Historical essay
Our Work is Not Complete Yet: The Tuberculosis Nurse Training Program at Virginia’s Piedmont Sanatorium

Our Work is Not Complete Yet: The Tuberculosis Nurse Training Program at Virginia’s Piedmont Sanatorium

E. Thomas Ewing

In May 1940, the Piedmont Sanatorium in Burkeville, Virginia, graduated eight African American nurses with advanced training in tuberculosis care. A “Class History” and “Class Prophecy” presented at the commencement ceremony articulated the value of educational attainment, individual determination, and collegial support. As discussed in the Nursing Clio series, Beyond Florence, the history of nursing needs to be critically examined in terms of racial and gender inequities. Situating the stories of Piedmont nurses in the broader context of segregated Virginia demonstrates how, in the words of historian Victoria Tucker, “Black nurses navigated both integration’s visible paths and segregation’s prominent shadows.”

Piedmont Tuberculosis Sanatorium was established in 1918 by the Virginia Health Department to provide treatment for African American patients, who were legally excluded from the whites-only Catawba Sanatorium (established in 1909) and Blue Ridge Sanatorium (1918).

Piedmont also provided advanced training for African American nurses. Beginning with two graduates in 1920, more than 350 nurses completed the training program in the next four decades. Piedmont graduates advanced their professional careers while contending with health inequalities produced by segregated institutions, eugenicist policies, and paternalistic assumptions. Our project brings the stories of these nurses to wider scholarly and public attention while also examining their histories in the broader context of a racially divided society.

A long room with a row of single beds in which patients are tended to by women in white nursing uniforms.
Piedmont Nurses in Ward (Virginia Health Bulletin 1938)

Class History, Poem, and Prophecy

The “Class History” delivered at the 1940 Commencement introduced the eight graduates by name, hometown, and personal traits.[1] Naomi Bishop, from Portsmouth, entered Piedmont “in a happy state of mind,” while Georgia Peterson, from Norfolk, was inquisitive, conscientious, and engaged. Nannette Lee Stanley, also from Norfolk, was “a little selfish” at first, but became more comfortable with others over time. Eva Jane Wheeler, from Hot Springs, had “a sweet disposition and modest ways” and Josephine Stokes, from Alexandria, at first seemed “very sophisticated and important,” but became “quite friendly” and told jokes “on others and herself.” Florence Virginia Brown, from Hopewell, used to cry “all the time,” but “she has improved very much – in fact, she is quite grown up now.” Mary Caroline White, from Covington, entered Piedmont “full of smiles and happiness,” bringing “sunshine to those around her.” Eddie Mae Shirley, from Jackson, Mississippi, was “very friendly” and an “outstanding” musician. These highly personal descriptions are suggestive of a context where racial and gender norms required young women to display an appropriate balance of intelligence, grace, enthusiasm, and professional competence.

The “Class History” also describes the experience of women in the Piedmont training program, beginning with the “happiest day of our lives,” September 19, 1938, when these women first met: “Our voices rose with excitement and eagerness to begin our work of the year.” Trainees understood the responsibilities of their role: “When we went on duty, our heads were held high and we wore our caps with pride and dignity.” In addition to studying and training, the women also enjoyed social events, including the Junior-Senior Prom of 1939, when “everyone had a good time.” Senior year has been a time “of ups and downs, of happiness and success.” During the past two years, the speaker concluded, the trainees have gained experience and knowledge: “Our work is not complete yet, we have many problems to face in the near future. As time passes, we the Class of 1940, as part of the present generation and possessing, we hope, some of the many qualities of our Founder, Florence Nightingale, will continue to sacrifice our time, service and lives for the cause of humanity.” These experiences, observations, and reflections are suggestive of the argument by Darlene Clark Hine that “parallel institutions,” such as segregated professional training programs, became “safe havens” which “sustained relationships and wove networks across communities served.”

The 1940 ceremony also featured a “Class Prophecy” that predicted remarkably productive and happy futures in the coming decade. By 1950, Bishop would become the head technician at Michigan General Hospital in Detroit. Shirley would be a public health nursing supervisor in Washington, DC, and a concert pianist playing at Constitutional Hall. Stanley would be married with ten children living in a beautiful home with a successful husband. Brown would be supervising nurse at a private sanatorium in Roanoke, directed by Stokes and her husband while they also raised twin boys. White would leave nursing to work as a mortician at the White Undertaking Establishment in Roanoke. Peterson, who was not mentioned in this prophecy, was likely the narrator of this imagined journey “among old friends and classmates.”

A classroom of women in nurses caps observe two instructors at the front of the room demonstrating a procedure. A church of the human chest cavity is the background
Piedmont Nurses in Classroom (Virginia Health Bulletin 1938)

In fact, all eight women followed career paths marked by public service and professional accomplishment. Bishop served as a nurse during World War II; her obituary listed her as a certified public accountant in 1993. Brown also served in World War II, earning the rank of second lieutenant, which was listed on her memorial in 1994. Peterson was a registered nurse when she married Charles Patillo in 1942; the same occupation appeared on her death certificate in 1983. Shirley worked in a Detroit hospital until 1968; after her husband died, she resumed work as a nurse in her hometown in Mississippi, retiring in 1984 and passing away in 2001. Stanley was a supervising nurse at Piedmont in 1941 when she married an orderly, John Vaughter; she held the same position almost two decades later at the 1959 graduation. Her death certificate in 1981 listed her “usual or last occupation” as a nurse in Richmond. Wheeler entered the Air Force as a nurse, served in World War II, and earned promotion to the rank of major; she was buried at Arlington National Cemetery in 2009. Stokes was a nurse in 1949 when she married Marvin Ragland, and White was a nurse in private practice at the time of her marriage to Roy Dykes in 1944, but no further records have been found of any activities prior to the deaths of these women in 1989 and 2001, respectively.

Race, Nursing, and Piedmont Sanatorium

Piedmont graduation ceremonies brought public acclaim to African American women in a time of racial segregation. The names of the 1940 graduates were printed in the Richmond Times-Dispatch, a white newspaper, while the ceremony was covered in the Norfolk Journal and Guide, a Black newspaper.[2] Photographs and names of graduates were published in the Virginia Health Bulletin and republished in National Negro Health News.[3] In 1978, the Piedmont nurse alumni association recorded the names of all graduates on a bronze plaque, still displayed at Piedmont Geriatric Hospital.

A black plaque with lists of names of Piedmont Nursing School graduates
Plaque listing names of all nurses trained at Piedmont, with 1940 graduates highlighted (Photograph courtesy of Piedmont Geriatric Hospital)

None of the commencement documents from 1940 explicitly address race, yet race directly shaped the experience of these women at every stage of their lives. African American women in Virginia had limited options to acquire training as nurses in segregated institutions, including Piedmont Sanatorium, Burrell Memorial Hospital in Roanoke, Burley High School in Charlottesville, St. Philip School of Nursing in Richmond, and Hampton Training School for Nurses. These limited options partially accounted for the fact that 400 African Americans made up just 7% of all nurses in Virginia. Piedmont was led by an all-white staff of physicians and supervising nurses, although pressure was growing from African American professional and community leaders for the appointment of an “all-Negro staff.” At the 1940 celebration, Dr. I. C. Riggin, the Commissioner of Health for Virginia, awarded diplomas, and Dr. J. Belmont Woodson, Piedmont’s medical director, gave a pin to each nurse. Graduates from Piedmont succeeded in becoming professionals in a context where women pursuing limited opportunities had to overcome substantial obstacles.

Piedmont Sanatorium was established with the goal of reducing death rates from tuberculosis among African American patients. In 1918, the death rate from tuberculosis was three times higher for African Americans. By 1940, Virginia’s tuberculosis death rate had decreased to one-third the rate two decades earlier.[4] Only a fraction of victims were treated at sanatoria, so decreased death rates were primarily attributable to improved diagnosis, out-patient treatment, public awareness, and improved living conditions. Yet even remarkable reductions in rates did not narrow health disparities: the tuberculosis death rate for African Americans in 1940 was three times the rate for white Americans (the same ratio as two decades earlier). Piedmont’s success in advancing nursing careers was not matched by similar success in eliminating health disparities along racial lines. Piedmont graduates followed the path of upward mobility available to trained nurses at a time when racial segregation and gender roles constrained professional opportunities to African American women.

One moment in the “Class Prophecy” hinted at “segregation’s prominent shadows”: the prophecy that Shirley would perform a recital at Constitution Hall. One year earlier, opera singer Marian Anderson was barred by the Daughters of the American Revolution. Black newspapers mocked the “DAR ban” while celebrating Anderson’s triumphal Lincoln Memorial concert.[5] The prediction that a Black woman would perform at Constitution Hall in the coming decade may have been a subtle, but recognizable, affirmation that accomplished professional women would lead the way towards a new society.


  1. Documents from the 1940 Commencement are available as typewritten manuscripts from Piedmont Tuberculosis Sanatorium (Ms2019-009), Virginia Tech Special Collections: https://ead.lib.virginia.edu/vivaxtf/view?docId=vt/viblbv01944.xml.
  2. Richmond Times-Dispatch, May 16, 1940, p. 8
  3. National Negro Health News, Vol. 8, No. 2, April/June 1940, p. 21
  4. Thirty-second Annual Report of the State Department of Health Commonwealth of Virginia For the Year Ending June 30, 1940 (Richmond: Division of Purchase and Printing, 1940).
  5. Just weeks before the commencement exercises at Piedmont, the Norfolk Journal and Guide published an article, “DAR Ban Seen as Ironic in View of Services of Freedmen, Slaves,” May 4, 1940.

Featured image caption: Nannie Helen Burroughs, holding sign, stands for a portrait with eight other Black women, c. 1905-1915. (Courtesy Library of Congress)

E. Thomas Ewing is a professor in the Department of History at Virginia Tech. He teaches courses in Russian, European, and world history. His research on the history of epidemics, including Russian flu (1889) and Spanish flu (1918), has been published in Influenza and Other Respiratory Viruses, Current Research in Digital History, Computer IEEE and Medical History. At Virginia Tech, he coordinates the Data in Social Context program that sustains an interdisciplinary approach of data analytics, computational skills, and critical thinking in the humanities and social sciences. He has received funding from the National Endowment for the Humanities to run workshops on the 1918 Spanish Influenza, Images and Texts in Medical History, and Viral Networks.E. Thomas Ewing is a professor of history at Virginia Tech, with research interests in the history of influenza epidemics. He has published essays in Nursing Clio on preventive measures during the 1918 pandemic, including a ban on kissing, a ban on the liquor traffic, mask fashions, and Stockton health officer Minerva Goodman (the latter two essays with Jessica Brabble and Ariel Ludwig).