Chapter 4. Shuttering the Service
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79 New York City’s nurses and social workers witnessed firsthand the devastation wrought by what was at first haltingly described as a “business depression,” or an “emergency.” The Research Bureau of the city’s Welfare Council, the now new and privately funded agency also addressing the issue of coordinating the delivery of health and social welfare services, turned to them to gain an initial “impressionistic” view of the plight of families and individuals during the harsh winter of 1930 and 1931. Some nine hundred women making close to their normal four thousand visits to homes each day between October 1930 and May 1931 participated. Most of these women had the kind of long-­ standing service in their neighborhoods and communities that allowed them to compare conditions before the economic collapse with the current ones. They saw “an unusual and disturbing amount of suffering.” They saw cases of “actual destitution ,” and families on the brink of such destitution because families and friends they might normally rely upon were in similar circumstances.1 Social workers felt grim. They experienced dramatic increases in cases, often marked by what they believed to be expectations for financial assistance rather than more humble and embarrassed requests for any resources that might be forthcoming.2 The city’s public health nurses, such as those working in the schools in the Bellevue-­ Yorkville Demonstration, noted difficulty in evoking interest among parents in their messages of health education for their children. They remained sympathetic, noting that messages about, for example, dental hygiene, would not become a priority among parents “who were worried about the rent and the next meal.”3 Those at the Henry Street Settlement’s Visiting Nurse Society remained adamant about separating their bedside nursing from any kind of Shuttering the Service Chapter 4 80 Nursing with a Message relief work. Unlike groups such as teachers and police officers who had devised impromptu relief strategies, they believed, echoing Wald’s need to maintain the boundary between nursing and social welfare, that such work would be distracting from its core mission of nursing the sick.4 But, overall, public health nurses in both public and private agencies felt cause for optimism about the long-­ term effects of the economic crisis on the future of their discipline. Perhaps , they wondered, “the time and attention they gave to helping people about their economic problems in time of need may bear fruit in a greater willingness to heed the advice of a nurse when she goes to them about matters of health.”5 Nurses at the East Harlem Nursing and Health Service knew of the effects of this massive economic collapse. The Depression and the accompanying unemployment had hit the community early and hard. An informal survey of families receiving its services in January 1934 found 73 percent dependent on outside sources of income; 24 percent with a bare subsistence income; and a mere 1 percent as moderately comfortable. A more formal 1934 survey of 602 families found 61 percent of families on relief; and of the 37 percent still described as “self-­ supporting,” 22 percent were still vulnerable as they were living on savings or with other family members.6 Yet, East Harlem nurses also felt reason for optimism. “In the face of the depression conditions, these families have maintained their morale and their children’s health to an amazing degree.”7 But if the East Harlem nurses knew about their families’ economic vulnerability , they thought little of the changing social and healthcare landscape. Throughout the 1930s, Puerto Rican families increasingly settled in the neighborhoods of East Harlem. Moreover, these families were moving into a public healthcare system increasingly dominated by the rise in hospitals and outpatient clinics where families increasingly sought medical care. This chapter argues that the nurses in New York City’s demonstration projects paid little attention to warnings about the implications of these new clinical sites for public health practice. They steadfastly maintained the site of their practices to that place where they thought it could be most effectively and independently exercised: with cooperative families in their own homes, in the clinics the nurses controlled, and in the classrooms they created. Despite their commitment to maternal-­ child health initiatives, this narrow focus allowed them to ignore professionally one of the most pressing public health issues in the city in the early 1930s: the newly rising rates of maternal mortality attributed by both the New York Academy of Medicine and the Maternity Center Association to poor...



Subject Headings

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