*Post written by Mona Meyer, Archives and Special Collections Metadata Librarian.

They were lifesavers—not the candy, nor the marine rescue apparatus, but women, mostly, who cared deeply about their communities and the needs of those who struggled to care for themselves and their families. “While it may seem strange in our modern world, for thousands of years people were born at home, died at home, and, if they became ill, were treated at home. Trained doctors were rare in early America. Most people lived in small communities where basic medical knowledge and care was handed down generation to generation. Women played an essential role–they were the primary caregivers and “keepers” of medical knowledge and they were the midwives that helped bring new life into the community. Their skills and knowledge were largely through passed down or from learning from other women.”

By the late 18^th century, medical care and medical training had begun to improve. There were now schools of nursing available.  After the Civil War it became more socially acceptable for women to work outside the home in professions other than teaching—for example, nursing.  The number of hospitals grew, and people began to turn to them for healthcare.  Concurrently, there were massive influxes of new Americans. The late 18^th and early 19^th centuries saw waves of immigrants coming to this country in search of a better life.  From 1820 to 1930, about 4 and a half million Irish immigrants came, seeking relief for a terrible famine in Ireland.  Many Asian immigrants were drawn to this country by the promise of incredible riches in California’s gold rush. “Between 1880 and 1920, a time of rapid industrialization and urbanization, America received more than 20 million immigrants. Beginning in the 1890s, the majority of arrivals were from Central, Eastern and Southern Europe. In that decade alone, some 600,000 Italians migrated to America, and by 1920 more than 4 million had entered the United States. Jews from Eastern Europe fleeing religious persecution also arrived in large numbers; over 2 million entered the United States between 1880 and 1920.  The peak year for admission of new immigrants was 1907, when approximately 1.3 million people entered the country legally.” Many of these people were desperately poor and, in addition, faced a certain amount of anti-immigrant sentiment. If they had any access to health care at all, and many did not, it was not going to be in a hospital.

Onto the scene at this time came a woman by the name of Lillian Wald. “Lillian D. Wald was a practical idealist who worked to create a more just society. Her goal was to ensure that women and children, immigrants and the poor, and members of all ethnic and religious groups would realize America’s promise of “life, liberty and the pursuit of happiness.”” She was born in Cincinnati March 10, 1867. Both of her parents’ families had come to the United States after the 1848 revolutions across Europe. Their pursuit of the American dream had been successful, and the family was well off. When she was 11, they moved to Rochester, New York. At the age of 16 Lillian applied to Vassar College but was not admitted due to her age. “Soon thereafter, Lillian attended the birth of her sister Julia’s child. She was so inspired by the work of the attending nurse that she decided to embark on a career in nursing.” She graduated from the New York Hospital Training School in nursing in 1891, and in 1892 enrolled in the Women’s Medical College in New York City. Living in New York, she saw firsthand the plight of the poor and determined to do something about it, she established what she called “public health nurses.”  While teaching a class in home nursing and hygiene to immigrant women on the Lower East Side, she had what she called her “baptism of fire.” A little girl asked Wald to come and help her sick mother. Following the child, “over broken asphalt, over dirty mattresses and heaps of refuse we went … There were two rooms and a family of seven not only lived here but shared their quarters with boarders… [I felt] ashamed of being a part of society that permitted such conditions to exist … What I had seen had shown me where my path lay.” Gone was all thought of more academic work—in 1893 Wald and colleague Mary Brewster established the Visiting Nurses Service. They lived in the community and soon saw that it was not enough to just take care of sick people, but social and economic conditions must be addressed.

“In 1895, Wald and Brewster moved out of their tenement building and into a house, also on the Lower East Side, that would become the Henry Street Nurses’ Settlement. They enrolled six more nurses and several activists, lawyers, union organizers, and social reformers; all lived together and collectively shared living expenses. In addition to nursing, they arranged picnics, excursions to the country, girls’ clubs, cooking classes, and tickets to concerts—all in an effort to let their neighbors experience life beyond the tenement and factory. The yard behind the house was converted into the largest playground on the Lower East Side, with preference given to crippled children and convalescents.  The Lower East Side was an area of the poor and immigrants—Jewish, Irish, Italian, and Chinese. As the Henry Street Visiting Nurse Service expanded, the nurses visited homes of all nationalities across the city. In 1917, the Nursing Service gave 32,753 patients bedside care and attended 21,000 sick children in their homes. … A number of wealthy women and prominent philanthropists supported the Henry Street Settlement activities and the enterprise grew dramatically. More than 50 nurses joined the group and volunteers provided courses in carpentry, sewing, art, music, and dance. Additional houses were opened around the city, and convalescent homes in the countryside.” By the time Wald retired in 1933, Visiting Nurse Service at Henry Street Settlement had grown to employ 265 nurses who cared for 100,000 patients.

Lillian Wald was not a woman to rest on her laurels, to be content with what she had accomplished. She also:

• Founded the Outdoor Recreation League, focusing on public parks and playgrounds;
• Convinced the school system to hire school nurses—in her first month on the job, the first school nurse hired treated 893 students and visited 137 homes;
• Convinced the New York City Board of Education to hire a teacher for special education classes for those with learning disabilities and/or physical challenges
• Founded the Women’s Trade Union League in 1903 to promote better working conditions for women;
• As part of the New York Immigration Commission, “traveled 1286 miles in fourteen days to investigate working conditions among immigrant laborers at highway and canal project camps. Their report, which called for the creation of improved living and working standards for the workers and their families, led to the formation of a State Bureau of Industries in New York.“;
• Joined with the Metropolitan Life Insurance Company to provide health care to workers;
• Promoted and insisted upon racial and ethnic equality—the NAACP was founded at the National Negro Conference, held at Henry Street;
• Defended workers’ rights and worked to improve workplace conditions through President Wilson’s Industrial Conference;
• Was a representative on the Joint Board of Sanitary Control of the Cloak, Suit, and Skirt Industry;
• Worked to abolish child labor and founded the Federal Children’s Bureau;
• Advocated for peace and lobbied to keep the U.S. out of World War I, fearing increasing nationalism and anti-foreigner sentiment;
• Strongly supported woman’s suffrage, working for the passage of the 19^th Amendment;
• Offered Henry Street as headquarters for the wartime Red Cross;
• Established treatment centers across New York City for the treatment of the Spanish flu epidemic of 1918 — “Under her direction, Henry Street cleared all cases of influenza and mobilized the efforts of thousands of volunteers.“

She clearly was a force with which to be reckoned!

Lillian Wald died at the age of 73 on September 1, 1940. “Wald’s greatest living memorials are her two institutions: the Visiting Nurse Service of New York, the nation’s largest not-for-profit home health care agency (which became independent in 1944) and Henry Street Settlement House. The Settlement still occupies its three original buildings on New York’s Lower East Side. Now serving the neighborhood’s largely Asian, African-American, and Latino population, the settlement continues Wald’s pathbreaking work with Jewish immigrants in the 1890s, working toward the realization of her vision of social justice and a unified humanity.”

Let’s bring this all back to Evansville. Although there is not a direct connection here to the work of Lillian Wald, her ideals were surely shared by local individuals. In 1888, an Evansville woman by the name of Eleanor Igleheart began an organization called the King’s Daughters Circle to provide cheer for those in Evansville’s only hospital. Two years later, it opened the first training school for nurses, which existed until Walker Hospital, a forerunner to Welborn, was built. In 1900, the organization began to supply milk and garments to the poor. Evansville’s first visiting nurse, Lydia Metz, was hired in 1902, only the second such nurse in the state of Indiana. She visited 2,000 patients by riding her bicycle and was paid $720 for her efforts (That’s about $21,496.10 in 2019 dollars). The 1904 Evansville City Directory has this listing on p. 71: “The King’s Daughters District Nurse Association—Organized 1888. Meets the second Tuesday of the month. Miss Eleanor Igleheart, Pres’t; Mrs. Marcus S. Sonntag, Treas.; Miss Sara Wartmann, Sec’y; Miss Lydia Metz, District Nurse. All calls for nurse left with Miss Carrie Rein, of Associated Charities.”

In 1913, a separate organization called the Babies Milk Fund association was established and began feeding clinics, teaching new mothers how to care for their children.  It provided 15,000 quarts of milk the first year, and by 1923 there were 3 such feeding clinics. Also, in 1923, the King’s Daughters Circle changed its name to the Visiting Nurse Association and in 1926, the VNA and the Babies Milk Fund Association merged to become PHNA, Inc. (Public Health Nursing Association). The organization continues today as Visiting Nurse Plus.

Just as Wald exploited her social connections for the benefit of those she worked to help, so the PHNA benefited greatly from its association with the founder of Mead Johnson, E. Mead Johnson. After his March 21, 1934 death, an article in the Evansville Press lionizing his contributions to the city of Evansville noted that the Public Health Center stood as a monument to his generosity. Johnson authorized Health Center officials to get all they needed for the baby food clinic from his plant, free of charge. He insisted, during his lifetime, that this not be made known. This donation was estimated to be worth $30,000 yearly, and his son pledged to continue his father’s generosity. In addition, E. Mead Johnson purchased the PHNA building at 120 SE 1^st Street and furnished it for $25,000, then gave it to the organization.

UASC holds a collection of materials, a few photographs but mostly scrapbooks and newspaper clippings, from the Visiting Nurse Association of Southwestern Indiana, covering the years 1926 to 1971. There are also a business diary and a director’s diary from the early 1930’s, compiled by the director at that time, Hulda B. Cron. Browsing through these gives a glimpse of the problems, personnel, health issues addressed, and triumphs of the organization.

From the Director’s Diary, October 1931 – July 1933:

Monday, October 19, 1931: “The morning Courier Journal carries article stating that American Trust Bank has closed. PHNA has all but 4000 of its funds in this bank. H. Cron requested distribution among several banks last Jan. or Feb. but suggestion was not accepted.  Committee however, did agree to [establish] emergency fund of $3000 in Peoples Bank and board members dues account of 1000 or 1200 was opened at Old National.” There follows a listing of the accounts in the American Trust Bank when it closed, noting a total loss of $23,913.71.  Another note in December notes that the bank had not yet sent out any information to its stockholders.

November 5, 1931: “Board voted a 10% … cut in salary affecting entire personnel.”  This was in response to a failure to reach the goal in a recent financial campaign.

Undated newspaper article, presumably in November 1931 contained an article about a 2 ½ month old baby who only weight 6 lbs. 13 oz. and was benefitting from a PHNA milk distribution program.  A nurse noted that mothers whose husbands were unemployed said that their babies could not survive without the PHNA.  Upon seeing a good weight gain in her child, the mother noted that she simply had enough milk to drink that week. The article said that PHNA had distributed 1582 quarts of milk in April 1930 and 2569 in April 1931.

November 10, 1931: There was a complaint from doctors about the increasingly large numbers of children being seen at clinics. Adding more weekly clinics would alleviate the congestion, but the loss of money due to the bank failure made this impossible. Cron said, “These are trying times of course due to the economic depression which has persisted for so long. If ever there has been a need for the type of service rendered to the group eligible for the C. Health service it is now. If we fail to meet our obligations during this coming winter we stand in a position to receive criticism.”

March 28, 1932: Cron notes that suspicious communicable diseases, unless diagnosed by a physician, are no longer being reported to the Board of Health.  She says, “With this policy in force the Board of Health never would know whether or not an epidemic existed….”

May 12, 1932: “The PHNA funds will no doubt carry the work until the next campaign which will be held in Oct. However, at this time the organization will be bankrupt unless the American Savings and Trust…pays a substantial dividend.  To date—after 7 months the bank hasn’t paid out a dollar.”

A June 5, 1932 newspaper article notes that the PHNA provides hot lunches for .07 each to McCutchanville students, helping them to keep fit.

From the Director’s Business Diary, August 1933 to December 1934:

October 20, 1933: “Campaign funds $10,169.20 coming slowly—this amount a long way from 20,000.  Unless $20,000 is obtained (which of course can’t be done) we must again work on a restricted basis as we have this year—18 nurses with director—3 pediatricians—1 Par. S. N. [possibly parish school nurse?]—no dental nurse….”

May 15, 1934: “There is a strong desire to re-instate the child health clinic service for children from 3-6 years of age [a previous budget cut had necessitated lowering the cut off age to 3].  However, some members apparently do not appreciate perhaps as fully as they should that clinic service without adequate follow-up by nurses is absolutely ineffectual.”

May 27, 1934:  A brief Courier article noted that PHNA director Hulda Cron would be on “vacation” until September 1 due to curtailment of the association’s funds—and this was the third year this had occurred.

September 1934: “The PHNA will not conduct a financial campaign the middle of Oct. as usual since the citizens will once more attempt a C. [Community] Chest.”   Community Chest was a forerunner of the United Way.  Apparently, there was some dissention regarding one fund drive vs. individual asking. Evansville’s famous cartoonist and community supporter, Karl Kae Knecht, drew cartoons in support.

November 13, 1934: PHNA was asked to consider providing services to transients, to be reimbursed from Federal Relief Funds.

Despite all the financial woes (and to be fair, many of these woes stem from the time period covered by these diaries, during the Depression), PHNA provided many services: clinics, dental clinics, hot lunches, milk distribution, education, family planning, treatment and/or vaccination for smallpox, diphtheria, scarlet fever, polio, and tuberculosis, and addressed a myriad of other physical and mental health and social welfare issues.

“The history of visiting nurses dates back to the 1880s in the Northeast United States, where free nursing care was provided to the sickest and poorest populations who otherwise would not have access to health care. The influx of immigrants to the Northeast spurred several VNAs to emerge and address the increased prevalence of illness and infectious diseases, such as polio and smallpox.  Lillian D. Wald pioneered this form of public health nursing. VNAA’s members still embody Wald’s founding principles by sharing the desire to provide cost-effective, compassionate home-based care to some of the nation’s most vulnerable individuals, especially the elderly and individuals with disabilities.” If your family lived in Evansville during the early part of the 20^th century, it is entirely possible that family members benefited from the hard work of the PHNA. No matter where you’re from, however, we certainly owe a debt to visionaries like Lillian Ward–her influence spread across the country, touched the lives of many, and continues today. Thanks to the lifesavers!

Resources Consulted:

Fee, Elizabeth.  The Origins of Public Health Nursing: The Henry Street Visiting Nurse Service.  American Journal of Public Health, July 2010; 100(7): p. 1206-1207.

The History of Nursing in the United States: Brief Historical Overview.  National Women’s History Museum

Lillian Wald in Encyclopedia.  Jewish Women’s Archive

Lillian Wald in Women of Valor.  Jewish Women’s Archive

U.S. Immigration Before 1965.  History.com editors.  May 16, 2019

Visiting Nurse Plus website: About Us

VNAA website: Mission, Vision & History