Florence Wald and the care for the terminally ill in the 1940s and 50s

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Saul Ebema: Florence Wald received a Bachelor of Arts degree in physiology and sociology from Mount Holyoke College in 1938 and immediately enrolled in the 30-month nursing program at Yale University.

However, by the time Florence went to Yale University School of Nursing, there was beginning to be a shift in philosophy of care where the primary focus was on the disease, and not on the patient. This disease orientation was a result of the rapidly growing knowledge in medical science that was overshadowing everything else at the time.

You are listening to Personhood. The story of Florence Wald and the Hospice movement. This is episode 2- “the care of the terminally ill in the 1940s and 50s” and I am your host- Saul Ebema.

As American lifestyle shifted into high gear after the great depression, dance and music styles did as well. The upbeat tempos of swing music seemed to match the mood of the country. As the economy boomed, the people danced.

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Saul Ebema: While the dance music got louder and fun, world events got louder and dangerous.

The Second World War had already started in September of 1939 in Europe. At first, the United States remained officially neutral in the conflict.

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Saul Ebema: Even if the draft was not popular, in hindsight, it helped the United States to be ready in case of an attack. It was not long after that the Japanese empire ended America’s isolation from the war with a surprise attack.

While Americans were going through their day, all of a sudden, all the media channels were interrupted. Those who were listening to the baseball game between the Dodgers and the Giants over the radio where interrupted by this message.

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Saul Ebema: Japan had staged a surprise attack on American military installations in the Pacific. The most devastating strike came at Pearl Harbor. In a two-hour attack, Japanese warplanes sank or damaged 18 warships and destroyed 164 aircrafts. Over 2,400 servicemen and civilians lost their lives. President Roosevelt knew that something had to be done.

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Saul Ebema: As American soldiers marched on to war, the president acted as pastor in chief and led the entire country through prayer.

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Saul Ebema: And off- America went to war.

Despite of the fact that America was in the second world war, the medical arena in the early 1940s was filled scientific discovery and a growing faith in medical authority. That faith in medicine was even strengthened by the development of injectable penicillin.

This new development showed promise in medical progress. Then there was the development of more anti-tuberculosis therapies that enabled the disease to be controlled. Not long after that, sanatoriums for tuberculosis patients were no longer necessary.

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Barb Newton: As medicine progressed, death came to be discussed only in terms of its avoidance, and any other conversation on the topic, at least from the American Medical Association, was practically nonexistent. Instead, articles regarding terminal diseases focused on symptoms and new treatment options rather than outcomes or mortality rates. Despite acknowledgment by at least some specialties in the medical profession that death was a part of patient care, the American Medical Association at that time was not willing to make this concession of inadequacy.

Saul Ebema: As a powerful coalition representing the entirety of the medical profession, the American Medical Association was the medical authority of the time, and their refusal to acknowledge dying patients greatly influenced society’s perception of terminal care.41 In the eyes of the medical profession, however, if it could not be visibly cured, it was not a medical concern, and discussion of such conditions was seen as counterproductive to medical efforts. To acknowledge dying was to admit that medicine had failed, and that the authority which the public had assigned to the medical profession was not deserved.

Veronica Drase: With the heavy focus on disease during that time, Florence was dismayed that nursing was lost in the treatment of the disease, and she questioned if she had made a major career mistake.

While still questioning her choice of career, she went on to work for the Visiting Nurse Service of New York. Initially, the Visiting Nurse Service of New York was patient focused. That is what was attractive to Florence.

However, after their reorganization, the Visiting Nurse Service of New York took on a physician driven model of care that focused more on the disease than the patient. Florence found physicians were unprepared to accept her vision of care. She remained with the Visiting Nurse Service of New York for 2 years (1941-43) but left dissatisfied. For Florence, the art of nursing was being lost to the science of medicine, so she quit.

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Saul Ebema: Florence had not anticipated how nursing would be heavily influenced by the medical model that focused on the disease and symptom treatment rather than the patient focused model of care. She left the nursing profession in 1944. Around that time, the Second World War was raging, and it was a difficult emotional time. Florence wondered if her beliefs about life and medicine fit the times.

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Barb Newton: After that, Florence did the unthinkable and enlisted in the Army. She felt an obligation to help the military men and women who were fighting the atrocities of Hitler. Ironically, Florence was assigned to a small maternity ward at the United States Military Academy at West Point. Eighteen months later, the war ended, and so did her military service.

Veronica Drase: During her 8-year sabbatical from nursing, Florence became a clinical research assistant at Columbia-Presbyterian Hospital on a surgical metabolism unit. It was here that she met her husband to-be, Henry Wald, one of Florence’s research subjects who was in officer’s candidate school.

Florence and Henry dated 3 years before he proposed marriage to her in 1948. Henry had completed his military service and had graduated from the Cooper Union for the Advancement of Science and Art in NYC with a degree in engineering. Because Florence’s father was dying, her mother had breast cancer, and her professional path was uncertain, she declined Henry’s proposal and there- the relationship mutually ended.

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Saul Ebema: In Florence’s years as a researcher at Columbia-Presbyterian Hospital, the medical landscape was changing. In 1946, the Hill-Burton Act was passed and with it came the campaign to build more hospitals.

Barb Newton: With the building of hundreds of hospitals around the country due to the Hill Burton Act, hospital care for the sick became the norm instead of home care. This led to a new turn of events because more people started dying in the hospitals instead of at home. While the establishment of many large hospitals by 1950 was a big accomplishment for the country, for the dying, it resulted in a difficult and painful journey.

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Veronica Drase: Where once families gathered around the deathbed at home, dying patients now found themselves alone in ICUs tethered to machines. The denial of mortality also reinforced the most gruesome features of death and dying. Unable to face their own anxieties, doctors prolonged life long after the hope of recovery had ended and failed to communicate honestly with the dying.

Families hid behind falsely cheerful demeanors or withdrew entirely, thus heightening patient’s sense of isolation. In addition, Intensive Care Unit regulations at the time severely restricted the presence of relatives who wished to keep deathbed vigils.

Saul Ebema: Although there was plenty of space for the dying in those hospitals, the hospital administrators did not demand the delivery of adequate care for the dying. Within the medical staff, there was this attitude that death signaled a physician’s failure. This led to terminally ill patients being largely ignored by the medical staff.

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Saul Ebema: Then came the 1950s!

The 1950s were marked by the post-World War II boom. America had already cemented its status as the ultimate superpower. The economy was booming, and the fruits of this prosperity led to people being able to afford–new cars and suburban houses. The middle class became stable and of course, rock and roll music became a big thing.

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Saul Ebema: Rock and roll music celebrated themes such as young love, freedom, and self-discovery. For Florence, this meant pursuing a second master of science from Yale—this time in psychiatric nursing.

Barbara Newton: Upon completing her psychiatric nursing master’s degree from Yale University in 1956, Florence was invited to join the Rutgers University faculty. This opportunity was particularly appealing because Rutgers was beginning a master’s program in psychiatric nursing. More importantly, she would have the privilege of working with Hildegard Peplau. For Florence, she was finally in the right spot, at the right time.

Saul Ebema: Hildegard Peplau was a visionary nurse leader who was enhancing communication and creating the scientific foundation of the patient-nurse relationship. Florence enjoyed working as her assistant and she continued to develop her own skills and theories that would later influence her work in hospice care.

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Saul Ebema: In 1959, Florence officially became the fourth dean of Yale University’s School of Nursing.

Veronica Drase: Florence also had a major personal triumph as a result of being named dean—after 10 years, she reconnected with Henry Wald. As Henry was sitting in a coffee shop, the man next to him had a newspaper open to an article and picture announcing Florence’s deanship. Henry had been married for nearly a decade and, with two children (Shari and Joel), had recently lost his wife in a car accident. He couldn’t believe he had found Florence for the second time in his life.

In 1959, Florence, at 40, and Henry, at 35, met again and soon married. Florence was delighted to also have found two wonderful children, who were 6 and 8 at the time, to complete a family.

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Saul Ebema: Although there were no major changes in the 1950s regarding care for the terminally ill. A group of Psychologists and psychiatrists, begun to openly talk about the subject of death and dying.

Barb Newton: In 1956, psychologist Herman Feifel organized a symposium at the annual conference of the American Psychological Association to address ‘The Concept of Death and Relation to Behavior.’

Soon after that, articles begun to emerge in both national and state medical journals urging physicians to restore dignity to the dying. A major way was to focus less on prolonging life and more on improving its quality.

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Saul Ebema: In 1959, McGraw-Hill released the book, The Meaning of Death, which later went on to receive international acclaim and became a big inspiration for the modern hospice movement.

The Meaning of Death finally called attention to the problem that had affected the medical profession for over half a century, and demonstrated that, by the second half of the twentieth century, at least some medical professionals had come to acknowledge the denial of death as a detriment to quality care and many agreed that U.S. physicians rarely devoted full attention to care of the terminally ill.

They often turned away from their patients after realizing that they could not cure them. Terminally ill patients felt isolated, abandoned by their doctors, and able to see family only during rigidly enforced hospital visiting hours.

In the 1940s and 50s, the dying process was still not considered a part of medicine. It continued to lack the sense PERSONHOOD!

End notes

Saul Ebema: This podcast is written and produced by Saul Ebema. Our historians are Barb Newton, and Veronica Drase.

This podcast is recorded at Audiohive podcast studios in Joliet, IL and our studio engineer is Brian Mackender.

Thank you for listening!

[1] John Gabriel. “The Hospital and the Changing Social Order,” 17.

[2] Ernst P. Boas, “A Community Program for the Care of the Chronic Sick,” Hospitals: A Magazine for the Hospitals of the United States and Canada February (1936): 18-19.

[3] Carl Voegtlin, “Approaches to Cancer Research,” National Cancer Institute Journal 1 (1940): 15.

(4) Sarah E. Pajka, “Doctors, Death, and Denial: The Origins of Hospice Care in 20th Century America.” 2017.

(5) Beth P. Houser and Kathy N. Player, “Pivotal Moments in Nursing: Ladies who changed the path of a profession.” Volume 11, 2007.

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