The house on Henry Street

by Lillian D. Wald

I had come to the conclusion that the nurse would be an essential factor in making effective whatever treatment might be suggested for the pupils, and, following an observation of mine to this effect, the president asked me to take part, as nurse, in the medical supervision in the schools. This offer it did not seem wise to accept. We were embarking upon ventures of our own which would require all our faculties and all our strength. It seemed better to be free from connections which would make demand upon our energies for routine work outside the settlement. Moreover, the time did not seem ripe for advocating the introduction of both the doctor and the nurse. The doctor himself, in this capacity, was an innovation. The appointment of a nurse would have been a radical departure.

In 1897 the Department of Health appointed the first doctors; one hundred and fifty were assigned to the schools for one hour a day at a salary of $30 a month. They were expected to examine for contagious diseases and to send out of the classrooms all those who showed suspicious symptoms. It proved to be a perfunctory service and only superficially touched the needs of the children.

In 1902, when a reform administration came into power, the medical staff was reduced and the salary increased to $100 a month, while three hours a day were demanded from the doctors. The Health Commissioner of that administration, an intelligent friend of children, now ordered an examination of all the public school pupils, and New York was horrified to learn of the prevalence of trachoma. Thousands of children were sent out of the schools because of this infectious eye trouble, and in our neighborhood we watched many of them, after school hours, playing with the children for whose protection they had been excluded from the classrooms. Few received treatment, and it followed that truancy was encouraged, and, where medical inspection was most thorough, the classrooms were depleted.

The President of the Department of Education and the Health Commissioner sought for guidance in this predicament. Examination by physicians with the object of excluding children from the classrooms had proved a doubtful blessing. The time had come when it seemed right to urge the addition of the nurse’s service to that of the doctor. My colleagues and I offered to show that with her assistance few children would lose their valuable school time and that it would be possible to bring under treatment those who needed it. Reluctant lest the democracy of the school should be invaded by even the most socially minded philanthropy, I exacted 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.

Four schools from which there had been the greatest number of exclusions for medical causes were selected, and an experienced nurse, who possessed tact and initiative, was chosen from the settlement staff to make the demonstration. A routine was devised, and the examining physician sent daily to the nurse all the pupils who were found to be in need of attention, using a code of symbols in order that the children might be spared the chagrin of having diseases due to uncleanliness advertised to their associates.

With the 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’s office, the present system of thorough medical inspection in the schools and of home visiting was inaugurated. Many of the children needed only disinfectant treatment of the eyes, collodion 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. Where more serious conditions existed the nurse called 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. In the families of the poor information as to dispensaries was given, and where the mother was at work, and there was no one free to take the child to the dispensary, the nurse herself did this. Where children were sent to the nurse because of uncleanliness, the mother was given tactful instruction and, when necessary, a practical demonstration on the child himself.

A Short Cut over the Roofs of the Tenements

One month’s trial proved that, with the exception of the very small proportion of major contagious and infectious diseases, the addition of the nurse to the staff made it possible to reverse the object of medical inspection from excluding the children from school to keeping the children in the classroom and under treatment. An enlightened Board of Estimate and Apportionment voted $30,000 for the employment of trained nurses, the first municipalized school nurses in the world, now a feature of medical school supervision in many communities in this country and in Europe.