The first nurse was placed on the city payroll in October, 1902, and this marked the beginning of an extraordinary development of the public control of the physical condition of children. Out of this innovation New York City’s Bureau of Child Hygiene has grown.
The Department of Health now employs 650 nurses for its hospital and preventive work. Of this number 374, in the year 1914, were engaged for the Bureau of Child Hygiene.
Poor Louis, who all unconsciously had started the train of incidents that led to this practical reform, has long since moved from his Hester Street home to Kansas, and was able to write us, as he did with enthusiasm, of his identification with the West.
Our first expenditures were for “sputum cups and disinfectants for tuberculosis patients.” The textbooks had said that Jews were practically immune from this disease, and here we found ourselves in a dense colony of the race with signs everywhere of the white plague, which we soon thought it fitting to name “tailors’ disease.”
Long before the great work was started by the municipality to combat its ravages through education and home visitation, we organized for ourselves a system of care and instruction for patients and their families, and wrote to the institutions that were known to care for tuberculosis cases for the addresses of discharged patients, that we might call upon them to leave the cups and disinfectants and instruct the families.
Since 1904 the anti-tuberculosis movement has been greatly accelerated, and although it is pre-eminently a disease of poverty and can never be successfully combated without dealing with its underlying economic causes—bad housing, bad workshops, undernourishment, and so on—the most immediate attack lies in education in personal hygiene. For this the approach to the families through the nurse and her ability to apply scientific truth to the problems of human living have been found to be invaluable.[3]
Infant mortality is also a social disease—“poverty and ignorance, the twin roots from which this evil springs.” There is a large measure of preventable ignorance, and in the efforts for the reduction of infant mortality the intelligent reaction of the tenement-house mother has been remarkably evidenced. In the last analysis babies of the poor are kept alive through the intelligence of the mothers. Pasteurized or modified milk in immaculate containers is of limited value if exposed to pollution in the home, or if it is fed improperly and at irregular periods.
The need of giving the mother training seemed so evident that, in the course of lessons given on the East Side antedating our nursing service, I had demonstrated with a primitive sterilizer a simple method of insuring “safe” milk for babies.
The settlement established a milk station in 1903, when one of its directors began sending milk of high grade from his private dairy. Following our principle of building up the homes wherever possible, the modification of the milk has always been taught there. The nurses report that it is very rare to find a woman who cannot learn the lesson when made to understand its importance to her children.