At age twenty-one, Lillian Wald noted that her family's affluence was pushing her toward a life devoted largely to making her way in polite society. But this did not satisfy Wald's need for a mission. Deploring the inadequate health services available to the impoverished immigrants flooding American cities, she was soon organizing nursing classes for newly arrived Europeans on New York's Lower East Side. By 1895 she had established the Nurses' Settlement House on Henry Street, which within a decade had become one of the most noted institutions devoted to improving life in immigrant ghettos. In the process, Wald herself became a leading advocate of many reforms, including the abolition of child labor and the regulation of industrial sweatshops.

When Wald sat for this portrait by the Munich-trained artist William Schevill, her work as chairman of an emergency council for curbing the influenza epidemic of 1918 had recently ended. Of the experience, Wald observed that she had never worked harder or felt better. According to recollections of friends, the artist captured Wald at this moment in her career with remarkable accuracy.