1901 — International Congress of Nurses, Buffalo NY

About eight years ago a tenement-house life in its most pitiable aspect was presented to me. I had been giving a course of lessons in home nursing to a group of proletariats from the older world, — people who find a renewal of hope in New York, if not for themselves, at least for their children. One morning one of the women of the class was not present, and her little daughter came in to ask me to call upon her mother, as she was ill. Despite my experience in a large metropolitan hospital, and the subsequent knowledge gained through a year’s residence in a reformatory and asylum for the waifs of New York, the exposure of that rear tenement in the lower East Side was a most terrible shock, — a shock that was at first benumbing. A picture was presented of human creatures, moral, and, in so far as their opportunities allowed them, decent members of society, in rooms reached through a court that held open closets to be used by men and women, from some of which the doors had been torn away; up dirty steps into a sick-room where there was no window, the one opening leading into a small, crowded room where husband, children and boarders were gathered together, — impossible conditions under which to attempt to establish a home and bring up children.

Upon further acquaintance with the house and neighborhood I learned that kindly intention from the outside had not been wholly absent. The visitor from a medical dispensary had called, and, touched by the poverty of the place, had sent a bottle of beef extract with directions for use printed upon it, but there was no one in the house who could read English. Other charitable persons had sent coal; but my nurse’s instinct revolted at the knowledge that nobody had washed the woman, made her bed, or performed any of the offices that every human creature should feel entitled to in like condition. I will not take time now to describe all of the circumstances, nor my reflections on the responsibilities of the community, as they appeared to me, to this one family; to me personally it was a call to live near such conditions; to use what power an individual may possess as a citizen to help them, and to give to all of my world, wherever it might e, such information as I could regarding conditions that seemed to be generally unknown.

To a friend the plan was revealed: “Let us two nurses move into that neighborhood; let us give our services as nurses, and let us contribute our sense of citizenship to what seems like an alien community in a so-called democratic country.” Having formulated some necessary details of the plan, we proceeded to look for suitable quarters, and in the search discovered the “settlement.” In the stress of hospital training neither of us had learned that men and women, moved by some personal experience or by theoretical training, had arrived at the same impulse to action and had established themselves in the crowded quarters of cities and called themselves “settlement workers.” The idea was identical with our own, and though many activities have grown from that idea, the fundamental principle remains: that people shall take up their residence in industrial communities, giving what they may have of public spirit, and partaking of the life about them; preserving their identity as individuals and endeavoring to keep the settlement free from the institutional form of philanthropic work.

For the first two months of our experiment we two nurses lived at the College Settlement. After that the top floor of a tenement that gave reasonable comfort was our home for two years, and that was practically the beginning of the present association of workers known as the “Nurses’ Settlement.” The life possible through making our home among the people in a simple, informal way led us easily and naturally into all the questions that affected them.

Through our visits to the children and our interest in their general welfare we learned of the unsatisfactory school conditions, and of the absurdity of a compulsory school law when there was no adequate school accommodation for the children. Such knowledge as came to our notice, such effective protest as would illustrate the conditions of our neighborhood, was brought before a suitable public, individuals, or societies especially concerned whenever occasion could be found or made.

The women on the lower floors in the tenement where we lived were employed in the needle trades, and unbearable treatment at the hands of a foreman had moved them and their fellow workers to agitate for trade organization. In the search for some one of their own sex who could speak for them in what they called “better English” they came to us, and that was our first introduction to the protest of the workers which is expressed in Trades-Unionism.

A semi-official recognition by the Board of Health gave us the privilege of inspection of the tenements, and valuable information was thus stored up on the housing problem. The experience thus gained had its share of influence in the general education of the public which later led to the Tenement-House Exhibit; to the appointment of a Tenement-House Commission under Governor Roosevelt, and the final creation of a separate department for the city of New York. One of the members of the settlement took active part in the movement, and was one of the two women on the jury of awards for plans of model tenement-houses. Through her efforts to obtain a legacy that had been bequeathed for a fountain somewhere in the city, the Schiff foundation was erected in the neighborhood of the settlement, and was the strong influence in having an adjacent site selected for a park and public playground, to make place for which no more congested and unsightly rookeries could have been demolished.

The movement for public playgrounds is now well known. They have been valiantly fought for and their need wonderfully told by Mr. Jacob A. Riis, that best friend of, and most lovable fighter for, the children of the poor. His efforts have been assisted by the Nurses’ Settlement for years.

To meet the rightful demand of the children for play, we conducted in our back yards one of the first playgrounds in the city. It was an experimental station, in a way, as well as an enlightenment of the general public, and was instrumental in helping to develop public feeling in the mater. After a time the interests of the residents of the settlement were directed to the “Our Door Recreation League,” share being taken in its executive work, and cooperation given to Mr. Charles B. Stover, the apostle of New York of out-door play places for the children of crowded districts.

The workers of the settlement can look with gratification upon the increasing interest in public-school matters affecting their neighborhood as in part the result of their efforts to bring public attention to the lack of room for the children in the schools, and in other ways to bring the interest of their localities directly to the School Boards. One of the household was for a time a school inspector, but whether in official relationship or not, the members have been frequently consulted by those in authority on the Board of Education.

I have passed over the steps of growth of the settlement, and to understand how it has attained its present status I should go back to that first beginning in the tenement, when it was apparent that not only were the nurses’ services needed for the sick, but that, likewise, their friendly offices were needed as interpreters for bringing to the proper sources the larger and more general matters that affected the life of the people they were in contact with.

Mr. Jacob H. Schiff, who from the very beginning had made us feel his support, encouragement, and confidence, suggested the change from the tenement quarters to a house, arguing that a more permanent basis would be established for these personal services if it were made possible for others to join us. The desire of others to cooperate with us had bene for some time apparent, and therefore this most generous and public-spirited citizen’s offer was accepted. A house near the tenements, once the property of the fashionable and well-to-do who had inhabited Henry Street half a century earlier, was purchased by him. Necessary changes were made in it, and almost immediately the house was filled with residents and the nursing was extended. The clubs and social features of the house then began to assume organized form.

The next year another house was given for the use of the settlement by a new member, a laywoman, who came into residence, fitted up the second house, and contributed the means to carry it on, and who has taken charge of much of the social work among the young people. Not long after that offers of money and suitable workers came, and fresh opportunities to extend presented themselves.

The needs of an uptown district having been urged, a house was selected there and purchased by Mrs. Butler Duncan for the use of the settlement, and workers were placed in it who had served as apprenticeship in the down-town house. A little later also one floor of a house in still another locality was given by the family of one of the residents, and several nurses are accommodated there. Finally, a dream of the nursing staff was realized in the gift, received from a young married woman, of a charming home in the country, where all the year round, and without restrictions or conditions save those imposed by the circumstances of the patients, the convalescents and tired-out people who need rest are entertained and where, in the summer, many delightful outings for the young people are planned.

From the needs of the neighborhood has sprung the service that we call the “First Aid Room” in three very crowded quarters. In each one a nurse is in attendance at certain hours a day, and cases that require dressings, fresh cuts, old wounds, simple eye cases, eczemas, etc., are treated. These are such nursing cases as might be attended to by the members of the families if the mothers had sufficient leisure or sufficient intelligence. Many of them are sent by the physicians of the large dispensaries, who have not confidence that the parents will apply ointments, dress wounds, or syringe ears daily and in a cleanly way. These are often school-children, and the nurse is thus able to care for a far greater number than would be possible if she went to them.

This work has also a direct bearing on the school attendance of the children, and though many of the cases are not important from a medical point of view, they are of the utmost importance from the educational stand-point, as the children are sent home by the medical school inspectors, and, not being allowed to reënter while the trouble continues, often miss much precious school time, for it must be remembered that few of these children can attend school after fourteen; at that age they all begin wage-earning. As an illustration, I knew of a lad of twelve years who had never been in school because of eczema of the scalp. True, the mother had gone to the dispensaries and obtained ointments, but the overdriven, wornout woman said they did no good. Careful epilation, systemic disinfection, and careful application of the medicament was so successful that when school opened in the fall I had the pleasure of placing the boy there for the first time in his life.

The settlement in cooperation with the New York Kindergarten Association maintains a kindergarten. The children upon graduating from the kindergarten and entering the public schools are invited to come back as members of clubs. They are the youngest club members, and when the first one was called “The Alumnæ Association of the Nurses’ Settlement Kindergarten” the name seemed longer than some of the members.

Probably the boys’ clubs connected with the settlement hold the most intimate place. The first one organized, of which I have the honor of being a member, undertook the study of the lives of American heroes. We too the term “hero” broadly, and men or women who by fearless living had made the world a better place to live in were counted as such. Thus we had the biographies if those who had contributed as statesmen, soldiers, philanthropists, and writers to the realization of the highest hopes of the country, and living members of the family under discussion often came to contribute personal reminiscences or family history. Since then as this club matured it has taken up the study of civil government and other similar study, and is but a type of what all the clubs are doing. Some of the girls’ clubs combine study with the boys and young men, and interesting debates on important topics of the day are held in their meeting-rooms.

In the interests of a considerable number of boys not responsive to the more intellectual stimulus of study, rooms have been set apart for manual work, and with the cooperation of the Children’s Aid Society carpentry, wood-carving, and basket work are carried on. The large dancing-school lasses, gymnasium work, etc., are possible through the courtesy of this society — it gives us the privilege of using its large and roomy floors after school hours and in the evenings. Our dancing-school has led us to the same conclusion that experience with young people anywhere would bring: that the desire to dance and to meet their kind socially is a wholesome and healthy one, and that it is a dangerous thing not to recognize and meet the want wholesomely, lest innocent desires be diverted wrongly.

The dancing-classes are refined gatherings, property chaperoned, and with no other restrictions than the ordinary ones of good manners. They are successful rivals to the public dances that are over or back of the saloons, and also provide opportunities for those young people whose careful parents would not allow them to go elsewhere.

We have a penny provident bank, and habits of thrift are inculcated by making it easy to save the pennies. When the deposit reaches the sum of one dollar, an account may be opened in the savings-bank in the locality.

All of such work is not done by the nurses, for besides our valued lay members who share in the social and educational work, a large staff of non-residents take part in the classes and clubs.

The kindergarten teachers are, of course, trained for that purpose. Leaders for clubs and teachers for the various classes are recruited from the outside, and among them are distinguished lecturers who find their students responsive and their audiences sympathetic. Musicales, private theatricals, and the varied undertakings that bring gayety and zest into the social life are successful with us. We are fond of saying that next to nursing typhoid fever we love to give a ball!

Our nursing work is the “raison d’etre” of our existence, from which all our other activities  have had their natural and unforced growth, but the papers at this Congress have dwelt upon the detail and method of district nursing, and our methods do not differ sufficiently to warrant my taking up time and space to enlarge upon it. We conceive the underlying thought of the district nurse to be that of neighborliness, and plan to have each nurse work in a small district in close touch with the settlement house that she belongs to, that recourse may be hand to it in emergency as quickly as possible.

We hope that the nurse, with her knowledge of hygiene and sanitation and the care of the body in health and illness, will be an educator, and we lay much stress upon this, that she should not have too large a district or too many patients to look after. We believe she should have time to give the bath, and if necessary to make the second and even the third visit in the day, and not be adviser and instructor only, not forgetting her charity organization tents of the dangers of doing for people what they out to do for themselves, yet holding to the ideals of the nurse in her work.

With this in mind, thought we do not undertake night nursing as a rule, yet we would have a night nurse obtained through a registry if in our opinion this was the only thing to be done for the patient. We also send women to scrub and clean in the homes that the nurses go to, if there is no one who should rightfully perform these services, awe consider it a part of good nursing to have the rooms kept clean.

The various needs of the patient are kept vividly in mind. For what we call the settlement point of view we believe that the patients should know the nurse as a social being rather than as an official visitor, and that all legitimate relationships which may follow from her introduction as a nurse shall be allowed to take place.

It is good from this point of view that the patient should know the home of the nurse, and that the nurse should be intelligent about the housing conditions, the education provisions, and the social life of the neighborhood in which she works and lives.

From this motive has come the opportunity for the settlement to show where the neighborhood has been neglected, and to bring into communication the different elements of society that go to make up a great city. We think and feel sincerely that the relationship is reciprocal, that we are partaking of the larger life, that society in general has closed the avenues that lead to this knowledge, and that the different elements of society need one another.

The well-meaning employer needs his interpreter, and the people of such neighborhoods as our own should have their point of view considered and given dignified place in the councils of the public-spirited. This is the ideal of democracy, the best “Spirit of the Times,” and in its accomplishment we have responsibility and privilege, — our share in speeding the realization of the unity of society, the brotherhood of man.

The numerical record of work done through the settlement for one year was:

NURSING WORK

Three thousand nine hundred and ninety-one calls for nurses to the homes of the sick; twenty-six thousand six hundred nursing visits made; twelve thousand six hundred and ninety-four cases treated in three First Aid Rooms; two hundred and twenty-five convalescents entertained in the Country Home.

SOCIAL WORK

Thirty-five clubs, from kindergarten classes to clubs of married women; dancing school, four classes; singing classes, private theatricals; concerts; gymnasium; fresh air work.

EDUCATIONAL WORK

Kindergarten; reference library; sewing, crotcheting; etc.; basketry; carpentry; carving; housekeeping classes (including cooking, laundry, etc.); home nursing; civics — municipal and national government.

Source: The American Journal of Nursing, Vol. II, No. 2 (May, 1902), pp. 567-574.

Also: Short Papers on Nursing Subjects, (New York: M. Louise Longeway) 1900, reprinted in Lavinia Dock Reader, ed. Janet Wilson James pp. 30-31.