one.
  • When Ella actually left employment at the hospital.  A Morganton Herald article of August 18, 1904, says she went home (for how long, it doesn’t say) to Lenoir to help take care of her sick brother.  By late 1907, she was living in Asheville.

What the Certificate Makes (Sort of) Clear

  • However much formal training Ella had in nursing, and however long she worked as a nurse, her certificate of registration was entered by the Burke County Clerk of Superior Court on December 19, 1903 as “No. 30,” which may indicate that at least twenty-nine Burke County nurses had been certified as trained by then.  But there could have been more than the twenty-nine others, and some could have been working outside the State Hospital setting.  And in any case, December 19, 1903 was Ella’s registration date–probably not the date when  the hospital doctors certified her as trained.
  • When she came to register, she presented either a “Diploma from State Hospital, located at Morganton” or “a Certificate signed by the following Physicians: P[atrick] L. Murphy, Isaac M. [Taylor], John M. Campbell.”  On a first glance, I had hoped this might provide a clue to exactly what training Ella actually had. But upon closer examination, the document disappoints. All of the handwriting (including the doctors’ names) is the same, indicating that the clerk simply wrote down the names of the doctors who had signed whichever other document (Diploma or other hospital-issued Certificate) Ella presented to them. We still don’t know what that might have been.
  •  The photograph of the nursing class above cannot be first or 1905 if I am correct about the fourth-row nurse being Ella, as I am confident that I am.

What Studying the Certificate Led Me to Inquire About Further

What about the program of study?

Having learned that Ella had been in some program of study, I tried again to discover what a program for nurses might have been at the time.  But as before, I discovered no actual curriculum for the State Hospital program.  What I did find was that a training school for nurses opened at Rex Hospital in Raleigh at about the same time offered an eighteen-month course, the main texts for which were “[Lavinia L.] Dock’s Materia Medica for Nurses (1890), Clara Weeks-Shaw’s A Textbook of Nursing (1892), and “Hutchinson’s Physiology.”

Since Superintendent Murphy was widely recognized as competent, progressive, and knowledgeable about current best practices, his program likely would have been similar to the one at Rex Hospital.

A recently-passed state law

Trying to find out about the legal status of the Certificate and its relationship to whatever certificate or diploma had earlier been issued by the hospital, I learned that on March 3, 1903, North Carolina became the first state to pass a law requiring the registration of nurses.  That key fact suggested a probable sequence: After the law was signed, blank certificates had to be printed and distributed to clerks of Superior Court in all North Carolina counties.  The clerks presumably put out the word (through notices in local newspapers would be my guess) that nurses whose training and experience their supervising physicians were willing to vouch for should present a “Diploma”  or “Certificate” signed by those physicians, and be registered by the clerk.  To put such a process into place would probably have required at least a few months.

After reading the text of the law, I began to consider the likelihood that Ella’s Nurse’s Certificate of Registration No. 30 might in fact reveal little except that during some undefined period, she passed through a training process of some description and length, that she had learned enough to assure the hospital Superintendent and two other physicians that she met the legal standard suggested (but not defined) by the Nurse’s Certificate of Registration.  They gave her a “certificate or diploma,” she took it (after how long a time we don’t know) to the clerk, and he gave her official registration certificate No. 30 on December 19.  That date was perhaps determined (it occurred to me) more by the new state law than by anything else.

As it turned out, my “perhaps” was not necessary.  A short search on Phoebe Pollitt’s North Carolina Nursing History website brought me to the text of the law.  Here is the relevant part of Section 1:

[A]ny nurse who may present to the clerk of the Superior court in the State on or before December 31, 1903 a diploma from a reputable training school for nurses conducted in connection with a general hospital, public or private, in which medical, surgical, and obstetrical cases are treated, or in connection with one of the three State Hospitals for the insane [at Morganton, Raleigh, or Goldsboro], or who shall exhibit a certificate of attendance upon such training school for a period of not less than two years, or who shall present a certificate signed by three registered physicians stating that he or she has pursued as a business the vocation of a trained nurse for a period of no less than two years, and is in their judgment competent to practice the same, shall be entitled to registration without examinations, and shall be registered by the clerk of Court in the manner hereinafter provided.

So Ella may or may not have had a formal training course, because the three-doctor certificate vouched for her knowledge and skills.  I suspect, however, that she had had the State Hospital training course (whatever it was and whenever she took it), since by 1903 she likely had been working at the hospital o perhaps as long as fifteen years, first (maybe) as an “attendant,” and then (it seems logical to assume) as a nurse for something like a decade, and was going on thirty-five years old.

Had she waited another two weeks to register, however, Ella would have had to appear before the newly created State Board of Examiners of Nurses (in Raleigh, one would guess), undergone an examination in “elements of anatomy and physiology, in medical, surgical, obstetrical and practical nursing, invalid cookery and household hygiene,” and returned to present a license from the Examiners to the Burke County Clerk of Court.

OK, now I finally get it.  I now know what this Nurse’s Certificate of Registration proves, and doesn’t.  It answers a couple of my prior questions, but leaves others unanswered. It raises still others that it had not previously occurred to me to wonder about. It led me to a key contextual factor (the law) that then allowed me to avoid a tantalizing but incorrect assumption (that the Certificate proved she had had formal training).

What I Am Still Trying to Determine

I would like to know why Ella’s work as a nurse (and perhaps earlier as an “attendant”) in the State Hospital for a decade was lost to memory in the family, as it seemed to be.  That work was betokened proudly by the watch she wore daily, recorded on a certificate in the court house of her home county, and verified by a few documents (including at least one photograph) buried in family records.

I would like to know whether there was some sort of de facto nurse training program prior to October 1895, and whether Ella was a part of it.  Several bits of evidence make that seem likely:

  • Prior to working at the hospital (as I discovered accidentally in the 1940 census while
    Lenoir Topic, June 23, 1886

    Lenoir Topic, June 23, 1886

    working on this blog some sixty years after her death), Ella seems to have attended college for a year, probably at Davenport College in her home town of Lenoir (see previous blog post). Whether other women (or men, for that matter) in her group of nursing trainees had had a similar experience, I have no idea.  But anyone who had, likely would have been an especially valued prospect for the hospital’s first formal nursing class.

  • A long and detailed article in the Asheville Daily Citizen on December 27, 1892 following an on-site visit by at least one reporter (conducted by the Superintendent) noted that among the many laudable features of the hospital were “skilled nurses [who were] on hand to look after the wants of the people under their care.”
  • Even by 1892 when the Daily Citizen article appeared, the hospital had been operating nearly ten years, had a capacity of at least 500 patients, and had a program of patient care and rehabilitation that had attracted
State Hospital at Morganton, 1896. Documenting the American South.

State Hospital at Morganton, 1896. Documenting the American South.

national attention.  It seems inconceivable that the hospital had no trained and experienced women and men who were doing the work of nurses.  But “skilled” (the Daily Citizen reporter’s term) would certainly have connoted “experienced,” and likely also some kind of systematic training–“on-the-job,” “in-service,” or something equivalent.

What I Came Out With

This document wasn’t all I hoped it would be, but it did offer a key fact or two: Ella did become a registered nurse during her time at the State Hospital, and her  registration occurred at the county level.

Checking into the document also expanded my framework and knowledge significantly: A state law requiring nurses to register was passed in 1903.  During the final months of that year, there were several possible  paths to registration.  And the timing of Ella’s just-before-the-deadline registration probably was significantly influenced by the cut-off date specified in the law.

And finally, a document doesn’t have to provide the precise facts you are seeking in order to serve usefully to expand and redirect inquiry.

 

References

Phoebe Pollitt, North Carolina Nursing History (Appalachian State University); Carrie Anne Streeter, Let Me See Some Insane People”: Progressive-Era Development of the State Hospital at Morganton, 1883-1907  (M.A. thesis, Appalachian State University, 2011); “Thirteen Nurses Graduate” The Charlotte Observer, June 15, 1904; “Training School for Nurses,” Raleigh News and Observer, July 24, 1896.

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