By Jean C. Whelan, PhD, RN and Julie A. Sochalski, PhD, RN, FAAN

Welcome to Echoes and Evidence, a new blog from the Barbara Bates Center for the Study of the History of Nursing that brings hidden treasures from nursing and health care’s rich history and their policy implications to the public arena. Echoes and Evidence delves into the instrumental place that nurses and the nursing profession hold within the wide scope of health care history and health policy.

The Affordable Care Act has brought health and health care to every corner of the public forum, entreating us to look at the system we have and ask “how did we get here?” Nursing’s role in caring for the nation’s sick and preserving the nation’s health is a critical part of the answer, and this blog will highlight the unique place of nursing in our society and in the delivery of modern health care services.

The Story of One Nurse

Much of what people learn about history tends to focus on those who were famous or held leadership positions. The history of nursing is filled with examples of significant, yet largely unknown, individuals and events. As an example, this initial blog offers the experience of one nurse, Louise Geary, for your consideration. Geary, a 1904 graduate of the Hospital of the University Of Pennsylvania School Of Nursing, was a student in 1903 when a typhoid epidemic descended on Butler, Pennsylvania. The epidemic spread rapidly and continued into 1904. News reports of the epidemic swept across the country. Medical journals discussed the public health implications and the popular press, from as far away as California, carried stories about Butler. Clara Barton, President of the American Red Cross visited the area, raising money to support the relief efforts. Overwhelmed by the intensity of the sickness the city issued an appeal for doctors and nurses to care for the sick.  Geary traveled to Butler to nurse the city folk. Her heroic efforts—remember those who traveled to a typhoid area placed themselves at tremendous risk for contracting the disease—earned Geary a certificate of commendation for the superb care she delivered to the citizens of Butler.

Typhoid Certificate, circa 1904. Photo Courtesy of the Hospital of the University of Pennsylvania School of Nursing Alumni Association.

Geary’s story and her part in stemming the effects of the epidemic is more than just the saga of one dedicated nurse. Prior to the installation of adequate water filtering systems, typhoid fever, caused by the bacterium, Salmonella Typhi, plagued the nation’s communities wreaking havoc and leaving death in its wake. The Butler epidemic occurred when one of the city’s filtering systems, underwent repairs and was shut down. Typhoid struck soon after. The local Board of Health proved inadequate to the task of handling the outbreak. Further the state Board of Health failed to keep adequate statistics or supervise water supplies. One contemporary report blamed the state legislature for not appropriating adequate funding to preserve the public’s health. It wasn’t until 1905 that the drinking water in Pennsylvania was regulated.

The role Geary took in nursing the citizens of Butler was enormous. This was the pre-antibiotic era, a time when there was little physicians could do for typhoid fever victims. Survival depended on nursing measures such as  replacing fluid loss, making sure the patient ate, keeping the patient clean and preventing secondary infection to others. It was often the presence of professional nurses who made the difference in stemming the tide of typhoid epidemics.

The story of the Butler typhoid epidemic encompasses several narratives. It is a story that involves health care workers— in particular the nurses who went to care for the victims of the epidemic. It is also a story about policy, and how policy decisions, such as critical lack of funding for the public health system, were instrumental in creating an environment in which typhoid flourished and required nurses to respond to the crisis in order to preserve the safety of the community. Geary’s story also shows how ordinary people dealt with the crises of their day, often exhibiting extraordinary effort.

Linking Nursing History and Public Policy

It is our hope that Echoes and Evidence explores history and public policy in a way that provokes dialogue and fosters collaborative scholarly growth. Knowing what has gone before and how that affects the creation, design and implementation of public policy is essential for enacting policies that improve the public’s health. We will offer analysis, commentary and discussion of the ways in which history shaped the health care system today and how such knowledge can be used to form health care policy of tomorrow. Join us as we explore this rich history and become part of the discussion.

Special thanks to the American Journal of Nursing for providing free access to the article A Look Back: Nursing Care of Typhoid Fever: The pivotal role of nurses at the Children’s Hospital of Philadelphia between 1895 and 1910: how the past informs the present

Dr. Jean C. Whelan is the Assistant Director of the Barbara Bates Center for the Study of the History of Nursing and is an expert on the history of U.S. nursing workforce, workforce issues shaping nursing’s development and policy implications involved in maintaining adequate nurse services.

Dr. Julie Sochalski is an Associate Professor of Nursing at the University of Pennsylvania School of Nursing and serves as a fellow at the Barbara Bates Center for the Study of the History of Nursing. Dr. Sochalski is recognized as a national and international expert in health policy and the health care workforce.