Public Health Nursing Vol. 24 No. 3, pp.

293–297
0737-1209/r 2007, The Authors
Journal Compilation r 2007, Blackwell Publishing, Inc.

HISTORY

For the Good of a Common Discipline

Sarah E. Abrams

ABSTRACT This historical commentary reprints excerpts from Mary Sewall Gardner’s January 1,
1931, editorial in the original Public Health Nursing journal. Gardner (1871–1961) directed the Provi-
dence District Nursing Association until her retirement in 1931. She had also served as president of the
National Organization for Public Health Nursing. In her editorial, Gardner sought to relieve the sense of
hopelessness caused by the deepening Depression and ameliorate the fear that public health nursing ad-
vances had been reversed. An introduction to the impact of the Great Depression on working classes and
its impact on organizations responsible for visiting nurses provides the background to help evaluate Gard-
ner’s intent. Her words find parallels in the inaugural address of Franklin Delano Roosevelt in 1933. This
suggests that the pervasive crisis produced a distinctive tone and perspective of interdependence and
mutual resolve that leaders used to help their followers through troubling times.

Key words: Great Depression, history of public health nursing, Mary S. Gardner.

Out of Work, Out of Hope
The October 1929 crash of the New York Stock Ex-
change set off a panic of selling that commonly marks
the infamous decline of the U.S. economy known as
the Great Depression. In the ensuing month, the price
of stocks continued to plummet, losing 47% of its
value in 26 days (Kirk Report, 2004). Manufacturing
production declined rapidly in the steel, auto, and
retail industries, followed by other businesses and
then farm income, which declined by 50% in 3 years
(Phillips, 1969). By the time the economic nadir oc-
curred in 1932, stock values had lost nearly 90% of their
value (Kirk Report, 2004). Banks failed or suspended
business. The average family income, about $2,300 in
1929, declined to $1,600 or less by 1932 (Phillips, 1969)
or to $495 per capita in 1933, and at one point, 28% of
the population—about 34 million people—had no in-
come at all (Watkins, 1999, p. 44). Bread lines were
common sights in cities and families all over the country
Sarah E. Abrams, Ph.D., R.N., is Assistant Professor,
Department of Nursing,College of Nursing and Health
Sciences, University of Vermont, Burlington,Vermont.
Correspondence to:
Sarah E. Abrams, Department of Nursing, College of
Nursing and Health Sciences, University of Vermont,
002 Rowell Building, 106 Carrigan Drive, Burlington,
VT 05405. E-mail: Sarah.Abrams@uvm.edu
were torn apart as despair and destitution took their
toll. While businesses and the urban poor were the first
casualties of the economic crisis, three summers of
drought across the Midwest and Plains states spurred a
westward migration of dispossessed farm families.
Unemployment climbed from 4.3 million in 1930 to
12.1 million in 1932 (Phillips, 1969). By the time F. D.
Roosevelt was inaugurated, 25% of the civilian labor
force was without work (Watkins, 1999). Many more
people were able to work only a day or two each week
and then for only a nickel or dime per hour.
Every morning a shuffling, tattered, dispirited group
of fifty, maybe as many as a couple of hundred,
congregated around the hiring halls, the docks and
railroad yards, the construction sites, or the public
employment offices, wherever casual labor might be
needed. When the word went out in Pittsburgh or
Detroit or Los Angeles that one of the big factories
was hiring, the cops got to the gates ahead of the
applicants to put down the rioting as hundreds of
desperate men fought and shoved to be numbered
among the two or three score of lucky ones at the
head of the line (Phillips, 1969, p. 40).
Eventually, all aspects of American life were
disrupted. Among the nation’s women, an estimated
8,000–10,000 graduate nurses were also out of work,
sparking controversies about whether hospitals should
close their training schools and employ graduate
nurses rather than continue to produce new nurses
who would find no work (Kalisch & Kalisch, 1995).

293
294 Public Health Nursing Volume 24 Number 3
Mary Sewall Gardner was one of the nation’s
premier public health nurses and served as superin-
tendent and then director of the Providence District
Nursing Association between 1915 and 1931 (Ameri-
can Nurses Association, n.d.). Author of the first
American textbook on public health nursing in 1916,
Gardner explained the impact of the country’s
economic woes on visiting and public health nurses
in its third edition.
In public health nursing the effects were first felt by
the private agencies, whose budgets, compiled in the
easy comfort of what was then believed to be the
assured prosperity of the summer of 1929, could not
be met by the usual means. As time went on,
conditions became more acute. Not only was the
giving public unable to supply its usual support, but
the earning capacity of the agencies and the returns
from their invested funds fell off enormously. At the
same time the character of the work itself became
more demanding for, as unemployment grew, each
family visited presented a complicated social problem
which required solution (Gardner, 1936, p. 49).
Some 5 years earlier, Gardner had written an
editorial for the original Public Health Nursing jour-
nal that addressed the desperate situation facing the
country. Its title ‘‘Qui Bono?’’ raises the question that
she was concerned public health nurses would ask,
‘‘What good is it?’’ Nurses, Gardner implied, might be
tempted to despair of the value of their work and the
permanence of advancements in public health.
The chaotic opening of this year, 1931, when
unemployment rends the country, and when so
much that has been built up seems in a fair way to
topple to the ground, is for many nurses a moment of
apprehension and discouragement. They are very
close to the unemployment problem in its most
acute aspect, and to listen daily to the ineffectual
cry for work requires courage (Gardner, 1931, p. 1).
Work Changes the World
Empathizing with the workers who thronged any
place of potential employment could not have been
difficult, given the rising unemployment among
graduate nurses. Public health nurses fared about as
well as American women teachers before ‘‘Black Tues-
day.’’ The National Organization for Public Health
Nursing (NOPHN) estimate of salary ranges for pub-
lic health nurses in 1929 shows that inexperienced
public health nurses made between $100 and $135
per month, with experienced nurses earning $125–
$175, and executive salaries ranging between $1,800
May/June 2007
for supervision and $5,000 for directors of large
urban agencies (NOPHN, 1932). Inexperienced
female teachers made about $1,265 per year (Ander-
son & Stubbs, 1929). Job loss came more slowly to
public health nurses than to those in private duty, but
it came. Initially, the salaries of both publicly and
privately employed visiting nurses were cut. Gardner
observed, however, that while the cost of living
declined because people could not afford goods and
services, salary reductions exceeded declines in the
cost of living (1936, p. 49). As conditions worsened,
the demand for governmental intervention increased.
Emergency plans created new alliances. The programs
conceived as part of the New Deal resulted in different
types of relationships between governmental agen-
cies, community charities, voluntary associations, and
public health nursing agencies. Directors of public
health agencies were not unfamiliar with governmen-
tal funding, but for the first time, the government
imposed new conditions of work with funding for care
of selected populations. The Federal Emergency Relief
Administration (FERA) helped to provide nursing
care for the unemployed sick, while the Civil Works
Administration (CWA) put unemployed nurses to
work in public agencies and institutions. The Chil-
dren’s Bureau sponsored the Child Health Nursing
Project using unemployed nurses (Gardner, 1936).
The strain of putting nurses who were inexperi-
enced in public health to work as visiting nurses or
specialists in maternal-child care or tuberculosis
created demands on the leadership of the NOPHN
and on the administrators and supervisors on whom
they were imposed. As Gardner noted, ‘‘All types of
nurses and all types of women were among the num-
ber applying, the only thing in common with all being
the vital necessity of securing a job that would keep
body and soul together . . .’’ (p. 51). If the agencies
were concerned, as Gardner suggests, with maintain-
ing the standards so painstakingly established in the
years before the Depression, the newly employed
nurses also faced significant challenges.
Worried, harassed and preoccupied by the
conditions of their personal situation, drawn largely
from the field of private duty, the technique of which
they understood, they were called upon to adjust
themselves to work wholly unfamiliar to them, the
principles of which, as we know, are none too easy to
grasp (Gardner, 1936, p. 51).
Looking at the situation from the perspective of
a career advocate for public health nursing and an
 Sarah E. Abrams: For The Good of a Common Discipline
administrator of one of the leading visiting nurse
associations, Gardner acknowledged a number of
problems inherent in supervising nurses essentially
unprepared for their roles. Training was required.
Equipment must be found. The excess demand on
the internal resources of agencies created new stress-
ors. Successes varied based on organizational struc-
ture, program funding, and a variety of other factors.
Good supervision was essential to preserving the
standards of practice in public health nursing. But it
was not simply the nurses who posed challenges for
public health nursing directors. Federal and local pro-
grams were implemented and abandoned because
there were no plans for continuity or even acceptabil-
ity to the communities to which they were offered. A
careful administrator might view the times as chaotic
and the results as a debacle for public health nursing,
but Gardner (1936) reminds us that the situation was
‘‘artificial,’’
for with three days work a week, and that with no
assurance of even temporary permanency, provides
only for bare subsistence, not for normal living, and
no one working under these conditions is, or should
be, satisfied (p. 53).
The work was worth it. The employment brought
nurses relief and, Gardner admits, ‘‘forwarded, not
retarded, the progress of the public health nursing
movement’’ (p. 53). New nursing services, while oper-
ating sometimes by trial and error, were created in
an atmosphere of experimentation, resulting in new
organizational structures, broader nursing roles,
and wider exposure to the general public.
Hope and Work
By the time Franklin Delano Roosevelt was inaugur-
ated on March 4, 1933, recovery from the worst of the
Depression had probably already begun, but the na-
tion remained in need of both hope and work. Work
was foremost in Roosevelt’s inaugural plan, although
in remembering only his famous words, ‘‘. . . the only
thing we have to fear is fear itself,’’ subsequent gener-
ations may have forgotten Roosevelt’s characteriza-
tion of fear, ‘‘nameless, unreasoning, unjustified
terror which paralyzes needed efforts to convert re-
treat into advance’’ (Roosevelt, 1933). The problems
faced by visiting nurses must have felt overwhelming,
and the financial burdens faced by directors and
boards of voluntary, private, and even public agencies
likely seemed insurmountable. Gardner’s approach
295
was to remind individuals of their significance in the
movement to advance public health and public
health nursing. In the editorial, she reminded her
readers,
Since any movement is as strong or as weak as those
who are forwarding it, we must first look at the
workers. The little handful of nurses who went forth
during the closing years of the last century and the
first years of the present one had little of the
knowledge that we now consider essential, but their
spirit of devotion, their creative ability and their
undaunted courage made of them true leaders
(Gardner, 1931, p. 2).
Like their predecessors who forged the way
by experimentation, the nurses whom Gardner and
her administrative colleagues later remembered as
challenges to the quality of public health nursing were
also a great blessing. To the question of whether
public health nursing had fallen short of its promise,
Gardner replied,
On the contrary hundreds of young women, who in
other economic fields might have failed to develop
these qualities, are now at work where the daily
demand brings about a spiritual development of the
highest order. That exceptions exist, none would
venture to deny, but I believe nothing has been lost
of that early beauty; rather that it has germinated
and is bringing forth a thousand fold. We have
therefore in the great majority of public health
nurses, and in those who serve the cause in other
ways, an attitude toward their work which is in itself
perhaps one justification for the thing that has
developed it (Gardner, 1931, p. 2).
Gardner seems to have been saying in the lan-
guage of the time that what does not kill you makes
you stronger. Moreover, she argues that what makes
us stronger may, indeed, strengthen our cause. The
remedy for despair, which she believed was as devas-
tating as fear in its ability to paralyze, was for her
readers to appreciate their role in a succession of
advances, despite adversity.
The Work Speaks for Itself
It is possible during times of hardship to lose sight of
what has been achieved, and to focus on the enormity
of work as yet undone. Gardner wanted her readers to
remember their successes. Public health nurses had
proved themselves invaluable in bringing messages
related to hygiene, nutrition, child care, and care of
296 Public Health Nursing Volume 24 Number 3
the sick to millions of families all over the nation and
had ameliorated the suffering of the present crisis.
That there are literally millions of the sick all over
the country who are receiving care that thirty years
ago was denied them cannot be questioned. Does it
ever occur to the average person to picture what this
means? Can you yourself visualize the withdrawal of
all bedside nursing as done by visiting nurses, and
what it would mean to the people of the country? We
are not doing nearly enough, and there are still far
too many so deprived now. We must keep pressing
forward to lessen this number, but if the sick now
being nursed in their homes were the only
accomplishment of the public health nurse surely
we can answer that the comfort of skilled care
brought into these homes would justify our past
thirty years of work (Gardner, 1931, p. 2).
Of course, individual nursing visits were just one
part of the picture. The evidence of achievement in
terms of mortality and morbidity was more challen-
ging to amass. Some advances had been made, and
some older problems simply exchanged for new ones.
Educational preparation had not kept pace with the
demands for new skills.
Suffice it to say that death rates have fallen among
certain groups; that morbidity has lessened among
others, and that in bringing about these reductions,
the public health nurse has had an important part.
Indeed, without her we know that the public health
movement, as at present developing, would be
impossible. Nor is the movement static. As everyone
knows, new fields of activity are being entered every
year and new means of preparing nurses for these
added responsibilities are being sought (Gardner,
1931, p. 2).
Despite the achievements and continuing chal-
lenges, Gardner, like Roosevelt 2 years later, gave
voice to the stark realities of the situation. ‘‘Only
a foolish optimist can deny the dark realities of the
moment’’ (Roosevelt, 1933). Yet, Gardner spirits
her readers on to pride and a sense of usefulness in
their work.
Those who are in touch with the present economic
situation make no secret of its gravity. On the debit
side of the social page are many danger points. On
the other side, among the assets, some of the leaders
in social thought put the public health nurse. They
feel that the fact that women with training,
experience and understanding, daily enter the
homes of some millions of our people for purposes
of helpfulness is a truly important factor in the big
issues at stake. It is such years as these that our true
tests come (Gardner, 1931, p. 2).
May/June 2007
For the Good of a
Common Discipline
The sense of kinship with the receivers of care is
arguably a new tone in the journal. Public health
nurses had, as a group, always been benevolent and
helpful, but they were also the field workers of change,
the bearers and interpreters of scientific and practical
knowledge. To some, they may have also been agents
of social acculturation or enforcers of the standards
and morality of a dominant culture. Conditions of
deprivation and the universality of, if not privation, at
least awareness of suffering, perhaps contributed to a
more egalitarian ethos.
If I read the temper of our people correctly, we now
realize as we have never realized before our
interdependence on each other; that we can not
merely take but we must give as well; that if we are
to go forward, we must move as a trained and loyal
army willing to sacrifice for the good of a common
discipline, because without such discipline no
progress is made, no leadership becomes effective
(Roosevelt, 1933).
Gardner recognized the struggles that public
health nurses had endured; she did not deny that
nursing and nurses had faced many obstacles, but
they had also received help. Significantly, adversity
had tempered them as a professional group. The
worsening conditions of the Depression would find
them able to meet new challenges.
In the last 30 years, there has been much to help our
development and that of our cause; much of
sympathetic understanding and backing; something
of misunderstanding and opposition. We have
passed through the experience of a great war and a
devastating epidemic. We have attacked our
problem under every conceivable geographic and
economic condition, and we are no longer as young
and as crude as we were a few years ago (Gardner,
1931, p. 3).
In 1931, then, the army of public health nurses
might go forward, Gardner implied, holding its banner
high, just as Roosevelt later challenged the American
people to move forward, to be willing ‘‘to sacrifice for
the good of a common discipline’’ (Roosevelt, 1933).
These things our movement has to its credit, a vast
body of trained, disciplined, and devoted workers;
a ready entrance into countless homes; a record
of very real accomplishment in the alleviation of
suffering and in the prevention of disease; a good
start in a better promotion of health, and perhaps
 Sarah E. Abrams: For The Good of a Common Discipline
most important of all a future which is only limited
by our own powers of fulfilling its possibilities, for
past effort has certainly placed opportunity in our
hands. To those then who on the first of January 1931
are asking this pregnant question of ‘‘Qui bono?’’ I
say: It is good, it is worth while, this thing that we are
trying to do (Gardner, 1931, p. 3).
References
American Nurses Association. (n.d.). Mary Sewall
Gardner, 1871–1961. ANA Hall of Fame
inductee Web page. Retrieved February 5, 2007,
http://www.ana.org/hof/gardms.htm
Anderson, E. W., & Stubbs, E. M. (1929). Salaries of
inexperienced teachers. Educational Research
Bulletin, 8(13), 289–294.
Gardner, M. S. (1931). Qui bono? [Editorial]. Public
Health Nursing, 23(1), 1–3.
Gardner, M. S. (1936). Public health nursing
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Kalisch, P. A., & Kalisch, B. J. (1995). The advance
of American nursing (3rd ed.). Philadelphia:
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National Organization for Public Health Nursing
(NOPHN). (1932). Principles and practices in
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New York: Macmillan.
Phillips, C. (1969). From the crash to the blitz, 1929–
1939. New York: Macmillan.
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address of Franklin D. Roosevelt. The Avalon
Project at Yale Law School. Retrieved February
7, 2007, from http://www.yale.edu/lawweb/
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Watkins, T. H. (1999). The hungry years: A narrative
history of the Great Depression in America.
New York: Henry Holt & Co.