Each day at 7 pm, New Yorkers sheltering at home celebrate the city’s heroic front-line medical staff, including the thousands of nurses who are risking their lives to care for the victims of COVID-19. We often describe these times as “unprecedented,” but for nurses—a profession historically dominated by women—answering the call of a public health crisis is nothing new. As we contemplate our current predicament, we also want to look back at epidemics of previous generations and the work nurses put in to battle devastating diseases.
During the 1918 influenza outbreak, it was nurses who saw the early signs of the pandemic and recognized the need to act quickly. On October 10, 1918, the Atlantic Division of the Red Cross called a meeting of the city’s nurses to coordinate an emergency response to the quickly moving crisis. A new group was formed, the Nurses’ Emergency Council, which was chaired by legendary nurse, educator, and Henry Street Settlement founder Lillian Wald. The Council quickly mobilized, recruiting public health nurses, who promoted good health and hygiene practices and connected New Yorkers to social services, and visiting nurses, who provided in-home care. Because these nurses worked in already-established care networks and had community ties, they were well-placed to respond.
Given the mystery surrounding the flu—no diagnostic tests existed, and it was not even understood that the flu was viral rather than bacterial—skilled nursing was the primary treatment. As New York’s nurses understood, however, the needs of flu-stricken households extended beyond medical care. Sick caregivers struggled to cook for their families, wash clothes and bed linens, sanitize shared living spaces, and watch their children. And regardless of health, New Yorkers still needed to pay rent. The temporary or permanent loss of a wage earner might shake a family’s stability, and the consequences would ripple out into the surrounding community.
The Council acted as the central organization point, dispatching nurses and volunteers from local nursing centers to respond to medical needs. Overseeing social needs as well, the Council coordinated with city agencies and social service organizations and relayed requests for cleaning or childcare assistance to local community centers. Volunteers delivered soup, aided nurses on home visits, and even worked in short-staffed hospitals. Marriage had forced the retirement of many visiting and public health nurses, but many were encouraged to return to help the influenza response.
Visiting nurses worked non-stop in the field, bringing medicines, thermometers, whiskey, Listerine, and other supplies into homes citywide to care for the sick and their families. Red Cross volunteers drove visiting nurses from visit to visit to save time and transport more supplies. In October, nurses delivered fresh linens, flannel “pneumonia jackets”, and “12,241 quarts of soup and 2,255 quarts of cereals, junkets, and custards.” Although New York City had more casualties from the 1918 flu pandemic than any other U.S. city, the quick work of the city’s nurses and the existing public health infrastructure helped the actual death rate remain below that of many other urban areas.
This public health response was decades in the making. Public health nursing had developed in the early 20th century to improve the health of communities through preventative medicine, teaching good hygiene and sanitary practices, and addressing unmet needs that affect health, including food, stable housing, and employment. Wald established the Henry Street Settlement House—with its cadre of visiting nurses—on the Lower East Side in 1893. Carrying oversized black bags of tools and medicines, the nurses not only tended to the sick in small tenement apartments, but also made sure that children and other dependent family members were cared for. Wald partnered with the Metropolitan Life Insurance company in 1909 to provide visiting nurse services in tandem with the company’s industrial insurance policies, offering low-cost insurance to working-class families. By the time of the 1918 flu outbreak, Wald’s visiting nurses worked in districts ranging from the Lower East Side to Harlem.
In the decades before the 1918 outbreak, the city’s health department had also introduced new efforts to improve health citywide. Health department nurses implemented health education campaigns, traced outbreaks of contagious diseases like tuberculosis, and connected New Yorkers with social services. Although nursing schools in New York were tacitly segregated, research has shown that the city’s health department employed black and white nurses, paid them equally, and assigned them to districts indiscriminately. The Henry Street Settlement also employed both black and white nurses, but only assigned black nurses to majority African American neighborhoods.
Just as one example: Harlem Renaissance writer Nella Larsen worked as a nurse for the city’s Bureau of Disease Prevention in the Bronx following completion of her program at Lincoln Hospital and Home in the Bronx, a training school for black nurses, in 1915. Larsen and her fellow Bureau nurses canvassed their assigned districts for outbreaks of contagious disease, determined whether a person’s illness required hospitalization or quarantine, and instructed families on in-home nursing care and maintaining sanitary conditions to prevent further spread. With 1918 pandemic, Larsen’s unit was one of the many that was diverted to influenza response.
The demands of World War I had created a nationwide shortage of doctors and nurses. Out of 98,000 registered nurses in the U.S., around 20,000 were serving in the military, with 9,000 serving overseas. The military and the Red Cross initially refused to accept black nurses, despite consistent advocacy by black nursing organizations. In May 1918, the Red Cross began a massive recruitment campaign, and the following month accepted the first of a handful of black nurses who would serve colored troops.
The Council not only identified the city’s desperate need for more nurses but also determined that an effective public health response required more women to fill essential support roles. A half-page advertisement in the Sunday papers called for women volunteers to investigate possible influenza cases, join public education efforts, and act as nurse’s aides. The Council had thousands more copies made into handbills distributed, according to a retrospective account by the Council’s Executive Secretary, to women’s clubs, women’s organizations, and passersby along Fifth Avenue, in front of large department stores, and at Grand Central Station. Placards were installed in theater lobbies and lantern slides shown at movie theaters.
The Nurses Emergency Council disbanded in November 1918 after developing an aftercare program to support recovering New Yorkers with community-based follow-up medical care and to ensure access to nourishing food. In the years afterward, public health nursing continued to attract women as a well-paid profession that allowed for autonomy and increasing public recognition. The women who supported the city’s anti-influenza efforts carried the harsh memories of the pandemic. Yet many maintained pride in their highly organized response that allowed so many suffering New Yorkers to receive care and recover.
Written by Laura Mogulescu, Curator of Women’s History Collections, Center for Women’s History