Historians Have Given Various Interpretations of Middle-Class

LILLIAN D. WALD AND VISITING NURSING

Keiko NAKAMURA

Introduction Historians have given various interpretations of middle-class women reformers, who at the turn of the twentieth century found opportunities to advance their ideals of social betterment. In the late sixties, reflect- ing the rise of historians of feminism, a figure like Jane Addams, who was once admired as America's conscience, came under attack. She and her sister activists were perceived as failing to challenge the domi- nant values of their time about women's proper role-values which limited the social sphere of women to that of the family and perpetuat- ed its preservation. Such criticisms, coupled with a rejection of elitism in historical research and with disappointment in the liberal tradition of reform itself, discouraged further research about notable reform figures. The decade of the seventies, however, brought a trend in social history with a more positive view of women activists. Recent scholar- ship, through scrutiny of groups of anonymous women and their organizations, contends that the separation of and emphasis on a distinct feminine quality was a necessary strategy for these unknown women. It enabled them to create their own network and through its informal but powerful channels to extend their sphere of activity beyond that of traditional domestic concerns. As part of the ongoing reevaluation of women activists at the turn of the twentieth century, this paper will focus on the formerly neglected early career of Lillian D. Wald and the sisterhood of nurses she inspired in the embryonic stage of the professionalization of nursing. An exami- nation of Wald's initial career as a nurse is crucial to an understanding

104 of her later career as a lobbyist and then as one of the architects of a social welfare state.1)

I "Ah , Nurses! like the old agnostic, I might say 'they make me almost believe in God',"2) wrote Lillian D . Wald in 1931, two years before she retired as founding Head of Henry Street Settlement . That was a long way from the beginning of her career as a nurse , when she entered New York Hospital training school in 1889 saying , "My life hitherto has been... a type of modern American young womanhood , days devoted to society, study and housekeeping duties . This does not satisfy me now. I feel the need of serious definite work ."3) Lillian D. Wald's political activity and aggressive public campaigns from the Progressive movement to the New Deal and the reputation of Henry Street Settlement, which attracted people of all nations with different backgrounds, overshadow Wald as a nurse and the world of sisterhood she created. Behind her constant fight against injustice, there was the world of women she cherished. Behind her goal of social betterment and the settlement credo of the "brotherhood of man- kind,"4) there were her ideal of Visiting Nursing and the dynamic atmosphere she nurtured of women fervently united in their work. I will seek to explain in this paper how her vision of Visiting Nurs- ing established a framework for her ideal of social betterment. I will attempt to show that intrinsic to this explanation are Wald's concep- tions of womanhood and sisterhood as strong motivating forces. Wald's conviction that maternal and infant health was crucial to social betterment and that home care through visiting nursing was vital in the struggle to achieve that goal will be explored. Her crucial role in the expansion of Visiting Nursing services and in the founding of public health nursing will be portrayed. Throughout I will stress her conception of women being uniquely qualified to wage this battle for social betterment. My final concern will be the importance of sisterhood as a base for the strength of Visiting Nursing as practiced at Henry Street. Visiting Nursing was not only the best vehicle for the kind of preventive

105 home care advocated by Wald and her co-workers. Carried out from the communal setting of Henry Street it fulfilled certain personal and professional needs of its practitioners. They formed a sisterhood of close companionship, living together as a substitute family, giving each other emotional support and intellectual stimulation in their extraordinary work and above all receiving support and nurture from Wald, their "mother." Alice Lewisohn Crowley describes meeting Lillian Wald at Henry Street:

The Leading Lady, as Miss Wald was called by her as- sociates, led us downstairs to the dining room.... Lively spirits sparred across the table, and presiding at its head, Lillian Wald played not one part, but innumerably changing characters. In her role as hostess, her hands seemed to work automatically as she mixed the crisp green leaves in the salad bowl, while she clarified some problem about unions, interlarding her conversation With whimsical stories.5)

This scene, repeated time after time, provides a clue to understanding the world of sisterhood Wald created at Henry Street.

II When Wald entered New York Hospital training school for nurses in 1889, professional nursing was still in an embryonic stage . Meager wages, long hours and heavy patient loads characterized hospital jobs . Private nurses were treated as servants by many rich patients . To become a nurse meant to throw away a good education.6) "Parents ," it was noted, "might admire self-sacrifice but not for their own daugh- ter."7) On the other hand "when there was little medical teaching in most hospitals, the presence of a nursing school created a more dynamic situation."8) Since women were excluded from the professional sub- culture, an organization of their own was a means to fulfill the need for professional and social contact.9) It was an outlet through which to

106 seek social nexus for a young woman like Wald who was tired of office

work and who was trying to shed "social ties" to her hometown , Ro- chester.10) It provided a chance for pioneering leadership and a challenge for organizing skills without sacrificing qualities traditionally perceived as feminine. Wald herself put in her application form to nursing school:

I choose this profession because I feel a natural aptitude

for it and because it has appeared to me womanly , congenial work that I love and which I think I could do well .11)

For over thirty years Wald wrote speeches on "Nurses and Nurs- ing." They showed little variation through the years. "The feeling of woman,"12) "the social interest of her sex,"13) "woman's aptitude for the service and moral zeal for the cause,"14) were invoked throughout her speeches. She shared the traditional view that femininity embodied certain natural gifts and capacities uniquely inherent in women. She believed that these qualities were a source of strength and positive identity which made women trained as nurses uniquely qualified to carry out the needed transformation of professional nursing. Graduating in 1891, Wald spent the next year as a nurse in New York Juvenile Asylum developing a strong dislike for institutional care for children. In 1893, though no record remains to indicate her clear motivation, she entered the Women's Medical College of the New York Infirmary. That year she was asked by a Jewish Sabbath school, spon- sored by Mrs. Solomon Loeb, to give a few classes to young immigrant women on the Lower East Side. It was Wald's "baptism of fire," as she later called it.15) She accompanied a little girl from the classroom to nurse her sick mother and discovered the living conditions in tenement houses.

Deserted were the laboratory and the academic work of the college; I never returned to them. On my way from the sick room to my comfortable student quarters, my mind was

107 intent on my own responsibility. To my inexperience it seemed certain that conditions such as these were allowed because people did not know, and for me there was a challenge to know and tell.16)

In 1893 Wald and another trained nurse, Mary Brewster, rented an apartment in Jefferson Street. They had "no defined program other than the desire to find the sick and to nurse them."17) Living in the district was their first principle. This move led to the birth of Nurses' Settlement, later called Henry Street Settlement, and gave new impetus to the development of Visiting Nursing in the United States. The inspiration for District or Visiting Nursing was derived from England where it was first practiced. Fifteen years before Wald's move to Jefferson Street, the New York City Mission employed a Bellevue graduate to give care to the poor and ill in their homes. Mission workers gave out leaflets inviting patients to become Christians. Shortly after, the first nonsectarian organization, the Ethical Culture Society, engaged the services of visiting nurses. By 1890 there were twenty-one organizations in the United States which employed visiting nurses.18) But it was Wald's organizational ability and the financial support from Jacob Schiff and Mrs. Solomon Loeb which allowed her to expand her ideas and practices of visiting nursing and make the Henry Street Visiting Nursing world-famous.

III Early letters to Jacob Schiff and Mrs. Solomon Loeb described the work of visiting nurses and the appalling conditions on the Lower East Side. The depression of 1893 made the misery acute. Exposed to the neighborhood every day, a nurse was transformed into an "investigator" whose newly acquired knowledge of social and medical science enabled her to see the connection between conditions in the neighborhood and the sick.19) At the turn of the century, as a result of advances in medicine and science there was a shift from concentration on the remedial aspects of

108 medical practice to preventive aspects . Wald was one of the first to initiate the campaign of preservation of health, of "preventive medicine." Preventive medicine in its "medical" sense meant the practical application of bacteriological techniques to control contagious diseases . But the scope of preventive medicine in Wald's mind was not limited to medical prevention. Disease was a social as well as a biological pheno- menon.20) It was difficult to fail to see the relationship between the conditions surrounding the poor and their ill health. Sickness was related to bad air, darkness, dampness, foul water , undernourishment and unemployment. A nurse needed to be a researcher to investigate and ascertain facts which had been hitherto neglected. This can be attained only by living "in the district in which she works, in a settlement where all matters affecting the neighborhood of her patients are of concern."21) Under the slogan of "an ounce of prevention is better than a pound of cure,"22) the nurse was also transformed into an "educator." Her first concern was the health of mothers in their homes, the wellspring of society.23) Home care was not considered to be a supplement to hospital care. Despite the rapid increase in the number of hospitals, they could care for only one-tenth of the sick in the city.24) Compound- ing this inadequacy, they had no planned relationship to each other or to community needs and resources. For Wald the first phase of health care should be provided in the home by nurses with an intimate knowledge of these homes, their occupants and their neighborhoods. This conviction was derived from humanitarian concerns for the sick at home. People dreaded the thought of leaving their homes for a hospital. Home care also was economical compared to the hospital bed. But it was a social reason for home care on which Wald put most emphasis. "Women should not be taken from their homes as their departure often brings disaster to their homes,"25) she said. The nurse's abilities to take care of mothers and children were specially emphasized. She was not a "perfunctory social worker," but "trained" to "teach mothers theirjobs."26) In Wald's mind visiting nurses working as investigators and educa-

109 tors served as a community agency. Their work should be flexible, autonomous and efficient in order to meet the needs of the people in a district. It had to be nonsectarian and to respond to the call of the people. The idea was revolutionary, since "it was usual to forbid [a nurse] to answer calls except upon the written request of a physician. Often she was assigned to a particular dispensary or physician and her services placed entirely under his direction."27) Challenging the ethical code of nursing, of "loyalty to the physician," the Visiting Nurs- ing that Wald envisioned was a trained nurse's warning to ill-prepared hospitals and doctors. Responding to people's immediate needs and dispelling the stigma of charity, her nurse's uniform badge and bag became familiar to the neighborhood. By 1905, the staff had increased from two to twenty- seven, the service area was enlarged to include the entire borough of Manhattan, and 48,000 visits were made.28) Accompanying this expansion, Wald's ideal of Visiting Nursing as a community agency was projected into a wider arena.

The first fifteen years of Visiting Nursing at Henry Street under Wald's leadership gave birth to the profession of public health nursing, saw the introduction of fieldwork for post-graduate training and experience as part of nurses' training at Teachers College and attained hardwon appointment of women to executive posts in health care organizations. Wald also made public expressions of support for state- supported health insurance administered along the lines of the structure she and her colleagues had initiated at Henry Street. The common idea behind these and indeed most of the innovations of this period was the principle of preventive medicine to be achieved in the most efficient and practical way. Professional nursing care in the home included educational and thus preventive measures and could be delivered at a cost lower than hospital care. Nevertheless, the work of the visiting nurses gave rise to tension between them and the medical profession.

110 Doctors regarded visiting nursing as unprofessional care and did not like nurses to challenge their authority. The letters to Wald from Lavinia Dock suggest the tension and difficulty in maintaining the autonomy of visiting nursing.

She [Mrs. Felix Adler] told Miss B. [Bonfield] with strong disapproval that Miss Wald's nurses carried ointments in their bags and that they even gave pills. She is of the opinion that it is quite wrong for district nursing to be in any way except under the strict control of the physicians.... I don't doubt that the downtown physicians' society has taken their com- plaints to the uptown men hoping to get stronger support and perhaps injureyou in your finance.29)

"You must all be on your guard against them ," she added. "You remember the clause [of the American Medical Association] that no nurse should practice medicine-of course we don't practice medicine or don't want to-but they might say that our first aid was a practice of medicine."30) The writer of this letter who worked with Wald at Henry Street was the most militant spokesman for the autonomy of nurses. Even Wald, who was always careful not to be outspoken against doctors and stressed that co-operation with doctors made home care through visiting nursing successful,31) wrote at the end of her career:

The struggle to obtain the more dignified position was difficult because there was for a long time an acceptance of submission to absolute hospital management and to com- mercial middlemen, and the nurses had no voice in their own affairs. There was stubborn resistance to the emergence of the nurses from these controls, which seemed to cling like barnacles.32)

Wald's efforts to protect visiting nursing services from attack can also be seen in her views on birth control issues. She said, "I wish I could

111 enlist in this particular battle for the married woman's freedom, but thinking it over with real sympathy," she concluded, "it would not be advisable to take a leading part."

However much I may cherish my individual liberty to say and do things, I am under obligation to the army of nurses affiliated with me on the staff and less directly in other organizations.... You will observe that I dwell upon the nurses and not upon my social worker colleagues, because the nurses have frequently been a target for criticism upon

this particular point.33)

To be sure, nurses encountered the misery of overcrowded homes and mothers' helplessness in the face of the burden of too many children. Since Wald had been advocating the special capacity and acceptability of nurses to teach sexual hygine to mothers, "who were enjoying a pre-Eve ignorance of most elemental facts of life,"34)the stand she took on this issue seems significant. Wald was by no means always defensive. Her belief in nurses' usefulness and Visiting Nursing led her to publicize and dispatch her nurses to various fields of health care. The first appointment of a school nurse in 1902 in New York City was the result of a suggestion by Wald. She pointed out from the beginning of the school inspection system the wastefulness of inspection by doctors without follow-up services by nurses. To convince the Board of Health, she offered the services of Lina Rogers of Henry Street. Although Rogers was responsible for 4,500 pupils in one of the worst slums, her success was so evident that twelve nurses were appointed. Then in city after city school nursing became an essential component of health care and came to be called "public health nursing."35) A joint program of Henry Street with the Metropolitan Life Insur- ance Co. in 1909, providing nursing service for industrial policy holders, also came about as the result of a suggestion by Wald to Dr. Lee Fran- kel.36) Her statesman-like ability in organizing this program37) saw the

112 number of nurses' visits increase from 8,800 to 14,000 in one year.38) Within three years the company made contracts for service with over hundred visiting nurses' groups, the number of such agencies having mushroomed to that extent in the United States and Canada.39) The effectiveness of this form of cooperation helped Wald envision a form of nursing insurance as a first step toward general health insurance. Visiting nursing was advantageous as a starting point because its cost was low and its benefits were known. One finds its essentially national scope and goals in her description:

It requires no far reach of the imagination to visualize the time when our country will be districted from the northern- most to the southernmost point, with the trained graduate nurse entering the home wherever there is illness.... Such an organization of national scope, its powers directed toward raising the standard in the homes without sacrifice of in- dependence, is bound to promote the social progress of the nation.40)

Though she prophesized a form of insurance that would be financed through taxation at the first meeting of the National Organization for Public Health Nursing,41) she did not develop the scheme and instead contended that until the state assumed the responsibility for health care, utilizing existing services such as health organizations and private insurance companies in cooperation with state administration was advisable.42) Providing severely needed home nursing care and financing it were always Wald's primary concerns. She did not hesitate to point out the grave inadequacies of the existing means of funding and their consequences for the patient. In an article written during the influenza epidemic of 1920 she remarked:

Until the doctors and the hospitals are completely social-

ized, the bedside care of the nurses working with the differ-

113 ent doctors and institutions must needs conform more or less to their financial states.

Later in the same article she makes explicit reference to the inadequacy of funding:

This is an occasion to point out that hitherto great philanthropists have not strengthened the nursing service by adequate gifts.43)

Strengthening the services of nursing, for Wald, included expand- ing and improving for the preparation and education of trained nurses to meet increasing demands for their services. It was Wald who helped secure the endowment in 1909 of the Hospital Economics course at Teachers College. Mary Adelaide Nutting had been endeavoring to improve the education and training of nurses by promoting uniformity in curricula and in methods of teaching. Sharing interest with Nutting that nursing training and education were essential, Wald persuaded Mrs. Helen Hartly Jenkins to donate money for this purpose. The endowment provided for the establishment of a department of Nursing and Health at Teachers College. Wald's belief in the training of public health nurses in fieldwork was actualized when Henry Street Visiting Nursing offered field practice placements to post-graduate students from the new Department.44) With Nutting and Dock, Wald fought for the professionalization of nursing and agitated for the appointment of women to executive posts, a move which she believed would prevent moral deterioration. "Women believe that they can best represent the h uman interests in government in those measures that immediately concern them and for which tradition and experience have fitted them,"45) said Wald.

Through these expansion years with difficulties and achievements , the association of visiting nurses at Henry Street attests to the desire to be useful to the public and independent from hospitals and doctors. This is not surprising when one remembers that Wald and her disciples

114 saw themselves as best equipped to carry out the mission of home care as the first phase of preventive public health care.

The crusade to expand the practice of home care was launched from Henry Street, and in pursuit of this goal a sisterhood of those "best equipped" for this struggle evolved. Alice L. Crowley once looked back on the "sense of relationship"46) which Wald developed among her nurses and co-workers. To explore this relationship gives a clue to Wald's drive for Visiting Nursing and her commitment to public health. During the first couple of years before Wald aquired the house on Henry Street at 265, there were only three nurses. Then the numbers increased and lay members, who shared the spirit, joined them. In 1898, of eleven members, nine were trained nurses.47) Though male residents later joined, it was not until 1926 that Wald wrote to Dock, "The family is large and properly balanced with more men than before."48) "As the Settlement family is quite a permanent one , its members entering for indefinite periods and never wishing to leave,"49) the nurses and co-workers not only could form real friendships with the people they served but also with each other. Wald was the head of the family. She presided at the table with her "buoyant and infectious good humour," a rare attribute according to George Alger, who commented that "so many of these social service people don't seem to have any humour at all."50) Frances Perkins, In- dustrial Commissioner in New York and later the first woman appointed to a cabinet post as Secretary of Labor by Franklin Roosevelt, who visited the settlement from time to time and worked with Wald, noted that Wald's education of visitors started with her dining table conversation.51) Wald felt most at ease with the family at table. The breakfast was at half past seven "which was the only meal at which the members of the family find themselves alone together." The work and plan for the day were arranged and daily reports were

115 made and the difficulties were settled by "family council."52) Wald shared letters with the family members, reading them aloud on these occasions. There were letters from Lavinia Dock who was travelling in Europe and examining the condition of nurses there for her book on the history of nursing.53) As the author of Materia Medica, one of the first textbooks on nursing and with her militant views against doctors, she was heroine to young nurses. From Germany and from Holland she reported on conditions and legislation movements. "It is all a part of the big woman's movement,"54) wrote Dock and encouraged the Henry Street family. She was the one to bring the suffragist spirit to the family. Later when Dock was arrested, Wald wrote to her amusingly:

Even though you have been arrested the second time I am not converted to the wisdom of your propaganda, but I hope you are just the same and I hope that by this time you are home and taking bugs off of potatoes.55)

Another occasion Wald wrote to her,

I can't bear to think of your gallant spirit held down to household drudgery. I feel like coming on and washing the dishes.56)

Dock's "gallant spirit" never ceased to cheer Wald . Dock said at one time, "I will be your right-hand man when sister Waters goes away."57) Her readiness to help Wald lasted till the end of Wald's life. For Wald she was "Docky Darling," and "there is no one like ante [sic] you and there never will be!"58) As an expert on nursing, she was of great help With Wald"s writings.59)

There were also thank-you letters from Florence Kelley , who wrote: "I come back to Hull House feeling fifteen years better and younger than when I left it two months ago."60) As a pioneer in child labor reform, a special investigator for the Illinois State Bureau of

116 Labor, she was another heroine for the members of the family at Henry Street. It appears that she brought to them the news and vigor of Hull House so that the family could share in the spirit of Jane Addams' Hull House. Kelley moved to Henry Street in 1899 and became general secretary of the National Consumer League, the most vital body which pioneered in legal and political campaigns in favor of welfare legislation. To Wald, Kelley was her "Beloved sister." To her, Wald wrote, "I am always your most grateful sitter at your feet."61) Kelley stayed at Henry Street for twenty-four years and worked with Wald for child labor reform, setting up a New York Child Labor Committee, the New York City Bureau of Child Hygiene and the Federal Children's Bureau. How Wald missed her friend after she left can be seen in this letter to Kelley:

I miss you terribly when people ask for statements of achievements and visions of the future. Will you not be darling and dictate to someone near at hand or I will send you a stenographer. What in your judgement have been the social achievements and failures in the past forty years and what you would want of the future?62)

Kelley appreciated Wald's "hearth of adoption"63) at Henry Street. Once she wrote to her:

I have made a New Year's resolution for this my 49th

year. In order to form the habit for the remaining century... I am starting at noon today to be nice, and say only agreeable things especially about the absent. This is due to the force of

your example.64)

Both Dock and Kelley were inspirations to Wald. They seemed to provide a theoretical and intellectual framework for her work. Living with Wald at Henry Street they could articulate Wald's goals. There were also many "settlement sick"65) letters to be read at the

117 table. They were from those who had left the family or were travelling. By spending holidays in their own homes, going away from the settlement family they realized "how fortunate we were in the breadth and liberty and vital interest of our life at '265' with the beautiful bond of friendships."66) They complained about the placidity and stagnation compared to the atmosphere at "265".67) Assuming various responsibilities and official posts, they remembered Wald's encouragement and warmth when they encountered difficulties. "You shine on every one with warmth like the sun,"68) Dock wrote to her. "When God made you Lillian dearest, it certainly must have been a glad hour, otherwise it would not be possible for you to put so much gladness into the lives of others,"69) wrote Yssabella Waters, Wald's travelling companion. It is interesting to note that some co- workers apologized for themselves as "selfish," "spoiled"70) and "different,"71) before they poured out their problems with their profession, expressingthe need to "feelthe strength of [Wald] individually."72) It was not only Mary Brown who remembered "we had a nice little goodnight at bed time."73) Helen Arthur once wrote to Wald:

I think so often of how happy your thoughts must be each night-tired as you are when you sleepily tumble into

your bed. I think so often of the hundreds who remember you with affection and of the tens who openly adore you and I appreciate a little what it all means and I am grateful to think that your arms have been close around me and that you did once upon a time, kiss me good night and even good morning.74)

It is impossible to say whether sexual love was part of these rela- tionships. But a craving for love and assurance from Wald, in the face of lack of confidence in themselves, can be clearly seen in some of these letters to Wald. Even Wald herself expressed feelings of attach- ment on one of the very rare occasions when she revealed her feelings in a letter to Waters inviting her to visit her home after Waters moved

118 to live uptown.

It seems too odd to have you an uptowner. I cannot visualize you in the dining room of the hotel, though it is not so hard to see you in a bed room there.75)

At the same time, one of her male friends,R.L. Duffus,observed in her "a controlledemotion... which kept her externallyas cool and preciseas any scientistin his laboratory,"76)and George Alger, another male observer,pointed out that Wald "seem[ed]to have the lower passion so thoroughly under controlthat there seem[ed] to be only one horse and no team to worry about."77)He emphasized the spiritualcomfort and inspirationthat Wald brought to him. It would appear that she may have discouragedexpressions of love and adoration from men but did not discouragethem from women. Engaged in pioneering work in the tenements and learning to do professional jobs without specialized training, nurses and co-workers cherished the House at 265, which Wald made "home" to them.78) Wald was not only a mother figure to turn to for some, but "Leading Lady" and "A gate of knowledge." Their eagerness to learn from Wald and to be with her are seen in this passage written by Mabel H. Kittredge:

I am getting altogether too close to you-Lady Wald or is it your life and all those doors that you have pushed open for me? Half open dear-just halfopen....79)

There is little indication of what Wald's direct response was to such expressions of adoring love and respect. Her disciples were eager to be favored by her and to make her proud of them.80) One assumes she returned their respect as she undertook the responsibility of securing and dispatching them off to important administrative and executive posts. There was not the rigidity of a patriarchial or highly structured

119 system, although Wald was the head or mother to the workers. "The entire absence of any kind of restrictive regulation allows each nurse to manage her patients and arrange her time according to her best judgement.... Each one takes up some special work of her own, according to her talent,"81) Dock observed in the early days of visiting nursing at Henry Street. This atmosphere allowed open discussion and disagreement and criticism of each other, but one doubts that there was much self-analysis, since Wald spoke of "self-analysis and con- sequent self-consciousness, so prone to hinder and to dwarf wholesome instincts, and so likely to have proved an impediment to the simple relationshipwhich [they] establishedwith [their]neighbors."82) For Wald openness extended beyond the family setting to her relationship with Nutting. The exchanges between them, expressing their different emphases on common concerns, are testimonies to their friendship. Wald wrote:

Sister dear, Take down your tomahawk. It does not belong to me. I wanted to make the point the other night that sick people were still to be nursed and my plea was for a balance. Nor for a single thousandth part of second did I want them to be less prepared or less educated... I am vexed to have large bodies of doctors and municipal departments forbid the nursing. You do know of course that there are tremendous amount of people going into homes advising and educating and that it is possible that even if all of them were nurses, the patient might not get the bath, might not have the wound dressed 83) ....

Nutting responded:

Dear Lady, I see your point, and the tomahawk is down. Some day in the future I shall find a chance of talking this whole ques-

120 tion of nurses over with you. All the problems which we are facing now involving nurses and their fields of work we are

turning back upon the training school, at every step .84)

This exchange not only illustrated their open discussion but also indicat- ed the different roles they were playing in the development of the profession. Wald emphasized field services and experience, and Nutting promoted a more systematic classroom-oriented plan for professionalization. Isabel Stewart remembered this period and said, "I think that the actual work in the home appealed to Miss Wald much more than study in the classroom. I think we had to stand for some things that Miss Wald did not entirely approve of. That is , we had to stand for getting a good base in sanitation, statistics and sociology and all of that."85) Yet the Nutting and Wald friendship extended over thirty years. Nutting was always welcome to dine with the family at Henry Street. Wald was asked to give lectures on "general ground"86) at Teachers College. Correspondence between Wald and sisters who worked together in formative years, Yssabella Waters, Jane Hitchcock, Lina Rogers, Rebecca Shatz, Harriet Knight, Annie W. Goodrich and Naomi Deutsch, extended from twenty to forty years. They recommended and recruited young nurses, enjoyed exchanging news from other sisters, took care of their own and each other's relatives, worried about each other's health and reported the last moment of a comrade, so that every one shared the grief and love. "Old loyalty and love"87) among Wald's contemporaries and adora - tion of her by some of those who shared the drama and excitement of nursing enriched Wald's activity at Henry Street. "They weren't working for salaries," said Stewart, commenting on Henry Street nurses who often came from good training schools and families of good in-

come."88)

Looking back on her days as a nurse in a hospital, Wald wrote:

121 The long hours "on duty" and the exhausting demands of ward work scarcely admitted freedom for keeping informed as to what was happening in the world outside. The nurses had not time for general reading; visits to and from friends were brief; we were out of the current and saw little of life save as it flowed into the hospital wards.89)

The radical contrast between that work setting and the one Wald created at Henry Street draws attention to how the unique characteristics of Henry Street stemming from the nature of its internal organization were necessary to achieving its goals of social betterment. The sisterhood of kindred women around Wald provided the intellectual stimulation and emotional support so necessary in their work, which was more demanding and challenging than traditional and accepted practices. The ongoing struggle to finance her work and maintain autonomy from the medical establishment and yet not to be alienated from it required firm convictions and manifest self-assurance. These qualities were fostered by the close and constant exchanges among nurses and co- workers at Henry Street about the problems and satisfactions of their work. The strength of Visiting Nursing as practiced at Henry Street was drawn in part from its base in the sisterhood of its workers. Their strength in turn was derived from each other, even when dispersed providing another testimonial to the constructive nurturing leadership of Lillian D. Wald.

After Wald's move to the Lower East Side, her life at Henry Street was devoted to broadening nursing service to meet the needs of the people. It had started with her mission of home care to secure people's health, especially that of mothers and infants. It was an effort to make the knowledge of medical and social science common knowledge shared by the people through the visiting nurse's role as investigator and educator. Carrying out her role through Visiting Nursing, she had to

122 fight for the right to practice it, and to publicize and convince people of the value and efficiency of the techniques of Visiting Nursing. In so doing she broadened her activities and moved into arenas related to public health situated far beyond the Henry Street neighborhood. Her conception of the nurse as an investigator and educator within a framework of preventive medicine was a prelude to her fights for reform in housing, playground construction and child labor. She suc- ceeded in setting up milkstations, mothers' clubs and boys' and girls' clubs for vocational training and for teaching of citizenship. She was a vital force in setting up a New York Child Labor Committee, the New York City Bureau of Child Hygiene and the Federal Children's Bureau. Her conviction of the need for these programs and reforms sprang from her ideals based in Visiting Nursing. Thus these ideals served as stimuli for the growth of medical and social programs beyond the seminal con- cept of nursing home care. In carrying out her mission of home care through Visiting Nursing and the variety of related activities which evolved from it, the siter- hood of "265" was the source of Wald's strength. Wald said that a nursing career "could be satisfying to women of ability-intellectual, organizational, administrative and executive-for it permitted development of these powers."90) Demonstrating this, she developed her own abilities as she worked to extend her ideas and the practice of Visiting Nursing. Nursing provided a kind of fulfillment that avoided the imprisonment of self-centeredness. Underlying it was a self-abandonment to a cause unrelated to obvious personal advancement. Wald and her workers were not atomized selves, each striving for a career. Living together, working together and cherishing friendships, they were able to have not only intellectual stimulation and vital professional contact but also emotional support and security. The latter was extremely important for them since they were detatched from their own backgrounds and at the same time were pursuing pioneering professional jobs for which there could be no previous direct training. Their first principle for visiting nurses, that of "living in a district in which she works," not only brought them discovery of the other half91) but allowed them to lead

123 a communal life with each other. In the report on "Henry Street and Teachers College Affiliation in 1925," one can find an interesting summary of the consequences of the students' experiences.

The work has not generally been well related to the curriculumas a whole. It has been consideredas a kind of extra or as a specialconcession to the growing demand for betterbasic preparationfor nurses who latergo into public healthwork.

•c•c .

There has been a tendency for students to count too much on this short introduction as a preparation for the more responsible positions in public health work.92)

For Wald, the emphasis in Visiting Nursing on the field and on field experience as training had never been an extra nor a concession to demand. Enthusiasm for "living in the neighborhood" seemed lost in this report of student experience. For the new generation of women what Wald had called "woman's aptitude for the service and moral zeal for the cause,"93) sounded alien. They were more interested in personal fulfillment. This change in temperament and values in the twenties would undermine the strength of the sisterhood. The very idea of the nurse as investigator and educator was also going to become obsolete. Highly specialized and skillfull college- and university-trained professionals in Nursing and Social Work were to assume the role of the nurse as investigator. The medical profession would assert its willingness to assume the task of preventive medicine and to take over the role of the nurse as educator. The final down-fall in 1928 of the Sheppart-Towner Maternity and Infancy Protective Act, the first federal welfare legislation initiated by the Federal Child- ren's Bureau, during an era of declining Progressive impulses, brought a victory for the practice of preventive medicine by the private family physician rather than by the public health nurse.94)

124 These seeming retreats from Wald's goals as professional and as reformer are modified considerably, however, in a comment by A.A. Berle, former resident at Henry Street and a member of Franklin D. Roosevelt's original braintrust. Berle was quoted in an article in the New York Times, "Seed of New Deal Found in Henry St.":

Describing the Visiting Nurses Services as the "spearhead" of the work at Henry Street, Professor Berle said that it enabled the underprivileged to reach up to receive some of the benefits of modern civilization. The New Deal, he added, is really nothing more than making these advantages of civihzation available to all.95)

Almost forty years after the inception of Wald's work it was credited as being seminal to New Deal measures and goals. Fifty years after Wald prophesized national health insurance it was actualized through Medicare and Medicaid in the United States. The current national health insurance debate points up again the unsolved problems in the struggle for social betterment in which Wald and her disciples and colleagues pioneered. And finally, one remembers that Wald's life was an inspiration to her disciples and colleagues and that their world of sisterhood was a support behind her struggles.

Notes

1) The standard work on reformers at the turn of the century, except for eulogistic biographies, is Allen F. Davis's Spearhead of Reform: The Social Settlements and the Progressive Movement 1890-1914 (Oxford University Press, 1967). The best known works of criticism on the limitations of women reformers came from William O'Neil in Everyone Was Brave: A History of Feminism in America (Quadrangle, 1974), Aileen Kraditor, The Idea of the Woman Suffrage Movement 1890-1920 (Columbia University Press, 1965) and Jill K. Conway, "Women Re- formers and American Culture 1870-1930" in Our American Sisters: Women in American Life and Thought, ed. Jean E. Friedman and William G. Shade (Allyn and Bacon Inc., 1973). Representative works which take a positive view of women reformers include Estelle Freed-

125 man, "Separatism As Strategy" in Feminist Studies V (1979) and Mary R. Walsh, "Doctors Wanted: No Women Need Apply": Sexual Barriers in the Medical Profession 1835-1975 (Yale University Press, 1977). 2) Lillian D. Wald to Mrs. Simon Flexner, Dec. 14, 1931, Lillian D. Wald Papers, New York Public Library. 3) Wald to George P. Ludlum, May 27, 1889, NYPL. 4) Henry Street Settlement, "Report of the Henry Street Settlement 1893-1913," NYPL. 5) Alice Lewisohn Crowley, The Neighborhood Playhouse: Leaves from a Theatre Scrapbook (Theater Arts Books, 1957), p.5. 6) Isabel Stewart, "Reminiscences of Isabel Stewart," Oral History Col- lection, Columbia University, p.23. 7) Mary M. Roberts, American Nursing: History and Interpretation (The Macmillan Co., 1954), p.54. 8) Ibid., p.56. 9) J. Stanley Lemons, The Woman Citizen: Social Feminism in the 1920's (University of Illinois Press, 1973), p.43. 10) Wald to George P. Ludlum, May 27, 1889, NYPL. 11) Ibid. 12) Wald Speech at Vassar College, "New Aspect of Old Social Responsibil- ities," Oct. 1915, NYPL. 13) Wald, "Nurses and Nursing," 1915, NYPL. 14) Wald, "Visiting Nurses and Tuberculosis Control," 1912, NYPL. 15) Wald, The House on Henry Street ([1915], Dover, 1971), p.7. 16) Ibid. 17) Wald, "The Henry Street Settlement," Charities and the Commons, April 7, 1906, p.35. 18) Roberts, p.15. 19) Wald to Jacob Schiff and Mrs. Solomon Loeb, Dec. 8, 1894, NYPL; Wald, "The Helps to the Immigrant through the Nurse," 1907, NYPL. 20) Wald Speech at Teachers College, Dec. 1909, NYPL; Wald, "Preven- tive Medicine," 1923, NYPL. 21) Wald, "District Nursing," 1905-1906, NYPL. 22) Wald, "School Nursing," 1903, NYPL. 23) Wald, "Development of Visiting Nursing," 1913, NYPL. 24) Wald, "The Henry Street Settlement," Charities and the Commons, April 7, 1906, p.36. 25) Wald, "History and Development of Visiting Nursing," 1913, NYPL; Wald, "The Treatment of Families in which there is Sickness," A- merican Journal of Nursing, March-May 1904. 26) Wald, "Preventive Medicine." 27) Yssabella Waters, Visiting Nursing in the United States (Charities Publication, 1909), pp. 16-17. 28) "Report of the Henry Street Settlement 1893-1913." 29) Lavinia Dock to Wald, June 30, 1904, Lillian D. Wald Papers, Colum-

126 bia University. 30) Dock to Wald, Feb. 1, 1904, CU. 31) Wald, "On Cooperation," Article for Public Health Nurse , Jan. 1924, NYPL. 32) Wald, Windows on Henry Street (Little Brown and Co., 1934), p.76. 33) Wald to Juliet Barrett Rublee, Oct. 29, 1920, NYPL. 34) Wald, "Moral Prophylaxis," 1907, NYPL; "Preventive Medicine," 1923 35) John Duffy, A History of Public Health in New York City 1866-1966 (Russell Sage Foundation, 1974), p.254; Wald, House, pp. 51-53. 36) "Historic Interlude by Lillian D. Wald" in The Quarterly Bulletin for Metropolitan Nurses, Oct. 1937, NYPL; Wald, House, pp. 62-63. 37) Stewart, p.148. 38) "Report of the Henry Street Settlement, 1893-1913." 39) Roberts, pp. 86-87. 40) Wald, House, p.62. 41) R.L. Duffus, Lillian Wald: Neighbor and Crusader (The Macmillan Co., 1938), p.144. 42) Wald to J. Lies, Sep. 1, 1910, NYPL; Wald, "Tuberculosis," 1923, NYPL. 43) Wald, "Influenza: When the City is a Great Field Hospital," Survey, XLIII Feb. 14, 1920. 44) Teresa E. Cristy, Cornerstone for Nursing Education (Teachers College Press, 1969), p.40. 45) Wald, "New Aspects of Old Social Responsibilities." 46) Crowley, p.8. 47) Duffus, p.69. 48) Wald to Dock, Oct. 1, 1926, NYPL. 49) Dock quoted in Duffus, p.64. 50) George Alger, "Memoir," Oral History Collection, Columbia Uni- versity, p.261. 51) Frances Perkins, "Memoir," Oral History Collection, Columbia Uni- versity, pp. 324-327. 52) Dock quoted in Duffus, p.63. 53) Dock to Wald, March 4, nd., CU; Dock to Wald, Feb. 1, 1904, CU. 54) Dock to Wald, Aug. 22, 1904, CU. 55) Wald to Dock, Aug. 31, 1971, NYPL. 56) Wald to Dock, Oct. 2, 1931, NYPL. 57) Dock to Wald, nd., NYPL. 58) Wald to Dock, Nov. 4, 1931, NYPL. 59) Stewart, p.285; Wald to Dock, Oct. 13, 1931, NYPL. 60) Florence Kelly to Wald, July 20, 1899, NYPL. 61) Wald to Kelley, Jan. 19, 1927, NYPL. 62) Ibid. 63) Kelley to Wald, Jan. 24, 1899, NYPL.

127 64) Kelley to Wald, Jan. 11, 1909, CU. 65) Harriet W. Knight to Wald, Sep. 17, 1902; Nov. 14, 1909; Rebecca Shatz to Wald, July 26, 1907; Sep. 2, 1901, CU. 66) Helen Heillard to Wald, June 30, 1905, CU. 67) Yssabella Waters to Wald, Aug. 8, 1911, CU. 68) Dock to Wald, Sep. 24, 1904?, CU. 69) Waters to Wald, Dec. 21, 1911, CU. 70) Mary Brown to Wald, May 4, 1901, CU. 71) Helen Arthur to Wald, Friday Eve., nd., CU. 72) Mabel Hyde Kittredge to Wald, nd., CU. 73) Mary Brown to Wald, Dec. 25, 1901, CU. 74) Helen Arthur to Wald, Wednesday, nd., CU. 75) Wald to Waters, April 20, 1917, NYPL, 76) Duffus, p.34. 77) Alger, p.250. 78) Helen Heillard to Wald, June 30, 1905, CU. 79) Mable Hyde Kittridge to Wald, nd., CU. 80) Ibid. 81) Dock quoted in Duffus, pp. 63-64. 82) Wald, House, p.17. 83) Wald to M. Adelaide Nutting, May 13, 1911, M. Adelaide Nutting Papers, Nursing Archives of Teachers College, Columbia University. 84) Nutting to Wald, May 23, 1911, NATC. 85) Stewart, p.148. 86) Nutting to Wald, Jan. 6, 1913, NATC. 87) Wald to Nutting, Dec. 24, 1926, NATC. 88) Stewart, p.144. 89) Wald, House, pp. 1-2. 90) Wald, "Newer Aspects of an Old Profession," 1912, NYPL . 91) Wald, House, p.5. 92) Isabel Stewart to Marguerite Wales, Dec. 9, 1925, NATC. 93) Wald, "Visiting Nurses and Tuberculosis Control," 1912, NYPL. 94) Lemons, Chap. Six; Sheila M. Rothman, Woman's Proper Place: A History of Changing Ideals and Practices 1870 to the Present (Basic , Books, 1978), Chap. Four. 95) "Seed of New Deal Found in Henry Street: Berle Declares Settlement Workers Made Possible the Roosevelt Program," New York Times, Nov. 23, 1933, NYPL.

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