Arthur H. Aufses, Jr. MD Archives Blog

NINA D. GAGE, ROOSEVELT HOSPITAL SCHOOL OF NURSING ALUMNA and NURSING IN CHINA 

One of the collections held by the Arthur H. Aufses, Jr. MD Archives is the Roosevelt Hospital School of Nursing records (1896-1974). A gift to the collection is a scrapbook from alumna Evelyn I.V. Howard, class of 1908, who captured images of her fellow classmates and house staff physicians during her years in training there. Included among her friends were images of Nina Gage, who went on to join a missionary outreach in Changsha, Hunan Province in China in 1909. Gage worked in the hospital created by the team, and established a nursing school for both men and women. The scrapbook includes images of the hospital founded by the team as well as the nursing school students’ classes and hospital scenes sent to Howard by Gage. They illustrate an important time in the development of China’s medical history. 

This is the cover of the Howard scrapbook, which is wrapped in the blue and white striped cloth of the Roosevelt Hospital School of Nursing student uniform. The Roosevelt family coat of arms and motto is pictured at the bottom right. The Roosevelt family coat of arms, as depicted here in blue and black, includes a rosebud bearing three roses with a crest consisting of a helmet and three ostrich plumes. The family motto in the ribbon below the crest reads “Qui plantavit curabit” which means “The one who planted it will take care of it” or “He who will plant will cultivate.”

NURSING IN CHINA

Nursing, as a profession, was almost unheard of in pre-20th century China. Traditional Chinese healers diagnosed patients by observing various parts of the body – the tongue, the pulse (taken in both arms), and asking extensive questions. They then prescribed herbal remedies, massage, acupuncture or other methods to balance yin and yang – the two great opposing and complimentary forces in nature – to bring the body back into balance. (Forgive the simplification; this is a very basic explanation of Chinese medicine.) The family themselves, or their servants, in wealthy households, treated the patient at home – hospitals were also introduced by western missionaries – following the prescribed treatment. It is significant to note that most of the care givers were men.

Bathing a hospital patient
Men’s medical ward decorated for Christmas. The man in black is a probationer (nursing student in training).
Feeding a helpless patient in Yali Hospital.

THE YALE-IN-CHINA MISSION 

Starting in the 1880s, western missionaries brought modern medical methods to various large cities of China where they established missions’ projects. One team, organized by Yale University’s Christian Missions Society, was the Yale-in-China mission. The team consisted of members of the Yale class of 1898 and their families. Additionally, Nina Gage, a 1908 graduate of the Roosevelt Hospital School of Nursing, and sister to team-member Brownall Gage, joined them in 1909 to work as a nurse in the hospital/clinic and to help establish a modern nursing program. 

One of the team members, working with experienced missionaries from a northern project, arrived in 1902 to visit possible cities to establish the work. He then reported back to the Yale Missions Society board and the project team about the cities he visited for their consideration. Eventually they chose the city of Changsha, Hunan Province in southern China to establish the Yale-in-China Mission. Selected for its large size, Changsha was considered extremely clean and well built, according to the more experienced missionaries. Changsha’s alleys were paved with granite and it had a good sewage system, compared to other cities. Other missionaries had high opinions of the people there, citing them as born leaders who were very independent and influential in Chinese culture and life.

Map of southern China, highlighting Hunan province and the city of Changsha (this image and the following two are courtesy of Nancy E. Chapman)

In 1904, the team rented two buildings near the center of the city that were large enough to support their plans to establish a prep school and college, a medical school and hospital/clinic, as well as a nurse training school. One building was large enough to carve out several classrooms and dormitory space for students and housing for the team, while the other building served as a hospital/clinic.

Left: The Yale Mission’s early medical work was led by Edward Hume, M.D., Yale class of 1897. Hume (right) is pictured with two Chinese colleagues at the door of the mission’s first clinic and hospital, housed in a converted inn in the crowded center of Changsha.

NINA D. GAGE

Nina Diadamia Gage was born in 1883 in Brooklyn, and she and her siblings grew up in and around New York City. She attended Wellesley College, where, like her older brother, she was an active member of the missionary committee. After graduating, Gage entered Roosevelt Hospital’s Training School for Nursing, which had opened in 1896. (Roosevelt Hospital was renamed Mount Sinai West in 2015.)  

Nina Gage as a student nurse, relaxing on a building rooftop, at Roosevelt Hospital’s School of Nursing, circa 1907

At that time, student nurses were trained at the bedside by the senior student nurses, as graduate professional nurses were few in those years. The junior nurses, who served as floor staff, were taught to take vitals, change bandages, feed and clean patients, note changes in the patient’s condition to report to the attending physician during rounds, and keep the ward itself clean. Weekly lectures by the staff physicians supplemented and expanded the bedside training. Monthly lectures considered a different area of medical care. One would assume these lessons were repeated by Gage to her Chinese students.

This page describes part of a year’s weekly lectures for the nursing student at Roosevelt Hospital’s School of Nursing. Taken from Fifty Years of Service: History of the School of Nursing of the Roosevelt Hospital, New York City, 1896-1946 by Evelyn G. Fraser.

After graduating in 1908, Gage was employed as a night nurse while making the necessary arrangements to move to Changsha in 1909 to join her brother and the Yale team. She thought it was important to learn the language, and took that first year to study it while she worked in the “Yali Hospital” (as it was called) clinic and assisted the doctors in surgery and planning the establishment of the nursing school, which opened in 1913. 

This image captures nurse Gage in preparations for surgery at the Yali Hospital, undated (note: faded original image)

THE HSIANG-YA NURSING SCHOOL

Since nursing as a profession was new in China, Gage had the interesting – and daunting – privilege to create the Chinese name for it. She selected “Scholars to Watch and Guard” or more briefly, “Guard Scholars” – to indicate nurses. 

Advertising posters were hung around the city to announce the opening of the school, inviting “both boys and girls to be admitted for training in a new profession” (Hume, E., p. 168). The entrance requirements for the “Scholars to Watch and Guard” training were two years of middle school and passing the school’s entrance examinations in Chinese and arithmetic. Parental consent and the payment of school fees were also required. On examination day, twenty girls and forty boys arrived to take the tests. A few applicants backed out, intimidated by the exam questions, but in the end, five girls and seven boys became the first class of trainees. 

Nurses and probationary students in the Men’s Nursing School division, undated

Female students, in particular, had problems gaining entrance, as at that time, girls were prepared from a young age for marriage and lived very secluded lives, neither meeting nor socializing with boys outside of immediate family. However, once they demonstrated success in passing the entrance exams, doubtful parents were content to allow them to continue and in the end were very proud to have graduate ‘Guard Scholar’ daughters in crisp white uniforms, ready to serve their communities in such a positive way. 

The images above and below are of bandaging class practice. Men and women were taught separately, out of respect for Chinese culture, which kept women apart from men who were outside of their immediate family. Likewise, only men worked in the men’s ward and the women in the women’s wards, at least until the 1930s, by which time women dominated the nursing field in China.

Initially the nursing school and hospital were simply called the Yali School, but in the early teens, both were renamed “Hsiang-Ya” – “Hsiang” indicating “Hunan” and “Ya” indicating “Yale,” highlighting the partnership of Hunanese teachers and students with the Yale teachers and administrators. 

Yale School front courtyard, 1909 (note: faded original image)
Preparing salt solutions, 1915
Preparing and sorting of supplies, 1915

In 1927, due to the on-going political turmoil, all foreigners were expelled from China, the Yale-in-China Mission closed, and the team returned to the United States. By 1929, however, the Yale-in-China work resumed, but under Chinese leadership and direction. The hospital and schools of the Yale Mission continue to exist to this day, though they have been absorbed into larger university settings. The relationship between Yale University and China also continues to this day as Yale-China (雅礼协会), based in New Haven, CT, which “bridges the United States and China through collaborative partnerships in education, healthcare, and the arts” (The Yale-China mission statement, from their webpage).

Most of the photographs in Ms. Howard’s scrapbook have short captions on the back, usually with dates. This one reads: “During the Tuchun’s war – bringing in wounded,” unfortunately it is undated.

Gage is among the handful of notable women who brought modern professional nursing to China. In additional to teaching and working in the hospital, Gage helped found the Nurses’ Association of China (NAC) in 1909, signifying the start of a professional nursing movement in the country. The founding members were mostly western missionary nurses who came together to organize, but they were soon joined by Chinese colleagues. By 1915, China established an examination system for the professional certification of nurses, followed by other advances to promote nursing education across the Asian continent. 

Nina Gage taking a meal in her home, circa 1915

In 1912, Gage was elected as the first president of the NAC, serving a two-year term. She went on to serve as the chairperson of its education committee. After a brief return to the U.S. during WWI, where she taught wartime nursing at Vassar, Gage returned to Chine and was appointed Dean of the Hsiang-Ya Nursing School, as it was renamed.

Superintendent Gage and the senior class of 1915

GAGE’S POST-CHINA LIFE 

Upon returning to the United States in 1927, Nina Gage continued to work in nursing and was active in its support organizations. From 1925 to 1929, she served as president of the International Council of Nurses, representing China. She was executive secretary of the National League for Nursing Education from 1928 to 1931. In 1930, during her term as president of the Roosevelt Hospital School of Nursing Alumnae Association, she started The Roosevelt Hospital School of Nursing Alumnae Association Bulletin, later renamed The Roosevelt Review, which published news about alumnae activities but also included articles on developments in nursing practice and medicine in general. Throughout her working years, Gage remained active in the National Nursing Association and the American Nurses Association. Gage also published several articles on nursing in China for The American Journal of Nursing and as well as authoring two books: A General History of Nursing in 1933 and Communicable Diseases in 1940. 

In the U.S. Gage continued working as a teacher to the next generation of professionals. In 1927 she became educational director and director of the nursing department of the Willard Parker Hospital in NYC. In 1931, the historically Black Hampton Institute (Hampton, VA) appointed Gage as director of its new nursing school. She taught at the Jersey City Medical Center Nursing School during the 1934-1935 school year and then went to the Newport Hospital (Newport, R.I.) as director of its school of nursing from 1935 to 1943. In 1949, Newport Hospital’s Gage Hall was named in her honor. From 1943 until her retirement in 1945, she was the Director of Nursing at the Protestant Hospital in Nashville, Tennessee. She died on October 18, 1946, at the age of 63.

Right: An older Nina Gage, undated

Authored by Michala Biondi, Associate Archivist


Sources

Burst, Helen Varney. “Yale School of Nursing: celebrating 90 years of excellence.”  Yale University EliScholar, 2013. https://core.ac.uk/download/232765997.pdf

Chapman, Nancy; J. Plumb. The Yale-China Association: A Centennial History. Hong Kong: The Chinese University Press, 2001.

Clark, Alice. “The Nurses’ Association of China.” The American Journal of Nursing, Vol. 15, No. 1 (Oct., 1914), pp. 42-46 (5 pages).

Gage, Nina D. “Nursing in China,” The American Journal of Nursing, Vol. 18, No. 9 (Jun., 1918), pp. 797-800.

Hume, Edward H., M.D. Doctors East Doctors West: An American Physician’s Life in China. New York: W. W. Norton & Company, Inc., 1946.

Hume, Lotta Carswell. Drama at the doctor’s gate; the story of Doctor Edward Hume of Yale-in-China. New Haven: Yale-in-China Association, 1961.

Levitan, Kathi. “Nina D. Gage: An American Nurse in Early Twentieth Century China.” Master’s Thesis, Yale University School of Nursing, 2000 Dec.

“Nina D. Gage, R.N.”, The American Journal of Nursing, Jan 1926, 26:1, pg. 8. https://www.jstor.org/stable/3408648

Smith, Derek R. Nursing in China: Historical development, current issues and future challenges. Oita Journal of Nursing Science 5(2), (2004), 16- 20.

Wikipedia entry: Nina Gage. https://en.wikipedia.org/wiki/Nina_Gage

WikiLectures – Nursing in Ancient China. https://www.wikilectures.eu/w/Nursing_in_Ancient_China

Yuhong, Jiang. “Shaping modern nursing development in China before 1949.” International Journal of Nursing Science. 2016 Dec 29; 4 (1): 19-23. https://pubmed.ncbi.nlm.nih.gov/31406712/


To read a profile of another Roosevelt Hospital School of Nursing alumna, see our post on Elise Galloway, class of 1906.

The Closing of the Mount Sinai Hospital School of Nursing, 1881-1971

The Mount Sinai Hospital School of Nursing diploma program officially closed 50 years ago in 1971. At that point, it had existed for 90 years and had graduated 4,700 students, including the one and only male student in the last class. (A complete history of the School is available here.) Many hospital diploma schools closed during the 1970s, including the St. Luke’s Hospital and the Roosevelt Hospital Schools of Nursing, both in 1974. This wave of closings was due to the schools being fiscal drains on the parent hospitals, as well as the changing educational standards professional nursing organizations championed, including the baccalaureate degree as the best entry-level credential for nurses.

By the mid-1960s, the Mount Sinai Hospital School of Nursing was at a crossroads, trying to find a way to move forward in the face of these trends. In 1967, the newly formed Mount Sinai School of Medicine affiliated with The City University of New York (CUNY). This triggered a review of other possible interactions between the two institutions. That year, the School of Nursing joined with Hunter College, a part of CUNY, to start offering elective humanities credit to the students, easing their path to an eventual baccalaureate degree.

The next twist appeared in the Hospital’s Annual Report for 1968: “This has been a milestone year for the Department of Nursing. Negotiations with the City University led to the joint announcement of a baccalaureate program in nursing to be launched in September 1969 with the [Mount Sinai] Director of Nursing holding the position of Dean of the School of Nursing. Alumnae, staff and students have all expressed enthusiasm at the forward step. They are particularly pleased at the acceptance of the name, The Mount Sinai Hospital School of Nursing at The City College.”

And so it was, but only briefly. The first class was admitted to the program in fall 1969, along with a sophomore group that had started at Sinai, and a graduation ceremony was held in 1972 for thirteen students. However, the two institutions could not work out long-term arrangements and so the relationship was terminated by 1974.

The closing of the School left behind a saddened but vibrant Alumnae Association that continues to serve its members and The Mount Sinai Hospital today.

Mount Sinai’s Missing Streets

The Upper East Side home of The Mount Sinai Hospital and the Icahn School of Medicine at Mount Sinai spans continuously from 101st St down to 98th Street, with other buildings arrayed nearby. To achieve this continuous campus, what had once been 99th and 100th Streets between Madison and Fifth Avenues have disappeared. How and when did that happen?

View along 100th St., around 1937

The Mount Sinai Hospital moved to 100th Street in 1904, taking up the whole block between the avenues and up to 101st Street. In 1911, the Hospital started buying lots on the south side of 100th Street in anticipation of a large expansion program. By 1921, those new buildings stretched from Fifth Avenue across but not quite to the end of 100th Street. The street was used for physician parking, and in December 1949, New York City deeded the bed of 100th Street to Mount Sinai. It continued as parking for a few more decades, but with the construction of the Guggenheim Pavilion starting in 1986, the street disappeared into a plaza between the original buildings and the new.

The story on 99th Street is very similar: Mount Sinai had expanded to having buildings spread along the northern side of the block. At the end of the 1950s, when construction of the Klingenstein Clinical Center (KCC), fronting onto the corner of Madison and 99th Street, was being planned, Mount Sinai sought the help of the City, and in August 1958, the road bed of 99th Street was deeded to Mount Sinai.

And what about the former streets? Once the construction on KCC was finished, this area became known as the Hospital Gardens, and graduation ceremonies for our School of Nursing, as well as special events were held out there. The plaza across 100th Street was covered in bricks, and a large sculpture called La Sfera Grande by Arnaldo Pomodoro was placed there in 1974. In the late 1960s, all of the buildings along the former southern side of 100th Street and the northern side of 99th Street were torn down to make way for the Annenberg Building. The Gardens became Ross Park, and today the Sfera Grande sits adjacent to the Nathan Cummings Atrium in the Guggenheim Pavilion. This is only appropriate since Mr. Cummings had originally given Mount Sinai the sculpture.

Nursing School graduation in the ‘Gardens’ in 1961. Note that KCC is being built in the back left of the image.

Florence Nightingale’s 200th!

This year the world marks the 200th anniversary of the birth of Florence Nightingale (1820-1910.) Her name is known around the world and nurses everywhere enjoy the fruits of her labors today. She lived a long time ago in a very different world, but she enunciated the basic philosophy of modern nursing, and introduced statistics into the study of disease.

The Aufses Archives has copies of two of Miss Nightingale’s books: Notes on Nursing and Notes on Hospitals. The Mount Sinai Hospital School of Nursing, which existed from 1881-1971, had a small collection of Nightingale letters that they had gathered over the years. Some of these were given to the Columbia University School of Nursing in 1953, as shown in the image below.

      From the Aufses Archives

 

 

 

 

 

 

 

 

 

Hospitals, schools of nursing, archives, and history of medicine collections will be marking the 200th anniversary of Florence Nightingale this year with celebrations, blog posts, exhibits and lectures. Here are links to just a few of those celebrations going on this year:

Nightingale: Lady and Legend at the National Library of Medicine: https://circulatingnow.nlm.nih.gov/2020/05/12/nightingale-lady-and-legend/   This includes this note on sources: The National Library of Medicine’s holdings of Nightingale materials are (unsurprisingly) extensive, with over seventy printed titles and editions. In addition, the Library holds a group of Nightingale letters written between 1845 and 1878, all of which may be read as part of the Florence Nightingale Digitization Projectand a copy of an oral history interview conducted by M. Adelaide Nutting (herself a giant in the history of nursing) in 1890. A transcript is available at http://oculus.nlm.nih.gov/2935116r.

A blog post on the University of Maryland, Baltimore School of Nursing ties to Nightingale: https://www2.hshsl.umaryland.edu/hslupdates/?p=4177

A blog post at the UCLA Library about the Elmer Belt FN Collection and other Nightingaleiana we have and use: https://www.library.ucla.edu/blog/special/2020/05/11/happy-birthday-florence-nightingale

Finally, there is a special exhibit at the Florence Nightingale Museum in London called Nightingale in 200 Objects, People & Places  https://www.florence-nightingale.co.uk/200objects/  Sadly, the Museum is closed due to the pandemic and is struggling financially. As they note:

Nursing, washing your hands and evidence based-healthcare, pioneered by Florence Nightingale, have become more important than ever before and we’re calling upon our friends and supporters to help us preserve her story and legacy.

Nurses Do It All!

In honor of National Nurses Week, the Mount Sinai Archives would like to recognize that for over 100 years, Mount Sinai nurses have been doing it all, and then some.  When she was a student at The Mount Sinai Training School for Nurses, Class of 1917, Sybil E. Elzas created a little notebook containing important things she needed to know on her clinical rotations, and then once out on her own as a graduate nurse.  (Most professional nurses at this time still did private duty nursing, not hospital work.)   The notebook was sized just right to slip into the pocket of her uniform’s apron. After pages and pages of definitions of terms and lists of operating room tray set-ups and dressings, towards the back of the book is a lone page noting the recipe for “Mount Sinai Hand Lotion.”   Why purchase something nurses could so easily make, and at reduced cost?!

 

Nurses, still making a difference at Mount Sinai, 100 years later.

Inside cover of the clinic notebook belonging to Sybil E. Elzas.

  Inside cover of the clinic notebook belonging to Sybil E. Elzas. She is shown here as a student while on rotation to Sloane Hospital. The recipe for the lotion is at the end of the volume.                                                                        

Mount Sinai lotion152