{"id":846,"date":"2017-02-18T21:22:44","date_gmt":"2017-02-18T21:22:44","guid":{"rendered":"http:\/\/www.lillianwald.com\/?page_id=846"},"modified":"2018-07-31T19:34:08","modified_gmt":"2018-07-31T19:34:08","slug":"school-nurses-section-ii","status":"publish","type":"page","link":"https:\/\/www.lillianwald.com\/?page_id=846","title":{"rendered":"School Nurses, Section II"},"content":{"rendered":"

 <\/em><\/strong>NEW YORK<\/em><\/strong>\u2019S PILOT PROGRAM FOR SCHOOL NURSES<\/em><\/strong><\/h1>\n

 <\/p>\n

Lillian Wald was a reluctant critic of the 1897 reform policy that excluded contagious children from schools.  She believed that the Board of Health meant well, but thought that government should take an active role in treating students instead of just sending them home. She also argued that public health nurses could be \u201can essential factor in\u2026whatever treatment might be suggested for the pupils.\u201d She made this \u201cobservation\u201d on a number of occasions to people who could make a difference. <\/p>\nngg_shortcode_0_placeholder\n

Wald\u2019s critique proved prescient.  New York City\u2019s exclusion policy did not provide adequate provision for treatment and follow-up.  Soon the schools found themselves literally \u201cdepopulated.\u201d<\/p>\n

Powerful people were listening to Wald\u2019s ideas\u2014and agreeing with them.  At one point, the President of the Board of Health asked Wald \u201cto take part, as nurse, in the medical supervision of the schools.\u201d However, he did not offer to appropriate any money or endow official status for nurses\u2019 services. Wald concluded that it \u201cdid not seem wise to accept\u201d the offer, and regretfully declined.  She reasoned that the Henry Street Settlement was just beginning to flourish and residents were \u201cembarking upon ventures of their own which would require,\u201d as she put it, \u201call our facilities and all our strength.\u201d In her mind it \u201cseemed better\u201d for the Settlement to be \u201cfree from connections which would make demand upon our energies,\u201d especially if these entailed \u201croutine work\u201d that happened \u201coutside the settlement.\u201d<\/p>\n

Wald also reasoned that \u201cthe time did not seem ripe for advocating the introduction of both the doctor and the nurse\u201d into the schools.  The doctor\u2019s presence alone, she argued, was an \u201cinnovation,\u201d and \u201cthe appointment of a nurse would have been a radical departure.\u201d <\/p>\n

During her trip to England in 1900, Wald found a possible solution to the problem.  While attending a tea with her friend Graham Wallas<\/a>, she met Fabian philanthropist Honner Morten<\/a>. Morten had recently conducted a limited experiment.  Paying out of her own pocket, she had temporarily put a nurse into one of London\u2019s schools.  The trial proved successful and officials began to look at the idea of expanding the experiment throughout the school system.  <\/p>\n

Wald was interested in adapting Morten\u2019s idea in New York City schools.  However, nothing came of it until Mayor Seth Low’s<\/a> reform administration took office on January 1, 1902.  Low appointed Dr. Ernst J. Lederly\u2014whom Wald described as \u201can intelligent friend of children\u201d\u2014to the post of Commissioner of Health.  Under Lederly, \u201cthe whole department shuddered at the shake-up and housecleaning that occurred.\u201d  Lederly made the school system\u2019s \u201cthe medical staff\u201d more efficient by reducing their numbers, increasing their salary \u201cto $100 a month,\u201d and demanding \u201cthree hours a day\u2026from the doctors.\u201d<\/p>\n

The trachoma<\/a> epidemic in schools first came to light in the spring of 1902, shortly after Lederly took office. Suspecting a problem, he sent a few specialists (“oculists”)<\/a> into the schools to determine \u201cthe prevalence of trachoma among school children.\u201d  The specialists found \u201cthat about 17 per cent. of the school children examined were afflicted with trachoma to some degree.\u201d  This was enough evidence for Lederly to recommend that all school inspectors be \u201crequired to take special instruction in the New York Eye and Ear Dispensary\u201d in order to become \u201cbetter qualified\u201d to diagnose trachoma.  Once trained, the regular examiners found so many cases of the disease that \u201call the dispensaries and hospitals were so congested with trachoma cases that almost no other class of cases could be attended to.\u201d <\/p>\n

The rise in the number of cases diagnosed led many \u201cauthorities of the dispensaries and hospitals\u201d to outright refuse to treat trachoma.  They simply did not have the resources. Even when trachoma patients did get the treatment they needed, over-burdened surgeons often failed to complete the accompanying paperwork.  Since the Board of Health insisted on \u201crigid\u201d surveillance and exclusion of infected children, the child who lacked paperwork, even after treated, could not be re-admitted to school.  Eventually, authorities were forced to deal with the problem by dedicating the \u201cold portion of the Gouverneur Hospital<\/a>\u201d as an \u201cEye Hospital and Dispensary of the Department of Health.\u201d<\/p>\n

The aggressive efforts to make schools safe meant that once again \u201c[t]housands of children were sent out of the schools.\u201d This was, as Wald pointed out, not only counterproductive for the individual child\u2019s education. It was also an inadequate response to the epidemic\u2014\u201c[I]n our neighborhood,\u201d she said, \u201cwe watched many of them, after school hours, playing with the children for whose protection they had been excluded from the classrooms.\u201d  Once again, \u201c[f]ew received treatment\u2026truancy was encouraged, and\u2026classrooms were depleted.\u201d<\/p>\n

The Board of Health \u201cbemoaned the fact that the schools\u201d were \u201cdepopulated,\u201d but they continued to maintain that \u201cit was their strict duty to exclude\u201d children with contagious diseases in order to protect healthy children. Health Department office employees found themselves \u201cbesieged with mothers and children berating inspectors\u2026.\u201d  It had become \u201cevident\u201d that \u201cthis wholesale exclusion of children\u201d was not working.  <\/p>\n

Thus Seth Low\u2019s reform administration, by being more efficient and demanding, had ironically made the problem more acute. The Boards of Health and Education faced a tricky problem.  While one of them was busy \u201cprohibiting children from attending school,\u201d the other was expending efforts \u201ccommanding the parents to send them to school.\u201d  The Health Commissioner and the President of the Department of Education reached out and \u201csought guidance in this predicament.\u201d  Wald decided that the \u201ctime had come when it seemed right to urge the addition of the nurse\u2019s service to that of the doctor\u201d and \u201csuggested to the Board of Education the employment of nurses to see that the advice of school physicians was acted upon.\u201d <\/p>\n

School nurses, Wald knew, were the ingredient that would make a medical inspection program work.  They could follow up on diagnoses and treat children (or make sure others treated them) for minor contagious illnesses.  With nurses in place, Wald reasoned, not only would schools be safer, but fewer \u201cchildren would lose their valuable school time\u201d in order to make them that way.<\/p>\n

Yet Wald was still reluctant to commit the Settlement\u2019s time and resources to an ongoing formal relationship with the school system.  Instead, she proposed a variation of Morten\u2019s London plan. In the fall of 1902 she offered and obtained permission to donate the time of one of the settlement\u2019s staff for a demonstration project\u2014but only at a few locations and for a limited amount of time.<\/p>\n

Before Wald agreed to the plan, she \u201cexacted a promise from several of the city officials that if the experiment were successful they would use their influence to have the nurse, like the doctor, paid from public funds.\u201d Once she secured this agreement, Wald and other leaders of the pilot project chose four schools \u201cfrom which there had been the greatest number of exclusions for medical causes.\u201d  Lina Rogers, a Settlement resident and \u201can experienced nurse, who possessed tact and initiative,\u201d agreed to implement a model program in these schools that would last for one month.<\/p>\n

Those involved in the project \u201cdevised\u201d a routine for the four schools.  Every day, the \u201cexamining physician\u201d in the chosen schools would send \u201call the pupils who were found to be in need of attention\u201d to the nurse. With no more than \u201cthe equipment of the settlement bag[*] and, in some of the schools, with no more than the ledge of a window or the corner of a room for the nurse\u2019s office,\u201d Lina Rogers \u201cinaugurated\u201d a \u201csystem of thorough medical inspection in the schools and of home visiting.\u201d <\/p>\n

Rogers incorporated a variety of levels of care for the children.  A large proportion of them required<\/p>\n

only disinfectant treatment of the eyes, collodion<\/a> applied to ringworm, or instruction as to cleanliness, and such were returned at once to the class with a minimum loss of precious school time.<\/p>\n

With more serious cases, Rogers \u201ccalled at the home, explained to the mother what the doctor advised, and, where there was a family physician, urged that the child should be taken to him.\u201d When families were too poor to be able to afford a private doctor, Rogers gave them \u201cinformation as to dispensaries,\u201d and in homes where \u201cthere was no one free to take the child to the dispensary, the nurse herself did this.\u201d In cases where children were sent to the nurse simply because they were unclean, \u201cthe mother was given tactful instruction and, when necessary, a practical demonstration on the child himself.\u201d<\/p>\n

During the course of the month-long trial, Lina Rogers\u2019 completed a total of 893 examinations and treatments, and made 137 visits to the homes of sick school children. While at these homes, she also treated twenty five children who had already been excluded, allowing them to return to school.  The month\u2019s trial \u201cproved that, with the exception of the very small proportion of major contagious and infectious diseases,\u201d a nurse\u2019s work \u201cmade it possible to reverse\u201d the previous outcome of medical inspection from a program that excluded children to one that kept \u201cthe children in the classroom and under treatment.\u201d<\/p>\n

At the end of the demonstration project an \u201cenlightened\u201d Board of Estimate and Apportionment voted to allocate the sum of $30,000 to employ trained nurses in the schools.  Lillian Wald and Settlement resident Lina Rogers had succeeded in their mission.<\/p>\n

 <\/p>\n

*\u201cNURSES’ SETTLEMENT DISTRICT BAG \/ THE Nurses’ Settlement in New York has \u2026 a district nurses’ bag \u2026. modelled after a Boston shopping-bag, with some slight changes.  It is wider, and has square box ends. It is twelve inches long, five and a half inches wide, and nine and a half inches high\u2026. There is \u2026.a linen strap for safety-pins\u2026. On the other side of the bag there is one long pocket running from one end to the other for the stationery. On one corner of that is a wide, stiff strap for holding the pencil, spatula, scissors, and two thermometers. The bag can be carbolized inside and out. The contents are as follows:<\/em><\/p>\n

One three-ounce bottle for alcohol; five one-ounce bottles containing respectively listerine, whiskey, glycerine, tincture of green soap, and carbolic acid, ninety-five per cent.; one wide-mouthed bottle with screw-top for bichloride tablets; one one-ounce wide-mouthed bottle with screw-top for boracic acid powder; small screw-top bottle for cascara tablets; one two-ounce porcelain jar containing boracic acid unguent; two one-ounce porcelain jars with ichthyol unguent, ten per cent., and Thiersch powder; one one-ounce porcelain jar for special dressing containing iodoform, balsam Peru, etc.; half-ounce porcelain jar for vaseline; one white-enamel bowl, used as soap-dish and measure, holding six ounces; one cake of soap; nail-brush; hand-towel; apron of light-weight muslin, made like a butcher’s apron; white-enamel funnel; spatula; pencil with tip; two thermometers rectal, mouth; scissors; instrument case of linen, containing rubber and glass catheters, a syringe and a dropper of glass, forceps, probe, and wooden picks; toilet powder in shaker; safety-pins, large and small; linen bag for gauze and unbleached bandages; linen bag for dressings, containing gauze rolls, absorbent and non-absorbent cotton, linen, and pads; stationery, consisting of bedside notes, brown envelopes in which to keep them, and pad; rubber tissue; adhesive plaster\u2026.. The instrument case\u2026. has one pocket for holding the rubber catheter, which measures five and a half inches long by three and a quarter deep\u2026.The bag, exclusive of the fittings, costs three dollars and fifty cents. M. M. B.\u201d Excerpt from \u201cEditor’s Miscellany,\u201d <\/em>The American Journal of Nursing, Vol. 1, No. 10 (Jul., 1901), pp. 766-773, \u201cNurses Settlement District Bag\u201d, pp. 769-772, includes photos of bag and contents).<\/em> <\/em><\/strong><\/p>\n

Bibliography<\/em><\/strong><\/p>\n

Baker, S. Josephine, Fighting For Life,<\/em> NY:  The Macmillan Company, 1939.<\/p>\n

Baker, Josephine, Speaker, \u201cNursing News and Announcements,\u201d The American Journal of Nursing, Vol. 10, No. 6 (Mar., 1910), pp. 422-441.<\/p>\n

Bullough, Vern L., and Bonnie Bullough, The Emergence of Modern Nursing<\/em>, 2d ed., London:  The Macmillan Co.,  1969.<\/p>\n

Bullough, Vern and Bonnie, The Care of the Sick:  the Emergence of Modern Nursing<\/em>, NY:  Prodist, 1978.<\/p>\n

Daniels, Doris Groshen, Always a Sister:  The Feminism of Lillian D. Wald<\/em>, New York, Feminist Press, 1989.<\/p>\n

Darlington, Thomas, \u201cPrecautions Used by the New York City Department of Health to Prevent the Spread of Contagious Disease in the Schools of the City.\u201d  By Thomas Darlington, M.D., Commissions* Of Health Of New York City.   From Medical News:  A Weekly Journal Of Medical Science. <\/em> Vol. 86.  New York, Saturday, January 21, 1905. No. 3, Pp. 97-104.<\/p>\n

Davis, Allen F., Spearheads for Reform:  The Social Settlements and the Progressive Movement, 1890-1914<\/em>, New York, Oxford University Press, 1967.<\/p>\n

Dock, Lavinia, \u201cSchool Board Nurses,\u201d and \u201cLederle,\u201d excerpts in \u201cForeign Department,\u201d The American Journal of Nursing, Vol. 3, No. 5 (Feb., 1903), pp. 396-401.<\/p>\n

Dock, Lavinia, \u201cSchool-Nurse Experiment in New York,\u201d by L. L. Dock, The American Journal of Nursing, Vol. 3, No. 2 (Nov., 1902), pp. 108-110.<\/p>\n

Dolan, Josephine A., Goodnow\u2019s History of Nursing<\/em>, Eleventh Edition, Philadelphia:  W.B. Saunders Co., 1963.<\/p>\n

Duffus, R.L., Lillian Wald:  Neighbor and Crusader<\/em>, New York:  The Macmillan Company, 1939.<\/p>\n

[Epstein], Beryl Williams, Lillian Wald:  Angel of Henry Street<\/em>  [author\u2019s name on title page is \u201cBeryl Williams\u201d], NY:  Julian Messner, Inc., 1948.<\/p>\n

Henry Street Settlement, \u201cOur History,\u201d (1902)  http:\/\/www.henrystreet.org\/about\/our-history\/<\/a> Current 1\/2\/17.<\/p>\n

Hunting, Harold B., \u201cLillian Wald:  Crusading Nurse,\u201d in Lotz, Philip Henry, ed., Distinguished American Jews<\/em>, (Creative Personalities, v. VI), NY:  Association Press, 1945.<\/p>\n

Morten, Honnor, \u201cThe London Public-School Nurse,\u201d Honnor Morten. The American Journal of Nursing Vol. 1, No. 4 (Jan., 1901), pp. 274-276.<\/p>\n

Mottus, Jane E., New York<\/em> Nightingales:  The Emergence of the Nursing Profession at Bellevue and New York Hospital 1850-1920<\/em>,  [Revision of thesis-Ph.D.), New York University, 1980], Ann Arbor, MI, UMI Research Press, c1981, 1980.<\/p>\n

Notable American Women 1607-1950: A Biographical Dictionary<\/em>, Edward T. James, Janet Wilson James, & Paul S. Boyer, eds., v.3, Cambridge, MA: The Belknap Press of Harvard University Press, 1971.<\/p>\n

\u201cNurses Settlement District Bag,\u201d in \u201cEditor’s Miscellany,\u201d The American Journal of Nursing, Vol. 1, No. 10 (Jul., 1901), pp. 766-773, \u201cNurses Settlement District Bag\u201d, pp. 769-772, includes photos of bag and contents).<\/p>\n

\u201cOfficial Reports,\u201d The American Journal of Nursing, Vol. 9, No. 1 (Oct., 1908), pp. 56-64   (\u201cA RESIGNATION which will cause regret is that of Lina L. Rogers from the staff of school nurses of New York City\u2026.)<\/p>\n

 <\/em>\u201cProfessional Nursing in School and Tenement,\u201d New York<\/em> Times<\/em>, August 27, 1905.<\/p>\n

Rogers, Lina, \u201cThe Nurse in the Public School,\u201d paper presented at the \u201cEighth Annual Convention of the Nurses’ Associated Alumn\u00e6 of the United States: Minutes of the Proceedings,\u201d The American Journal of Nursing, Vol. 5, No. 11 (Aug., 1905), pp. 725-836. <\/p>\n

Rogers, Lina,  Reporting in \u201cOfficial Reports of Societies,\u201d in The American Journal of Nursing, Vol. 3, No. 7 (Apr., 1903), pp. 556-571, p. 566.<\/p>\n

Rogers, Lina L. \u201cSome Phases of School Nursing\u201d By Lina L. Rogers, R.N. Supervising School Nurse, New York City, American Journal of Nursing<\/em>,<\/em> 8 (12), 966-974, 1908. Reprinted with permission in the October 2002 issue of the Journal of School Nursing<\/em>.<\/p>\n

Rogers, Lina, \u201cA Year’s Work for the Children in New York Schools,\u201d Lina L. Rogers. The American Journal of Nursing, Vol. 4, No. 3 (Dec., 1903), pp. 181-184. <\/p>\n

Schumacher, Casey, \u201cLina Rogers: A Pioneer in School Nursing, The Journal of School Nursing, <\/em>October 2002 vol. 18 no. 5 247-249.<\/p>\n

Smith, Helena Huntington, \u201cProfiles:  Rampant but Respectable; Lillain D. Wald,\u201d The New Yorker, <\/em>Dec. 14, 1929.<\/p>\n

Wald, Lillian D., The House on Henry Street, N:Y:  Henry Holt & Co., 1915.<\/em><\/p>\n

Wald, Lillian, \u201cMedical Inspection of Public Schools,\u201d Lillian D. Wald, Annals of the American Academy of Political and Social Science, Vol. 25, City Life and Progress (Mar., 1905), pp. 88-96.<\/p>\n

Wald, Lillian D., Lillian Wald Papers<\/em>.<\/em> New York: New York Public Library, 1983.<\/p>\n

Woods, Robert A. & Albert J. Kennedy, Handbook of Settlements<\/em> (Russell Sage Foundation), NY:  Charities Publication Committee, 1911.<\/p>\n

Woods, Robert A. and Albert J. Kennedy, The Settlement Horizon:  A National Estimate<\/em>, New York:  Russell Sage Foundation, 1922.<\/p>\n

Illustrations<\/em><\/strong><\/p>\n

Gouverneur Hospital Children\u2019s Ward. 3 children seated at low table; others are in beds. May, 1902. NYC Dept. of Records. Link to Illustration<\/a><\/p>\n

Gouverneur Hospital Children\u2019s Ward, northeast wing. May, 1902 NYC Dept. of Records. Link to Illustration<\/a>  Current 1\/11\/17<\/p>\n

Gouverner Hospital  Dr. Emily Dunning Barringer<\/a> as a resident at Gouverneur, c. 1900.<\/p>\n

https:\/\/en.wikipedia.org\/wiki\/Gouverneur_Health#\/media\/File:EmilyDunningBarringer.jpg<\/a>    Current 1\/11\/17<\/p>\n

Gouverner Hospital Male Surgical Ward. Patients, mostly sitting up, and several nurses. May, 1902. NYC Dept. of Records. Link to Illustration<\/a>  Current 1\/11\/17<\/p>\n

Gouverner Hospital Operating Room, eastern and western exposure. May 1902. NYC Dept. of Records.  Link to Illustration<\/a>  Current 1\/11\/17<\/p>\n

Gouverner Hospital, Original building of Gouverneur Hospital (formerly a market) on Gouverneur Slip, erected in 1883. Horse-drawn ambulance. NYC Department of Records. Page from Medical Journal & Record <\/em>6\/5\/1929   Link to Illustration<\/a>    Current 1\/11\/17<\/p>\n

Gouverneur Hospital: Patients on curved verandas with protective shades. Ambulance garage center; dispensary at R. 1913-1917. NYC Dept of Records. Link to Illustration<\/a>  Current 1\/11\/17<\/p>\n

Gouverneur Hospital. Southeast elevation. Showing wings for wards. Ambulance house and stable between wings. 1907-1910. NYC Dept. of Records. Link to Illustration<\/a>  Current 1\/11\/17<\/p>\n

Gouverneur Hospital Tuberculosis Clinic. Seated patient with man at desk taking notes. Another patient background. May, 1902. NYC Dept. of Records. Link to Illustration<\/a>  Current 1\/11\/17<\/p>\n

Gouverneur Hospital Waiting Room: Patients crowded on benches, some standing, in hallway. May, 1902. NYC Dept. of Records Link to Illustration<\/a>  Current 1\/11\/17<\/p>\n

Low, Seth, Seth Low<\/a>, head-and-shoulders portrait. Public Domain.  Created 31 December 1900. https:\/\/en.wikipedia.org\/wiki\/Seth_Low#\/media\/File:Seth_Low_cph.3a37073.jpg<\/a>  Current 1\/11\/17<\/p>\n

Rogers, Lina, with schoolchildren.  Caption reads:  The superintendent of nurses, Ms. Lina Rogers, inspecting school children. http:\/\/www.harvardsquarelibrary.org\/wp-content\/uploads\/2012\/07\/jb2-baker6a.jpg<\/a>  Current 1\/6\/17<\/p>\n

School nurse weighing and measuring pupils, Philadelphia PA ca. 1912   This IMAGE (or other media file) is in the public domain because its copyright has expired. This applies to the United States, where Works published prior to 1978 were copyright protected for a maximum of 75 years. Works published before 1923 (in this case c 1913) are now in the public domain. Title: American journal of public health: the journal of the American Public Health Association, Volume 3, Issues 1-6. Author: American Public Health Association. Publisher: American Public Health Association, 1913. Original from: the University of California. Digitized: Aug 3, 2007. Subjects: Medical \u203a Public Health Medical \/ Public Health, Public health 
\nTEXT CREDIT: American journal of public health: the journal of the American Public Health Association, Volume 3, Issues 1-6<\/em><\/a> http:\/\/publicdomainclip-art.blogspot.com\/2011\/09\/school-nurse-weighing-and-measuring.html<\/a>   Current 1\/6\/17<\/p>\n

Wallas, Graham. Younger years. Public domain. https:\/\/en.wikipedia.org\/wiki\/Graham_Wallas#\/media\/File:Graham_Wallas.jpg<\/a>  Current 1\/11\/17<\/p>\n

Wallas, Graham, Graham Wallas portrait taken c.1920s. Public domain. https:\/\/en.wikipedia.org\/wiki\/Graham_Wallas#\/media\/File:Graham_Wallas,_c1920s.jpg<\/a>  Current 1\/11\/17<\/p>\n

Copyright Anne M. Filiaci 2016<\/p>\n

< Previous<\/a>Next ><\/a><\/span>
\n <\/p>\n