Karen Egenes
Centennial, Colorado, United States

In 1883, the board of the Guardians of the Poor, the administrators of the Philadelphia almshouse, faced a dilemma. The institution, founded in 1732 and often referred to as “Old Blockley,” was a combination of an almshouse for paupers, workhouse for vagrants, jail for criminals, asylum for the insane, and hospital for patients. The high patient mortality rate and unsanitary hospital conditions had led to cries for reform. But board members believed they had the perfect solution to the problem: find a proper graduate of the Nightingale School to reform the institution.

Florence Nightingale sought to forge nursing into a career for educated single women of impeccable moral standards. She selected upper-class women to assume leadership of the nursing profession and “set the standards by which all nurses would be judged.”¹ These lady probationers, called “Nightingales” after graduation, sought to bring respectability to nursing through their moral superiority and skill in patient care. Upon completion of their educational program, the lady probationers would be sent by the Nightingale Trust to yet unreformed hospitals. They were appointed as nursing superintendents, more because of their recognized social status than their nursing or administrative skills.

A board member’s friend in London suggested that Alice Fisher, a graduate of the Nightingale School, would be capable of reforming Blockley. He added that the board would be fortunate if they could secure her services.²

Alice Fisher was born in 1839 in a palace in Greenwich. Her father, Rev. George Fisher, was head of the Royal Naval School as well as an astronomer, scientific writer, and polar explorer. After the death of her mother, Miss Fisher assisted her father in entertaining men of science and culture. In 1875, motivated by her recent experience nursing her father, and a long-standing desire to embark on missionary work in India, she enrolled in the Nightingale School. After the year-long course of study, Fisher was sent by the Nightingale Committee to the Royal Edinburgh Infirmary to serve as assistant superintendent. However, only six months later, she angered Miss Nightingale by accepting a position, on her own, at the Fever Hospital at Newcastle upon Tyne. Although angered, Nightingale maintained correspondence with Fisher.

The following year, again without consultation with the Nightingale Committee, Fisher accepted a position at Addenbrooke’s Hospital in Cambridge. There she served as superintendent for five years, initiated hospital reform, and founded a training school. In quick succession, she reorganized the Radcliffe Infirmary in Oxford and accepted the position of superintendent in Birmingham. From there she was invited to Philadelphia in the summer of 1884.

In October 1884, Alice Fisher sailed for Philadelphia aboard the ship British Crown. She brought with her Miss Edith Horner, a friend and co-worker at Cambridge and Oxford who would serve as her assistant. Horner recalled about Fisher, “[Birmingham] did not suit her. … She missed the society she had been used to at the two universities, where her rooms were the meeting place of the cleverest men and women of the day.”³ It is unclear exactly what led Fisher to emigrate to Philadelphia. Perhaps the proximity of Blockley to the University of Pennsylvania appealed to her interest in an academic environment, or the pathetic descriptions of Blockley may have appealed to her latent desire to embark on missionary work.

But political controversy erupted in Philadelphia even as Miss Fisher sailed. Several Board members wanted a Philadelphia woman, or at least an American woman in the position, and thus refused to vote for her approval. There were also debates about the nurses’ salaries.

But Alice Fisher worked at carving her own path. While onboard, she met a party of women influential in Philadelphia society who were impressed by her British manners, culture, and background. She interested them in her planned work and enlisted their help in promoting philanthropic activities to benefit the hospital and its patients.

The Philadelphia Times announced the nurses’ arrival, stating, “Both Miss Fisher and Miss Horner are ladies of good social position in England.” A Philadelphia physician later recalled, “[Their] gentle birth and superior education… and the fortuitous meeting with the Philadelphia ladies on the ship, combined to give these women a social position not previously enjoyed by any Philadelphia nurses.”⁴

Nevertheless, Alice Fisher and Edith Horner encountered challenges they had not anticipated.

Alice Fisher knew the perils of care provided by uneducated assistive personnel. At Blockley, she retained and developed only those attendants who had proven themselves to be competent and caring. But she quickly dismissed political appointees who were “vicious, ignorant, or intemperate.” Disgruntled hospital attendants wrote threatening letters. When she paid no attention, a box was mailed to her, set to explode when she opened it. Luckily, the “bomb” was intercepted at the post office.

Hostility also came from more refined citizens. Fisher arrived in Philadelphia barely more than a century after the city’s occupation by British troops during the American Revolution. Certain Philadelphia citizens delighted in taking the British nurses for tours of Revolutionary War battlefields. Despite the harassment she encountered, she continued her work with her usual grace and composure.

Fisher understood the value of informing the public about the nature of nursing. It was her manner to begin reform of a hospital by first organizing classes for patient attendants and student nurses. The lectures held at Blockley were open to the public and were said to “raise an interest in nursing as it has never previously been aroused in Philadelphia.” The lecture hall was reportedly filled “from the floor to the ceiling.” Within three days of the school’s opening, reporters from Philadelphia newspapers huddled by the hospital’s doors, hoping to catch a glimpse of “trained nurses at work.”⁵

But Miss Fisher remained first of all a British lady. Her quarters were decorated with portraits of British nobility. She scheduled tea for her probationers from three to five each afternoon, with dinner served at 8:30 pm. However, this practice was discontinued when the wait staff complained about the long hours they were made to work to adhere to the schedule of the British nurses.

Within her first three years in Philadelphia, Fisher was able to reform Old Blockley. She created a caring environment for the institution’s 3,000 ill, infirm, and insane patients; founded a notable training school that endured for over ninety years; and won the admiration of the citizens of Philadelphia. Unfortunately, she died of valvular heart disease only four years later at the age of only forty-nine. During the last year of her life, although her condition weakened, she refused to return to England. Instead, she continued to make rounds in the hospital, pushed from ward to ward in a wheelchair. Even as she made plans for her funeral, Alice Fisher requested that her coffin be constructed of British oak and draped with a British flag that bore the insignia of the Royal Navy.

Her death marked a great loss to nurses, physicians, and noteworthy Philadelphia citizens who knew and admired her. For several years following her death, on the Monday after Easter, graduates of the school she founded held a procession to her grave that, by her direction, “overlooked her beloved Blockley.”

Just before her death, her able assistant Edith Horner resigned her position to marry Senator Hawley from the state of Connecticut. Marion Smith, a student from Birmingham, was recruited to serve as the hospital’s superintendent.

Despite Fisher’s accomplishments, hard feelings arose among both the British nurses and the American-born nurses they supervised. Although the British nurses had been actively recruited to come to the US because of their expertise in nursing and hospital organization, they sometimes were met with disdain and resentment. American-born nurses resented the implication that the only “proper” nurses were those educated in the United Kingdom.

Some of the discontent undoubtedly arose from cultural differences. For example, Fisher’s travel to the US was in keeping with the Nightingale tradition that British nurses went to assignments in groups. But Americans who lacked understanding of this tradition might have been resentful that administrative positions were given the British colleagues who were members of the group. The decision to hire Fisher was made by a board of directors, with no input from the persons to be affected by this decision. The tradition of “tea time,” with the evening meal being served later in the evening, was viewed as an inconvenience as well as an oddity.

These difficulties might have been resolved through open dialogue. However, in the Victorian era, open communication was often considered improper, and possibly an attack on an authority figure.

Alice Fisher, as a member of the first generation of modern nurses, had the task of recruiting and training respectable women, and then using these recruits to cleanse and reform hospital wards. She was a pioneer who reformed nursing care and established proper nursing education. Once this foundation had been laid, later generations of nurses could focus on issues such as the development of nursing as a profession and the improvement of nursing education.⁶ But we should also consider the many cultural influences from abroad that impact American nursing today.

References

1. Martha Vicinus, Independent Women: Work and Community for Single Women, 1850-1920. (University of Chicago Press, 1985), 86.
2. J. William White, “Alice Fisher.” In Philadelphia Hospital Report, Vol. II, ed. Charles Mills and James Welk (Lippincott, 1893).
3. Edith Horner Hawley, “Alice Fisher.” Unpublished paper. Alumni Association of the Training School for Nurses of Philadelphia General Hospital collection, Barbara Bates Center for The Study of The History of Nursing, University of Pennsylvania.
4. J. William White, “Alice Fisher.”
5. Stephanie A. Stachniewicz and Jean Axelrod, The Double Frill, The History of the Philadelphia General Hospital School of Nursing (George F. Stickley Company, 1978), p. 21.
6. Vicinus, Independent Women, 87-8.