Keeping the "Household Machine" Running: Attendant Nursing and Social Reform in the Progressive Era

We need to organize that old spirit of neighborly helpfulness which still exists in our hearts, if not in our deeds, and make it do its work again by bringing it up-to-date. ¹

For charity director Richards Merry Bradley, reviving "that old spirit of neighborly helpfulness" meant restoring women's traditional role in health care to resolve the knotty problem of female poverty. In 1907, Bradley conceived the Brattleboro Mutual Aid Association (BMAA), a novel household nursing organization, as a means to supply the poor women of Brattleboro, Vermont, with charitable aid. Chief trustee and steward of the Thomas Thompson Trust, a Boston-based charity dedicated to the needs of poor "seamstresses, needle-women, and shopgirls" of Brattleboro, Bradley sought to resolve his clients' health and domestic problems and reduce the rising cost of health care in the community. In the process, he hoped to revive and reshape the benevolent impulses of the town's middle-class women as well. He urged them to recruit laboring women into a corps of trained "nurse helpers," who would provide essential care in the homes of the poor under their supervision. At a rate of only $1.25 to $1.75 a day, a nursing attendant would be far less expensive than hospital care or the services of the district nurse, who could command nearly three times the rate. In Bradley's view, household nursing embodied not only an efficient use of charitable funds but also the crucial role of women in restoring the family and reviving the social obligations that appeared to have waned with industrial development. ²

The story of the BMAA, one of the earliest organizations of attendant or practical nurses, and of Bradley's promotion of household nursing reveals the connection between efforts to alleviate poverty during the Progressive Era and the genesis of two grades of nursing. In the late nineteenth century, the association of women with caring and domestic labor dictated that any woman might qualify as a nurse, but differences in education, class status, and ethnic or racial identity differentiated the ranks of potential nurses. Nursing histories have detailed the struggle for professionalization among white nurses and the exclusion of most immigrant and black women from the training process. While the latter developed separate institutions, the nursing elite promoted nurses' autonomy within established medicine and sought to upgrade the profession with training requirements, hoping to distance the work from domestic labor. ³ Trainees (or, in some areas, African Americans) served as nurse helpers, but by the 1910s an increased demand for household care for the poor and for low-cost hospital labor precipitated calls for another class of lower-paid attendant nurses. The nursing elite, who viewed the creation of two nursing grades as a threat to nurses' compensation, full employment, and identity, resisted this development and significantly retarded the acceptance of attendant nursing for several decades. ⁴ Focusing on gender and the problems of professionalization, recent historians have largely portrayed those who promoted this deskilling as either exploiters of female labor or zealous advocates of efficiency. ⁵ This study shifts the focus from the results of grading to the ideological roots of attendant nursing, which were largely embedded in efforts to diminish charitable direct aid and deliver health care to poor households.

The development of professional preventive health care and the focus on urban poverty at the turn of the twentieth century reinvigorated the age-old connection between nursing, womanly duty, and charity. The gradual acceptance of germ theory, the development of new medical therapies, and the evolution of hospitals from charitable to fee-based institutions led social reformers to preventive health education for the poor and home nursing care to alleviate poverty. They believed that ill health and infant deaths could be prevented not only through new vaccines, milk...