Abstract
Lillian Wald brought public health nursing to New York City’s congested Lower East Side in summer 1893, where she recorded tenement dwellers’ suffering from cuts, burns, breaks, deaths, illness, and childbirth. Together, nurses traveling streets, alleys, rooftops, and hallways, alongside dwellers acting as “local guides,” inaugurated vernacular mappings. Drawing on letters Wald wrote to her benefactor, Jacob Schiff, in July 1893, describing visiting, cleaning, healing, and connecting, this article uncovers a spatial dimension to pain that invites historians of urban America to discover the sick city.
“read each figure a human being; read that every wretched unlighted tenement described is a home for people, men and women, old and young, . . .” (259)
On the afternoon of Tuesday, November 17, 1896, near the beginning of her career as the nation’s most prolific visiting nurse, Lillian Wald made the trip uptown from New York’s Lower East Side to Tuxedo Hall—a handsome building located on Madison Avenue and 59th Street. There, she addressed the First Convention of the National Council of Jewish Women. Her topic was congestion in large cities, and her lecture drew from social scientific claims, statistical summaries, and personal interactions—the latter comprised principally of her own “witnessing” of illness, filth, and healing. 1 In a talk in which she appeared to reject antipathy for immigrants encoded in the word “congestion,” Wald connected the fates of the well-healed audience to the fates of the tenement dwellers where she lived in the Lower East Side, explaining that the “crowded districts of great cities” impact “the more fortunate regions.” 2 These “infected and unsanitary tenements,” she added, “are your direct affairs.” Wald’s innovation was to put a human face on the horrors of urban poverty. To illustrate her point, she recalled the conditions of a “filthy basement where a sick girl lay, and where candy was being made.” 3 But, this was not the first time she had written about this particular “girl”; in fact, Wald had described the conditions of seventeen-year-old tubercular Hattie Isaacs in a July 1893 letter to her benefactor Jacob Schiff after encountering Isaacs’s living, working, sleeping—and sick—in a damp basement apartment at 20 Rutgers Place, where the impoverished family operated a candy store. 4 At the time that she met Issacs, in the late nineteenth century, her accounts of nurses’ movements and activities would uncover a spatial understanding of pain.
In this article, we draw on a rich trove of letters penned by Wald on July 2, July 7, July 24, and July 25, 1893, to her benefactor, New York banker and reformer Jacob Schiff. In the letters, she describes responding to infections, aches, and breaks, often mired in blood and sadness, and almost always isolated. She invites Schiff to observe what she observes, and, critically, to fund her intervention into, and movement through, the spaces of the Lower East Side. These interventions spurred Visiting Nurses along rooftops and across streetscapes, and into tenement corridors where they would land inside private homes. In the process, they bridged scales—homes to the cities outside their doors, cities to the countrysides surrounding them—connecting dwellers to services, care, assistance, and forging new bonds that shattered their isolation. 5 Their mobility inscribed new patterns into the urban landscape.
Wald was not alone in her mapping of late nineteenth-century urban life. In fact, urban reformers on both sides of the Atlantic were busy devising new ways to organize and classify illness, people, and places; in the process, they introduced new orderings that categorized the impoverished and afflicted. Historian Saul Jarcho tells us that the mapping of disease “gained permanent acceptance” by the 1840s, made manifest that decade in famous cartographies assembled by John Griscom, Edward Hall Barton, and Edwin Miller Snow. 6 In the 1880s, English Industrialist-turned-socialist Charles Booth famously classified London’s urban poor hierarchically—from irregularly employed, to ill, vicious, and semi-criminal. 7 Unlike the medical cartographies, which focused on places and neighborhoods, these mappings would focus on categories of people. American Social Scientist J. J. McCook enthusiastically adopted Booth’s hierarchy of “worth” in his 1893 study of New England “tramps,” as did Alice Solenberger in her study of Chicago’s homeless a decade later. 8 By contrast, Jane Addams’s Hull House published mappings of westside Chicago neighborhoods in the 1890s that focused on the ethnic dimensions of space. 9 And, New York photographer Jacob Riis—who once marveled that Wald would never “shut the door and go away to report [a] case” but “got straight to work to do what she could”—and Chicago Homes Association researcher Robert Hunter, equated urban disorder with filthy, airless, lightless tenement housing in stunning accounts of poverty designed to elicit outrage and reform. 10 In fact, the connection between reform and housing, or place, inspired Englishman and stenographer Ebenezer Howard—perhaps orthodox planning’s greatest visionary—to propose The Garden City, where sunlight and nature nourished dwellers and communal ownership displaced private property. 11 Lillian Wald’s intrepid campaigns into the squalid spaces of New York’s Lower East Side resonated in, and were informed by, the reform activities of Griscom, Barton, Snow, Booth, McCook, Solenberger, Addams, Riis, Hunter, and Howard: all communicated social conditions spatially. While Wald and her nurses would focus more on individual people and encounters—than on categories of people, places, and their mappings—each substantiated their interventions into the dim, fetid tenements—“the old houses” where, she observed, “the vermin . . . are horribly active at night.” 12
Wald’s nursing initiative was distinguished by its capacity to define the spaces, mobilities, and networks that latticed New York’s Lower East Side in the last decade of the nineteenth century. In contrast to other nineteenth-century mappings, she was less interested with the lines along which illness spread than the people and places that lay beneath “dry” figures, systematic charts, and “sweeping classifications.” 13 As described in this article’s epigraph, Wald invites us to think about life at the human scale: tenements, addresses, rooms, floors, privies. In her 1896 speech on congestion, she explains that her knowledge of congestion derives from “personal experiences” in a small “quarter of the city”; however, what she perceived as a limitation of her knowledge—that it was personal and local—was in fact the strength of her spatial understanding of pain.
The vernacular of pain described in this article engages three analytical categories: the social city, the sensory city, and the sick city. 14 It corroborates Susan Wirka’s claim that cities are social—“concerned with the social and economic injustices underlying urban problems” and rooted in everyday practices. 15 In recent years, scholars have reinforced analyses of the social city by focusing on women, migrants, and the impoverished—individuals who often find themselves excluded from political processes—and the role they would play in organizing cities. 16 To this analysis, we add the figure of the local guide, typically a tenement dweller, who sought out and directed nurses and in the process influenced the paths they traveled, maps they made, fashioning vernacular understandings of the late nineteenth-century Lower East Side. This article also ratifies claims that cities are sensory spaces, where sound, smell, and touch validate how we experience the built, urban environment. 17 To this list of senses, we add pain. In fact, Wald captured the role of the senses in a May 1894 letter to Jacob Schiff: “The summer is hot, malodorous, and nigh unbearable down here,” adding “[a]lready the streets reek, the children crawl in nakedness, [and] courage need be screwed to goodwill for endurance.” 18 In fact, these “reeking” streets intersect and ratify the insights of the third analytical category—what we call the sick city—which focuses on the ways that illness and pain separates and isolates individuals. Sanitation reform, characterized by the single-minded pursuit of the location and origins of pandemics, was a staple of nineteenth-century city life that gave rise to the mapping of health decades before Wald. 19 But, visiting nurses differed from sanitation reformers in at least three ways. First, unlike sanitarians, visiting nurses were women. 20 Second, the nurses mapped communities at the neighborhood level, where they would focus on people. Third, they viewed space differently; unlike the sanitarians who imputed disease into fixed spaces, the nurses revealed that space was fluid and changeable. The vernaculars of pain they mapped shifted.
By inviting urban historian to see urban space the way that Lillian Wald and her nurses did more than a century ago, this article promotes the claim that pain is spatial. In the process, it invites us to view buildings and landscapes, like historian Conevery Valencius, as sickly or unhealthy. “[T]errain,” she argued “possessed ‘health’ just as the body did.” 21 If landscapes, buildings, rooms, and people could be sick, as Valencius suggests, then the healing that Wald described might best be observed in the connection’s nurses fostered. Each recorded nursing visit started with a building’s address, connecting stories of human pain with physical locations. The maps, as seen in this article’s first four figures, chart the addresses of the different tenements the nurses visited. They illustrate that the boundaries of the nurses’ mappings were fluid rather than fixed. They also show the intimacy of the scale with which Wald is working, where distances can be measured in terms of feet rather than miles.
Visiting nurses cleaned the buildings, like they scrubbed and disinfected the bodies of the patients they treated. They believed that “environmental interventions,” such as modifying the physical environment of the home or even removing a patient from a “sick” space, aided in healing. In this practice, Wald echoed the sentiment of other progressive social workers of the time who advocated “environmental interventions” as a way to improve health. 22 By viewing pain as spatial, we can begin to understand—as the nurses did—that local guides generated vernacular mappings, that pain isolated people, and that they could work with local guides to create connections between tenements, streets, and services that diminished suffering. The spatialization of pain invites urban historians to look at the Progressive Era city anew—as fluid, contingent, and bottom up—beginning with nurses’ forays from the College Settlement at 95 Rivington, the physical site from which New York’s visiting nursing began.
Cases and Connections
Before Lillian Wald piloted the nationally renowned Henry Street Settlement and months before the nurses moved into their own tenement at 27 Jefferson Street, she and nursing school classmate Mary Brewster ventured into New York’s densely packed Lower East Side from the College Settlement where they thought they could help dwellers of the district’s notoriously squalid tenements manage their pain. 23 The moment was inauspicious—neither woman was particularly well known, and the city was mired in an economic recession that historians have subsequently labeled the Panic of 1893. 24 But, their location was central. According to Wald, the Rivington address was important because it enhanced their access to “the neighborhood” and made “more visits possible.” 25 From Rivington, they navigated congested streetscapes and, when needed, traveled across rooftops—slipping in and out of tenements through fire escapes. In the process, they forged new routes that brought them inside the dwellings of the poor, where airless and lightless corridors and stairwells connected them to homes where they could offer comfort—and possibly relief—to individuals suffering pain. Inside tenement homes, physical pain came in many forms, and typically included the agony of childbirth, the aching of burned and scabbing skin, the ordeals of sick infants, the discomfort of continuous hemorrhaging, the nightmare of chronic disease, and suffering from sprained and broken limbs. 26
To be viable, Wald’s venture needed funding. For this, she turned to affluent New York banker and philanthropist Jacob Schiff and his mother-in-law Mrs. Betty Loeb; each was broadly engaged in improving conditions in the city’s tenements, and in improving the lives of the poor, and largely Jewish, immigrant population that lived in them. 27 One can only imagine that from Jacob Schiff’s perspective, an ambitious, young Lillian Wald—who could put him in direct contact with the poor, with the very people he hoped most to aid—was a godsend. Schiff pledged six months of funding, “to do what they could do; to see what they could see; to publicize all that was wrong and remediable.” 28 Wald dutifully wrote Schiff and Loeb with accounts of her work, describing the people and conditions to which she tended. In these letters, she scrupulously outlined names, locations, conditions; sometimes, she even described life stories.
By her own account, Wald was an active witness—in the tradition of many social reformers—to dwellers’ conditions. 29 Her letters to Schiff would publicize and heighten the visibility of the suffering she observed. The congested quarters of the “crowded little people” she describes would reveal that in the tenements, illness isolated sick dwellers, removed them from family, and separated them from local resources. For instance, she described how illness separated and disaggregated people, as illustrated by “Tille’s” experience; she spent her days washing, cooking, and cleaning inside a tenement on Monroe Street caring for an ill father, mother, and five younger siblings. At fourteen years of age, Tille had yet to attend school. 30 She describes how illness entrenched poverty, as exemplified by her description of a peddler who had “$40 saved at the beginning of illness,” but three weeks later, had lost this money because he had “been obliged to remain home to care for five children and [a] wife.” 31 Finally, she describes how illness deepened isolation, as illustrated by Nathan Sullivan’s case: where a child was struck with pneumonia, and he could not heal in the tenements. However, his mother could not take him to the hospital, because she was nursing two babies at home, and the household had a recent outbreak of measles. 32 For Wald, healing was predicated on connecting the isolated. Her letters to Schiff, by and large, detailed nurses’ roles in creating those connections.
This article is based on letters Wald wrote Schiff on July 2, July 7, July 24, and July 25. The letters, analyzed chronologically, organize the different sections of this article. The connections forged by these nursing visits would link addresses and personal encounters to other addresses and personal encounters to comprise networks that redefined the spaces of the Lower East Side. These letters, penned in hurried and harried cursive, betray more than Wald’s excitement and exhaustion; they reveal how, to the nurses, health was spatial—marked by distances and destinations. Over the following pages we trace—through words and maps—Wald’s and Brewster’s movements along streets and through tenements to examine how they experienced and described pain spatially. The accompanying maps render these letters into visual form (see Figures 1 through 4).
Sites visited by Wald and Brewster on July 2, 1892.
Sites visited by Wald and Brewster on July 7, 1892.
Sites visited by Wald and Brewster on July 24, 1892.
Sites visited by Wald and Brewster on July 25, 1892.
July Second
On July 14, 1893, Wald sent Schiff a letter that enclosed her, and Brewster’s, initial two rounds of nursing notes. These notes trace the nurses’ incipient movements through the Lower East Side. The first round of visits from July 2, 1893, illustrates that public instances of pain prompted initial contact between the nurses and dwellers, demonstrating that the people who lived in the Lower East Side were, in part, directing the movement of the nurses, and acting as local guides. The day began with Wald and Brewster—armed with a bottle of boric acid (a mild antiseptic) and clean cloths—as they set out to find a baby that Wald “had seen on the street” the day before. 33 This “hunt” would lead the nurses to Number 7 Hester Street, where they trailed the anonymous child—a local guide—inside a building located roughly seven blocks from the College Settlement; this tenement “proved” to be two separate buildings. From there, Wald and Brewster moved through the building, diagnosing and treating both the insalubrious tenement spaces and the sickly bodies of the inhabitants alike. Climbing the stairs in search of the mother of the child with inflammation of the eye, Wald discovered “terrible filth everywhere,” including “sinks filled with slops,” “floors reeking,” and “vessels standing in the rooms unemptied from the night’s use.” Acting on this filth, Wald entered “every room in the front and rear tenement”; she would discover seven nursing infants with bowel troubles. She also encountered a three-week-old with measles and “excoriated” buttocks whom she treated, showed the mother how to care for, and for whom she left supplies. Next door to this family, she found Sarah Kern whose fifteen-month-old baby had “summer complaint”—diarrhea caused by poor hygiene or food contamination. As this baby was “being properly cared for,” she left only a Herald ice ticket—a coupon for ice made available by the newspaper, the New York Herald. As these visits demonstrate, nurses attended to the needs of both dwellers and the physical spaces of the buildings they inhabited (see Figure 1).
As they traveled the spaces of the tenements, nurses would discover that they were not always initiators of contact; sometimes, dwellers found them. When Nathan Solomon called Wald to his room to examine a baby recovering from measles, she hurried over from another part of 7 Hester. Similar to the sick baby glimpsed on the street, Nathan Solomon guided Wald’s and Brewster’s movement through the tenement, and in the process mapped it through pain. When Wald left, she made her way to the building’s top floor, where she found the child that she had initially entered 7 Hester in search of. The child had an eye inflammation that she cleaned, showed the mother how to treat, and for whom she, once again, left supplies. Back on the ground floor, she encountered a “baby scarred with vermin bites,” and a father with rheumatism; the mother supported the family by nursing another family’s infant. They lived together in an unlighted room. At Hester Street, Wald responded to individual isolations by cleaning, sweeping, bathing, cooking, and sorting—all while forging connections between the ill, themselves, and the services available in the surrounding community. 34 It was with these types of everyday movements and activities that the pursuit of pain and healing charted new mappings of the spaces of the Lower East Side.
Around the corner from Wald, also on July 2, Mary Brewster visited 183 Clinton Street, where she assisted a doctor in giving treatment to Mrs. Goldberg who was suffering from puerperal septicemia, a common postpregnancy infection. Reinforcing the connection between body and place, Brewster cleaned the sheets and room. When she had a neighbor promise to do the “necessary laundry,” she also generated a connection between neighbors. Like Wald at Hester, Brewster found the yard to be dirty and spoke to the janitor—once again reinforcing the idea that the physical spaces of the building could be unhealthy. 35 At Hester and Clinton, nurses used pain to link neighbors and dwellers and to facilitate the connections that neighbors drew themselves; they responded to instances of pain that isolated individuals and families by connecting each to healing—folding, cleaning, washing, sorting. Alongside dwellers like Sarah Kern and Nathan Solomon, Wald and Brewster inaugurated vernacular mappings that pointed to the ways that pain defined space.
July Seventh
The second set of visiting rounds that Wald enclosed in her July 14, 1893, letter to Schiff detailed visits to eight separate buildings on July 7, 1893 (see Figure 2). Some of these visits were new, while others were repeats—sometimes in response to chronic conditions, which had the effect of strengthening new connections between nurses and dwellers (see Figure 2). On these rounds, Wald visited typhoid patients in the basement of 182 Ludlow before making the nine-block trek—five blocks south and four blocks east—back to 7 Hester Street where she checked in on Nathan Solomon and his three sick children, two with measles. After bathing the children—Wald reported sardonically, “for their first time”—and realizing their contagion kept them from the dispensary, Wald elicited promises from the parents that they would seek work and housing in the countryside, and keep their living conditions cleaner in the meantime. In nearby rooms, she encountered Mrs. Davis and Mrs. Schneider, and their “nearly naked” children. Wald made plans to obtain clothes and gave the children tickets to the Hebrew Sanitarium, a beachfront escape located roughly 20 miles south of the College Settlement in the Rockaways. 36 On the ground floor at Hester, they checked in on Hannah Rooach in her rear tenement—a facility that New York social reformer Robert Deforest claimed was the subject of “more abuse and condemnation than any other type of building that has ever been constructed.” 37 Commending Rooach for bathing her two children, Wald directed her to the 42nd Street Hospital, where a “truss”—a padded belt designed to support a hernia—“will be applied gratis.” Meanwhile, one block west and two blocks south in a basement tenement at 11 Rutgers Street, the nurses inspired Mrs. Lanowitz to see a doctor at the 77th Street hospital, and to accept doctors into her home. With Solomon, Davis, Schneider, Rooach, and Lanowitz, the nurse’s recommendations—to the Rockaways, the countryside, or to a hospital—connected tenement dwellers to doctors, hospitals, recreation, and resources that drew them out of the sick spaces of the Lower East Side. 38
In fact, through their recommendations, the nurses further reinforced the idea that both sickness and healing were place-based, and staked their legitimacy on their visibility and movement along networks they helped to generate. Health could be affected by movement, not just the movement of nurses from one address to another, but by the movement of people to healthier environments. The nurse’s impact, which eroded traditional boundaries between interiors, streets and neighborhoods, as well as city and countryside, was instantaneous and would highlight the multiple voices involved in shaping new patterns and networks.
Working in concert with Wald, Brewster’s journeys also initiated new connections that situated the tenement at the center of evolving conceptions of space as a metric of pain and healing. While Wald stopped at Ludlow, Hester, and Rutgers, Brewster visited Mrs. Ehrlich at 31 Sheriff Street. She dressed her leg and cleaned her rooms—demonstrating how, for the nurses, healing the body and “environmental interventions” went hand-in-hand. After that, she went upstairs to visit the mother of an infant who had been taken to the hospital the day before. She found the mother cleaning, and presumed she was better after a good sleep. From Sheriff Street, Brewster traveled eight blocks west and three blocks south to 9 Ludlow Street. Here, she cared for Mrs. Lipski’s hand. Mrs. Lipski had not been able to work because of her sore hand, and her husband was disabled with rheumatism. Her landlord had just served her with an eviction notice, which the nurses would address in a return visit. In the same house, she cared for Mrs. Hannah Harris’s baby and her boy who had the ringworm of the scalp. After popping next door to 7 Ludlow to care for the baby of another Mrs. Lipski, she returned to 9 Ludlow with a letter for the original Mrs. Lipski requesting aid from the United Hebrew Charities, illustrating the importance of repeat visits in strengthening networks. On the way out, she advised Mrs. Harris to get some sulfur ointment for her son’s ringworm.
Traversing approximately six blocks southwest to 34 Division Street, Brewster found Abramson in “wretched condition” as she neared childbirth, and then turned around and traveled roughly 11 blocks northwest to 33 Attorney, where Mrs. Stellowitch was recovering from an operation. She discovered that the woman’s sister would, herself, need hospital treatment. Finally, Brewster made her way two blocks north and three blocks east to 11 Rutgers where she helped dwellers clean for Sabbath, complaining that by Sunday, the house will be filthy again—reiterating the need for a return visit. At Division Street and Attorney Street, Mrs. Brewster was able to make tickets available to outdoor excursions. 39 As this extraordinarily busy day reveals, return visits to heal hands, scalps, and bodies built more than connections to doctors and hospitals and medicine; they also marked sites of return that mapped nurses’ interventions. The networks that emerged from these connections were created—in part—by the least powerful.
Included in Wald’s letter to Jacob Schiff was a “follow up” summary that reinforced and solidified nurses’ presence at various sites across the Lower East Side. 40 Again, the nurses would link addresses with the people these buildings concealed—generating an understanding of pain and its treatment that eroded the boundaries between the body, interior, street, neighborhood, and city. In the summary, Wald describes the connection between health and the environment, documenting “an entire tenement made unhealthy from a neighboring stable.” 41 Her summary to Schiff also identifies some resolution to existing cases—ever elusive in letters—and reiterates the networks and connections the nurses forged between the interior and street, between the tenements and the larger community. Wald explains how at 183 Clinton Street, they assisted a doctor in giving treatment to Mrs. Goldberg who was suffering from a postpregnancy infection. In response to the “vermin infested bed without sheets or pillow cases,” they focused on the conditions of pain when they engaged a neighbor to do laundry, inquired about the filthy condition of the yard, cleaned the rooms, “carried sheets, and left patient in nursing condition.” Other problems were economic. Beyond obtaining wine and bread from the United Hebrew Charities, they could do little to help Mr. Goldberg who stayed home from his job as a peddler to look after his wife. They did initiate savings accounts for the five children they encountered at the Penny Provident Bank of the College Settlement. 42 At Clinton, they employed a willing neighbor, elicited support from Hebrew Charities, and again connected children to the settlement bank. Meanwhile, at 31 Sheriff, Wald described how Mrs. Brewster had rebandaged Mrs. Ehrlich’s leg. 43 As Wald’s “follow up” made clear, repeat visits cemented the human relationships that generated new mappings.
The nurses’ tireless work was ennobled by the rich connections they drew between people and services and between tenements and the larger city. Wald explained that the United Hebrew Charities had sent five dollars to Mrs. Lipski of 9 Ludlow: she was healing from an infection caused by an “ignorant midwife.” The boy with ringworm in the same house was provided with a letter of introduction to a “specialist at the dispensary.” At 11 Rutgers, Mrs. Lanowitz—the main provider “crippled by a long illness at home”—was finally taken to Mt. Sinai Hospital for treatment. On the first floor of 7 Hester, where Hannah Rooach was suffering from a bad hernia, the nurses washed her before negotiating her treatment at the 42nd Street Dispensary, where United Hebrew Charities would pay for her treatment. The Russian family in the same building was provided with a letter, endorsed by Mr. Solomon of the Baron de Hirsch Fund, in which he agreed to pay the transportation costs of the father who had just found work in Newark, New Jersey. 44 Within the same building, nurses encouraged a doctor to home-visit the pneumonia and measles cases upstairs (the family of Nathan Solomon) and sought space for them at the Hebrew Sanitarium at the Rockaways, explaining “the child cannot recover in the tenement, the mother cannot leave them (twins are nursing), the recent measles is a complication.” 45 These introductions, engagements, and relocations further diminished the isolation that accompanied pain in the tenements.
Meanwhile, the nurses spent the day with an anonymous typhoid case at 182 Ludlow, who—for reasons that remain unclear—would only seek care at the New York City Hospital. Finally, at 44 Allen, the nurses checked in on Annie Pillel, pregnant and tired, whose child, Meyer, was recently discharged from the hospital with chronic hip pain. Destitute and homeless, the family—by all appearances abandoned by the father—paid three dollars a week to sleep on the floor of a tailor. The nurses reached out to the Montefiore Homes at Broadway and 138th Street, the hospital over which Schiff, and the Hebrew Sheltering Guardian Society, presided. 46 The solution to pain, Wald reiterated with her summary, was in the networks that drew dwellers out of their Lower East Side tenements and connected them with services; these connections also transformed nurses’ understanding of the spaces of the city. 47 As Wald also makes clear, the nurses were extraordinarily successful at immersing themselves into the communities of the Lower East Side, as illustrated by their follow-up visits and by the connections they drew to services. These connections, cataloged in letters to Schiff, strengthened networks that formed around individual experiences of pain.
July Twenty-Fourth
Two and half weeks later and more than a month before she and Brewster would move visiting nursing out of the College Settlement and into a Jefferson Street tenement, Wald assembled and sent Jacob Schiff—an increasingly enthusiastic benefactor—another summary of visits. These visits further articulated the nurses’ spatial understanding of pain, as well as the role that local guides would have in mapping that pain. The account begins tragically on July 24th on the top floor of 169 Allen—roughly one block from the College Settlement—where Wald encountered a dead baby, and would help nurse the infant’s heartbroken father out of his drunk and back to work (see Figure 3). In the same building, Wald visited Mrs. D. V. Travis whose breasts needed bandaging. Two of her children had whooping cough and needed fresh air so Wald brought the children to play in the sand at the College Settlement on Rivington Street. From there, Wald traveled three blocks to 141 Eldridge Street. Here, she visited Beckie Silberstein who resided on the second floor of the rear tenement, and washed and combed her hair. She also bathed and dressed the children and urged Beckie, who was dying of a terminal condition, to give the children to an institution where they might have access to more resources. Wald would report in the same summary that they later returned with meat and brandy from United Hebrew Charities, and eggs and milk for eggnog—presumably for the children. In the next room, she found a pregnant woman with no work. She “gave nurse’s help” and decided to obtain medical attention. 48
Wald’s letters to Schiff would also indicate how mappings grounded in pain could evolve to include other concerns. Eight blocks from the College Settlement at 181 Clinton on the second floor of the rear tenement, Wald looked in on the Goldberg baby who had been ill. She brought whiskey and a clean dress for the baby. She suggested sending the mother—still weak from her own illness—and her child to the Seaside Hospital at New Dorp Beach on Staten Island. At 9 Ludlow, five blocks south of the College Settlement, they convinced the Lipski’s to send their children, sick with scarlet fever and diphtheria, to Millard Parker on East 16th. But, as their next patient would indicate, nurses’ travels also took them beyond strict conceptions of physical pain. On the way to 9 Ludlow, five blocks from the College Settlement, they were directed—likely by a local guide—to find “Frank,” who was reported to the nurses as a “waif.” Dirty, unattended, and neglected by a blind father, absent mother, and overworked sister, the nurses cleaned him up and took him to the Louis Technical School at 267 Henry Street. 49 Meanwhile, at 173 Clinton, seven blocks from the settlement, Mrs. Maborski “told [the] most horrible tales” of her daughter’s (ten-year-old Ida) “immorality,” and complained of “her presence being a menace to the children of both sexes in the tenement.” With the “mother’s consent,” the nurses reported her to the Gerry Society—another name for the Society for the Prevention of Cruelty to Children, a child protection agency located at 4th Avenue and 23rd Street. 50 The types of cases that Wald identified in her letter to Schiff describe how pain grounded and oriented mappings; these letters also describe how nurses’ work broadened out from pain to include the plight of the “immoral,” neglected, and precarious that also coursed through the Lower East Side.
This broadening also saw dwellers take a more active role in producing vernacular mappings. At 20 Rutgers Place, they encountered Hattie Isaacs, the young girl Wald describes in her speech on congestion before the National Council of Jewish Women in 1896: a seventeen-year-old with phthisis (pulmonary tuberculosis) in a damp basement apartment. Her mother supported her and her four siblings by operating a candy store in the small apartment where “the making of the candy, the sleeping, eating, washing of the family, the mingled odor of these and the street, in the same basement with the consumptive.” 51 This erosion of boundaries, separating public from private spaces, speaks to the ways pain was observable publicly, and was part of a product—candy—that would be sold to the public. Isaacs’s story also illustrates how dwellers had taken steps to create their own maps. Her mother had already written Schiff—suggesting he was becoming a known presence in the neighborhood—regarding admittance to Montefiore Hospital. As Wald describes, the nurses built on the efforts of these families; seeing that the Isaacs’s needs were “urgent,” Wald wrote at once to the superintendent at Mt. Sinai Hospital. Wald also describes returning to 181 Clinton, where she discovered the Goldberg baby “in a state of collapse.” 52 Here, she worked with a dweller to create a solution: the alarmed father ran for the doctor, finding “an intelligent one” Wald quipped; the nurses carried out his instructions. At 169 Allen, roughly a block from the College Settlement where she noted the deceased baby, Wald described efforts to put the Blashmen family in touch with United Hebrew Charities—and possibly the Baron De Hirsch Fund, which sponsored skills training—noting that the father, while well educated and musical, did not possess a tradable skill. 53 By the end of the first month of visiting, the patterns of nursing—many of which were shaped by local guides—took on an ever more coherent form. The vernacular mappings they would impute into the spaces of the Lower East Side organized and patterned life for thousands, but survive only in Wald’s letters.
July Twenty-Fifth
Wald’s accounts of activity from July 25 would enhance, but also replicate visits described on July 24 (see Figure 4). She noted that the Goldberg baby in the rear tenement on the second floor of 181 Clinton, roughly eight blocks from the College Settlement, was improving, and that nurses washed and took the baby’s temperature—as prescribed by doctors at the Seaside Hospital. They brought flowers to Hattie Isaacs in the basement of 20 Rutgers—nine blocks from the College Settlement—and washed and fed her. Just south at 11 Rutgers, they checked on the children whose mother was in the hospital, and arranged for them to go on a day excursion. Walking along Hester, they smelled outhouses in need of lime, and at 19 Hester—roughly seven blocks from the College Settlement—they encountered a child with “running ears,” one with “summer complaint,” and another with whooping cough. They directed the mother of the child with running ears to the dispensary, the “summer complaint” to a seaside excursion, and the whooping cough to outdoor play. The people at this address also “complained of the closets in the next house,” which Wald inspected. Although she “found them clean and with sufficient water for flushing,” the request speaks to the way residents continued to direct the nurses’ movements through the tenements. At 44 Allen, they bathed the Goldstein baby and cleaned clothes; one floor up in the same building, they visited the mother of a baby who had spent the past week in a dispensary for eczema. Meanwhile, on the top floor, they found the Jaekil baby much improved, but the baby’s mother underfed and worn out; they gave her a pound of beef for soup. On the top floor at 34 Norfolk Street, located just next to 19 Hester and roughly six blocks from the College Settlement, they encountered Mrs. Gittelman, a peddler supporting herself and five children and her mother; she was recovering from pulmonary trouble. While Gittleman did not need treatment, they were able to give her money—60 cents she earned for a days’ work and 40 cents transportation cost—so she and her family could visit the Hebrew Sanitarium in the Rockaways. The offer only reiterated the conception that the buildings of the district could be sick and the ways that healing people was equated with healing spaces, or with getting away from them. As they rotated through the rest of the house, “in the usual way,” they encountered two women who were not well, but also did not need attention, complained to the housekeeper that the halls were “not very orderly,” and found one child with “running ears.” A return visit to the Goldberg baby—the figure with which this accounting to Jacob Schiff began and about whom they were clearly concerned—concluded the days’ rounds. In communicating their value to Schiff aiding and assisting sufferers, the nurses drew and then redrew new connections that charted and defined the spaces of the Lower East Side around healing. This charting drew on the direction of local guides, the insistence of repeat visits, and the accessibility of nurses to help solidify their authority in the management of pain.
Conclusion
A towering figure in twentieth-century public health, Lillian Wald dates her visiting nursing origins story—her “Baptism of Fire”—to 1893. In Wald’s version, outlined in her 1915 book describing her life in public nursing and the famous Henry Street Settlement that grew out of it, she describes teaching a class on bed making at the Louis School at 267 Henry Street when an anonymous “little girl” interrupted her with grave concerns about her mother, who had just given birth. 54 Wald recounted bursting into action: following the girl down Montgomery Street, snaking along Division and Hester Streets, before turning onto Ludlow. 55 In summarizing the ordeal, she recalled how despair populated a landscape marked by “broken roadways . . . mattresses and heaps of refuse,” alongside “tall reeking houses,” through streets that operated as “a marketplace, unregulated, unsupervised, unclean.” Along the way, Wald recalled, “odors assailed me from every side.” Her trip concluded at a tenement. Once inside, she disparaged the husband as “a cripple, one of those who stands on the corner exhibiting deformities to enlist compassion”—marking him as an extension of the bleak landscape she had just crossed. Meanwhile, his wife—the person she had been brought to see—was sick, “lay[ing] on a wretched unclean bed soiled with a hemorrhage two days old.” 56 The path she traveled, carved by the child she trailed, points to the way that pain and its resolutions were spatial—comprising physical networks, derived from vernacular understandings that mapped and remapped neighborhoods, and cut paths through them. The anonymous girl who initiated Wald’s “baptism” reminds us that tenement dwellers played an active, integral role in contesting their isolation; here, she might be understood as the nurses’ original local guide. From her earliest recollection, Wald revealed in her biography, she mapped space though pain.
For Wald and Brewster, tending to pain in the sick city was an immersive experience—a tissue connecting rooms and rooftops, buildings and streetscapes, cities and countryside, tenement dwellers and philanthropic bankers. The sick city, as envisioned by Wald and the nurses, reorganizes city life around the human scale—captured in letters describing addresses, names, faces, ages, filth, minutiae, family relationships; each existed alongside conditions of illness—bleeding, aching, diarrhea, miscarriage, and cures—ointments, foods, and philanthropy. These people, conditions, and cures generated the networks that nurses’ travels mapped.
In her address before the National Council of Jewish Women in 1896—cited in this article’s epigraph—Wald describes her own inability to see the larger city beyond the human scale as a limitation. Arguably, however, it was among her greatest strengths and stands among the most important legacies for urban historians who seek to see city life anew, by starting with people, understanding them, and then to expanding out. “Realize with me,” she explained in the same speech before the National Council, “that a crowded district in its entirely is too great for single handling.” 57
Nurses Map of HSVNS Health Center Districts, 1948. Box 226, Folder 15. Visiting Nurse Service of New York Records. Archives and Special Collections at the Augustus C. Long Health Sciences Library of Columbia University. Photo Courtesy of the Visiting Nurse Service of New York.
Footnotes
Acknowledgements
The authors would like to thank the anonymous reviewer at the Journal of Urban History for their helpful insight into the paper’s topic and valuable guidance through the revision process. This article manuscript is for Josephine.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
