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Wald and her colleagues brought basic nursing time, the number of children sent home from
care to the people in their home environment. schools dropped from more than 10,000 to 1100.
These nurses were independent practitioners who The New York Board of Health was so impressed
made their own decisions and followed up on their that they hired nurses to continue the original
own assessments of families’ needs. Like nurse’s work. Wald’s nurses treated illnesses,
Nightingale, they were very aware of the effect of explained the modes of transmission, and explained
the environment on the health of their clients and the reasons that some children had to be excluded
worked hard to improve their clients’surroundings. from class and why others did not. The nurses also
Wald was convinced that many illnesses result- followed up on the children at home to prevent
ed from causes outside individual control and that recurrence of illnesses.
treatment needed to be holistic. She said she Wald was also responsible for organizing the
chose the title public health nurse to emphasize the Children’s Bureau, the Nursing Service Division of
value of the nurse whose work was built on an the Metropolitan Life Insurance Company, and the
understanding of the social and economic prob- Town and Country Nursing Service of the
lems that inevitably accompanied the clients’ ills American Red Cross. Her dreams of expanding
(Bueheler-Wilkerson, 1993). public health nursing, obtaining insurance coverage
Because she had the freedom to explore alterna- for home-based preventive care, and developing a
tives for care during numerous births, illnesses, and national health nursing service have not become a
deaths, Wald began to organize an impressive reality. However, in view of today’s health-care con-
group of offerings, ranging from private relief to cerns, she was a visionary who believed that health
services from the medical establishment. She care belongs in the community and that nurses
developed cooperative relationships with various have a vital role to play in community-based care.
organizations, which allowed her access to goods She died in 1940 and is remembered as one of the
and jobs for her clients. News of her successes foremost leaders in public health nursing.
spread. Private physicians sought her help and
referred their clients to her for care. Margaret Sanger

The Henry Street Settlement House Background
Within 2 years, the nurses had outgrown their Margaret Higgins was born in Corning, New York,
original quarters. They needed larger facilities and on September 14, 1879. After recovering from
more nurses. With the help of Jacob Schiff, a tuberculosis, which she contracted while caring for
banker and philanthropist, they moved to a larger her mother, she attended nursing school at the
building at 265 Henry Street. This became known White Plains Hospital School of Nursing. In her
as the Henry Street Settlement House (Mayer, autobiography, she described the school as rigid
1994). Nine graduate nurses moved in soon after. and at times inhuman; perhaps this provides an
By 1909, the Henry Street Settlement House indication of where her future interests would take
had grown into a well-organized social services sys- her (Sanger, 1938). During her affiliation at the
tem with many departments. The staff included Manhattan Eye and Ear Hospital,she met William
37 nurses, 5 of whom were managers. Sanger. They married and moved to a suburb of
New York, where she stayed at home to raise their
Other Accomplishments
three children.
Wald is credited with developing school health nurs-
ing. Health conditions were so bad in the New York Labor Reformer
City schools that 15–20 children per school were sent Sanger was very concerned about the working con-
home every day. These ill children were returned to ditions faced by people living in poverty. Many
school by their parents in the same condition. As a workers were paid barely enough to buy food for
result, illnesses spread from child to child. themselves and their families. At that time, the
Ringworm, scabies, and pediculosis were common. income for a family with two working parents was
To prove her point about the value of communi- about $12–$14 a week. If only the father worked,
ty health nurses, Wald set up an experiment using earnings dropped to $8 a week. When only the
one nurse for a month in one school. During that mother worked, the family income was lower. A