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CHAPTER 4 Public-Health Nurses and the "Gospel of Health," 1920-1955 As private-duty nurses faced the steady decline of their market, public-health nurses were building a place for themselves in the setting ofthe expanding lay public-health reform movement. Trudging down city streets orjolting over country roads in their Fords, public-health nurses brought bedside nursing services to people who could not afford private duty, and solicited patients for the new services ofpreventive medicine . Like private-duty nurses, they often traveled to their patients, and most worked alone. But the organization of public-health services and their relative independence from mainstream medicine gave public-health nurses an unprecedented autonomy at work. Even as the skills and status of private duty eroded, public-health nurses claimed special expertise in the developing field of preventive medicine and established themselves as an elite corps within nursing. Public-health reformers self-consciously marked the distance between their work and traditional curative medicine. Physicians' clientele was largely self-selected, and patients rarely solicited medical advice except when driven by unpleasant symptoms. For the most part, doctors limited themselves to curing disease or moderating its discomforts. Scornful ofthose humble aims, public-health reformers enthusiastically assumed the task ofconquering disease altogether. Scientific medicine had revealed the "laws ofhealth": an informed public had only to apply this wisdom to their daily lives. "Health Bows from right living," one nurse explained. "It comes as a by-product oflife that is wholesome, fine and full of opportunity for growth and function of natural body sys- 114 CHAPTER 4 terns." With millennial optimism, participants in the publichealth movement set new goals for medicine. "What are we working toward?" asked another nurse, and she answered buoyantly, "I see a new type ofhuman being, strong, vigorous and virile, not merely free from disease but enjoying abundant health and vigor." United behind this new vision, public-health nurses tirelessly promoted the new services of preventive medicine to skeptical doctors and potential clients. In the process, they carved out a special place for themselves. 1 The history of public-health nursing offers a glimpse of the possibilities available to nurses in a setting somewhat removed from the controlling influence ofphysicians. In public -health work, nurses developed a special identity and their own nursing method. Allied with reformers, they set themselves apart from their medical colleagues and from other nurses. The organization of public-health work provided an institutional form within which nurses' independence could flourish. Located on the fringes ofmainstream medicine, public -health nurses worked in institutions that operated beyond the lengthening reach of the hospital and largely outside the control of the medical profession. On the job, they expanded the scope of nursing duties and responsibilities, acting with considerable independence even as they honored the formal line between nursing and medical prerogatives. More than either private-duty or hospital nurses, public-health nurses shook off their role as the physician's hand, to set out and act on their own sense of nursing's sphere and mission. Public-health nurses would come closer than any other nurses to claiming the privileges of professionals. Their history would show the pleasures and opportunities ofrelatively unconfined work, which is the enduring attraction of the professions. It would also point to the limitations of professional ideology, its elitism and self-defeating exclusivity. Inspired with a mission of reform and the hubris of expert knowledge, public-health nurses sometimes grew insensitive to their clients. Proud of their separate place, public-health nurses could not make common cause with other nurses when THE "GOSPEL OF HEALTH" 115 they most needed that support. And in the end, as they found their autonomy undermined by their own successes in promoting preventive work, their history would confirm and clarify the limits imposed on nursing by medical professionalization . 1. "THE BOND OF A COMMON PURPOSE": ORIGINS AND IDEOLOGY Coined in 1912, the term "public-health nursing" reflected an emerging sense ofcommon identity among nurses working outside the usual contexts ofprivate duty or hospital jobs. The mission of"positive health" linked nurses in visiting nurses' associations and settlement houses, child welfare and anti-venereal disease associations, factory dispensaries and department store clinics. The public-health movement of the early twentieth century drew its special character and ideology from a range of reform and medical activities, and nurses self-consciously claimed this diverse heritage as their own. The professionalization of reform had created new opportunities for nurses well before public health became a...


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