Question: Why History?
The U.S. in 1904: A Look Back
Cindy Connolly
t is the dawn of a new century. A large influx of new immigrants is threatening the status quo, creating a new multiculturalism and forcing people to redefine core American values. The economy is unsteady but seems to be coming back after a recession. A president makes it a centerpiece of his administration to convince the American public that the United States has a manifest destiny to install democracy in other parts of the world. The country is intervening in a war abroad and many inside and outside of the nation are critical of the action. New technology is bringing people closer together and the world seems to be becoming a much smaller place. And in just a few short years a great ocean liner called Titanic will set sail.
That’s right, this is not the United States in 2004, but 1904. The beginning of the 20th century was last time this many people emigrated from other countries to our shores. It was ventures into the Philippines, the Caribbean, and Mexico, not Iraq, that created intense debate about the role the United States should play in world affairs. It was the telephone not the Internet that had recently brought people in far away lands closer together.
Most of us have seen our predecessors peering at us from pictures taken long ago. Wearing starched uniforms as they toil on a non air-conditioned ward and implementing little remembered therapeutic techniques that have long since been replaced by what we believe to be more efficacious treatments, it is easy to feel as though we have little in com-mon with our forebears. That is a mistaken impression.
Cindy Connolly, PhD, RN, PNP, is Assistant Professor, Yale University School of Nursing and Assistant Professor, History of Medicine, Yale University School of Medicine, New Haven, CT, and Series Editor for this department.
If you listened to a child health nurse in 1904 summa-rize pediatric health care issues, here is what she (they were almost all she) might have said:
The care of sick children is in a dynamic state, moving from home to hospital. The way in which health care is financed has resulted in great inequity and an imbalance regarding access to care. Frightening new infectious diseases hold nations captive to their threat. The use of tech-nology is exploding and changing the role of nurses and physicians. There is a
great deal of rhetoric about child health and social welfare issues, but many children die or suf-fer from preventable or remediable conditions.
As I intimated above, health care in 1904 was facing unprecedented transition, just as today. Then the care of the sick was moving from the home to the hospital; today much care is shifting back out of institutions. Then health care financing limited many people’s access to care. In 1904 peo-ple either had the money to pay or if they were poor but lucky (meaning that they were considered deserving and lived in a place where it was available), they qualified for charity-based care. Today, many people are uninsured or underinsured, severely restricting their access to care. The numbers of unin-sured Americans in 2002 was estimated at 15.2 percent of the population, which is 43.6 million people (United States Census Bureau, 2003).
Just as the germ theory of infectious disease causation iden-tified the microorganisms that created diseases with modern names out of old scourges, advances in science and new tools such as the human genome project are uncovering the molec-ular underpinnings of many conditions. We have new infections such as ebola and hanta virus and frightening permutations of old diseases such as drug resistant TB.
Just as surgery and other novel interventions revolution-ized health care 100 years ago, new therapeutics and tech-nologies continue to reshape care and the way in which it is delivered today. In 1904, society claimed it prized the welfare of children, when in reality thousands of children worked in sweatshops, became ill from impure milk, and faced limited access to care that would have improved their health. Today, in our supposedly child-centered America, thousands of chil-dren die every year or become disabled because of pre-ventable or treatable diseases. Among those under the age of 18 years, 11.6% (8.5 million) of children were without health insurance in 2002, and many millions more have inadequate insurance (United States Census Bureau, 2003).
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Jennifer developed the Graduate Nursing Residency Program at Presbyterian that helps new nurses get started in their profession. “I enjoy helping people and really being able to make a difference in their lives,” says Jennifer, RN, Operating Room Services. “Being a nurse means that you have been given a valuable gift to help others,” says Jennifer.
It’s people like Jennifer that make Presbyterian Healthcare Services a great place to work. As New Mexico’s premier healthcare provider, we are always looking for individuals like Jennifer to join us.
Recently, we have expanded our NICU to 50 beds and our PICU to 21 beds. We have outstanding opportunities for RNs in the following areas:
PICU • L&D • Maternity • NICU • Outpatient Pediatric
• Pediatric Surgery • Urgent Care
To find out how you can be a part of the team of nurses at Presbyterian, visit us online at www.phs.org or call 1-800-708-1151.
Presbyterian is committed to ensuring a drug-free workplace. We are an equal opportunity employer.
A Lot Has NOT Changed
One striking theme when taking an historical snapshot of 1904 and 2004 is how much hasn’t changed. No where is this truer than in health care. Caught up in today’s hectic world, we often think things have never been worse and that the world, in general, and health care, in particular, has never faced such crises. In fact, our nurse forebears faced equivalent issues 100 years ago. They wrestled with major professional obstacles in an era in which they could not vote and had minimal control over their practice environment. Then they faced TB instead of AIDS and health care was moving into, not out from, the hospital. New frontiers in research and technologies redefined nursing and physician practice and forced practitioners to consider new ways of thinking about old diseases.
But why should busy pediatric nurs-es spend any of the valuable energy needed to solve today’s problems learning about what happened in the past? Aside from making us feel glad that we practice in the present day, even though we seem to be in a peren-nial health care “crisis,” does health care history, in general, and nursing history, in particular, have anything meaningful to say to contemporary pediatric nurses? The narratives to be featured in this column cannot be used to concretely help pediatric nurses care for the next patient or solve the next complex management problem. But what history can do is help envision a better future. Knowing what happened in the past can lead to an informed appraisal of both the intended and unintended outcomes of previous actions and policies. This knowledge can then be used to serve as a template to consider a new and better future. As pediatric nurses we know that to pro-vide the best care to the child and fam-ily, taking a thorough history is criti-cal—it shapes our assessments, plan, and intervention. History can also be useful when thinking on a broader scale, about how to develop a nursing role, run a unit, shape a hospital proto-col, or envision a new government pol-icy. Please join us in this new feature in Pediatric Nursing series as we journey into child health care and pediatric nursing’s past to study selected histori-cal topics that are critical to an under-standing of child health care delivery today and for the future.
Reference
U.S. Census Bureau. (2003). Health insur-ance coverage in the United States: 2002. Retrieved June 10, 2004, www.census.gov/prod/2003pubs/p60-223.pdf.
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