Public bodies, private lives: the historical construction of life insurance, health risks, and citizenship in the Netherlands 1880–1920

may have been far more beneficial than the nurses assumed. It also is possible that nurses who felt insecure about their own competence were especially likely to send neighbours home. Although visiting nursing in the United States is associated overwhelmingly with the immigrant poor, Buhler-Wilkerson notes that the major employment opportunity for early-twentiethcentury graduate nurses was private duty work in affluent homes. She also discusses how contemporary notions of race shaped the interactions between white visiting nurses and black patients in both Charleston and Philadelphia. An especially fascinating chapter focuses on Lillian Wald, the New York City nursing leader who coined the phrase "public health nursing" and established the Henry Street Settlement, which she directed for many years. In 1911, the Settlement's nursing staff numbered fifty-five, and made more than 175,000 home visits. One of Wald's most remarkable achievements was to convince the Metropolitan Life Insurance Company (MLI) to offer a home nursing benefit. By 1913, that company provided 20 to 30 per cent of the annual budgets of many visiting nurse associations. Buhler-Wilkerson concludes, however, that the MLI's involvement in home care offers a "cautionary tale". The company's focus on cost containment occasionally distorted the nurses' work; moreover, several studies failed to support the claims that the nursing benefit helped to save money by reducing mortality rates. In 1950, the MLI finally discontinued the nursing service. Although various communities experimented with Coordinated Home Care Programs during the following decade and a half, home health care had to await the enactment of the Medicare Program in 1966 for a substantial infusion of funds. Despite the current deinstitutionalization of medical care, home health services continue to be relegated to a marginal place in the health care system. Buhler-Wilkerson suggests that one reason may be that visiting nurses have historically focused on the poor and the chronically ill, two groups that command little social respect. The isolated settings in which such nurses work also may contribute to their undervaluation. By making visible the enormous contributions of visiting nurses in the past, this book helps us recognize their indispensability today.