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Lillian Wald: The First Public Health Nurse

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Over 100 years ago, Lillian Wald invented public health nursing.

Wald was born in 1867, of German-Jewish parents in Cincinnatti, Ohio; her father was an optician. She completed her high school education at Miss Cruttenden’s English-French Boarding and Day School for Young Ladies and applied to Vassar College, only to be rejected, since the school believed she was too young (she was 16 at the time). She became interested in nursing upon seeing her sick sister being taken care of by a private nurse, and chose to enter the nursing profession at the age of 22. She would complete her nursing studies at the School of Nursing at New York Hospital.

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Becoming a nurse in a crowded city like New York was much different than today, as Karen Buhler-Wilkerson, Ph.D., RN. explains:

“A century ago, American cities were dirty, crowded, and unhealthy places to live. The fluctuating, dramatic, and often frightening presence of infectious disease was a source of great public concern. As popular knowledge of the germ theory of disease spread, urban dwellers came to realize that individual health depended to some extent on the health of the population generally. Not only was illness a major cause of destitution, but the infectious diseases contracted by poor people appeared to threaten the well-being of middle- and upper-class urban dwellers as well.”

Thus it is within this turbulent context that Lillian Wald pursued her nursing career.

In 1893, after having worked in an orphanage that mistreated children (an experience which she would later describe as pathetic), she began to give nursing courses to low income women on the Lower East Side, a largely Jewish neighborhood. Not much later, she began to take care of the sick in this neighborhood, ultimately deciding to devote all of her efforts to this task. She decided to move there along with another nurse, Mary Brewster.

Buhler-Wilkerson explains what happens next, in the winter of 1893, when Wald learned that a Sabbath school for immigrants needed a course in home nursing:

“Unaware of the work of those who had preceded her to New York’s Lower East Side and even more ignorant of life’s realities for most immigrants, Wald agreed to establish and teach the class. A call for help to the home of one of her immigrant students, Mrs. Lipsky, changed the course of nursing history within an hour.”

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Wald later wrote of being guided by Mrs. Lipsky’s young daughter, through crowded “evil-smelling” streets, past open courtyard “closets,” up the slimy steps of a rear tenement, and finally into the sickroom:

“All the maladjustments of our social and economic relations seemed epitomized in this brief journey and what was found at the end of it. The family to which the child led me was neither criminal nor vicious. Although the husband was a cripple, one of those who stand on street corners exhibiting deformities to enlist compassion, and masking the begging of alms by a pretense at selling; although the family of seven shared their rooms with boarders… and although the sick woman lay on a wretched, unclean bed, soiled with a hemorrhage two days old, they were not degraded human beings, judged by any measure of moral values.”

“In fact, it was very plain that they were sensitive to their condition, and when, at the end of my ministrations, they kissed my hands…it would have been solace if by any conviction of the moral unworthiness of the family I could have defended myself as a part of a society which permitted such conditions to exist. Indeed, my subsequent acquaintance with them revealed the fact that, miserable as their state was, they were not without ideals for the family life, and for society, of which they were so unloved and unlovely a part.”

In order to better organize the help that she was giving to the neighborhood sick, she founded the influential Henry Street Settlement. Wald attracted the attention of Jacob Schiff, a prominent New York- based Jewish banker and philanthropist. Schiff secretly helped fund Wald’s project.

During this time, which followed a wave of immigration of Jews from Russia, the American Jewish community was divided between these newly-arrived poor and the “traditional” group of American Jews, who generally originated from Germany. Schiff and Wald were part of the latter group and helped forge links between the two immigrant groups, all while lending help to the Russian Jews. With Schiff’s help, Wald was able to expand her work, employing 27 nurses in 1906.

“During its early years, no public or formal reports were issued by the settlement, nor was it necessary to make appeals for money,” writes Buhler-Wilderson. “Patients were encouraged to pay what they could, but most of the care provided was free. Money received from patient fees was placed in an emergency fund to be used for expenses incidental to the nursing service-items such as car fare and supplies. With moderate success, Wald contracted with several Lower East Side lodges and benefit societies to provide nursing care for members; an annual retainer was paid for these services.”

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Wald’s remedies were both innovative and pragmatic, as Buhler-Wilkerson explains:

“What she called ‘our enterprise [of] public health nursing’ was not an isolated undertaking, nor was she a lone American heroine. Wald’s paradigm for nursing practice was based on knowledge gained during two decades of experience in visiting nursing and owed much to the Progressive reform and public health movements of the turn of the century. Historically, Wald is often characterized as a visionary whose accomplishments are legendary. Due credit must be accorded, however, to thousands of public health nurses who struggled to create institutional settings that would allow them to practice. This combined effort changed the course of nursing history.”

Wald’s practice grew as did her staff, which had grown to 92 people by 1912. She worked in the area for forty years. But beyond her work for the poor and sick, Wald also advocated for several other causes. According to the National Women’s History Museum:

“Wald helped establish the United States Children’s Bureau and lobbied for years for the end of child labor laws, allowing all children to attend school. She helped President Theodore Roosevelt create the Federal Children’s Bureau. Wald advocated for education of the mentally handicapped. As an active campaigner for civil rights, Wald insisted that all Henry Street classes be racially integrated…”

“Wald was influential in advocating for nurses at public schools and her idea led to the New York Board of Health organizing and running the first public nursing system in the world. As first president of the National Organization for Public Health Nursing, Wald suggested a national health insurance plan. She also helped found Columbia University’s School of Nursing. Wald was not content to simply help improve the immigrant’s health through nursing but also taught the women how to cook and sew and provided recreational activities for the families. In 1915, Wald founded the Neighborhood Playhouse to serve as a cultural center.”

Wald was also a firm believer in women’s voting rights, and was at one point even asked by the leaders of the women’s suffrage movement to run for office (she declined but supported the New York State suffrage campaigns). According to the Jewish Women’s Archive:

“When the 1915 amendment failed to pass, one suffrage leader blamed immigrant voters. Wald pointed out that many immigrants, and especially Jews—female and male—were anxious to exercise the political rights that they had been denied elsewhere. Wald, as always, saw the women of the Henry Street neighborhood as her primary constituents, and continued to champion both the cause of suffrage and immigrant rights with equal zeal. She considered 1917’s successful campaign a great victory.”

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In 1909, Wald co-founded the National Association for the Advancement of Colored People (NAACP). She also organized New York City campaigns for women’s suffrage, marched to protest US entry into World War I and helped establish the Women’s International league for Peace and Freedom. In 1915 she was elected president of the newly formed American Union Against Militarism (AUAM). She remained involved with the AUAM’s daughter organizations, the Foreign Policy Organization and the American Civil Liberties Union (ACLU) after the US joined the war.

In 1922, the New York Times nominated Wald as one of the 12 greatest living American women; she did not make the final list but later received the Lincoln Medallion for work as an “Outstanding Citizen of New York.”

Wald would never marry, preferring to dedicate herself fully to her career. She eventually would write two books about her experiences: “The House on Henry Street” in 1911, and “Windows On Henry Street” in 1934.

Wald died of a cerebral hemorrhage in 1940 at age 73; her memorial service was conducted by a rabbi at Henry Street’s Neighborhood Playhouse.

A few months later, another service to Wald was attended by over 2,000 people, including the mayor, governor and president. She is buried in Rochester, New York.

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