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By Anne M. Filiaci, Ph.D.

Instead of getting another job as a nurse, Wald decided to go to medical school. Her work at the New York Juvenile Asylum convinced her that she needed more formal medical education. Nursing school had provided her with practical experience, but in her mind, its “theoretical instruction” was not much better than “casual and inconsequential.” She may also have decided to go to medical school because she did not want to be submissive and subservient to physicians. Her experience showed her that doctors–even women doctors–had much more autonomy treating the sick than did nurses.

Wald chose to remain in New York City, enrolling in the Women’s Medical College (WMC). WMC had been founded in 1868 by Elizabeth Blackwell, the first woman in the United States to obtain a degree from a recognized medical school. It was established as an offshoot of the New York Infirmary for Women and Children, a dispensary that offered health care services to the poor in New York City.

When Wald entered WMC in the fall of 1892, it was located in a six-story building on the corner of Stuyvesant Square at East 15th Street, just a few blocks from where she had trained as a nurse. A highly respected institution, WMC offered women one of the finest medical educations in the country. Its students had access to impressive classroom and laboratory space, and the dispensary provided them with invaluable clinical opportunities–something that women medical students had a hard time obtaining. When Wald enrolled, the school’s course of study was three years long. The next year, in 1893, it joined Harvard to become the second medical school in the country to institute a four-year course.

By the time Wald matriculated at WMC, the school’s population was just under 100 students. Dr. Emily Blackwell (Elizabeth’s sister), a professor of obstetrics and “women’s diseases,” was its dean. According to one of her students, “Dr. Emily…belonged to the tradition of the great pioneers.” A tall woman, “broad-shouldered and commanding in her presence,” her voice “was low and calm and of an uncanny quality: you could have heard a proverbial pin drop in any room where she was speaking.” When Dr. Blackwell “entered a room full of students, there suddenly seemed to be only one person in that room, and that person was Dr. Blackwell.” The same student also recalled that Dr. Emily “…inspired us all with the vital feeling that we were still on trial and that, for women who meant to be physicians, no educational standards could be too high.”

The starting point of Wald’s education was “the plodding and elementary work of learning the names of muscles and bones….” In addition to tedious memorization, she was expected to read textbooks on physiology and chemistry and to spend hours in labs, dissecting and peering through a microscope.

Yet even with all of this study, Wald found herself with more free time than she had had in years. A medical student, she later noted, did not have to spend hours each day working in a hospital ward, as did a nurse in training. In her spare time, the young medical student often went to the gardens in Stuyvesant Square to sit and relax. One morning, when she was unable to find a seat, an old vagabond, seeing her look around, moved over and beckoned her to join him. When she sat, he offered her a share his breakfast–a loaf of bread that he held out to her on the point of his knife. She politely refused but, reasoning that bread was an awfully dry breakfast, gave him a dime to buy beer. Upon receiving the money from her, he stood up and bowed. “Madame,” he said, “I will drink to your health.” From then on, whenever Lillian encountered the same man on her visits to the park, he rose and took off his hat to her. One day, curious, she asked him where he slept. “In fine weather,” he proclaimed, with a sweeping gesture around the park, “what could be better than this?” (Later, upon recalling the story, Wald would ask her friends and acquaintances, “How could you call such a man a bum?”)

This example of the city’s poverty stuck in her mind, but it was nothing compared to what Lillian Wald would encounter in the spring of 1893, while still a medical student. In the beginning of the year, she was asked to teach health and home nursing techniques one day a week to poor immigrant women at a Sabbath School on the Lower East Side. Having extra time on her hands, she agreed.

Wald most likely found no resistance from the College upon taking up this work. In fact, she may well have been encouraged. In addition to its dispensary, in 1866 the WMC had appointed a “sanitary visitor,” a person responsible for going into the community, caring for the poor and giving instruction to poor women on how to care for their families. This service was the first medical social services program in the country.

The classes Lillian agreed to teach had initially been established with the financial backing of Mrs. Solomon Loeb, a wealthy philanthropist and wife of a prominent New York banker. Its creators hoped to find poor women who would qualify to become students in a nurses training program. Minnie Louis, a representative of the Sabbath School, felt that Wald, being Jewish, would be sensitive to the culture and observances of the students she would teach.

While planning the course, Wald drew upon her experience as a nursing student. “Remembering the families who came to visit patients in the wards,” she said, “I outlined a course of instruction in home nursing adapted to their needs.” Reality intruded upon her careful plans soon after Wald entered the classroom, located in “an old building in Henry Street, then used as a technical school….” She found that the students in her class had never been taught even the simplest facts about health and hygiene. Unperturbed, she cast her notes aside and plunged right in, teaching them the basics.

It was during one of these classes that Lillian’s life changed forever. On a rainy morning at the end of March, 1893, she was teaching her students how to properly make a bed. As she later recalled, “a little girl” interrupted the class and “told me of her sick mother.” Guessing from the girl’s “incoherent account that a child had been born,” Wald “caught up the paraphernalia of the bedmaking lesson,” left the schoolroom, and began the short but memorable journey to the girl’s home.

As a nurse, Lillian Wald had worked with the poor in New York hospital and in the Asylum. As a medical student, she had conversations with the homeless in Stuyvesant Park. But she had never before been exposed to the actual conditions under which poor people lived. The events she witnessed that day shocked her, etching themselves permanently onto her memory. She recalled the details often, recording them for posterity in her book, The House on Henry Street. “The child led me over broken roadways,” she wrote, where “there was no asphalt, although its use was well established in other parts of the city….” She stepped “over dirty mattresses and heaps of refuse,” walking “between tall reeking houses.” Looking up, she saw that the fire escapes lining the buildings had been rendered useless for their purpose because they “bulged with household goods of every description.”

The rain continued to fall, dampening everyone’s spirits, casting a grey pall over the already dismal scene. It also intensified “the odors which assailed” her “from every side.” “Through Hester and Division streets we went,” Wald remembered, “to the end of Ludlow; past odorous fish-stands…past evil-smelling, uncovered garbage cans.” Yet in spite of the rain, the noxious smells, the depressing scene that spread before her, Lillian pushed on toward her goal. She took in everything but let nothing get in her way.

When she entered the cluster of buildings where the child lived, she pressed forward, past “a court where open and unscreened closets [outhouses] were…used by [both] men and women, up to a rear tenement, by slimy steps whose accumulated dirt was augmented that day by the mud of the streets, and finally into the sickroom.”

She walked into a miserable scene. The child had led her to a “family of seven” that “shared their two rooms with boarders” — “literally boarders,” she said–“since a piece of timber was placed over the floor for them to sleep on.” The woman’s husband “was a cripple, one of those who stand on corners exhibiting deformities to enlist compassion.”

But Wald looked past all of this. She met the situation head on–as a nurse, a professional, trained to be calm and collected in the face of the worst human suffering, trained to be of use to those in need. What she concentrated on was “a sick woman” who “lay on a wretched, unclean bed, soiled with a hemorrhage two days old.” She got to work–bathing the woman, changing her clothes, making her bed. She comforted the family, cleaned the rooms, and fed the children. When she finished, much to her embarrassment, “‘that poor woman kissed my hands.'”

Later, when Lillian Wald was able to reflect on her experience that day, she noted that these people, in spite of their humiliating condition, “were not degraded [i.e., immoral] human beings.” “In fact,” she insisted, “it was very plain that they were sensitive to their condition….they were not without ideals for the family life, and for society.” She believed that they should not be ashamed about their situation. To the contrary–if anyone should be embarrassed, she thought, it was those who were more fortunate and powerful–those who “permitted such conditions to exist.”

The idealistic and, in her own words “inexperienced” Wald was convinced that the only reason such conditions “were allowed” was “because people did not know.” For her, the solution became simple. She would be a witness and an advocate. It would be her “challenge to know and to tell.” Once “people knew things,” she was sure that “such horrors would cease to exist.”

Wald walked out of the tenement building that day “awakened.” She “rejoiced” that she “had a training in the care of the sick” that would give her an “organic relationship to the neighborhood in which this awakening had come.” Lillian Wald had found a way to be useful. No longer did she feel the need for the abstract training of medical school. She would leave behind her microscope, her dissections, her lectures and her textbooks. From that day forward, her laboratory would be the world.