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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.

The Lyon nuns at Tredegar House, London, 1926. 6 other sisters had received the same training in 1925.

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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.
The Wedge of Fellowships 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.