Lillian Wald (1867-1940) and Public Health Nursing

Profiles in Nursing

Lillian Wald (1867-1940) and Public Health Nursing

The Henry Street Settlement and the Visiting Nurse Service

By Elizabeth Hanink, RN, BSN, PHN
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Many people have a single experience that turns their life upside down. For Lillian Wald, it was the combination of two related events that led her to become a pioneer in the field of public health nursing.

A LIFE OF PRIVILEGE 

Wald was the daughter of a well-to-do Jewish family in Rochester, N.Y. In her youth, she was a well-educated but (by her own later description) spoiled and rather frivolous socialite. The first of the two events that would shape Wald’s life came when she witnessed the work of the professional nurse who tended her sister Julia during childbirth in the 1880s. That nurse so impressed Wald that she decided to become a nurse herself, graduating from the New York Hospital Training School in 1891.

“BAPTISM BY FIRE” 

In 1893, Wald began teaching hygiene and health classes to immigrant families and their children. During this period, she visited the home of one of her students, an experience that would become the second pivotal event of her life. She later called it her “baptism by fire.” Making her way through the gritty streets of an overcrowded neighborhood, Wald found her student’s mother, who had been hemorrhaging for two days since giving birth. The woman’s bed was filthy, soaked in blood, and her family stood by helplessly.

Wald was able to treat the woman, but the grim realities of the poor immigrant neighborhood shook the former socialite to the core. As she later wrote in her 1915 book, The House on Henry Street, she walked away “ashamed of being part of society that permitted such conditions to exist.”

By the time she returned home, Wald said, “What I had seen had shown me where my path lay.”

THE HENRY STREET SETTLEMENT

Within a few weeks, she and her friend Mary Brewster had moved into the vacant top floor of a house on Jefferson Street on New York’s Lower East Side, an area crowded with new immigrants, who endured marginal housing conditions and unsafe streets.

Determined to make a difference, Wald and Brewster established what they called the Visiting Nurses Service. They had much support; Wald was still socially well-connected and proved to be an energetic fundraiser, assembling a broad coalition of philanthropists to finance her work.

By 1895, the original quarters were too small and Wald found a new home for her service at 265 Henry Street. The Henry Street Settlement House, as the location became known, would be her  headquarters and home for the next 40 years, beginning a lasting tradition. (Even today, the director of the Henry Street Settlement lives onsite.)

LINKING POOR HEALTH TO POVERTY

Wald believed strongly that health was not simply an individual condition, but a reflection of the community at large. She witnessed the often brutal relationship between poverty and poor health, and recognized that remedying those conditions was a matter of public interest.

She used her connections to expand employment opportunities during the severe depression that followed the beginning of the new century. She also worked actively for the Women’s Trade Union League and campaigned for the formation of New York’s Bureau of Industries and the establishment of a national health plan.

Wald’s concern with broader social, economic and political issues did not diminish her personal connection to her culturally diverse neighborhood. Although she conducted studies and gathered statistics, she was always conscious that the results represented not just numbers, but her friends and neighbors.

CHILDREN AT PLAY

The settlement houses (there eventually were several) always included provisions for recreation and the arts. Wald’s particular concern for children also led her to establish in her own backyard what became the largest playground on the Lower East Side and to push for the establishment of the Federal Children’s Bureau in 1912.

The Henry Street Settlement lobbied for and sponsored New York City’s first school nurse. Although it was not originally her idea, Wald also pressured the New York Board of Education to offer education to children with physical or learning disabilities and provide free lunches for all children. She sought funding from multiple sources to allow needy children to remain in school rather than be turned out to the workforce.

PEACE AND SUFFRAGE

Wald was a committed pacifist and a fierce campaigner for women’s suffrage and racial integration. In an era of widespread, systemic racism, she hired the first black nurse to work with tuberculosis patients and in 1915 hosted what became the first meeting of the NAACP.

Although ill health forced her to retire in 1933, Wald’s work left a lasting mark on New York and the nursing profession. She played a key role in the founding of the Columbia University School of Nursing and today, the direct descendant of her original organization, the Visiting Nurse Service of New York, is still the largest of its kind in the U.S.

Wald was a pioneer of public health nursing — a term she herself coined — and nurses’ roles as advocates not only for patients, but for entire communities. It would no doubt please her that so many nurses today are continuing that work.

Wald wrote two books about her experiences, The House on Henry Street (1915) and Windows on Henry Street (1934), which offer a singular glimpse of an era whose problems still sound all too familiar today. 

Elizabeth Hanink, RN, BSN, PHN,  is a Working Nurse staff writer with extensive hospital and community-based nursing experience.

This article is from workingnurse.com.

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