Liping Bu

The Origins of Public Health Nursing: The Henry Street Visiting Nurse Service

LILLIAN WALD COINED THE term “public health nurse.” She believed that public health nurses must treat social and economic problems, not simply take care of sick people. The public health nurse should be involved with the health of an entire neighborhood and cooperate with social agencies to help improve living conditions. In 1893, Wald and Mary Brewster, both graduates of the New York Hospital School of Nursing, moved to the Lower East Side of New York City to put this concept of public health nursing into practice. They arrived during one of the nineteenth centurys worst depressions and began to give patients ice, sterilized milk, medicines, meals, and referrals to hospitals and dispensaries. Most importantly, they were able to use their social connections to provide many people with jobs. In contrast to social commentators who held that the poor were to blame for their own poverty and disease, Wald always emphasized the human dignity of even the poorest and most wretched of the families in the tenements, as in this account: The family to which the child led me was neither criminal nor vicious… . It would have been some solace if by any conviction of the moral unworthiness of the family I could have defended myself as a part of a society which permitted such conditions to exist.1 In 1895, Wald and Brewster moved out of their tenement building and into a house, also on the Lower East Side, that would become the Henry Street Nurses’ Settlement. They enrolled six more nurses and several activists, lawyers, union organizers, and social reformers; all lived together and collectively shared living expenses. In addition to nursing, they arranged picnics, excursions to the country, girls’ clubs, cooking classes, and tickets to concerts—all in an effort to let their neighbors experience life beyond the tenement and factory.2 The yard behind the house was converted into the largest playground on the Lower East Side, with preference given to crippled children and convalescents. The Lower East Side was an area of the poor and immigrants—Jewish, Irish, Italian, and Chinese. As the Henry Street Visiting Nurse Service expanded, the nurses visited homes of all nationalities across the city. In 1917, the Nursing Service gave 32 753 patients bedside care and attended 21 000 sick children in their homes.3 In this image, a visiting nurse is pictured with a Chinese mother and six of her seven children. The nurse, Miss Pearson, taught science at St. Marys Hospital before joining the Nursing Service.4 The photograph, taken in the early 1930s, shows the mother and children looking healthy despite the hard times of the Great Depression. Chinese families were often large because children represented family prosperity and happiness. Miss Pearson of the Henry Street Visiting Nurse Service with a Chinese mother and her 7 children. Source. Courtesy of the Prints and Photographs Collection, History of Medicine Division, National Library of Medicine. A number of wealthy women and prominent philanthropists supported the Henry Street Settlement activities and the enterprise grew dramatically. More than 50 nurses joined the group and volunteers provided courses in carpentry, sewing, art, music, and dance. Additional houses were opened around the city, and convalescent homes in the countryside. In 1906, Wald hired her first Black nurse, and thereafter the number of Black nurses on her staff increased steadily. By the time she retired in 1933, Wald managed a staff of 265 nurses who cared for 100 000 patients. The Nursing Service provided badly needed health care for the poor that was not available anywhere else. Later, the Nursing Service moved uptown and today is the Visiting Nurse Service of New York, the largest not-for-profit home health care organization in the country.5

John B. Grant International Statesman of Public Health

JOHN B. GRANT WAS BORN to Canadian medical missionaries in Ningbo, China, in 1890. He graduated from Acadia College in Nova Scotia in 1912 and received his medical education at University of Michigan and his public health degree from the Johns Hopkins University. He would later often refer to Arthur Newsholme and Victor C. Vaughan (his professors in public health), together with George Newman, as the men who had most influenced his thinking about public health.1 Grant joined the International Health Board of the Rockefeller Foundation in 1918 and gained practical experience in a county health program in North Carolina. He went to China to conduct a hookworm survey in 1919. In 1921, Grant was appointed International Health Division representative in China and associate professor of public health of the Peking Union Medical College.

Communicating With Pictures: The Vision of Chinese Anti-Malaria Posters

The article focuses on Chinese health posters, specifically an anti-malaria poster from the 1960s. The posters visual characteristics reflect the social and political context of the time. The posters teach the interrelation between health and happiness and define malaria and the best way to eradicate the disease. The poster depicts community cooperation in the elimination of mosquito breeding grounds. The six parts of the poster summarize the Chinese health campaign which had great success in reducing the incidence of malaria.

Isaac Williams Brewer (1867–1928): An Unsung Hero

The article profiles Isaac William Brewer, public health physician. He was born in Fort Leavenworth, Kansas and received his medical degree from Columbia University in 1897. Most of his medical career was spent working with infectious disease epidemics in rural American towns. Brewer served in the U.S. Army during World War I, and wrote academic articles and books on public health topics.

Education and International Cultural Understanding

The United States enjoyed a popular movement of international cultural understanding to promote world peace after World War I. Private citizens in elite social and cultural circles deepened their international engagement in shaping America’s role in world affairs when the U.S. government, under the Republican platform of “return to normalcy,” stepped back from Wilsonian international activism. A group of Americans composed of lawyers, editors, professors, civic leaders, and philanthropists were particularly enthusiastic and active in international affairs. They strongly advocated cultural understanding as a means to develop friendly relations among nations. After the horrors of World War I, these elites with broad international interests believed that war was waged in the minds of men whose ignorance of other cultures nurtured aggressive nationalism and hatred. They came to the conclusion that peaceful relations among nations depended, to a large extent, on the cultural understanding and personal relations of international leaders. Nations could not maintain friendly relations if their leaders did not understand each other. In their efforts to promote cultural understanding, those citizens aimed at expanding U.S. cultural relations with other nations, but more importantly, they were intent on spreading American influence across the world. Convinced

Unite to Fight Malaria

The article discusses the public health campaign in China to eradicate malaria and the use of health posters depicting prevention, the cornerstone of the public health policy of China from the 1950s throughout the 1970s. The author reports that malaria was controlled by 1990, although not completely eradicated.

Food Hygiene and Global Health

IS IT SAFE TO EAT? MEDIA reports of contaminated food imported from China have aroused concerns about food safety and public health in the United States and worldwide. The United States and China have recently moved to tighten the control of food inspection and enforcement of food laws. In the 21st century, the global economy ties local markets to international markets on an unprecedented scale. The process of food production, processing, and transportation frequently passes through many nations. Contaminated food is thus not restricted to Chinese imports, but involves a dozen countries in Asia, Europe, and Latin America.1 Be that as it may, American consumers are rightly concerned about food imported from China. Does China have laws and regulations regarding food hygiene and safety? The answer is yes. Food safety in China is regulated by the Food Hygiene Law of 1995, which has 57 articles elaborating specific regulations governing food hygiene standards, hygiene of containers, packaging, utensils, and equipment, measures for food hygiene control, and legal responsibility for violations of the law.2 In the history of the People’s Republic of China, there have been several stages in the effort to safeguard food hygiene and public health. In our examination of the Chinese Public Health Collection at the National Library of Medicine, we found that food hygiene and safety was a central concern in the public health education and propaganda movements of the 1950s through the 1980s. Having examined over 3000 health posters, such as the one illustrated on this page, we observed that they constantly hammer into the viewers’ minds the visual messages: “pay attention to food hygiene” and “prevent diseases from entering through the mouth.”3 These public health posters emphasize simple hygienic methods—cleanliness, nutrition, exercises, and vaccination—for an inexpensive and highly effective program of disease prevention. Health posters instructed people to buy fresh fruits and vegetables, wash them with hot water if eaten raw, drink boiled water, and wash hands before meals and after using bathrooms. Many diseases, such as cholera and typhoid fever, were eliminated, and others, such as childhood diarrheal diseases, were greatly reduced. During the period of socialist reconstruction and revolution in the 1950s to 1970s, hygienic methods were often promoted with political slogans favoring increased production. Food hygiene was said to be directly linked to the health of workers and therefore their productivity. Being hygienic became a standard of exemplary behavior for both adults and children—part of being good, progressive, moral, modern, and civilized. Food hygiene, water hygiene, personal hygiene, environmental hygiene and sanitation, manure disposal and management, and eradication of flies, mosquitoes, and other pests were all part of the campaign to prevent infectious diseases among the people. “Carefully Carry Out the Five Sets of Four Rules of Hygiene in the Food Industry.” Produced by the Patriotic Health Movement Committee and the Health and Prevention Station of Qinghai Province, China. February 1964. Source. Prints and Photographs Collection, History of Medicine Division, National Library of Medicine. Official instruction in food hygiene and prevention of diseases culminated in the so-called “five four rules” (five sets of four rules each) issued by the Ministry of Health and the Ministry of Commerce of China on March 12, 1960, as a supplement to their Joint Announcement of Strengthening Hygienic Work in the Food Industry. The rules instructed people not to buy or sell bad food, to keep food safely stored, to keep food utensils clean, and to maintain good personal hygiene and environmental sanitation. The “four don’ts” were don’t buy, keep, use in cooking, or sell rotten foodstuffs; the “four separations” were to separate cooked food from raw, food from medicine, ready-made from half-cooked foods, and foods from untreated water. The “four processes” for cleaning food utensils were washing, scrubbing, rinsing, and sterilizing. The “four designations” for environmental sanitation were to designate people, material, time, and quality. Finally, the “four frequents” of personal hygiene were to frequently wash hands and cut fingernails, bathe and have haircuts, wash clothes and bedding, and change work clothes often. Until 1980, traditional methods of farming and food production dominated China’s state-run economy. However, beginning around 1980, when the market economy was introduced into agriculture, and chemicals began to be used in food production, new legal mechanisms were needed to deal with the changing economy. The first Chinese food hygiene law was enacted in 1982, which established governmental food inspections and gave all citizens the right to file charges in court reporting any violation of the law. The Chinese Ministry of Health printed 400000 posters to promote the new food hygiene law to the public (see poster on this page). The key points of the law included food hygiene regulations, clear labeling of ingredients and production dates, and criminal punishment for violations of the law. “Pictorial Explanation of the Food Hygiene Law of the People’s Republic of China.” Produced by the Patriotic Health Movement Committee of the Central Government and the Ministry of Health, China, circa 1982. Source. Prints and Photographs Collection, History of Medicine Division, National Library of Medicine. The supervision and enforcement of the food hygiene law proved an administrative challenge in China, because there was no central agency to coordinate such enforcement. Especially since the 1990s, greed for higher profits in China’s booming market economy, combined with the lack of effective inspection and law enforcement, and the abandonment of public health and hygiene educational campaigns, have all contributed to the worsening situation of food safety. China is now reaping the consequences. More than 30 000 people were reported to have died from food poisoning in China in 2001 and 2002.4 The central government finally established a Food and Drug Administration in 2003 as the central authority to supervise and administer food and drug safety. The execution of its former director, Zheng Xiaoyu, for corruption reveals both the serious failure to safeguard the public from harmful foods and drugs and the Chinese government’s desperate attempt to correct the situation. In a survey of Chinese opinion in early 2007, more than 65% of the respondents were concerned about food safety. In a global economy, contaminated food harms people without regard to national boundaries. The recent tainted food scandals have alerted both consumers and national governments to the issues of food safety. Indeed, we suggest that the time has come to create an international mechanism to guarantee standards for food hygiene and ensure the public’s health.