chapter 15 | Nursing Yesterday and Today 243Early Health-Care Reform
Nightingale’s work marked the beginning of mod-
ern military nursing. As a result of her documenta-
tion of the conditions in Crimea and the nurses’
efforts to improve them, reforms were undertaken.
Nightingale’s statistics were so accurate and
clearly reported that she was elected a member of
the British Statistical Society, the first woman to
hold this position. At their conference in 1860, she
presented a paper entitled, “Miss Nightingale’s
Scheme for Uniform Hospital Statistics.” Before
this paper was written, each hospital had used its
own names and classification systems for diseases.
Nightingale’s opinions on improving health care
were solicited constantly. This led to another
publication, “Notes on Hospitals.”
For more than 40 years, Nightingale played an
influential part in most of the important health-
care reforms of her time. At the turn of the 20th
century, however, her energies had waned, and she
spent most of the next 10 years confined to her
home on South Street in London. She died in her
sleep on August 13, 1910.
Nightingale’s Contributions
Nightingale is believed to have been in error in only
two areas. First, she did not believe in or appreciate
the significance of the germ theory of infection,
although her insistence on fresh air, physical
hygiene, and environmental cleanliness certainly did
a great deal to decrease the transmission of infec-
tious diseases. Second, she did not support a central
registry or testing for nurses similar to what was in
place for physicians. She was convinced that this
would undermine the profession and that a letter of
recommendation from the school matron was suffi-
cient to attest to the skill and character of the nurse.
Florence Nightingale was a woman of vision
and determination. Her strong belief in herself and
her abilities allowed her to pursue and achieve her
goals. She was a political activist and a revolution-
ary in her time. Her accomplishments went beyond
the scope of nursing and nursing education, affect-
ing all aspects of health care and social reform.
Lillian Wald
Background
Born in Cincinnati, Ohio, in 1867, Lillian Wald
moved to Rochester, New York, where she spent
most of her childhood. She received her education
at Miss Crittenden’s English and French Boarding
and Day School for Young Ladies and Little Girls.
Her relatives were physicians and had a tremen-
dous influence on her. They encouraged her to
choose nursing as a career.
Wald attended the New York Hospital School
of Nursing. After graduation, she worked as a nurse
in the New York Juvenile Asylum. She felt a need
for more medically oriented knowledge, so she
entered Women’s Medical College in New York.Turning Point
During this time, Wald and a colleague,
Mary Brewster, were asked to go to New York’s
Lower East Side to give a lecture to immigrant
mothers on caring for the sick. Wald and Brewster
were shocked by what they discovered there.
While showing a group of mothers how to
make a bed, a child came up to Wald and asked for
help. The boy took her to a squalid tenement
apartment where nine poorly nourished people
were living in two rooms. A woman lay on a bed.
Although she was seriously ill, it was apparent that
no one had attended to her needs for several days
(Kalisch & Kalisch, 2004). Miss Crittenden’s
School had not prepared Wald for this, but she
went right to work. She bathed the woman,
washed and changed the bedclothes, sent for a
physician, and cleaned the room.
This incident was a turning point in her life.
Wald left medical school and began a career as an
advocate and helper of the poor and sick, joined by
Brewster. They soon found that there were thou-
sands of cases similar to the first in just one small
neighborhood.The Visiting Nurses
Wald and Brewster established a settlement house
in 1893 in a rented tenement apartment in a poor
section of New York’s Lower East Side. To be clos-
er to their clients, they gave up their comfortable
living quarters and moved into a smaller, upper-
floor apartment there.
It did not take long for the women to build up a
nursing practice. At first, they had to seek out the
sick, but within weeks calls came to them by the
hundreds. The people of the neighborhood trusted
them and relied on them for help. Gradually, the
two developed a reputation among the physicians
and hospitals in the area, and requests to see clients
came from these sources as well.