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Other young nursing graduates opened up the field of public health nursing during these early years of the nursing profession as Visiting Nurses. These Visiting Nurses went to the homes of the poor to provide free nursing care and coordinate support services. Wealthier patients hired nurses to stay with them. The 1890s were years of severe economic need in the U.S.; an economic depression as severe as that of the more infamous 1930s Great Depression occurred. In addition, U.S. cities became home to thousands of immigrants who were new to the American language and customs. Some nursing organizations, staffed by a small cadre of trained nurses in the late nineteenth century, responded to the people adversely affected by these conditions. It is worthwhile noting that these nurses often connected with their patients through the use of the newly invented telephone. Patients and doctors typically called the local pharmacy and left messages for the nurse. The nurse, in turn, visited the pharmacy at a set time each day to review the messages and then plan her work Figure 3.3.

FIGURE 3.3 Chicago VNA nurse in patient's home, c. 1890s.

Source: Chicago VNA Collection, Midwest Nursing History Research Center, University of Illinois at Chicago, College of Nursing.

One of the foremost nurse leaders and activists at this time was Lillian Wald, who is regarded as the founder of U.S. public health nursing. After her nurse's training in New York, and disenchanted with her first job in a children's home, Wald entered medical school. During her first semester, in 1893, she was told of a need for a teacher to conduct a home nursing course for immigrants on the lower East Side of the city. Wald volunteered and thus changed her life and the lives of countless others. She described making her way to a student's home “… through crowded ‘evil‐smelling’ streets, past open courtyard ‘closets’, up slimy settlement steps, and finally into the sickroom” (Buhler‐Wilkerson, 2001, p. 99). That same year, 1893, Wald and her friend Mary Brewster founded New York City's Visiting Nurse Service and Wald founded the Henry Street Settlement House, a site for poor and immigrant children and families to receive social services and health care.

In 1889, 4 years before the Henry Street Settlement House, a group of society women in Chicago founded the Chicago Visiting Nurse Association (VNA). The Chicago VNA aimed to provide nursing care to the poor, many of them immigrants, in their homes. Remember, in these days before antibiotics became available in the 1940s, most invalids required long periods of nursing to recover from an illness or surgery. The Chicago VNA nurses were assigned to all parts of the city and cared for patients suffering from multiple diseases including tuberculosis, smallpox, and polio, as well as giving maternity and chronic disease care. Jane Addams, the Nobel Prize winner and founder of Chicago's Hull House Settlement, was a charter member of the Chicago VNA. One of the VNA nurses was based in Hull House. In 1892 her supervisor wrote: “No one could conceive the dirt and ignorance that the Hull House nurse has to contend with. She has often had to care for a typhoid fever patient in a small room crowded with a dozen or more chattering and gesticulating Italian men and women, not one of whom could speak a word of English. Pigeons underfoot or flying on the bed” (VNA Annual Report, 1892, pp. 14–15, cited in Lusk et al. 2016). We can reflect on the difficulties these families endured, in a strange city with a very ill loved one, enduring the dangers, the dirt, and the overcrowding. And one can admire the intrepid and hardworking nurses visiting these homes.

In addition, the Chicago VNA was an early provider of school nursing, industrial nursing, and social services. In 1893/4, the city's last major smallpox epidemic occurred. Chicago had 3,726 smallpox cases and 1,210 deaths. The city's smallpox hospital was so crowded that tents had to be set up to accommodate the overflow of disease victims. Chicago VNA nurses staffed a temporary isolation hospital and cared for 265 patients. Twenty‐six VNA nurses volunteered to work in this hospital and 4 contracted smallpox. In 1903, the VNA also formally recognized the high incidence and dreadful toll of tuberculosis and established a Tuberculosis Committee that became the Chicago Tuberculosis Institute in 1906 (Burgess, 1990).

Reflect on this. Over a hundred years ago, nurses exposed themselves to dangerous diseases such as smallpox, were active in public health such as forming a tuberculosis committee or initiating school nursing, and were responsible for skilled hospital work. Thus, nurses such as Harriett Fulmer, an early superintendent of the Chicago VNA and the founder of the Illinois State Association of Graduate Nurses, realized that trained nurses needed to organize in order to protect the name of “nurse” and thus the new profession of nursing.