"Much instruction needed here": the work of nurses in rural Wisconsin during the Depression.

In October 1936, Mildred Cook was looking for an address in Pulaski, Wisconsin. In the process, Cook, a nurse working for the State of Wisconsin Bureau of Maternal and Child Health, came across Mrs. J.B. This woman was pregnant and due in March, but she had not yet seen her doctor. Cook urged her to do so. The next day the nurse was gratified to learn that the woman had followed her advice and visited the physician. Moreover, she was proud to announce that "Doctor was very pleased with this work."1 Through her counsel, Cook had accomplished two important goals of the State Department of Health. She had convinced a client of the importance of prenatal medical examinations, and she had cemented a particularly positive relationship with the local physician. Cook's work illustrates the epitome of maternal health care throughout most of the twentieth century in the United States: physician supervised, nurse assisted, medically directed. Cook was a critical actor in a unique public health experiment, a joint effort that linked federal, state, and county governments and community members in an innovative program to improve maternal and child health in rural Wisconsin. Concern for the welfare of mothers, pregnant women, and young children led many governmental agencies and philanthropic organizations to develop programs to alleviate health and nutrition problems that were exacerbated by the worsening economic conditions of the Depression. In Wisconsin, the Department of Health instituted the Demonstration Nurse Program in which the state Bureau of Maternal and Child Health used federal dollars to hire public health nurses to work in rural counties. Most critically, this program was time limited. The state health officials planned to fund these nurses only for a year or two, after which they expected that the counties would recognize the advantages of county nurses and begin to employ these women with local funding. In other words, the goal was that the County Demonstration Nurses would demonstrate the efficacy of public health nurses. This situation placed nurses like Cook in a precarious position. As state employees, the nurses needed to follow the state program. As public health nurses, they needed to assure local physicians that the state was not interfering with private medical practice. As demonstration nurses, they needed to develop positive health statistics for the county. As frontline health care workers, they needed to improve the health and well-being of their clients and their children. This balancing of the various, at times competing, aspects of the position was difficult to maintain and could be torturous for the nurse. When she originally arrived in Barron County in February 1940, Louise Steifen, RN, assiduously cultivated physicians, county board members, township offices, and other community leaders, who generally agreed that a county nurse was needed and even offered their support. Yet, it was not until November 1943 that the County Board appropriated the funds; in December, Hazel Nordley, who had succeeded Steifen as demonstration nurse, was named County Nurse in Barron County.2 In Barron and some other counties, the nurses succeeded in convincing officials to fund the position; in other counties, officials declined to pick up the nurse's salary. This article is part of a larger study that will analyze the factors that contributed to the success of the program in some counties and that led to its demise in others. Here, I focus on the daily work of the County Demonstration Nurses in order to understand the tensions inherent in their positions and the factors that inhibited and encouraged their practices.3 I examine the day-to-day activities of frontline public health workers who consistently admonished women to use modern scientific medical discoveries in caring for their families. The nurses prepared statistical studies to provide quantitative evidence of their work and their successes, numbers for the Bureau to use to argue for the employment of a permanent county nurse. …