What Happened to the Cap? The Dawn of the Cap

Caps of Distinction

What started out as a pragmatic head covering gradually became a hallmark of a profession. Because a nurse's cap had to be earned, it was highly coveted and bestowed upon its wearer the status of an educated, self-supporting woman outside of the hospital and a well-trained, respected, and dedicated professional within. Early schools of nursing quickly realized that the nurse's cap could become a "brand" for their institutions, and it became desirable to design a unique cap to represent their school and the image they wished to convey.^[5] (Figure 8) As more schools of nursing opened, the diversity of cap styles grew, and some became as famous as the institutions they represented.

Figure 8. Display of caps at the Luckey Hospital Museum in Wolf Lake, Indiana. www.luckeyhospitalmuseum.org. Image courtesy of Melissa Crawley.

Some of these earliest caps were designed by the founders or superintendents of the first training schools in the United States. These caps became widely recognized -- and often copied -- by subsequent training schools.

Bellevue Training School for Nurses: The Fluff

Everyone recognized the Bellevue "fluff" or "cupcake," a rounded, pleated cap of organdy with a ruffled edge, a symbol of the highly regarded Bellevue Training School for Nurses (Figure 9). The Bellevue cap, like the training school, was patterned after the St. Thomas Training School for Nurses in London, the school established by Florence Nightingale. In fact, Bellevue was the first such school in the United States. A student in the first class named Euphemia Van Rensselaer is credited with introducing the cap to Bellevue. The other students initially opposed the wearing of caps and uniforms, but after seeing Miss Rensselaer model the cap, they were eager to adopt it.^[6](Figure 10)

Figure 9. The Bellevue fluff. Image courtesy of Mary and Nicholas Petraco (photographer).

Figure 10. A doll wearing the full 1969 graduate nurse's uniform, including the cap. Image courtesy of the Foundation of New York State Nurses Bellevue Alumnae Center for Nursing History.

Philadelphia General Hospital: The Double Frill

The Blockley (named after the school's nickname, "Old Blockley") frill or the"double frill" was the cap worn by graduates of Philadelphia General Hospital School of Nursing (Figures 11 and 12). Designed by the school's first director, Alice Fisher, in 1884, the double frill was made of linen with 2 rows of fluting joined at the back; it was described by its proud wearers as a "square of linen, fluted and shaped so gracefully" that it was often copied by other training schools.^[7]

Figure 11. The double-frill cap of the Philadelphia General Hospital School of Nursing. Image courtesy of the Museum of Nursing History.

Figure 12. A nurse wearing the Blockley double-frill cap. Image courtesy of Barbara Bates Center for the Study of the History of Nursing, University of Pennsylvania School of Nursing.

Undergraduates wore a simpler single-frill cap. The original single frills were made of organdy, with a single row of fluting and a high, gathered crown. This cap could be purchased for 13 cents and it lasted for 2 weeks before having to be replaced, unless the cap was pressed carefully between the pages of a book every night, which might make it last for a month.^[7] Later, a more practical Dutch-style cap of muslin, which could also be folded flat into a book, was introduced for students and worn until 1961 when the single frill was resurrected.

University of Maryland: The Flossie

The cap of the University of Maryland School of Nursing, known as the "Flossie," was designed in 1892 by the school's first superintendent, Louisa Parsons, who modeled it after one of Florence Nightingale's own caps and named it after the great lady (Flossie is a nickname for Florence). Miss Nightingale gave her a pattern for a cap and some point d'esprit lace, as well as the privilege of bestowing it upon the nurses at the school of nursing she planned to establish.

However, the original lace Flossie proved difficult to maintain (Figures 13 and 14). Convinced that too much time and effort went into making and laundering it, in 1900, Superintendent of Nurses Katharine A. Taylor simplified the design and designated it as the graduate cap. Students wore a different, probationer's cap. Senior nursing students at the school would be taught how to string their Flossie caps at graduation, and a "fluting ceremony" was held for probationers to teach them how to flute their caps.^[8]

Figure 13. The lacy Flossie, named for Florence Nightingale. Image courtesy of the University of Maryland School of Nursing Museum.

Figure 14. University of Maryland graduate nurse wearing the Flossie. Image courtesy of the University of Maryland School of Nursing Museum.

Massachusetts General Hospital: The Ether Cap or Flat Top

Credited with being the first hospital training school to mandate wearing of a standard cap style,^[6] a cap was designed in 1878 for the Massachusetts General Hospital (MGH) Training School for Nurses. MGH's first cap is believed to have been modeled after the ether cone, a device used to administer ether before surgery. In fact, the first public demonstration of the use of ether was conducted at MGH in 1846. This early nurse's cap was sometimes referred to as the "ether cap" or "ether cone." (Georgia Pierce, personal communication, March 28, 2011) (Figure 15).

Figure 15. MGH class of 1886 wearing the school's original nurse's cap, sometimes called the "ether cap."Image courtesy of the Massachusetts General Hospital Nursing Alumnae Association.

Caps were first introduced at MGH against the wishes of some of the nurses, but after the nurses had adopted caps, the maids of the hospital also requested them.^[9] Probationers were given a piece of crinoline and they made their own caps. Initially a tall cap large enough to cover the nurse's hair, the cap became smaller over the years, and in 1951 a new, smaller and flatter cap was introduced which became known (along with the nurses who wore them) as "flat tops" (Figures 16 and 17).

Figure 16. The original MGH nurse's cap (top) and the MGH flat top (bottom). Image courtesy of the Massachusetts General Hospital Nursing Alumnae Association.

Figure 17. A student and a graduate nurse wearing their MGH flat tops in the 1960s. Image courtesy of the Massachusetts General Hospital Nursing Alumnae Association.

Johns Hopkins

The Johns Hopkins cap did not have a nickname, but its unique style was widely recognized and coveted. A Johns Hopkins nursing cap was immediately identifiable. It was a mark of prestige, indicating that you worked with the nation's nursing leaders and knew doctors with names like Welch or Osler.^[10]

Miss Susan Read introduced the fragile, almost transparent organdy pouf cap, originally large enough to contain the hair for cleanliness.^[11] The cap was subsequently reduced in size, but the shape remained constant. The cap was worn by both students and graduates until the 1940s when a new, Dutch-style winged cap with the initials JHH emblazoned on the front was introduced for students (Figures 18 and 19).

Figure 18(a). The renowned Johns Hopkins graduate cap. (b) The trademark Johns Hopkins student nurse cap. Image courtesy of Johns Hopkins University School of Nursing.

Figure 19. Head nurses writing reports while wearing Johns Hopkins graduate caps. Image courtesy of Johns Hopkins University School of Nursing.

In the hospital, a nurse's cap could identify her alma mater to colleagues, patients, and physicians. In a letter to the American Journal of Nursing in 1931, nurse Julia Gardner wrote, "When entering a strange hospital, as an affiliating student or visitor, it is almost like seeing a familiar face to see the cap of one's own school on a nurse there."^[12]

Caps, along with crisp white aprons or unforms, had a pronounced effect on the public. Kalisch and Kalisch write of the St. Luke's nurses' "airily poised little caps of sheer white" conjuring up an "image of exquisite orderliness."^[6] No doubt many young girls were influenced to pursue a nursing career after seeing, and yearning for, one of those caps.

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Cite this: Laura A. Stokowski. What Happened to the Cap? The Dawn of the Cap - Medscape - May 03, 2011.