restricted access Chapter 1. Medicine and a Message
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13 Public health reformers had every reason for optimism at the dawn of the 1920s. Two seminal events had set grand plans in motion. The first, the decision of the American Red Cross (ARC) that its newly reconfigured peace-­ time mission would concentrate on the more effective organization of health and social services through neighborhood health centers, promised to solve the knotty problem of care coordination among the myriad of public and private entities operating in large urban areas like New York City. The second, the release of data from the Metropolitan Life Insurance Company’s intensive tuberculosis (TB) case finding and treating study in Framingham, Massachusetts, suggested a direct path to bring the “white plague” under control at last. Yet, New York City’s leading public health nurses looked askance at the developing plans to establish the city’s own health center and to eradicate tuberculosis—­ at least as it involved them. They believed they had already solved their discipline’s organizational issues with a private system that brought bedside nursing and health teaching to the individual homes of the sick poor and a public system that provided broader communities with health education, immunizations, communicable disease control and quarantines, and the oversight of the health of school-­ aged children. The city’s Henry Street Settlement and Visiting Nurse Service (VNS) was world-­ renowned for its ability to bring “medicine and a message” of health and American values into the homes of working-­ class and immigrant families. Its Department of Health, under the tutelage of Lillian Wald, the founder of Henry Street, had the first and now had the largest numbers of nurses working with children in the city’s schools.1 Medicine and a Message Chapter 1 14 Nursing with a Message This chapter maps the social, political, and public health landscape of New York City as it planned to meet these challenges in the aftermath of the First World War. It explores how a small group of white, middle-­ class, and well-­ educated public health nursing leaders worked among themselves and with other reformers to consolidate the disciplinary power they gained in their effective work bringing “medicine and a message” of American values to the working, poor, and often immigrant families they served prior to the war. It situates these women within the compromise brokered between public health and private medicine. Bruising battles between public health reformers and representatives of medical practitioners had established firm boundaries regarding who should treat the poor. Those nurses working in public agencies in large urban areas could only teach mothers and children about health and only rarely provided actual home bedside nursing care. In New York City, those working for private agencies like the VNS, the Association for Improving the Conditions of the Poor (AICP), and the Maternity Center Association (MCA) had more latitude. They provided bedside nursing care to sick individuals and prenatal care to mothers even as they taught their families the principles of health and hygiene. They also had a history of strong financial support from the Rockefeller Foundation. Yet, like their colleagues in other large urban cities, these nurses worked within a complicated matrix that also supported the work of hundreds of other public health nurses employed by small, private neighborhood settlement houses, churches, welfare associations, and community organizations in the city. The proliferation of such agencies across the United States drove the national postwar emphasis on care coordination as a central element of the ARC’s commitment to health demonstration projects. In New York City, the problem of so many clinicians working to solve the same kinds of problems brought together the same prominent male social workers and sympathetic physicians to consult with the Rockefeller Foundation and the Milbank Memorial Fund. They successfully found Foundation funding to create a community-­ based health center in the East Harlem neighborhood of the city that could more efficiently coordinate the delivery of health and social welfare services to those in need; and they dreamed with the Fund’s officers of constructing a “monumental enterprise” in the Bellevue-­ Yorkville districts of the city that would eradicate TB, compel the attention of “scientific men,” and force action among communities of voters that seemed far too complacent about the need to increase tax dollars to pay for public healthcare. The city’s leading public health nurses were not invited to these philanthropic tables, although they were aware of the plans. On the one hand, this Medicine and a Message 15 omission reeked of...


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Subject Headings

  • Community health nursing -- New York (State) -- New York.
  • Public health nursing -- New York (State) -- New York.
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