Flashback Friday: The Advent of School Nurses

With school’s start right around the corner, we look back at the invention of the school nurse – now a familiar role occupied by beloved individuals, but a century-old concept begun in America in 1902 in New York City, where chronic school absenteeism was a plague.

Why were so many kids absent? Health authorities who’d begun conducting medical inspections of city schools sent ill children (suffering from everything from rat bites and trachoma to lice, scabies and impetigo to ringworm) home for treatment, with a note to their parents advising they seek medical care before returning to school.

But as many immigrant parents either couldn’t read English, didn’t understand the notes’ significance, or couldn’t afford a visit to a private physician, many kids remained truant for weeks, if not months, unwitting vectors for the transmission of communicable disease. Lilian Wald, leader of the Henry Street Settlement – who’d tended many immigrant families on the Lower East Side – knew that lack of medical care for school children negatively impacted the entire community. So she and her colleagues hatched a plan.

In October, 1902 Wald sent fellow RN Lina Rogers into four neighborhood schools in the city. The project, which lasted a month, and in which Rogers managed to see upwards of 10,000 kids, offered in-school treatment for common, largely un-alarming conditions.

For nits, Rogers used “hot vinegar.” Ringworm? “Scrub with tincture green soap, epilate, cover with flexible collodion (a coating of nitrocellulose in a mixture of alcohol and ether).” Children with scabies? Rogers offered a “scrub with tincture green soap, and [applied a] Sulphur ointment.” And lice, she noted, “succumb readily to the kerosene and sweet-oil” treatments she gave.

from the 1903 American Journal of Nursing article by Lina Roberts "A Year's Work for the Children in New York Schools"

The month-long program was extended, and 27 additional nurses were hired that year. Between January and June of 1903, Rogers and her three fellow nurses offered a whopping 135,191 children treatments for their different diseases, including 65,987 cases of contagious eye disease; 55,631 cases of lice; 6,057 cases of ringworm; 2,285 cases of eczema; 163 cases of scabies; and 5,731 “miscellaneous” cases.

Within a year, the rates of absenteeism due to illness among kids enrolled in New York City schools had decreased by 90 percent. By 1909, 141 nurses were working in NYC’s 458 public schools as close affiliates of principals and medical inspectors. And in 1904, Los Angeles hired its first school nurse.

Rogers – who would go on to write the first textbook for school nurses in 1917, THE SCHOOL NURSE: A Survey of the Duties and Responsibilities of the Nurse in Maintenance of Health and Physical Perfection and the Prevention of Disease Among School Children – later wrote that she “hoped that other cities may find it [school nurses] part of their educational system which they cannot neglect, and that in a very short time the work will be universal.”

Today, while many school nurses move between schools, and occupy part-time roles, the American Academy of Pediatrics is among the organization that asserts their importance: “It is essential that all students have access to a full time school nurse all day, every day.”

Budget cuts may have lessened the ubiquity of school nurses, but their work – including that of nurse hero Eileen Tomasi, the school nurse in Flint, MI, who saw dozens of children with lead poisoning across the 11 schools she serves – are as critical as ever.

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This #FlashbackFriday brought to you by the Bjoring Center for Nursing Historical Inquiry. Source materials from the American Journal of Nursing (December, 1903), the National Association of School Nurses, and HISTORY OF PROFESIONAL NURSING IN THE UNITED STATES (Springer: 2018). Special thanks to American Association for the History of Nursing president Arlene Keeling, faculty emerita.