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 organi- zations, 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 better- ment 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 concep- tion 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 chal- lenge 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 seem- ed 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 organi- zations 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 "investi- gator" whose newly acquired knowledge of social and medical science enabled her to see the connection between conditions in the neighbor- hood 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 .