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Advances in Social Sciences Research Journal – Vol. 12, No. 1
Publication Date: January 25, 2025
DOI:10.14738/assrj.121.18116.
Caron, S. M. (2025). The Most Important Factor in Public Health Work: From Visiting Nurses to Public Health Nurses in Forsyth
County, NC, 1905 - 1930. Advances in Social Sciences Research Journal, 12(1). 19-42.
Services for Science and Education – United Kingdom
The Most Important Factor in Public Health Work: From Visiting
Nurses to Public Health Nurses in Forsyth County, NC, 1905 -
1930
Simone M. Caron
Wake Forest University
Winston Salem, NC
In 1901, Jessie Sleet Scales (1865-1956), the first African American public health nurse in the
United States, wrote, “I cannot but feel that this house-to-house visiting, these face-to-face
practical talks, which I am having with the people, must bring about good results.”
1 Over a
century later, a partnership in 2016 between Kate B. Reynolds Charitable Trust and The Duke
Endowment established Forsyth Connects to provide free in-home visits by registered nurses
to all parents of newborns in the county to help increase infant and maternal wellbeing.2 This
twenty-first century program has strong roots in the public health nursing movement of the
Progressive Era initiated at settlement houses in Northeast and Midwest cities. Forsyth County,
NC, and its largest city, Winston-Salem, had no settlement houses, but the history of public
nursing in this region reflects broader trends in public health and the professionalization of
nursing. The county experienced significant advancements in public health infrastructure,
including the establishment of health departments and the implementation of public health
programs. Funding for these efforts initially came from an informal network of private charities
and companies such as the Home Moravian Church and the Metropolitan Life Insurance
Company, and later from city, state, and federal agencies. While some critics dismissed public
health as one of many “fads” sweeping the nation, others asserted that it was a crucial
component in transforming Winston Salem into a progressive city with a rapidly expanding
industrial base in need of healthy workers.
3 Local officials responded with the creation of the
Forsyth County Board of Health (FCBH) in 1913 and the Winston-Salem City Health Department
(WSCHD) in 1916, the latter of which hired two public health nurses, one white and one Black.4
The growth of public health nursing in Forsyth County, NC, was a result of the desire of a
“progressive southern city” to follow national trends in preventative health, providing essential
services such as home visits, school inspections, control of contagious disease, health and
hygiene education, and support for new mothers and infants. African Americans in particular
faced disparities in healthcare access and quality due to segregation and systemic racism.
Against this backdrop, public health nurses became forerunners in providing vital health
services to underserved communities in Forsyth County.
A number of scholars have written about the development of public health nurses during the
Progressive Era. The most comprehensive history of nursing from the colonial period to the
twenty-first century is the overview by Arlene W. Keeling, Michelle C. Hehman, and John C.
Kirchgessner. Their work covers both nursing and public health nursing across the country.5
Most other sources analyze white public health nurses in Northeast cities such as NYC and
Boston, or Midwest cities such as Chicago, but little has been done on southern cities. Black
nurses gain some attention6 but few historians have examined Black public health nurses in the
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Advances in Social Sciences Research Journal (ASSRJ) Vol. 12, Issue 01, January-2025
Services for Science and Education – United Kingdom
1910s and 1920s. Marian Moser Jones and Matilda Saines argue that during these years, “few
cities employed Black public health nurses.”7 Similarly, Sandra Lewenson contends in “Hidden
and Forgotten” that many states either barred or discouraged Black nurses from taking the
state board exams in nursing.8 This article adds to this historiography by analyzing the gender
and racial dynamics of public health nurses in one southeastern county/city that attempted to
prove its progressive nature by mimicking trends initiated by pioneers such as Lillian Wald and
the Henry Street Settlement in New York and other major northern cities. In Forsyth County,
these women served as trailblazers in the modern campaign to expand public health in the
region.
At the dawn of the twentieth century, the progressive push for better urban sanitation and
control of infectious diseases resonated with the growing number of nurses across the country.
The US Census counted 9,632 white nurses but only 201 Black nurses in 1900. Nurses grew
exponentially over the next decade to 69,707 white and 3,010 Black nurses.9 The American
Nurses Association, established in 1896, was a federation of state nursing associations: one had
to belong to a state organization to belong to the national. The American Journal of Nursing,
founded in 1901, provided a “strong bond of interest between the nurses of this country,
and...greater unity of purpose.” 10 Women in North Carolina followed the news of the
organizational path taken by nurses in New York, Philadelphia and Boston.11 On October 28,
1902, the Raleigh Nurses Association held a meeting to organize a North Carolina State Nurses
Association with the goals of registering nurses and lobbying for legislation.12 They succeeded
in convincing the legislature to pass on March 2, 1903, the first law in the country to allow
nurses to gain a license: “An Act to Provide for the Registration of Trained Nurses” registered
graduates from a “reputable” training school connected to a private or public hospital.13 Mary
Rose Batterham became the first nurse to acquire the signature of “R.N.” under this law. The NC
State Nurses Association held its first annual meeting from June 3 through June 11, 1903.14 Two
years later, the third annual meeting took place in Winston from May 30 through June 1, 1905.
The doctors of the Forsyth County Medical Association offered welcoming remarks,15 and Dr.
Charles McIver agreed to organize a preliminary course for nurses at his school, the State
Normal School for Women.16 An amendment to the North Carolina Registration Law in 1907
increased the educational standards for a license to require an examination by the Board in
“anatomy, physiology, materia medica, in medical, surgical, obstetrical, and practical nursing,
invalid cookery, and household hygiene.” This placed North Carolina in the “first rank in state
registration.”17 Gendered assumptions added to the public acceptance of this career path for
women. Support for this “respectable occupation” was strong due to the belief that it “appealed
to the spirit of self-sacrifice which is inherent in every woman’s nature.”18
For African American women, this period was particularly challenging due to widespread
segregation and racism. African American nurses trained in separate institutions. Many had
been trained at the Freedman’s Hospital Training School for Nurses, founded in 1884 in
Washington, D.C. The initial eighteen-month training program expanded to three years in
1900.19 While many southern states had few educational opportunities for African American
women, North Carolina had three, albeit separate, nursing schools for Blacks:St. Agnes Hospital
School of Nursing in Raleigh (1896); Lincoln Hospital School of Nursing in Durham (1901); and
Good Samaritan in Charlotte (1903).
20 The North Carolina State Nurses Association prohibited
Black graduates from joining the organization; they therefore also could not join the American
Nurses Association. As result of such discrimination and exclusion, Mary Elizabeth Mahoney,
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Caron, S. M. (2025). The Most Important Factor in Public Health Work: From Visiting Nurses to Public Health Nurses in Forsyth County, NC, 1905 -
1930. Advances in Social Sciences Research Journal, 12(1). 19-42.
URL: http://dx.doi.org/10.14738/assrj.121.18116
Adah B. Thoms, and Martha Minerva Franklin founded the National Association of Colored
Graduate Nurses in 1908 and opened membership to all nurses regardless of race or gender.
Franklin, the only Black graduate of her high school in Connecticut and a graduate of the
Woman’s Hospital Training School for Nurses in Philadelphia (1897), became its first
president.21
Public health nursing was much smaller: by 1901, there were 58 associations across the
country with a total of only 138 public health nurses. Scholars generally recognize Lillian Wald
of New York City’s Henry Street Nurses Settlement (1895) as the first public health nurse in the
US.22 Less known is Jessie Sleet Scales (1865-1956), considered to be the first Black public
health nurse. Born in Canada, Scales graduated in 1895 from the Provident Hospital School of
Nursing in Chicago. She became a district nurse in New York City in 1901 initially to treat Blacks
suffering from tuberculosis but eventually assumed overall public health care in the “Negro
district” of Manhattan’s west side. In 1901, she published a report on her work in the American
Journal of Nursing detailing her 156 home calls to care for 41 families suffering from either
consumption, peritonitis, chicken pox, cancer, diphtheria, heart disease, pneumonia, or
rheumatism. The racial identity of public health nurses, in her opinion, influenced the success
of their work: “They have welcomed me to their homes, saying, ‘We don’t know you, but we
belong to the same race.’ They have listened to me with attention and respect, and if the advice
which I gave was not always accepted, in no case was it rudely rejected.”23 Not only was racial
identity important in developing relationships with community members, but it also helped in
what many Black leaders called “racial uplift.” Black women health professionals, according to
Bishop Joseph Blount Chesire of the Episcopal Diocese of North Carolina, had a “duty” and the
“power” to “elevate” and “dignify their profession.”24
In the early 1900s, public health in Forsyth County, North Carolina, was in its infancy, with
limited resources and infrastructure to address the health needs of a growing population. The
North Carolina legislature passed an act in 1909 that provided for the first full-time State Health
Officer, and another act in 1911 that encouraged counties to establish Boards of Health to
control communicable diseases; each board was to have a five-member mix of medical and lay
people.25 The Forsyth County Board of Health (FCBH) resulted on April 3, 1911, with W.B. Speas
(County Superintendent of Schools) as the Secretary; J.A. Vance as the Chair; Mayor O.E. Eaton;
and two physicians, Dr. S.F. Pfohl of Salem and Dr. J.C. Hammock of Walkertown.26 The success
of the RJ Reynolds tobacco industry in Winston led to the rapid growth of the city from 443
people in 1870, 8,018 in 1890, and 17,167 in 1910, making it the sixth largest city in North
Carolina and the third largest tobacco manufacturing town in the nation.27 The company often
recruited African American workers from eastern North Carolina and South Carolina: Blacks
constituted 31.6 percent of the Winston population by 1910.28 Black workers settled primarily
in the northern and eastern sections of the city, far from white elites in the west end,
entrenching the city’s defacto segregated residential landscape. 29 The importance of the
tobacco industry to the economic stability of the region helped spur the push for public health
measures to quiet white elite fears of perceived threats from Black and poor white bodies.
The first foray into public health nursing in Forsyth County occurred at the private level. The
Home Moravian Church’s Sunday school class formed the Wayside Workers in 1906. They hired
Berth Reginas as a visiting “practical nurse,” whose duties, unlike those of Wald and Scales, did
not include any work with contagious disease. Five years later, they hired Percy Powers, a