By Anne M. Filiaci, Ph.D.
By the last decade of the nineteenth century, American nursing was evolving from an unskilled, menial job into a profession staffed by educated, middle-class women. In 1873, the first three Nightingale-inspired nurses’ training programs opened in the United States. By 1890, Lillian Wald was one of 1,552 nursing students in thirty-five such schools. Ten years later, in 1900, almost ten times as many students–11,164—attended 435 nurse training programs in the U.S.
No longer was the typical nurse a poor, uneducated woman of “questionable” reputation who changed bedpans, served meals, and cleaned wards. While she might still perform these tasks, nurses were now increasingly known to be “respectable,” well-educated middle class women. Their work had expanded to include observing and reporting on patients’ conditions and treating patients based on physician instructions. They were also responsible for creating a healthy environment and making their patients comfortable.
Yet in spite of their higher class status and more advanced training and education, nurses continued to be treated as inferiors and subordinates by physicians and as servants by prosperous patients and their families. The doctor-nurse protocol of the period encouraged this subservience. Nurses had to stand whenever a doctor entered the room. They were not allowed to offer suggestions or opinions on the patients in their care, even when they knew more than the doctor about a patient’s status, the course of the illness, and its treatment. They had to follow a doctor’s orders even when they knew these to be wrong. When a patient asked a question, the nurse was forced to reply, “Ask the doctor.”
Doctors (mostly male) continued to demand that nurses (mostly female) assume a subordinate role. This mirrored society’s expectations that women should submit to men. Some doctors even argued against advanced training for women nurses, insisting that too much education would detract from what they saw as the “feminine qualities” essential to nursing—nurturing, self-sacrifice, etc.
Yet even as many physicians sought to keep nurses subservient and preferred them to be uneducated, nursing leaders worked hard to transform the field into a respected and independent profession. No matter how accommodating they wished to be when they began their careers, educator Isabel Maitland Stewart reflected, students soon learned that “[n]urses…always had to fight.” No matter how initially reluctant they were to create conflict, she said, before they had even “finished…training,” they found that for the sake of their patients and their profession they had to become “militant” about defending their status. Nursing trail-blazer Adelaide Nutting spoke for many when she asserted that
‘[T]he day for saying “Be good sweet maid and let who will be clever” has passed in this as in other women’s vocations. Rather must we continuously urge here the moral obligation to be intelligent.’
Leaders in the field of nursing moved on multiple fronts to elevate the status of their profession. They publicly criticized the many doctors who used commencement addresses as platforms to demean the profession by delineating (in great detail) a nurse’s subservient role. They fought to eliminate regulations that required private duty nurses to make themselves “generally useful” in the households that they served. They lobbied states to establish minimum education standards for nurses and to register only those who met those standards. Demanding that nurses themselves control and administer nursing education and training, they simultaneously worked to establish standards and ratings for nursing schools, as well as making sure that these schools had adequate libraries, equipment and laboratories.
In 1893—the same year that Lillian Wald moved to the Lower East Side—Isabel Hampton (later Robb), Principal of the Johns Hopkins Hospital Training School, worked with colleagues Adelaide Nutting and Lavinia Dock to formulate a plan creating an international professional organization for nurses. That year, a committee led by Hampton (Robb) arranged for a group of nurses to meet at the Chicago World’s Fair. At this “Congress,” held in June of 1893 and attended by about twenty training school superintendents, Hampton gave a speech arguing for higher standards and a more uniform curriculum for nursing education. Lavinia Dock—who would later become a long-time resident of the Henry Street Settlement—also gave a speech at the gathering, arguing that doctors and nurses should have separate chains of command, with nurses in charge of other nurses. Dock believed that the heads of nursing schools should have total authority over the school—“‘one sole source of authority, transmitted in a straight line, not scattered about through boards and committees, but concentrated in the head of the school as their representative and delegate.’”
Irene Sutliffe, Directress of the New York Hospital Training School for Nurses and Wald’s mentor, also spoke at the gathering, pushing for an association of nurses that would work to establish high standards for the blossoming profession. Sutliffe’s plea was soon met with action. Under Hampton, the Congress laid the groundwork to create a formal association of training school superintendents. In 1894, nurse leaders met in New York City and formed the American Society of Superintendents of Training School Nurses.
Hampton (Robb) and other leaders soon took action to organize not just teachers but all nursing school graduates. Nursing school alumnae had already begun to gather in smaller groups even before superintendents came together in Chicago in 1893. In 1889, Bellevue graduates formed an alumnae association. They were followed by graduates of Illinois Training School in 1891 and those of Johns Hopkins in 1892.
Wald’s own alma mater, the New York Hospital Training School for Nurses, formed its alumnae association within a few months of the International Congress in Chicago as a result of the “enthusiastic work” of Irene Sutliffe. Lillian Wald also played a leading role in the formation of the New York Hospital Nurses Alumnae Association, acting as the group’s secretary pro tem at their first meeting, held on September 26, 1893. Her notes from the meeting reveal that forty-seven members attended. They discussed dues and nominated officers to be elected at their annual meeting, which they decided would take place the following March.
The New York Hospital’s Nurses Alumnae Association soon collected mutual aid money for their members, and in 1894 established a fund to help sick nurses. By 1895, their membership had expanded to 131. They also established a continuing education lecture series, “given at Columbia College under the auspices of the St. Barnabas Guild,” where doctors spoke to graduate nurses about new advances in the field of medicine.
Lillian Wald was on board with nurses’ attempts at professionalization and autonomy from the very beginning of her career. As she would later write, the ultimate goal of nursing leaders in her mind was to “assert the essential independence of their profession” and to be seen as “the logical associate of the doctor” with whom they shared an “interchange of duties.”
In keeping with these ideals, Wald and Brewster chose to act as physicians’ colleagues rather than subordinates from the first day that they moved to the Lower East Side. They cooperated with doctors, dispensaries, and other charitable organizations, but refused to be subservient to any organization.
Wald described herself as a reluctant public speaker, yet she soon joined with other nursing leaders in promoting the field by giving talks to potential supporters. In February of 1895, she addressed a meeting of the New York Section of the National Council of Jewish Women at the Temple Emanu-el on the topic of “‘Friendly Visiting Among the Poor.” In the speech, she advocated for a systematic, scientific approach to charity, where trained professionals (including nurses) would aid the poor by investigating their homes and collecting data before deciding on treatment or relief. Analysis of the collected data, she asserted, would help philanthropists to target specific needs and provide aid more efficiently, in accordance with individualized circumstances. In the talk, Wald argued that these methods, practiced by professionals, should supplement—if not supplant—the noble yet haphazard practice of “friendly visits” by wealthy philanthropic (female) volunteers.
Soon after she moved to the Lower East Side, Wald also supported the move for nursing professionalization by mentoring and training student nurses and recent graduates, providing real-life experience under her professional guidance for those who wished to determine whether they were truly meant to work nursing the poor. As early as July 7, 1893, while she was still at the College Settlement on Rivington Street, Wald reported to her benefactors on the work of one intern, “…Miss Loeb (one of the visiting nurses)….” Once Wald and Brewster moved out of the College Settlement, their Jefferson Street residence became home to at least two other nurses, as well as a center for nursing field work and internships. Wald’s January, 1895 list of expenditures included $1.95 for “Miss Loeb’s carfare” for “ten weeks.”
Wald’s patience allowed the incipient settlement to be somewhat of a revolving door for aspiring public health nurses. Young nurses often quickly found that they were indeed unsuited for the work. In August of 1893, Wald wrote,
The first nurse sent by the Mount Sinai Training School unfortunately broke down, a second succeeded her for a few days and she in turn was succeeded by another member of the School who is now with us.”
In a letter to Jacob Schiff and Mrs. Loeb on February 11, 1895, Wald wrote in detail about one woman’s eventual decision to leave visiting nursing:
Miss Loeb did a share of the nursing for about two weeks coming down in the morning and remaining until afternoon and certainly did her work with enthusiasm. After that she found it advisable not to continue and though she is warm-hearted and has enthusiasm, she perhaps is better fitted for other branches of nursing.”
Sometimes this patience paid off. In the same letter, Wald described the internship of another young woman who found she had the requisite skills and character for public health nursing as a result of the internship. “Miss MacMillan,” she wrote, “started in the work about the middle of January,” feeling that “she could not test it or be tested unless she lived in the midst of it.” MacMillan “became a resident the first of Feb.,” and, after about a week and a half, “so far as one can judge in so short a time [she] is doing very well,” exhibiting “sympathy and understanding.” Wald reported that “the best thing I can say of her” is that “she has never returned after visiting the most wretched with any expression of disgust of the people but very much pity for their poverty and their ignorance….” To Wald, these qualities, along with her “good judgment and a very extensive hospital experience,” made her “good material for a start.”
Lillian Wald became a leader in the field of nursing and its emerging professionalization while still a young woman in her twenties. Not only did she take a role in nascent alumni associations. With her move to the Lower East Side, she also began to create a separate, autonomous role for the public health nurse. From her first weeks in the neighborhood, she began to create and embody the expanded role of nurse as educator—both of patients and of other nurses.
Bibliography
Armeny, Susan, “Organized Nurses, Women Philanthropists, and the Intellectual Bases for Cooperation Among Women, 1898-1920,” in Lagemann, Ellen Condliffe, Nursing History: New Perspectives, New Possibilities, NY: Teachers College, Columbia University, 1983.
Buhler-Wilkerson, Karen, “False Dawn: The Rise and Decline of Public Health Nursing in America, 1900-1930,” in Lagemann, Ellen Condliffe, Nursing History: New Perspectives, New Possibilities, NY: Teachers College, Columbia University, 1983.
Bullough, Vern L., and Bonnie Bullough, The Emergence of Modern Nursing, 2d ed., London: The Macmillan Co., 1969.
Bullough, Vern L., and Bonnie Bullough, History, Trends, and Politics of Nursing, Norwalk, Appleton-Century-Crofts, 1984.
Bullough, Vern and Bonnie, The Care of the Sick: the Emergence of Modern Nursing, NY: Prodist, 1978.
Christy, Teresa E., “Nurses in American History: The Fateful Decade, 1890-1900,” The American Journal of Nursing, Vol. 75, No. 7 (Jul., 1975), pp. 1163-1165 (includes photos).
Daniels, Doris Groshen, Always a Sister: The Feminism of Lillian D. Wald, New York, Feminist Press, 1989.
Davies, Celia, “Professionalizing Strategies as Time- and Culture-Bound: American and British Nursing, Circa 1893,” in Lagemann, Ellen Condliffe, Nursing History: New Perspectives, New Possibilities, NY: Teachers College, Columbia University, 1983.
Dock, Lavinia L., “Foreign Department,” The American Journal of Nursing, Vol. 4, No. 12 (Sept. 1904), pp. 995-998.
Dock, Lavinia, A Lavinia Dock Reader, edited with a biographical introduction by Janet Wilson James, New York: Garland Publishing, Inc., 1985.
Dock, Lavinia L., A Short History of Nursing: From the Earliest Times to the Present Day, In Collaboration with Isabel Maitland Stewart. NY: G.P. Putnam’s Sons, 1920.
Dolan, Josephine A., Goodnow’s History of Nursing, Eleventh Edition, Philadelphia: W.B. Saunders Co., 1963.
Feld, Marjorie N., Lillian Wald: A Biography, Chapel Hill, NC: University of North Carolina Press, 2009.
Hunting, Harold B., “Lillian Wald: Crusading Nurse,” in Lotz, Philip Henry, ed., Distinguished American Jews, (Creative Personalities, v. VI), NY: Association Press, 1945.
“Isabel M. Stewart Recalls the Early Years,” The American Journal of Nursing
Vol. 60, No. 10 (Oct., 1960), pp. 1426-1430
Jordan, Helen Jamieson, Cornell University-New York Hospital School of Nursing, 1877-1952, [NY], The Society of the New York Hospital, 1952.
Lubove, Roy, The Progressives and the Slums: Tenement House Reform in New York City, 1890-1917, np: University of Pittsburgh Press, 1962.
McIsaac, Isabel, “American Delegates and Societies,” The American Journal of Nursing, Vol. 1, No. 12 (Sep., 1901), pp. 878-917.
Mottus, Jane E., New York Nightingales: The Emergence of the Nursing Profession at Bellevue and New York Hospital 1850-1920, [Revision of thesis-Ph.D.), New York University, 1980], Ann Arbor, MI, UMI Research Press, c1981, 1980.
Muncy, Robyn, Creating a Female Dominion in American Reform, 1890-1935, New York: Oxford University Press, 1991.
Nutting, M. Adelaide, “Visiting Nurses in the Homes of Tuberculous Patients,” The American Journal of Nursing Vol. 4, No. 7 (Apr., 1904), pp. 500-506
“To Further Interests of Humanity: New-York Section of National Council of Jewish Women” New York Times, Feb. 12, 1895.
Wald, Lillian D., The House on Henry Street, N:Y: Henry Holt & Co., 1915.
Wald, Lillian D., “Nurses’ Settlement,” The American Journal of Nursing, Vol. 1, No. 1 (Oct., 1900), p. 39.
Wald, Lillian “The Nurses’ Settlement in New York,” paper read at the International Congress of Nurses, Buffalo. The American Journal of Nursing, Vol. 2, No. 8 (May, 1902), pp. 567-575.
Wald, Lillian D., Lillian Wald Papers, New York: New York Public Library, [1983].
Wald, Lillian D., Windows on Henry Street, Boston: Little Brown, and Company, 1934.
Woods, Robert A. & Albert J. Kennedy, Handbook of Settlements (Russell Sage Foundation), NY: Charities Publication Committee, 1911.
Woods, Robert A. and Albert J. Kennedy, The Settlement Horizon: A National Estimate, New York: Russell Sage Foundation, 1922.
Illustrations
Rivington Street Link to Illustration Current 9/23/15
Bellevue Hospital, 1890-1900. Children’s Surgical Ward: Tots on small chairs, attendants in distance, nurse at L; young woman seated, holding crutches, DORIS, Link to Illustration Current 9/23/15.
Bellevue Hospital, 1891. Marquand Pavilion (for children) : cots, some with mosquito netting. 2 men working at table. Nurses background. Nurses with children are very distant. DORIS. Link to Illustration Current 9/23/15
Bellevue Hospital, 1889. Montage: Children’s Surgical Ward, Operating Theatre, Convalescents in Garden, Morgue. DORIS Link to Illustration Current 9/23/15
Bellevue Hospital, 1890-1900. Nurses with little boys seated in cots. In foreground man is seated with little boy in his lap. DORIS. Link to Illustration Current 9/23/15
Bellevue Hospital, 1890-1900. “Old Time Blood Transfusion” 4 nurses, 6 male medical staff attend to donor and recipient. DORIS Link to Illustration Current 9/23/15.
New York City Hospital Area, Blackwell’s Island, 1895-1905. Diet Kitchen in Nurses School for Training; 3 nurses: 1 at stove, 2nd measuring, 3rd reaching into cabinet. DORIS Link to Illustration Current 9/23/15.
Isabel Maitland Stewart, Teachers College Archives, Columbia University Link to Illustration Current 9/29/15
Mary Adelaide Nutting, Teachers College Archives, Columbia University Link to Illustration Current 9/29/15
Sutliffe, Irene, Cornell Library, Dana, Irene Sutliffe, RN. gelatin silver print
1892 6.25″x 5″ Cabinet card of Irene Sutliffe, RN. Irene Sutliffe graduated from New York Hospital Training School for Nurses in 1880. She was directress of the school from 1886 to 1902. She had an distinguished career including organizing the following institutions: Harmot Hospital in Erie, PA (1880s), School for Nurses at Long Island College Hospital, Brooklyn (1880s); Infantile Paralysis Emergency Hospital in New York (1916). She was also in charge of Camp Black during the Spanish American War. She died on December 30, 1936. People identified: Irene Sutliffe. The photographer’s name and address are printed recto and verso. From Irene Sutliffe, RN Papers.
Medical Center Archives of NewYork-Presbyterian/Weill Cornell P-10114 portraits, heads/deans (nursing) portraits, alumni (NYHTSN) portraits, nurses portraits, administrators New York Hospital New York Hospital Training School for Nurses
Cornell: NewYork-Presbyterian/Weill Cornell Medical Center Archives Image Collection This image is in the public domain and is believed to have no known U.S. copyright or other restrictions. It is good scholarly practice to cite references. Please credit the Medical Center Archives of NewYork-Presbyterian/Weill Cornell. For information on our photo reproduction policies please see http://weill.cornell.edu/archives/photographs/Please provide us the accession number (P number) of the image you are inquiring about when you contact us.
http://search.openlibrary.artstor.org/object/SS7729499_7729499_8274711_CORNELL
Copyright Anne M. Filiaci 2016