Mildred Tuttle: private initiative and public response in nursing education after World War II.

I have long reflected on the complicated intersection between private sector initiatives and public policy, especially as it relates to nursing and health care here in the United States. We really have no overarching philosophy of health care in this country. Only rarely do we achieve political consensus leading to large-scale planned change. But we do muddle along, trying to respond to problems that strain the social fabric and worry us. One traditional approach to solving social problems is through private initiatives or projects undertaken by people or organizations with a special interest or stake in a given problem. These days we call interested parties "stakeholders" in a slightly pejorative way. But if these private initiatives can attract public favor, political support, and funding, they sometimes lead to significant policy changes. This paper is about a private/public initiative in nursing in the decades after World War II. This particular initiative helped stimulate the reorganization and redefinition of nursing education at midcentury. The paper calls attention to nurses who engineered it and the problems they encountered, and offers a glimpse at their impact on the present. A central but little-known figure in the postwar story is a nurse named Mildred Turtle. Her name is not familiar in the history of American nursing, but Mildred Turtle exerted important influence over the 1950s and 1960s from her position as director of the Nursing Division of the W. K. Kellogg Foundation in Battle Creek, Michigan. From 1943 until 1968, she oversaw grant making for as much as 20 to 30 percent of the Foundation's constantly expanding philanthropy. Almost all this money went to nursing projects in the United States, Latin America, and Canada.1 The long-standing involvement of the Kellogg Foundation with nursing is a larger story. For this paper, I want to focus on Tuttle's postwar plans for nursing. I am relying on the minutes of her Nurse Advisory Committee, her correspondence, and the recollections of participants on the Nurse Advisory Committee who I interviewed during the 1980s and 1990s.2 Mildred Tuttle and Post-World War II Nursing Mildred Tuttle was from Ohio. She began studies in music, but she ultimately earned her bachelor's degree in nursing at Western Reserve University in Cleveland. She practiced as a public health nurse for about six years before joining the Kellogg Foundation Community Healdi Education project in Hastings, Michigan, in 1932. Here she worked with Marguerite Wales, a leading figure in public health nursing from the Henry Street Settlement in New York City. In Hastings she met Emory Morris, a local dentist who also cared for patients in the Kellogg project. Later, Mildred earned a master's degree in education from Peabody College in Nashville, Tennessee, and did field experience at the East Harlem Nursing and Health Service in New York City. In 1940, she completed a second master's degree in public health nursing and returned to Battle Creek. By this time she was a well-known figure in public health nursing, well educated, and also well respected by the small group of local men selected by William K. Kellogg to develop his Midwestern foundation based on funds from his cereal company. When, in 1943, Kellogg picked Emory Morris, the aforementioned dentist, to be president of the Foundation, Morris in turn picked Tuttle to head the Nursing Division. Morris was very interested in nursing, and would fully support her efforts for the next twenty years. As World War II came to an end, a few nurses in the United States saw an opportunity to make sweeping changes in how nurses were educated and in the very nature of nurses' work. They saw that advances in medical knowledge and technology and rising demands for higher-quality health care completely overwhelmed the capacities of the existing hospital-based educational system for nurses. The American public was also interested in the state of nursing after the war. …