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• 1 2018-08-30T21:50:13-07:00 The Wedge of Fellowships 28 image_header 2022-11-05T11:08:30-07:00 From the moment Frances Elisabeth Crowell pushed for fellowships to be given to selected French nurses in 1922, she schemed that these fellowships and their beneficiaries would be a major mean for her to get “an entering wedge” within French hospitals and training institutions, chiefly in the Parisian Assistance Publique. In Paris, as elsewhere in France and in Europe, they were to play a key role in the long term development of the different nursing training centres created in France, as vectors of a wholly different conception of nursing, in France as in several other European countries. A ‘generous policy of fellowships’ was central to her European, French and Lyonese plans, as she worked on all these levels simultaneously.
   
  
  In France, this attempt to have French nurses converted to the "spirit of service" and the "conception of hygiene" was to be  implemented chiefly in Lyon, for Parisian undertakings proved too difficult. Here as elsewhere in Europe, Crowell wagered that the Lyonese nurses would absorb abroad, and then replicate in France, the kind of nursing attitudes and practices that American nurses of her calibre recognised as optimal, not without discussions, and which the Rockefeller Foundation embraced from 1918-1919 ( see Pierre-Yves Saunier and Ludovic Tournès; Philanthropies croisées: a joint venture in public health at Lyon (1917–1940), French History, Volume 23, Issue 2, 1 June 2009, Pages 216–240) 
   
    
  The  fellowship program in Lyon started with two French lay nurses who were sent to London to glean nursing teaching techniques in the hospitals there. Initially, Georgette Bauer and Hélène Mugnier  were included in a larger party of 6 young women who were supposed to join the Assistance Publique hospitals in Paris after their fellowship. They had been carefully chosen by Crowell, who knew them quite well. Since 1918, these two nurses had worked in the dispensaries supported or created by the Commission for the Prevention of Tuberculosis under the supervision of Crowell, and were quite familiar with her conceptions of nursing.
   
  It was these two women whom Crowell installed at the head of the Lyon school when it was created in the Summer of 1923, the result of complicated negotiations and preparations in which she had played a major role. Hélène Mugnier – who had attended high school in a suburb of Lyon, was chosen as directress, with Georgette Bauer as her assistant. This was done in full agreement with Crowell’s major local partners. One of them, Léonie Motte-Gillet, the spouse of an important Lyonese textile industrialist whose liberalities and networks had been crucial in the establishment of the school, was even brought to London by Crowell, in order to vet the two women. Crowell’s other accomplice, Professor Lépine, Dean of the Faculty of Medicine and administrator of the local hospitals, had been a supporter of systematic nursing education for years ( for more about the creation of the school, see Pierre-Yves Saunier and Ludovic Tournès; Philanthropies croisées: a joint venture in public health at Lyon (1917–1940), French History, Volume 23, Issue 2, 1 June 2009, Pages 216–240).  
     
  When it welcomed its first students in the Fall of 1923, the school was placed under the supervision of these two former fellows, adding yet another touch of Rockefeller patronage. Which it also explicitly claimed in its print documents (N.B.: the avenue where the school's new premises were subsequently built in the 1930s was soon christened Avenue Rockefeller by the municipality, and the École was officially named   École Rockefeller in the 1990s ) 
   
  
  
  
  
  
   
  Once the school was created, the provision of additional fellowships was conceived as a way to train its staff, and to create a propitious training environment for its pupils. Now it became crucial to instil the chosen principles of nursing down to the daily practices of the classroom and ward training, including moral behaviour and technical skills of student nurses. To do so, it was vital to win the hearts and minds of the Catholic sisters who provided the workforce in the Lyon hospitals since the 16^th century - the Lyon hospital sisters did not belong to any large nursing religious order, their communities were specific to each hospital house and they did not pronounce perpetual vows. The sisters were the ones to supervise practical work done by the nursing lay and religious students in the hospital. They were also indispensable for classroom work by the lay and religious students of the new school, which  the  younger sisters attended in order to obtain the state diploma of nursing created in 1922. As a result, Crowell placed all her energy in ensuring that nursing nuns from the Lyon hospitals were sent abroad. This required negotiation with her superiors, who reluctantly agreed that support would be given to religious nurses. Crowell, herself a Catholic, would regularly return to this theme in subsequent years. But she also had to convince the religious authorities in Lyon who feared the idea of sending sisters out of their communities,to argue with the hospital authorities in Lyon, who were reluctant about this distraction of working staff, and with the nursing supervisors of the targeted London hospitals who were not enthusiastic about the idea of training staff for foreign institutions (let alone for a Catholic order, possibly).
  
  
   
   
  Crowell ultimately mounted a concerted attack, mustering every resources : the religious authorities in Lyon were taken on a tour of London hospitals, and the matron of  London Hospital was invited to the United States on a Rockefeller fellowship. This was decisive, and  professor Lépine subsequently placed his authority behind the invitation in order to convince his colleagues at the governing body of the Lyon hospitals that they could consider the very idea of sending religious nuns out into the world ( see verbatim of the meeting). Eventually, 12 sisters were sent to University College Hospitals and the London Hospital for 10 to 12 months of training (6 in 1925, 6 in 1926).As mentioned in Dean Lépine's report, they were mostly chosen among "innovation friendly" sisters. A number of them  had just graduated from the  school they had joined at its creation in 1923, and were seen  as  promising subjects. Others were  more senior sisters.
  
  
  The idea was that all these sisters would return and take over positions of responsibility, especially as instructors in ‘model wards’ for the student nurses, but also in new administrative positions. The  most senior of the sisters was being considered as a future possible supervisor for the entering cohorts of aspiring religious nuns. Being installed in supervisory positions would make it possible for these sisters to implement the standards of modern nursing they had absorbed in London, both in terms of nursing technique and of practical nursing education. Conceiving the fellowship scheme and actually implementing it were two different things, however.  Although the nuns received English lessons and were introduced to hospital organization in England before they left Lyon, it was not enough to ensure them a smooth transition. Besides, the selection of nurses, who were chosen by the hospital authorities in Lyon, did not always prove propitious once the  nurses were on location in London.  When  the first group of sisters arrived in London, Crowell was still fathoming out  methods to select appropriate persons. Her notes express her attempts to find some compromise  between local rules in the Lyon hospitals, her own expectations and the criteria of the institutions that welcomed the fellows (have a look at her full account here).
   
   
  There were also mishaps at the return end of the trip. Although most of the fellows were placed at the head of the new model training wards created in 1926 with Rockefeller Foundation subsidies (full document here),  it proved difficult to place some of the fellows in strategic training posts within the hospital. In the face of seniority rules among sisters, or as a result of the lack of interest of their supervising medical doctors  who balked at the idea of  revamping ward operations, some projects did not come to fruition.  Thus the two 1926 fellows who had subsequently spent a few months at the Hospital Pasteur in Paris were not able to establish a new contagious ward in their hospital, as Mugnier acknowledged in the aforementioned letter, which she wrote in english to Mary Beard.
   
  
  Sister Anne Marie Claudia Montelimart, despite her good record in the religious community and the esteem she enjoyed among her sisters, was the most salient case where a fellow did not fulfil the original plans.  Aged 36 when she received a fellowship and left for the London Hospital with the other sisters of the second wave of fellows, she was an experienced nurse with a good level of education, and had served as an  instructor in the Hospices School of nursing between 1919 and 1923. A strong personality, if one believes her correspondence kept in her personnel file in the Lyon hospital archives, she was not happy with the work in London. According to  Crowell, during a visit she paid to the fellows in London in 1926, Montelimart made it clear that her long experience and the utmost quality of nursing in Lyon made it useless for her to learn about the nursing work in the English hospitals (read full account here)
   
  Sister Montelimart was returned to Lyon two months earlier than anticipated. Although she was initially used as an instructor in the school, she was removed from that position in January 1928, on the special request of Professor Lépine and against the opinion of the administrators of the hospital community she belonged to.  Her reluctance to embrace the tenets of English nursing led to her being side-tracked from educational tasks. Yet, she held supervising ward positions in the Lyon hospitals during the following years, and as late as 1965.
   
   
  Such impediments did not thwart Crowell’s drive, however, and fellowships were central in her arsenal to develop the school at different stages. In 1928, money was appropriated for the school to create its own health centre where the practical public health training of the students could be in its own control. This was an important step towards the construction of complete new facilities for the school. This stage included fellowships and travelling grants plan for religious and lay nurses alike. In January 1928, Crowell  submitted a plan for future action in Lyon to her superior Richard Pearce, the head of the Division of Medical Education at the Rockefeller Foundation. She required funds for a total of 12 fellowships to be given to lay nurses between 1928 and 1931, and 9 travel grants for religious head nurses (cheftaines) to visit hospitals in France and abroad (see her diary entry  of her conversations with Mugnier on January 30th 1928). The plan was approved.
  
  Lépine once again overcame the resistance of the hospital administrators and physicians, and 3 religious head nurses swiftly departed for a visit of hospitals and schools in France, Belgium and England in 1928, with one of Crowell’s assistants to guide them. At approximately the same moment, 4 recent lay graduates of the school also benefited from the new plan . They  received fellowships and travelling grants for training and observation in Toronto, Paris, Brussels, London, Montpellier or Mokotow in Poland. They were the ones who had been chosen to supervise or staff the new health centre.
   
  The 1929 stock market crash and the resulting diminution of the Foundation’s revenues compromised these plans. Additional fellowships and travelling grants would be awarded to graduates and staff members of the Lyon school until 1938, but the ambitious program sketched by Crowell in 1928 was far from being wholly implemented. Economic hardship was not the sole responsible, though. This was also the result of how local partners tweaked the whole process to their own ends, at the dismay of the Foundation officers. In Lyon, the fellows quickly went off the radar, for several reasons.

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• 1 2018-08-30T21:50:10-07:00 Hitting the glass ceiling 5 image_header 2022-03-08T09:32:18-08:00 But there was more. There was something specific to the Lyon school  that drove out  several fellows or travellers  with managing responsibilities.  The trajectory of  Miss  Hélène Mugnier, one of the first French nurses sent to London for training in the summer of 1922, provides the first clues as to the configurations of power that ultimately prevented  the fellows from leaving their mark on the Lyon school.
   
   
  It was in the Spring of 1923 that Crowell ‘set the wheels in motion’ for Mugnier to  become directress of the Lyon school.  When the school was inaugurated in the Fall, Mugnier was in charge of running the school with the support of Georgette Bauer, the other French nurse sent to London with a fellowship in 1922 (Bauer was hired in Lyon  as assistant-directress). At  Crowell's initiative and despite some reluctance from Mme Motte-Gillet, Mugnier went to England and the United States and Canada in 1926 (and recounted her experience at a  Congress of French nurses). Crowell organized this new fellowship  with the idea that this would strengthen Mugnier's managing capacity and expand her vision. However,  Mugnier eventually resigned in 1929, after a bitter showdown with Professor Lépine and a couple of disease / burn out leaves. A couple of interim directresses took charge until 1933, when a new, permanent directress was hired,  Miss Roberti.
  
  Crowell again embarked on ‘building her up’, one instance of that counseling and mentoring work being the tour of  Rockefeller Foundation supported European nursing centres that  Crowell and Roberti made together in the Spring of 1935. Elizabeth Crowell came out even a  stronger supporter  of Roberti, but the latter resigned from her position in the Fall of 1938. It was not only the directresses who found it hard to stay in charge in Lyon. Marguerite Ducroux, a 1928 fellow and instructor at the school, resigned in May 1929. Crowell was well aware of the difficulties that caused this resignation and showed no hard feelings, offering her help for guidance and advice. Other fellows like Hélène Rioux (a fellow in 1937) or Jeanne Coutagne, who had received a travelling grant in 1934, also resigned.
  
  The reason behind all these difficulties and departures seems to have been  the unwillingness of Dean Lépine, who presided the school Comité Directeur (Executive Board), to yield power to the directresses and staff of the school. Lépine, professor of Medicine and Dean of the Medical School, was in favour of higher standards in nursing education, and this was one of the reasons of his early and committed cooperation with the Rockefeller Foundation in this field since the Great  War. But he did not support the women’s empowerment side of the issue. As suggested by some of his positions as a member of the Hospices Civils Governing body, he was hostile to the idea that women physicians would get supervising responsibilities in hospitals. His ideal of nursing, though it was never formulated explicitly, might have been as mostly the provision of informed, effective and obedient subalterns to physicians in and out of the hospital. In any case, he was not willing to give leeway to the directresses of the school, which school regulations placed very strictly under the control of the Comité Directeur which he chaired. The directress was not even part of this committee.
  
  Alhough Crowell was not a staunch feminist, considering some hints in her diary, she was keen to have nursing schools run by women nurses with a high salary and the power to decide about educational issues. This proved impossible in Lyon, where Lépine did his best to keep the reigns in his hand, while the Comité Directeur, especially its ‘ladies bountiful’ committee led by Léonie Motte Gillet, constantly checked the directresses’ activities. In Lyon, Rockefeller fellows and travellers hit a wall  of male, medical  and class control: while practical aims of increased technical ability were certainly achieved by the provision of fellowships and other means, the social goal of turning nursing into a profession for women  and led by women was not fulfilled.