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Les trois soeurs: Trajectories of Rockefeller Foundation fellows at the Lyon Nursing School since the 1920s - Les trajectoires des boursières Rockefeller à l'École d'infirmières de Lyon et du Sud-Est à partir des années 1920.

A classroom at the École d'infirmières et de visiteuses de Lyon et du Sud-Est , late 1920s. The nuns behind the desk are, from left to right: sisters Daudet (a fellow in 1925), Pérouse and Bouland

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Introduction Many thanks to the historian and research comrade Sonya Grypma who kindly revised my english. Further introduction of errors has been committed under my watch.

On the left side of the blackboard, side by side with two other religious nurses, this picture taken circa 1928 shows a young religious nurse in her day garb. Likely the one she wore when she worked in the wards, or when she instructed the student nurses, lay and religious, who sat on the benches of that classroom in 1928.

It is quite appropriate that Sister Claudia Daudet is half masked by the skeleton, as she was probably the major but hidden legacy of the fellowships provided by the Rockefeller Foundation in connection with the École d’Infirmières et de Visiteuses de Lyon et du Sud Est in Lyon, France second city. This legacy was certainly not part of the intentions of the Foundation when it began to support nursing education in Lyon.

The school, when it opened in 1923, was located in the Hôpital de la Charité, an institution founded in the 17th century. Now placed at the urban core of the city, the Charité was scrapped in 1933. The school's new premises were then available, after having been delayed a couple of times since 1927 and the decision to move the school of nursing at the periphery of the urbanized area, just near a new hospital and a new school of medicine.

Both the nursing and the medicine school were supported by the Rockefeller Foundation, which provided substantial grants for staff salaries, equipment, general budget and building costs (see Pierre-Yves Saunier and Ludovic Tournès; "Philanthropies croisées: a joint venture in public health at Lyon (1917–1940)", French History, 23: 2, 2009, pp. 216–240).

Crucial under that regard was the provision of individual travel and training grants, the latter being part of the general fellowships program of the Rockefeller Foundation. Just in that program, about 1000 fellowships (counting) were awarded to nurses worldwide between 1917 and 1968. 186 travel grants were also extended to nurses or individuals linked to nursing. Between the two word wars, according to the list of European nursing fellowships compiled by the Rockefeller Foundation fellowship department in 1943, most of the French fellows were connected to the Lyon school.

From the inauguration of this school in 1923, to 1938 when links with the Foundation were severed, at least 40 people connected with the Lyon school of nursing received a training at, or visited nursing institutions in Europe and North America with support by the Foundation (read the complete list of French fellows). Out of that number, 21 received fellowships strictly speaking and 19 were given a travel grant (sometimes called "nurse leaders" grants in Rockefeller Foundation parlance). The range of recipients included nurses who were prepared for supervising positions in hospital and public health work connected with the school, several directresses and administrative or teaching staff of the school, but also a few men like the priests who supervised the religious nurses who staffed the Lyon hospitals, the executive secretary of the local hospital authority or the architect of the new nursing school building that the Rockefeller Foundation would finance in the early 1930s.

Thanks to these sojourns and visits that lasted from 1 week to 16 months, fellows and travelers from Lyon gained familiarity with hospital services, nursing schools and public health dispensaries supported by different Rockefeller philanthropic boards in
Debreczen and Budapest (Hungary), Cracow and Warsaw (Poland), Brussels (Belgium), Helsingfors (Finland), London (England), and in different North American locations in the Eastern regions of Canada and the United States.

Fellowships were mostly provided to nurses who were to contribute to the teaching and supervision of the school's students. Travel grants were extended to members of the direction of the school, or offered as a complement to a fellowship for nurses in charge of a specific project. Either way, what they learned and what they saw was encapsulated within travel itineraries carefully crafted by the Foundation nursing staff, such as the one Hélène Mugnier enjoyed in 1926 (recto and verso). Frances Elisabeth Crowell, the mastermind of the European nursing activities of Rockefeller-endowed organizations between 1917 and 1939, was responsible for the design of these visits and tours. She operated from the Paris office of the Rockefeller-endowed organizations with her assistants (without any order: Gladys Williams, A.Montagnon, Margaret Tupper, Miss Linton, Hazel Goff, Ethel Johns, Mary Elizabeth Tennant). When the fellowships and visits involved a North American leg, programs were finely tuned at the New-York headquarters of the Rockefeller Foundation by Mary Beard who joined the Rockefeller Foundation in 1924.

Socializing these nurses into a larger setting than their national professional community was a major concern for Foundation officers, for fellows as well as for visitors. Another by-product of these sojourns was a deep sense of sisterhood and gratitude for the nurses who provided support and guidance for the fellows and visitors. Indeed, the agenda for fellowships and visits was also about fostering an international esprit de corps. Situations for such outcomes were actively nurtured, for instance through specific events such as luncheons or dinners (see below preparation and list of tentative guests for Miss Mugnier's visit), in order that foreign nurses get acquainted with North American nursing leaders.

Still, the technical, educational and professional aspects of nursing were the most important aspects that fellows and visitors studied or observed during their sojourn. Nursing officers of the Foundation were keen not to let these different aspects be missed by the fellows and visitors. In order to do so, they briefed and debriefed fellows and visitors on arrival and departure, visited them on location, or actually travelled to be sure they would make most of the trip (for more about nursing officers' activities, Pierre-Yves Saunier, « Wedges and Webs. Rockefeller Nursing Fellowships (1920–40) », in Ludovic Tournès and Giles Scott-Smith (eds), Global Exchanges Exchange Programs, Scholarships and Transnational Circulations in the Modern World, New York, Berghahn Books, 2017, pp.127-140).

Thanks to documents from the Rockefeller Archive Center, the Lyon nursing school (Archives de l'École Rockefeller) and the Lyon hospitals archives (Archives des Hospices Civils), it is possible to assess the impact of these observation and study tours on the individuals and institutions that were involved. The diaries staff members of the Foundation had to keep about their daily activities are of special importance here, with fellows and visitors popping up at every page. Yet, the diaries were also written to convince the Foundation executives at the New-York headquarters that fellowships and travels were good value for money, and they are not to be taken at face value. Presentations occasionally made by a few of the Lyon fellows and travellers to other French nurses also derived from a specific posture, as they were keen to French nurses to catch up with their American counterparts (read Miss Mugnier complete account of her 1929 trip,here and here ). This material has to be carefully reconnected to their authors' roles and performing situations. By and large, and despite no specific "unvested" sources have been found that could provide access to how the Lyonese nurses felt about their education or observation abroad, there is a lot of material that unravel what they did, where they went, as well as the whys and whereabouts of their journeys.

Observation and networking were not the only items on the agenda, and fellows spent most of their time receiving basic or advanced training in nursing techniques, public health nursing, mental health nursing or dietetics at a selected list of schools, university departments and hospitals. They spent time in Europe and in North America, like Anna Fressenon. During her study period in North America, madame Fressenon visited or studied in some of the most important hospital, schools or public health nursing institutions at the time: the University of Toronto Department of Nursing, the Toronto General Hospital, the George Peabody School of Nursing in Nashville, Tennessee, the Yale School of nursing in New Haven, Connecticut, the East Harlem Nursing Health and Demonstration Center and the Nursing Education Program Teachers’ college at Columbia University, both in New York City (have a look at the different pages of Madame Fressenon's fellowship recorder card).

As a rule, the program of most Lyonese fellows and visitors was designed to immerse them into institutional, technical and human landscapes that nursing officers of the Foundation and related boards considered as congenial to the kind of nursing ethos, skills and organization they wished to generalize. Most often, they studied or observed in other institutions that were recognised or aided by the Foundation like the Kinderklinik in Vienna (Austria), the Saint Thomas Hospital (London) or the University of Debreczen school of nursing (Hungary) and a number of North American institutions. That was not too difficult, as there were many countries, cities and insttutions where the Rockefeller Foundation dabbled into nursing. Starting from this map of 1926, the triangles that stand for schools of nursing helped by the Foundation would grow more numerous later, in accordance with the motto that the Foundation adopted for itself.

Getting along with the distance from family and friends was certainly one of the many adjustments the fellows had to make to a new environment, beginning with language or the differences in working and educational rules and practices, or details of daily life. The 12 religious nurses from the Lyon hospitals who went to England in 1925 and 1926 certainly felt the bruise of the estrangement. Some unusual aspects might have been unusual but pleasurable, such as the fact that the sisters were provided with a stipend, whereas they just received a symbolic sum of money for their work in the Lyon hospitals. Others were certainly more dismaying. Although they were housed in a catholic convent during their stay in London, the sisters left behind the ties of affection with members of communities they had been used to live in for years. They also broke with the daily rituals and routines of their religious and working communitie. Besides, they had to follow intensive classes in English on their arrival, and to enlist in "nursing for beginners" classes at the probation school of the London Hospital. They even had to adapt their typical uniform into something slightly less cumbersome in order to work in the wards.

The Matron of the London Hospital, Miss Monk, would observe in her Annual Letter from 1926 that they overwhelmed these difficulties with flying colours. Conversely, the Lyonese beneficiaries of the fellowships and travelling grants often expressed their enthusiasm at their experience, which contributed to justify the expectations that Crowell and her team entertained as to the effects of such trips. The very existence of fellowships and travelling grants was premised on such expectations.