The Origins of Public Health Nursing: The Henry Street Visiting Nurse Service

LILLIAN WALD COINED THE term “public health nurse.” She believed that public health nurses must treat social and economic problems, not simply take care of sick people. The public health nurse should be involved with the health of an entire neighborhood and cooperate with social agencies to help improve living conditions. In 1893, Wald and Mary Brewster, both graduates of the New York Hospital School of Nursing, moved to the Lower East Side of New York City to put this concept of public health nursing into practice. They arrived during one of the nineteenth century's worst depressions and began to give patients ice, sterilized milk, medicines, meals, and referrals to hospitals and dispensaries. Most importantly, they were able to use their social connections to provide many people with jobs.

In contrast to social commentators who held that the poor were to blame for their own poverty and disease, Wald always emphasized the human dignity of even the poorest and most wretched of the families in the tenements, as in this account:

The family to which the child led me was neither criminal nor vicious… . It would have been some 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.¹

In 1895, Wald and Brewster moved out of their tenement building and into a house, also on the Lower East Side, that would become the Henry Street Nurses’ Settlement. They enrolled six more nurses and several activists, lawyers, union organizers, and social reformers; all lived together and collectively shared living expenses. In addition to nursing, they arranged picnics, excursions to the country, girls’ clubs, cooking classes, and tickets to concerts—all in an effort to let their neighbors experience life beyond the tenement and factory.² The yard behind the house was converted into the largest playground on the Lower East Side, with preference given to crippled children and convalescents.

The Lower East Side was an area of the poor and immigrants—Jewish, Irish, Italian, and Chinese. As the Henry Street Visiting Nurse Service expanded, the nurses visited homes of all nationalities across the city. In 1917, the Nursing Service gave 32 753 patients bedside care and attended 21 000 sick children in their homes.³ In this image, a visiting nurse is pictured with a Chinese mother and six of her seven children. The nurse, Miss Pearson, taught science at St. Mary's Hospital before joining the Nursing Service.⁴ The photograph, taken in the early 1930s, shows the mother and children looking healthy despite the hard times of the Great Depression. Chinese families were often large because children represented family prosperity and happiness.

Miss Pearson of the Henry Street Visiting Nurse Service with a Chinese mother and her 7 children. Source. Courtesy of the Prints and Photographs Collection, History of Medicine Division, National Library of Medicine.

A number of wealthy women and prominent philanthropists supported the Henry Street Settlement activities and the enterprise grew dramatically. More than 50 nurses joined the group and volunteers provided courses in carpentry, sewing, art, music, and dance. Additional houses were opened around the city, and convalescent homes in the countryside. In 1906, Wald hired her first Black nurse, and thereafter the number of Black nurses on her staff increased steadily. By the time she retired in 1933, Wald managed a staff of 265 nurses who cared for 100 000 patients. The Nursing Service provided badly needed health care for the poor that was not available anywhere else. Later, the Nursing Service moved uptown and today is the Visiting Nurse Service of New York, the largest not-for-profit home health care organization in the country.⁵