“Little Doc”: Architect Of Modern Nursing

Features appear in each issue of Pennsylvania Heritage showcasing a variety of subjects from various periods and geographic locations in Pennsylvania.

Lavinia Lloyd Dock (1858-1956) labored long and hard as educator, settlement worker, historian, author, editor, columnist, pacifist and radical suffragist. Beyond this, she strove to internationalize the public health movement while continually elevating the status of women. But her contributions to the field of nursing­ – which helped transform what was then a despised trade into a genuine scientific profession – earn her recognition as an architect of modern nursing.

Curiously enough, Lavinia Dock was an ardent and vociferous activist for causes she believed just, but she was so self­-effacing that she removed nearly all references to herself and her work in preparing the Dock family papers for the Library of Congress, Washington, D.C., and the Pennsylvania State Archives, Harrisburg. “Do not praise her. She does not like it,” she sternly wrote more than once. So great was her reluctance to commit her name to posterity that she did not, until she was extremely old, allow the Johns Hopkins School of Nursing in Baltimore to name its chemistry laboratory after her.

This aversion to fame, combined with the “embarrassing” militancy of her later years, may help to explain why she has received so little attention from historians interested in her gifted family. Yet, Lavinia Dock sought and found more adven­ture than most men of her day. She was one of the first nurses to arrive following the outbreak of Florida’s yellow fever epidemic and after the disastrous Johnstown Flood of 1889. She toiled in the roughest slums of New York City, journeyed throughout Europe to advance the cause of modern nursing, picketed with the shirtwaist strikers, cham­pioned birth control, and – at the age of sixty – served three prison terms for demonstrating on behalf of women’s suffrage in front of the White House.

Lavinia Dock was born in Harrisburg in 1858, the second of six children of Gilliard and Lavinia Lloyd (Bombaugh) Dock. The family, descended from Pennsylvania Germans, Hicksite Quakers and Huguenots, was noted for various achieve­ments. One grandfather was a judge, the other actively aided the philanthropist-reformer Dorothea Dix in her work for Pennsylvania’s insane. An uncle, Dr. George Dock, was a founder of the Dauphin County Medical Society and an early proponent of pure drinking water. Her brother George pioneered work in the treatment of coronary thrombosis, leukemia and Hodgkin’s Disease, and was pronounced “the greatest medical man of today” by Sir William Osler, the renowned Canadian physician. Three of her sisters also garnered accolades in various fields. Mira, an eminent horticul­turist, was the first woman to hold a major post in Penn­sylvania government as a state forestry commissioner; Laura was an artist whose work hung in the 1893 Columbian Exposition in Chicago; Emily was a talented violinist. A fourth sister, Margaret, acted as housekeeper for the family.

In an autobiographical sketch published twenty-one years after her death in the January 1977 issue of Nursing Outlook, Dock recalled her childhood as happy-go-lucky. She never cared for dolls nor owned any, but loved the outdoors. A compulsive reader by the age of five, she was, seven years later, reading and absorbing (in her own words) “the earliest challenges thrown out by defiant women.” Throughout her schooldays at a girls’ academy in Harrisburg, she was recognized as a brilliant scholar, but one who lacked ambition. A pianist of near-professional ability, seventeen-year-old Lavinia Dock caught the ear – and eye – of the great Polish violinist Adamowski and overheard him remark, in a casual, rather patronizing tone, that she would make a good wife. “Something in his manner conveyed a sense of inferiority. I felt keen mortification – also a sense of alarm. In a flash, I seemed to see my freedom gone, myself a household drudge, and no way out. I said to myself, ‘I never will,’ and that impression stayed with me all my life.”

None of the Dock sisters ever married. They remained at home, playing musical instruments with the Wednesday Club: painting and sketching, supporting charitable and civic causes and, after their mother’s death in 1876, accompanying their father on camping trips to Broadtop Mountain at Hopewell in Bedford County. Gilliard Dock encountered financial crises throughout his business career, but the family had inherited enough land to provide his children comfortable incomes until the Great Depression.

In November 1882, Lavinia Dock, then twenty-four years old, read an article in The Century that changed her life. The article, “A New Profession for Women,” depicted in powerful detail the grim plight of the sick in city tenements and the urgent need for nursing reform. The writer singled out the new Bellevue Training School for Nurses in New York for its unprecedented reform of nursing practices.

No occupation was more in want of reform than nursing. Earlier in the century, many police courts routinely offered prostitutes the choice of sentences: either prison or hospital work. In the 1870s, investigators found nursing at Bellevue still in the hands of female ex-convicts. Wards were filthy, care primitive and drunkenness common. Nursing standards were nonexistent and attendants often charged fees for their services, ignoring patients who could not pay. Nurses everywhere bore the stigma; English biographer Lytton Strachey characterized them as “coarse old women, always ignorant, usually dirty, often brutal.” Even the kindest and best-intentioned were so poorly trained and equipped that they risked harming patients, the medical profession and women’s struggle for equality.

The glamour surrounding nursing legends Florence Nightingale and Clara Barton began drawing new attention to the discredited field of service. Hundreds of thousands of young men died during the Civil War and the women who would have married them now sought something to replace the traditional roles for which they had been trained. Nursing schools based on the Nightingale Plan were set up in larger hospitals and intelligent young women seized on them as gateways to freedom from futile lives of enforced leisure. For the first time since the Middle Ages, women from “good” families left home in great numbers to care for the sick.

When Florence Nightingale announced her intention to become a nurse, her parents reacted “as if I wanted to be a kitchen maid.” Thirty years later, when Lavinia Dock voiced similar aspirations, a Harrisburg society leader cried, “Why, I had thought the Dock girls were ladies!” Even her most liberal friends feared for her reputation. But Dock would not be dissuaded. Whatever her father’s initial misgivings, Gilliard Dock came to respect her decision and later praised her “spunk” and sense of duty.

Lavinia Dock began the three-year training in 1884. It was a heroic period in nursing’s history. Taking responsibility for one’s own life was still a highly unnerving move for women in the second half of the nineteenth century and those who braved society’s disapproval to do so felt a solidarity, keen interdependence and sense of mission that transcended the twelve-hour days in the wards, the long evenings of instruction and training, and the spartan accommodations. “The women who plunged into this public housecleaning were so absorbed by it,” Dock wrote, “that to them, for a time, the outer world ceased to exist. It was quite as adven­turous, quite as exciting, as war musing.”

Following graduation in 1886, Dock held several posts at Bellevue. In 1888, she was hired by a private charity as the first visiting nurse in Norwich, Connecticut. When the “yellow jack” epidemic erupted in Florida in August, she left to supervise a ward in the temporary Sand Hills Army Hospital near Jacksonville. Of her experience she reported: “A strangely debased type of adventurer came to Jacksonville – immoral abandoned women and unprincipled men. . . . Through the scene of distress, terror and death moved many figures brought there by the great need – many of them ministering in faithful unselfishness according to their knowl­edge, others preying on a stricken community.” Cold weather eventually ended the epidemic and the hospital staff disbanded.

Six months later the dam above Johnstown collapsed and Lavinia Dock was among the first nurses to arrive in the ravaged valley. She met the legendary Clara Barton, founder of the American Red Cross Society, establishing a friendship that continued through the Spanish-American War and would lead to Dock’s writing, with others, The History of Red
Cross Nursing

Lavinia Dock returned to New York in 1890 as night superintendent at Bellevue, where she began researching and writing Materia Medica for Nurses, “the only piece of work I ever thought of myself.” Shocked by the paucity of basic nursing texts and horrified by doctors’ dangerous ignorance of drugs, she attempted to provide, as conveniently as possible, essential information which had previously been available only in ponderous medical tomes. She also collected safe recipes which made the nauseating liquid drugs then commonly used more palatable. She showed the book to no one but sent it by messenger to Putnam’s which agreed to publish it – on condition that she underwrite all expenses. Without hesitation, Dock borrowed money from her father who warned that she was gambling on a gold brick. The brick proved to be 24-karat: Materia Medica soon became a classic, reprinted many times and eventually selling some 150,000 copies.

In November 1890, Dock was appointed assistant super­intendent of the new Johns Hopkins Hospital Nursing School. While in Baltimore, she began her lifelong friendship with two other extraordinary nurses, Isabel Hampton (Robb) and Adelaide Nutting. The three, all in their thirties, would become preeminent in the establishment of nursing as a genuine and respected profession.

Dock took over the first-year classes, as well as much of the ward teaching. Her students never forgot the impact of her arresting personality, the brilliance of her teaching, nor the forthrightness with which she dispensed praise or blame. A notebook preserved from her classes reveals a demanding course of study far in advance of its time. A half-century later, a nursing historian noted that Lavinia Dock, from the beginning, used the basic principles of chemistry in her training. “Very soon we learned an extraordinary mind was among us – a scholar, a student, a teacher of rare originality and ability,” Adelaide Nutting later recalled. She characterized Dock as “the most noble, most unselfish, most largely helpful of women, in many ways the greatest spirit that ever moved in our midst.”

In 1893, Dock, Nutting and Hampton organized a nurses’ conference at the Columbian Exposition, the first step toward their goal of uniting American nurses through a national organization with established nursing standards. Following the exposition, Dock remained in Chicago and became prin­cipal of the Illinois Training School for Nurses. But it was not a congenial relationship. Although she laid the foundation for a three-year training course, she was not a success as an administrator and admitted candidly that she lacked diplomatic skills in personal relations. Even her staunchest supporters conceded that her want of tact and somewhat puckish sense of humor were not always understood or appreciated.

Gilliard Dock died in April 1895, leaving four daughters still at home. Lavinia returned to Harrisburg to manage the household so that Mira, at forty-one, could begin a year’s study at the University of Michigan in preparation for what would be a distinguished career in park development, town planning and forestry. While in Harrisburg, Lavinia outlined rules for the Harrisburg Visiting Nurse Association, some of which remain in effect today. Late in 1896, Dock departed Harrisburg to join Lillian Wald’s Henry Street Settlement House as one of its first resident nurses. Settlement work was publicly scoffed at by Emma Gold­man, the famous anarchist of the day, as “teaching the poor to eat with a fork,” yet Henry Street was second only to Jane Addams’s Hull House in Chicago in promoting wel­fare activities, community programs and preventive health care for destitute immigrant families living amidst the squalor of big city slums. The settlement house’s success in showing what good nursing could do to lower the absentee rate of impoverished school children prompted the creation of the New York City Bureau of Child Hygiene and the entire system of school nursing. Dock’s substantial contributions to Lillian Wald’s speeches and articles helped make the charismatic social worker one of the most famous women of her era.

In later reminiscences, Wald lauded “our dear Docky’s” fervent willingness to extend herself: “When confronted by needy immigrants unable to speak English (she) would try to learn enough of the family’s native tongue to make herself understood.” Neighbors recalled her trudging up back alleys, a nurse’s bag in one hand and a foreign language dictionary in the other. Presidential candidate Al Smith was just one of many former East Side children who had cause to remember “Little Doc” with affection.

Henry Street entranced Lavinia Dock. “This daily contact with the real things that are going on in the world gives an in­describable charm and fascination to life; one seems to be at the very heart of things,” she said. “I never began to think until I went to Henry Street.” She helped Leonora Reilly organize a woman’s local of the United Garment Workers of America, attended socialist meetings and became an early member of the Women’s Trade Union League. She tested the suffrage law by attempting to vote, was arrested, but Police Commissioner Teddy Roosevelt refused to jail her.

Despite these political activities, the professionalization of nursing remained Lavinia Dock’s primary goal. She played a pivotal role in the formation and achievements of the major nursing organizations of the late nineteenth century and served on the faculty of the first post-graduate course for nurses at the Teachers College of Columbia Univer­sity. She represented the United States at the first conference of the Inter­national Council of Nurses (ICN) in London in 1899. She wrote the council’s con­stitution and by-laws and served for twenty-two years as its unpaid secretary, traveling between Henry Street and Europe so frequently that a desk was kept for her in London. A vigorous force in helping nurses in a dozen countries unite, she was considered the communications center of the professional nursing world. Her unflagging enthusiasm is credited with keeping the ICN active and functioning amidst the international hatreds of World War I. “Nurses have no enemies,” Dock insisted.

In 1900 she helped found The American Journal of Nursing as a charter stockholder and foreign editor. Easily the most colorful of the Journal‘s original staff, she brought her own strong biases (“mildly socialistic, ardently pacifist and mili­tantly suffragist”) to her articles and wrote with a trenchant pen that gives her columns a timeless appeal.

Prudent investments – much of her earned income was donated to nursing groups – enabled Dock to travel freely throughout Europe. Fluent in French and German and somewhat understandable in other languages, thanks to her tenure at Henry Street, she spent several years gathering and translat­ing material from libraries in France, Germany, Austria, Italy, Greece and elsewhere. It was in 1902 while traveling abroad that Adelaide Nutting, by then superintendent of the nursing school at Johns Hopkins, suggested that they write the first real history of nursing. Their work was a happy collaboration which Dock claimed gave her more enjoy­ment than anything else she had done. (She was apt to say this about each new project she tackled; friends rightly called her an “appreciator.”)

Dock and Nutting completed the first two volumes of The History of Nursing in 1906. Again Putnam’s failed to envision commercial potential for such a work, so the dauntless authors secured a bank loan to underwrite all publishing costs. The History, the first copy of which went to the aging Florence Nightingale, created some­thing of a sensation in international medical circles. Osler declared it “splendid”; other physicians com­mended its scholarship and literary style and ap­plauded the absence of pious platitudes and superstitious conceits. The History of Nursing soon became a stan­dard reference which was reprinted for decades. The third and fourth volumes were published in 1912 bearing only Dock’s name. All royalties were assigned by Dock to the ICN.

Lavinia Dock continued campaigning for medical and social reform. She was the only nurse of her day to crusade against venereal diseases and one of a handful of women members of the American Society of Sanitary and Moral Prophylaxis, a volunteer physicians’ group dedicated to exposing the forbidden subject. Her book, Hygiene and Morality, published in 1910, was reviewed in The New York Times as a “plain-spoken manual on the medical, social and legal aspects of the Social Evil, with a graphic account of the white slave traffic based on her wide social work experience.” During her fifties, she initiated a national census of almshouses; helped Adah Thoms and other black nurses establish a national association of nurses; worked with the Equality League of Self­-Supporting Women for equal pay with men; strode the picket line in the 1909 shirtwaist strike; and spoke out for the legalization of birth control. In a major speech to the 1913 American Nurses Association convention, she strayed from her assigned topic and appealed for an understanding of the labor movement and a sense of sisterhood with other working women.

Convinced that only women’s suffrage could end the abuses of industrial society, Dock joined Alice Paul’s Woman’s Party, the radical wing of the suffrage movement, and, in 1912, wrote to Mrs. Bedford-Fenwick of The British Nursing Journal: “Do what I will, I can’t make anything else seem impor­tant just now. I only live for the work of meetings, propaganda and the reading of suffrage news. It’s the most fasci­nating, the most exhilarating work I ever did.”

Instead of returning to Henry Street following the ICN con­ference in Cologne in 1912, she joined Emmaline and Christabel Pankhurst in London, where the English suffrage movement was most militant. No records prove that she took part in the rash of mail­box bombings or window smashing at Whitehall, but Dock did confess in old age that it had been “a great joy to do a little guerrilla war in that cause.” A dismayed acquaintance reported seeing her in Piccadilly that spring armed with an advertising board, hawking the latest issues of a suffrage publica­tion in loud, piercing American accents that caused startled bypassers to stop, stare and buy a copy.

The following year, Dock operated a suffrage news­stand in New York, conducted rallies in the city’s Italian quarter and joined suffrage marches to Albany and Washington. Wald wrote in The House on Henry Street that Dock “mobilized Russians, Italians, Irish and the native-born, all the nationalities of our cosmopolitan community for the womens suffrage campaign. When the suffrage parade marched down Fifth Avenue in 1913, back of the settlement banner with its symbol of universal brotherhood walked a goodly number carry­ing flags with the suffrage demand in ten languages.”

A July 1915 issue of The New York Times gave extensive coverage to the pursuits of Lavinia Dock and Irish suffragette Margaret Hinchey, depicted as “‘two Trenchwomen’ who descend deep into the subway excavations to interview long­shoremen.” The newspaper quotes an enthusiastic Dock: “Every day between 12 and 1:30, Miss Hinchey and I carry our Irish, Italian, German, English and Yiddish leaflets and everywhere get a kind welcome. Men tell us how well their wives run their homes and that they will vote for the suffrage as tribute to their womenfolk. The police too are very kind. Wherever you find the American workingman, in the ditches or on the docks, he is a gentleman.” She had less faith in men from her own background, however, and advised Carrie Chapman Catt, leader of the more conservative National American Woman Suffrage Association, that the “upper classes of men whom you chiefly see will never let women vote if they can help it. … The only hope we have for winning is the labor vote.” She also warned that the Association’s refusal to unionize its offices antago­nized the workers.

An alarmed Lavinia Dock saw the approach of World War I as the wholesale denial of everything the settlement workers had tried to do in teaching immigrants to forget their race rivalries and prejudices. She, Wald and Jane Addams – who stayed at Henry House during her frequent trips to New York – entered the ranks of those opposing war at any price. Even after America entered the war, Dock was unreconciled and refused to permit any mention of it in her foreign department of the Journal. Her sentiments echoed those of Haldora the Dane who, on the eve of battle in the year 1000, urged the women of her household: “Let us go forth and dress the wounds of the warriors, be they friend or foe.”

Dock’s intensifying militancy was not well accepted in either nursing or social reform circles. And she would not lower her profile. “At a time when men are performing as they are with all manner of violence, it is queer indeed that it should be considered unseemly for women to urge their claims… I hold that it is right and timely for women’s protests to be heard on all sides and on every occasion.” Tensions grew until she was obliged to resign from the Henry Street Settlement House board. Although she remained friendly with Wald, she moved out of the residence she had known for twenty years.

Early in 1917 she arrived in Washington to participate in a massive drive to add a suffrage amendment to the U.S. Constitution. She already held membership in the Woman’s Party Advisory Council and was a regular correspondent for The Suffragist. On June 27, she was “privileged” to be one of the first six American women imprisoned for suffrage activities. Some 500 suffra­gists were arrested that year, although onJy 158 (twenty-one of whom were Pennsylvania women) were actually jailed for their protests. Other suffragists jailed for demonstrating were the great Catholic Worker Dorothy Day and Louise Bryant, characterized in the recent Academy Award winning film, Reds.

Dock was jailed three separate times for carrying a banner and flag in front of the White House – behavior described by the court as “unpatriotic, almost treasonable.” Her longest sen­tence was for thirty days in Virginia’s infamous Occoquan Workhouse. Conditions were so vile that the health of some of the prisoners was impaired and Dock, who believed that she had learned to eat anything, testified that she found it “hard work choking down enough food to keep life in.” Ever buoyant, however, Dock later said “going to jail gave me a purer feeling of unalloyed content than I ever had in any of my other work where I always saw some imperfection to cause chagrin.”

Lavinia Dock shocked her Journal readers for the last time in 1921 by advocating birth control to conserve life and by praising birth control advocate Margaret Sanger for “teaching poor women what other women may learn if they wish to.” The next year serious family illness forced her, at age sixty­-four, to resign her many posts and join her sisters at their secluded house in the forested mountains (now called “Dock’s Woods”) near Fayetteville in Franklin County. Failing eye­sight and growing deafness may have slowed her, but she continued her voluminous correspondence throughout the world, dispatching encouragement, oftentimes financial, to nursing clinics as far away as Turkey and China.

One by one, her sisters and brother died and, although she complained that “I seem to be living unnecessarily long,” her letters expressed her characteristic zest for life and living. She followed the New Deal eagerly and, far into her nineties, painted and played the piano for hours every day. To the end of her life, women’s rights sustained her interest; at ninety she petitioned the ICN to support the Equal Rights Amend­ment and felt “abounding discouragement” at its refusal. At no time in her life did she ever give up the cause.

Lavinia Dock died at the age of ninety-eight in the Chambers­burg Hospital and was buried in the family plot in Harrisburg. She left behind many legacies, lasting contributions to the reform of nursing, early social work and women’s equality. For more than thirty-five years she traveled about the world, rejecting the private, protected life prescribed by custom for a life of her own design, a life of action and controversy on the cutting edge of social change. And while she willingly engaged in public confrontation to further a principle – however unpopular – she shrank from personal publicity and remained adamant that a cause was more important than its leader.

As late as 1947, twenty-five years after her retirement from active crusading, she was feted by the International Council of Nurses at its national convention in Atlantic City. Wherever she went, the diminutive guest of honor was followed by hordes of admiring nurses as if she were the oracle of nursing. The assembled nurses had planned to establish the Lavinia Dock Fund to support an international traveling library of nursing literature. True to form – and to herself – she would not allow the fund to be named in her honor. “Using one person’s name would be too local,” she reminded them.


For Further Reading

Barton, Clara. The Red Cross. Washington, D. C.: American Historical Press, 1899.

Bridges, Daisy Caroline. A History of the International Council of Nurses, 1899-1964. Philadelphia: J.B. Lippincott, 1967.

Irwin, Inez Haynes. The Story of the Woman’s Party. New York: Harcourt Brace, 1921.

Johns, Ethel, and Blanche Pfefferkorn. The Johns Hopkins School of Nursing, 1899-1949. Baltimore: johns Hopkins Press, 1954.

Stevens, Doris. Jailed for Freedom. New York: Boni & Liveright, 1920.

Wald, Lillian. The House on Henry Street. New York: Holt, 1915.

Williams, Beryl. Lillian Wald, Angel of Henry Street. New York: Messner, 1948.


Alice K. Marshall is a freelance writer who has served as public relations director, Pennsylvania Department of State; executive assistant to the Secretary of the Commonwealth; deputy press sec­retary and chief speech writer, Pennsylvania Department of Commerce; editor, Pennsylvania Psychiatric Quarterly; senior research analyst, Pennsylvania House of Representatives; and reporter for The Washington Post. She maintains one of the most extensive private archives of women’s history source material in the nation.