Public Health Nursing


In the 1800s , the rise of industry and improvements in transportation , the country needed workers and the population of the United States grew as immigrants entered the country. From the 1820’s to 1910 nearly 30 million Immigrants came to the United States. [i] Cities grew as majority of immigrants settled along the east coast in cities  such as New York, Boston , and Philadelphia while some settled in interior cities such as Chicago  and Cincinnati and Cleveland. The majority of the new immigrants were poor and while they needed housing, they could not afford the mansions that were built to house the wealthier industrialists . Space was at a premium; the result was the rise of the tenement[ii];  the object was to house a many people as possible. In 1879 in New York, dumbbell shaped floor plan was designed allowing or an air-shaft in the middle with rooms on either side that allowed for increased number of occupants. While the air shaft was meant to provide the inner apartments with fresh air , many tenants used it as a garbage chute; rotting garbage giving the air a foul odor.

Airshaft “Dumbbell” Apartments on Either Side

Airshaft “Dumbbell” Apartments on Either Side

People were packed inside tenements; families – mother, father and children all lived in one room. Sanitary facilities such as water closets, were shared;  in the newer tenements  water closets were indoors usually at the end of a hall while older tenements facilities were outside. The crowded apartments with their minimal sanitary facilities, ventilation and vermin issues became a public health hazard with a high incidence of typhus, scarlet fever, smallpox, typhoid fever and tuberculosis.

Conditions in New York, as in other large American cities gave rise to philanthropic and religious organizations sending nurses to visit the working poor and sick inside their homes.For example, in 1877 the Women’s Branch of the New York Mission and Tract Society hired the one of the first graduates of Bellevue Hospital. School of Nursing as a “Missionary Nurse” into the homes of the poor to bring comfort ‘ to many who have no one to minister to them’.[i] Public health nurses became the third area of employment for trained nurses. -at first the nurses were referred to as district nurses (the title used in England) then renamed ‘ visiting nurses ‘.

Lillian Wald (1867 - 1940)


Lillian Wald was born in in Cincinnati, Ohio. Her father dealt in optical goods and moved the family to Rochester, New York, the location of Bausch and Lomb known for eye health products. Lillian graduated from the New York Hospital School for Nurses in 1891. Her first position was as a nurse in an orphan asylum. Seeking further medical knowledge, she attended the New York Women’s Medical College. As a student she was asked to give classes to immigrant women living in New York’s lower east side. During her class she was approached by a small boy, asking for help for his mother who was ill. The child led her to tenement where nine people lived. The mother ,who had given birth several days before and had received no lay on a bed, seriously ill. Lillian sent for a physician and cared for the woman,. She decided to leave medical school. In 1893 Lillian Wald and Mary Maud Brewster both graduates of the New York Hospital Training School for Nurses, decided to:

“live among their patients—mainly poor immigrants inhabiting Lower East Side tenements in New York City—providing not only nursing care but also "addressing nutritional needs, giving psychological support, and educating patients and families about sanitation and health."1 To this end, with the financial backing of Mrs. Solomon (Betty) Loeb and her son-in-law, banker Jacob Schiff, they formed the Henry Street Settlement in 1895.[i]

Lillian Wald coined the term "public health nurse" in 1893 for nurses who worked outside hospitals in poor and middle-class communities.

”Our basic idea was that the nurse's peculiar introduction to the patient and her organic relationship with the neighborhood should constitute the starting point for a universal service to the region... We planned to utilize, as well as to beimplemented by all agencies and groups of whatever creed which were working for social betterment, private as well as municipal. Our scheme was to be motivated by a vital sense of the interrelation of all these forces... We considered ourselves best described by the term 'public health nurses.' "[i] The Jewish Women’s Archive – Women of Valor[ii]

Visiting Nurse (1900’s) making visits by traveling the roofs of tenements

Visiting Nurse (1900’s) making visits by traveling the roofs of tenements

Check These Links VNSNY: History: and the “Legacy of Lillian Wald – VNSNY 125th Anniversary” from VNSNY on Vimeo. The video is available for your viewing pleasure at

[i] From Our basic idea..." From Lillian Wald, "We Called Our Enterprise Public Health Nursing" forward to The Public Health Nurse in Action by Marguerite Wales. (New York: The MacMillan Company, 1941)
xi. Ibid

[i] Berman, Paul MD,2010. Mary Maud Brewster, AJN, American Journal of Nursing,: August 2010 - Volume 110 - Issue 8 - p 62-63 doi: 10.1097/01.NAJ.0000387698.64779.6f

[ i] Kalish, Phillip  and Beatrice Kalish .2004  American Nursing A History ,Ch. 8[The Rise of Public Health Nursing, Lippincott, Williams and Wilkins 4th Ed  p.160

[ii] Tenement : A tenement is a multi-occupancy building of any sort. However, in the United States, it has come to refer most specifically to a run-down apartment building or to a slum (Wikipedia)  Tenements of the Industrial Revolution. Tenements of the Industrial Revolution. A tenement is a inferior multi-family housing in highly populated urban areas. This is usually old and heavily occupied by lower class citizens.

Private Duty Nursing

Hospital Employment