Microcopy Resolution Test Chart Lansl 0nd 150 Test Chart No 2l 5 III ...

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M ICROCOPY RESOLU TION TEST CHART

l ANSl 0nd 150 TEST CHART No 2 l

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A P P L IE D IM AGE inc

A H istory of N ursing

F rom the E arl iest T imes to the Present Day

w i th Speci al R eference to theWork of

the Past T h irty Years

E dited, and in Part Written, by

L avinia L . Dock , R . N .

Secretary of the I nternational Council of Nurses, Graduate cfBellevue T raining School, New York C ity

I n Four Volumes

Volume I I I

G . P. Putnam'

s SonsNew York and L ondon

9 1 3 1 4 7

Conv ent . rot a

BY

LAVI N I A L . DOCK

T he work of prepa ring Vols. I l l and I V has beencontribu ted for the service ofthe nursing profession. and the amount accru ing f rom the sales is to be u t i l ised for

the fund of the I nterna ti onal Counci l of Nurses.

E ighth

M ade inthe Uni ted Sta tes of Ameri ca

PR E FACE

HE construction of the final volumes ofA H i storyof Nursing has proceeded on somewhat di ffer

ent li nes from those followed in the first and secondvolumes . The collaboration of Miss Nutting hasnot been possible in finishing the task , because ofthe demands of her work as head of the Departmentof Nursing and Health at Teachers College . Shehas , however , w i th unabated interest given help andadvice in ways Open to her , which we gratefully ac

knowledge . The edi tor , therefore , in undertaking anaccount of the modern nursing movement , has soughtand received in abundant measure the assistance ofnurses in a ll those countri es here dealt wi th . That i thas been possible to do thi s so easily and directly aswas the case , to meet with instant and ready responseand unfai ling co-operation , i s one of the fine frui tsof international friendship and comradery grownfrom the International Counci l of N urses conceivedand founded in London

,in 1 899 , by Mrs . Bedford

Fenwick , whose ferti le genius for organisatio n hasbeen fel t as a poten t stimu lus among nurses c i ' almost

v i Preface

which she fel t most familiar , while others have beenpartly or entirely prepared , by individuals or bygroups

,in the countries from which they come .

Those arranged by the edi tor have been sent to thecountries they concern , to be read and cri t icised bynurses prominent in the modern movements there ,and , with those p repared abroad , the ed itor in turnhas added to or taken from , according to her bestjudgment

, or has reshaped in order to fit the generalplan . Not willingly has she entirely rewri tten anyparts of col laborative material , but this has had to bedone sometimes , because of the necessi ty of shortening down to the al loted number of pages . For thi sreason , too ,

many details of interest and importanceto their several countries have had to be cut out ,and the editor wishes here to express to her collaborators her regret at thi s necessi ty , and to off er to thegeneral reader the exp lanation that the variouscol laborators are not to be charged w i th omissionsor imperfections discoverable by cri tici sm .

In general , the p lan fol lowed in the selection ofmateri al has been to give as much fulness as possibleto beginnings , and to those aspects of our subjectwhich cannot easi ly be read of elsewhere . Thereare important aspects of modern nursing which mayseem to have been slighted here , such as v isi t ingnursing and tuberculosis work

,but they have his

tories or records of thei r own. Again , many problems of great professional importance , such as p rivatenursing w i th i ts attendant evi l of commercialagencies and i ts hopefu l outlook through central

,

p rofessiona l ly controlled clubs and di rectories ; inst i tu t iona l work and i ts status , and , even more

Preface v i i

serious,the vast influx of young g irls , of faulty

rearing and imperfect education , into nursing , wi ththe consequent di lu tion of standards , ~— many suchproblems have been left untreated , not because theirimportance has been overlooked , but for want ofspace to do them justice . Such problems a re alwayswith us , and in ou r p rofessional press we have aforum for their discussion . The advance in selfgoverning organisation , on the other hand , with i tsplea for state registrat ion , may be thought to havean undue share of space , but this movement is newand of great significance , resulting from the incessan teff orts of women who have had no t ime to wri tedown the history they have made and are busymaking .

The edi tor assumes full responsibil i ty for theinterpretat ion or colour of the narrative and forpersonal touches . A s to the former , however, shebelieves that her point of view coincides wi th thatgenerally held by the groups of leaders or “ progressives

" in the vari ous countri es .I t had been intended to add a comp lete biblio

graphy,bu t space forbids , and only a part ial l ist

of references has been selected .

Those to whom thanks are due for labours ofcollect ing , preparing , or revising material are , first ,the officers of the national groups and M rs . BedfordFenwick , Honorary President , International Counci lof Nurses ; Miss Margaret B reay , Counci llor andTreasurer, International Counci l of Nurses ; MissAmy Hughes , General Superintendent , Queen Victoria

’

s Jubilee Inst i tute for Nurses ; M i ss Gi ll ,Lady Superintendent , Edinburgh Royal Infirmary ;

vi i i Preface

A Commi ttee of Irish Matrons ; A Committee of

Swedish Nurses ; The Danish Nurses' Associat ion

Baroness Sophi e Mannerheim , Lady Superi ntendent ,Surgical Hosp i tal , Helsingfors , F inland ; M rs . M .

Loui se Lyman , Ottawa , Canada ; Miss A li ce R .

Macdonald , Sister , Melbourne Hospital , Austral ia ;Miss E ll en J . Gould , Matron , Private Hosp i tal ,Australi a ; Miss Hester Maclean , Assistant Inspectorof Hosp i tals and Deputy Regi strar of Nursos underthe government of New Zealand ; M iss Mabel M cCal

mont , late Chief Division of Hospital Constructionand Equi pment , Bureau o f Health , Philippine Islands ; and M i ss M . Eugenie Hibbard

,Department

of Health , Havana , Cuba .

A special contributor to the I ri sh material w asDr . Kirkpatrick of Dubl in , who placed his own histori ca l studies at our disposal , whi le Father Rushe ,author of A Second Theba i d t ook trouble to supplyhelpfu l references . Our sorrow at the loss of Mrs .Ki ldare Treacy lends pecul iar importance to her unfail ing interest i a the book . Up to the t ime of herlast i llness she w a s unti ring in her correspondencei n behalf of the I ri sh chapter .Especial thanks are al so due to the Dowager

Marchioness of Duf ferin and Ava , for the loan of

her own reports of her work in India , and to Mrs .E tha Butcher K losz , edi tor of the N urses J ourna l

of I ndia , for a special ly labori ous piece of work incol lect ing material on nursing in that count ry .

The data on reg i st ration in the United States havebeen suppl ied by the officers of the State Societi esof Nurses , while Miss Palmer , edi tor of the Amer icanJ ourna l of Nursing , placed “

i t our di sposa l her own

Preface

records and correspondence relat ing to the inceptionof regi stration in New York State .

The edi tor hopes that her work may stimulateothers to fill in the general outline here presented

,

by writ ing the history of nursing in individual countries , for then i t wil l be possible to p lace on recordmany valuable and interest ing detai ls which cannotbe included in our l imi ted pages , but which haveprofessional and human importance and deserve tobe known by our successors .

LAV IN IA L . Docx , R . N .

CONTENTS

PAGE

CHAPT ER I

T H E STORY O F T H E N URSES OF GREAT B R ITA INAND I RELAND

CHAPT E R I I

TH E GROWT H or NURS ING I N rm: unrr anSTAT ES 1 1 6

CHAPT E R I I I

N URS ING I N CO UNT R IES OF NO RTHE RN E UROPE 2 3 7

CHAPTE R I V

TH E RE VOLUT ION I N FRENCH HOSP I TALS

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x i v I l lustrations

MA RGARET B R E AYAssistant E ditor , B r i t i sh Journal of N ursing T reasu rerInterna t iona l Counci l o f N u rses ; Secreta ry , M a t rons’Council o f Grea t B ri ta inand I reland. T akenwhenStaflN u rse , St . B a rtholomew '

s Hospital .

I SLA ST EWARTLa te M a t ron, St . B a r tholomew ’

s Hosp ita l . P resident ,M a t rons' Council o f Grea t B ri ta in and I reland ; and

Council lor , Interna t ional Council of Nu rses.

LO U I SA STEVEN SON , LL .D ScotlandFirst P resident , Society for Sta te R eg ist ra tionof T ra inedNu rses.

T H E BUR IAL O F FLO RENCE N IGI I T I NGAL EH er casket w as ca rried by soldiers of the Gua rds whi chhad beenrep resented in the C rimea .

B y courtesy O f the L ondonI l lustrated News Company .

M R S . JANET PO RT ER , FO R 4 7 YEARS A N URSEI N T H E ROYAL INF I RM ARY , ED I NB URGH

M R S . LAM BERT , AN OLD STYLE N URSERO YAL I N FI RM ARY , ED I N BURGH

I N ST . V INCEN T '

S HO SP ITAL

C H I LDREN ’

S HO SP IT AL , DUBLIN

BR IG IT M . K ELLYM a t ron, S tccvcns'

s Hospita l , Dublin.

S IST ER MARY AL B E U SM a t ron, Sou th Infirma ry , Cork .

MARGARET HUXLEYT akenwhenM a i nin

, Sir Pa t rick Dun'

s Hosp ital . Dublin.

M R S . K I LDAR E TR EACYL a te M a t ron, C ity of DublinNursing Institut ion.

I l lustra t ions

I SABEL HAM PT ON ROBBT a ken when Superintendent of Nu rses at the JohnsHopkins Hosp ital .

M . ADELA IDE N UTT INGP rofessor of Nursing and Hea lth, T eachers College.T a kenwhen Surefi ntendent of Nu rses, Johns HopkinsHosp ital .

C I I AR I T Y E . CO LL IN SPub l ic School Nu rse appointed by the ci ty of Atlanta .Ga .

JUL I ETT E SM I T H TWO-AXEAnOneida Nurse.

ANNA C . MAXWELLSuperintendent of Nurses, Presbyterian Hosp ital , NewYork C ity .

L ILL IAN D. WALDFounder of the Nu rses' Settlement , New York C ity .

T a kenduri ng t ra ining inthe New YorL Hospita l .

DEACONESS HO SP ITAL S I ST ERS , STOCKHOLM

A COOK ING LESSON I N T H E SO PH I AH E M M E ’

I

COUNT RY N URS ING I N SWEDE N

I N T H E SO PH I AH E M M E T

XV

1 m I l lustra tions

M R S . AM ANDA C AJANDE R

ANNA B ROM S

S I ST ER L INA

SO PH I E MANN ERHE I MM a t ron, Su rg ica l Hosp ital a t Helsingfors.

A NO RWEG IAN R E D CRO SS N URSE

DOCT O R ANN A HAM I LTONF oundcrof the F lorenceN ight ingale System InF rance.R eading her Thesis a t M ontpel l ier.

CATHER IN E ELSTONDirect ress of the T ondu Hospital and Nu rsing School ,B ordeaux .

DR . LANDE LECT UR ING TO T H E TONDU N URSE S

PROTEST ANT HO SP ITAL N URSES DRESS ING T H E

C H R I ST M A S TREE

T H E SCHOO L F O R N URSE S OF T H E ASS IST ANCEPUBL IQUE O F PAR I SP ract ica l Demonst ra tions w ith M annikin and B ed

Pa tient .

3 4

A H ISTORY OF NU RSI NG

CHAPTER I

T H E STORY OF T H E NU R SE S OF GR EAT BR I TAI NAND I R E LAND

Col la bora tors: M R S . BEDFORD FE NWICK , M ISS MARGAR E T B RE AY , M ISS AM Y HUGHES ; M ISS GILL ; A

COM M IT TE E OF I R ISH MAT RONS

England.— Miss N ight ingale’s demonstrat ion of

the possibil i t ies of nur sing , followed by the successof her co-workers and disciples , drew widespread a ttent ion to i ts possibil i t ies as an opening for woman’swork , not as a career in the ord inary sense , for ofmateri al advantage i t had none to offer , but as a f

fording an opportuni ty for the rel ief of su ff ering andthe service of humanity . This appealed very stronglyto a group of earnest women of culture , refinement ,and organising genius , who , from 1 870 onwards ,carried on pioneer labours of the most in tensive type .We have ment ioned M rs . VVa rdroper and Mrs . DacreCraven x and may now only allude briefly to the important upbuild ing work of Miss Swift , at the LondonHospital , where She was succeeded by Miss E va

Vo l . I I . , Chap . v i .

2 A H istory of Nursing

Luckes ; Miss Thorold at the Middlesex , Miss Merrywea ther a t the Westminster , Miss Catherine J .

Wood at the Hospi tal for Sick Children in GreatOrmond Street , Miss Burt at Guy

’s , Miss Carol ineL loyd at St . John’s House , and Sister Amy , of theSt . John ’s House Sisterhood , at King

’s Col lege Hosp ital . Some others of the early reformers we Shal lpresently meet more closely .

For none of the pioneers were the cond it ions underwhich they worked easy ; for some they were ex cept iona l ly strenuous . Miss B ur t found the reform ofnur sing at Guy ’s a work of extraordinary difficulty .

In spi te of i ts urgent need , she received no encouragemen t from the medical staff of the hosp i tal , with theexception of the late Sir Wil l iam Gul l , who , to h ishonour be i t recorded , was alone in giving that support which Should have been freely extended by thewhole staff . M iss Rogers , once a Sister at Guy

's ,came inmmas the honoured Matron of the LeicesterInfirmary to address the Guy 's Hospital Nurses’

League and spoke of Old t imes , saying : Miss Bur twas a reformer . She was not popular— reformerswho get people out of their armchairs rarely are ; butshe fought a good fight

,won the victory for you .

"

Somewhat happier was the experience of Sister Amy ,who , at King

’s College , impressed upon i ts nursingthe trad it ions of d iscipl ine , order , and method laterdeveloped by Miss Katherine Monk ,which dist inguishKing 's nurses .Space forb ids us to name others of the many highly

educated , energet i c women who were soon found inhospitals and infirmaries al l over the country . The

great , almost magical eff ect which they produced on

Great Bri ta inand Ireland ab

prevail ing condit ions was the resul t of personal i ty .

Of necessi ty they were forceful and self-rel iant , or theywould not have ventured into such unknown territory

,or desired to adopt a call ing so widely regarded

as one suited only for women drawn from the lowerdomest i c classes . This was the force which reformednursing , and by which , in a few years , standardsof care for the sick were evolved such as no amount oftheoretical instruction alone could have produced .

To have a clear idea of our subject , we must nowglance at the provision of the United Kingdom forthe rel ief of S i ckness , and note i ts dual basis . At thetime of wr i t ing , Great Bri tain has general and spec ialhospitals and general infirmaries supported by volumtary contri but ions , and Poor Law infirmaries andhospitals for infect ious d iseases maintained out of therates (taxes) , both of wh ich rece ive patients of muchthe same social class ; indeed the latter might be t egarded as mun icipal hosp itals and be freely used bythe publ ic , if the law making a pauper of the S ickperson who enters a Poor Law infirmary for treatment were repealed . The weakness of the Poor L awi s that i t a ims not at the prevent ion of dest i tut ion ,but at its rel ief , and so has the eff ect of creating i t ,for to be ent it led to rel ief i t is necessary to prove dest i tu t ion. The voluntary aid system gr ew up by i tsside af ter the dissolut ion of the monasteries , when thekind , unscientific care of the rel igious orders was replaced by the harsh austeri t ies of the Poor Law . Thefirst statute in connection with the Poor L aw waspassed in 1 60 1 , inthe reign of Queen E l izabeth , andprovi sion was made for the rel ief of aged and impotentpoor people , coupled wi th cruel punishments for beg


gars , which Show the spir i t of the times . The officeof Overseer , then establ ished and sti ll , in 1 9 1 1 in existence , has never been popular , and , at one t imejus t ly fel l into d isrepute because of the misapp l icat ion of money raised for the rel ief of the poor .I n 1 834 an attempt was made to remedy the evi ls

aris ing from maladministration of the workhousesby passing the Poor Law Officers’ Superannuat ionAct , which was based on the princip le that no oneShou ld be suff ered to perish through the want ofwhat was necessary for sustaining l i fe . Under thisact , Poor Law Commiss ioners were created for England and Wales , who si t as a body and have theri ght to appoint other offi cers . The administrat ionof rel ief was placed under their control . Englandand Wales were d ivided into twenty-one distri cts,to each of which an assis tant commissioner was appointed ; Poor Law Unions were formed for visiting parishes for general administrat ion ; Guardianselected by the rate (tax)-payers were entrusted withthe general government and administrat ion of rel ief,and medical relief was arranged for by a contractwi th a medical practit ioner , outdoor rel ief of thisform being granted . I t was not unt i l 1 87 1 that i twas found exped ient to concentrate in one department the supervision of the laws relating to the publ icheal th , the rel ief of the poor , and local government ,and in that year the Local Government Board wasestabl ished by Act of Parl iament .The provision for the s ick in the infirmary wards

of the monasteries was replaced by the provis ion ofwards attached to the workhouses , although a t the

present day in most of the metropolitan , and many



ably nearer by the democratic legislat ion which isspeed i ly being enacted in the Uni ted Kingdom .

Again , the apportionment of cases between thevolun tary hospi tals and the Poor Law infirmaries

depends not mainly on the social or financial pos i t ionof the patient

,bu t upon the needs of medical educa

tion . Thus , one patien t who presents h imself fortreatment at a hospital may be admitted at once tothe wards

,because the disease or accident from which

he i s suffering is one which lends i tself to cl inical instruct ion . Another, equally in need of treatment ,bu t of less scient ific interest , may be passed on tothe Poor Law infirmary . The voluntary hospitalswith medical schools at tached are bound to make aselect ion from the numberless pat ients who presentthemselves , and natural ly select those who aff ordthe best cl inical material . The effi ciency of medicaland nursing education is of the gr eatest moment tothe communi ty , but when once the st igma of pauperism has been removed , as i t ough t to be , from thePoor Law infirmaries, they wil l inevitably developinto municipal hosp i tals , and i t wil l be recognisedthat the munici pal i t ies must make , i n each local i ty ,sufficient residential hospi tal provi sion for i ts needs ,where a high s tandard of medical and nursing careis provided

,and which

,as payment may be made ac

cord ing to the means of the pat ient , can be free lyused by all sect ions of the commun ity . Such hospitals , with the requisi te classification of the sick ,shou ld become the medical and nursing schools Ofthe fu ture , for the efficiency of which the commun ity ,and not private benevol ence , wil l be responsible . Asa natural consequence the hospi tals wil l be subj ect

Grea t Bri ta inand Ireland 7

to publ ic control , while in the case of the voluntaryhospitals the committees are responsible to no outside authority .

I t has been pointed out in an earl ier chapter thatthe work of re form in the Poor Law infirmaries adv anced more slowly than in the hospitals under voluntary management , because the di ff i cu l t ies were Somuch greater . Miss Twining's book

,Workhouses and

P a upen'

sm, whi ch should be studied by al l who wishto be conversant wi th the history and developmentof Poor Law nu rsing, quotes a description of the terrible condit ions in the Strand Workhouse in 1 855,

and one may gain a vivid impress ion of what has beendone , by comparing that descrip t ion with the presentday san itary , wel l-ordered wards of the Central LondonSick Asy lums , which now make provis ion for theStrand Union pat ients . Here

,under the supervision

of exper ienced Matrons and Sisters , nurses and proba t ioners in spotless uniforms give intell igen t andsympathet ic at tention by day and night , to the s ick ;a three years’ standard of training and examinat ionfor probat ioners is enf orced , and the cert ificatednurses have organised thei r own professional leaguesand have affil iated w i th the Nat ional Counci l ofNurses , through wh ich they are brought into contactw i th the nurses of the world . This is only an exampleof what i s taking p lace inmany other Poor Law infirmaries throughou t London and the provi nces .When we real ise the progress which has been madein the las t fi fty years there can be no question as toevolution in the future .

The department above the Boards of Guard ians‘VOl . I I . . Chap . v i .


i s the Local Government Board , whose approvaland sanction are necessary for the appointmentand dismissal of the higher officials , includ ingMatrons of infirmaries and Superintendents ofnurses .On September 29 , 1 897 , there came into force in

England and Wales the order known as “The N urs

ing in Workhouses Order promulgated by theLocal Government Board . The order , which didnot apply to any infirmary or nurs ing schr ol underanadministrat ion separate from the work l i ouse, w as

the firs t order aff ect ing nursing that had been issuedfor over fif ty years , at which t ime nur sing , as nowunders tood , was non-existent . I ts importance layin the fact that i t definitely abol ished nurs ing bypaupers , directed the appointment of a Superintendent Nurse whenever the staff of female nur ses in aWorkhouse consists of three or more persons , and specified that any Superintendent Nurse appointed afterthe commencement of the order should have receivedthree years ' trai ning in the wards of a hospital or infirmary . In regard to nurses and assistant nurses ,they must have had “ such pract ical experience innur sing as may render him or her a fit and properperson to hold such office . " The somewhat vaguecharacter Of this defini t ion gave rise to the proposit ion that a nurse with one year 's training should berecognised by the Local Government Board as a

Qual ified Nurse ," a proposi t ion which aroused such

wi de-spread protest that i t was allowed to drop .

In 1 899 , the” Asylum Officers

’ Superannuat ionAct ” became law , conferring the right to pension atthe age of fif ty-five, when twenty years of service

Great Brita inand Ireland 9

had been completed . A Simi la r bi ll , introduced in1 9 1 0 and referred to a Sf

‘cct Commi t tee , proposed

giving the (obl igatory and contributory) pensionafter twenty-five years’ servi ce , i rrespect ive of age .

The Committee held that the change Should be made ,so far as women are concerned . I t also cons ideredthe hours of attendants and nurses in asylums ; heldthem to be excessive , and opined that seventy hoursa week woul d be enough for day , and Sixty for nightstaff s . Up to 1 9 1 2 , no further action on these pointshad been taken .

A long step forward was taken in January , 1 9 1 0,

when the President of the Local Government Boardappointed three ful ly-trained and experienced nursesto act as inspectors in England of materni ty wards ,nurseries , infirmaries, and the nursing arrangementsin Poor Law insti tut ions . Miss Ina Stansfeld , whohad previously acted as Assistan t General Inspectorin London and the Metropol i tan District , was appointed chief woman inspector , the others be ing t esponsible to her . The appointment of an inspectorfor Wales quickly fol lowed , and i t i s hoped that theeff ect of these appointments wi l l be to raise thestandard of nursing in Poor Law infirmaries, and consequently the comfort of the Sick both in these i hfirma ries and in workhouse wards , which , so far , inmany instances , have not kept touch wi th modernprogress .

NU R S ING E DU CAT ION

The progress of nursing education , on efficien tl ines , has been retarded by the fact that trainingschools a re not control led by educationalists , but

1 0 A H istory of Nursing

by the Committees of Management of the hospitals ,who are primarily appointed or elected for the irabi l i ty to give

,or obtain , and administer , the funds

necessary for the maintenance of the hosp i ta l . Theaverage member of a hosp i tal committee has notthe Special knowledge enabl ing him to deal efficiently with nursing educat ion . Even the Counci lo f the N ight ingale Fund at S t . Thomas ’s i s composed entirely of men— no trained nurse has a seatupon i t— and the same app l ies to other hosp i talshaving so-called nursing committees . The reasonwhy the professional educa t i c '“

of trained nurses hasbeen , and cont inues to be , z ive , i s because thephilanthrop is ts and financiers who control the voluntary hosp i tals have , with very few excep tions ,determinedly excluded the educational and professiona l element .I n regard to the medical schools connected with

hosp i tals , th is difficul ty is non-exis tent . Medicaleducation is control led by the General MedicalCouncil , a body composed ent irely of regi stered medical pract i t ioners , and the educat ion of students inthe medical schools i s organised under the directcontrol of the Dean of the school , and a MedicalBoard , in conformity wi th the requirements of theabove Council . The hospi tal has no voice in the or

ganisa t ion of i ts curr iculum , al though the medica lschool i s so essential to i ts efficiency and even it sexi stence that many committees spend large sums ofmoney on col lege bu i ld ings

,pathological blocks , and

other departments in order to at tract students tothe hospi tal . I f the nursing schools connected withhosp i tal s were Similarly organised by a Counci l of

Grea t Bri ta inand Ireland 1 1

Trained Nurses , whose primary duty was the efficiency of the school and its pupils , Matrons would nothave to plead long before obtain ing necessary instruct ion and facil i t ies for the nursing staff , andadequate homes for them to l ive in ; nor would thenurses , through their professional societ ies , have toarrange and pay for lectur es on such subjects aselementary bacteriology , in order to Obtain knowledge without which , a t the present day , they cannotproperly perform their dut ies , because hospi tal commi t tees have failed to supply this instruct ion . Thepresence of a body within the hosp i tal which wouldintell igently d irect the stud ies of the pupils , and ofan outs ide professional controll ing authori ty , wou ldhave the same stimul at ing and wholesome eff ectupon nursing educat ion as has resul ted from the professiona l organisat ion of medical education . While ,therefore , in connection wi th the voluntary hosp i tals ,the work of organising thorough , systematic education for nurses has , in some instances , reached a highleve l of pract ical efficiency , i ts comp le teness has undoubted ly been retarded for the above reasons ; andin inst itut ions which do not possess the necessaryfacil i t ies for train ing , and which in establ ish ing atraining school are chiefly interested in obtainingcheap labour for the nursing of the i r patients , thecert ificated pupils are very ind iff erently equipped fortheir future work . Especially now that there isgreater class ification of pat ients , and many casesformerly admitted to general are now sent to specialhosp i tals , the need O f some plan of a ffil iat ion fortraining purposes is becoming increasingly urgent .I n regard to prel iminary nursing education only


a few hospi tals have organised courses , althoughwherever this has been undertaken . the benefit ofthe course is manifest . I n London such courses havebeen establi shed at the London , Guy

’s , and St .Thomas’s in the provinces , at the L eicester I nfirmary ,and the Royal I nfirmary , Bristol ; in Scotland , at theRoyal Infirmary , Glasgow , and in Ireland , throughthe Metropol i tan Technical Training School forN urses , in Dubl in . There is a d ifficulty also , in anybut the largest hospitals , of forming classes sufficientlylarge to warrant the appointment of special teachers ,and , i n the future , i t is probable that such prel iminarytrain ing wi ll have to be centralised before i t can beorganised on a comprehensive p lan. Nor , at thetime we wri te , are faci l i t ies yet afforded to nursesfor post-graduate courses , so that they may returnto hospital for a t ime and become acquainted withthe newest treatment and methods . This againneeds the stimulus which a central supervising au

thori ty would supply .

Nurs ing standards have developed and extendedto meet the requi rements of medical science . WhenM iss N ight ingale first laid down those laws whichmus t a lways be fundamental , a year

’s practical andtechn ical training was the period defined , but afurther term O f service w as exacted , so that althoughthe term of actual training may have been Short ,further pract ical experience was considered necessary . Two points must also be borne in mind inconnect ion wi th th is period : fir st , that the demandsmade upon trained nurses were nei ther so exact ingnor so extensive as at the present t ime ; secondly , thatthe N ightingale probat ioners were specially selected


I 4 A H istory of Nursing

staff on nursing , and on medicine and surgery as

appl ied to nursing . In the second year come classesfor instruct ion in pharmacy and dispensing , givenby the hospital pharmacist , and examinat ions fol lowin nursing , medicine , surgery , and dispensing . Fai lure to pass in any one subject wil l cause her to bedropped , unless , by special permission of the Matron

(presumably for pract ical efficiency) , she is reinstated .

The one-year paying probationer may be betweenthe ages of twenty-three and forty , and is trainedin medical and surgical nursing . She attends allclasses and lectures , paying a special fee for this ,besides the fee for board and lodging . She i s notplaced on night duty , and has special quarters .While she must agree to remain for the full year , theMatron may terminate her course at any t ime withthe sanct ion of the Treasurer and Superintendent ,if she is not adap ted for training .

After training is complete , the hospi tal offers permanent posit ions to staff nurses as wel l as Sisters .Salaries are paid , and the hosp i tal takes out a pensionfor each nurse in the Royal Nat ional Pension Fund

,

while she herself takes a s imilar but smaller pol icy .

At fifty the Sister or nurse ret ires , unl ess by a Specialresolut ion of the Governors she is r etained for notmore than five years ' longer act ive period of service .Many three-years ’ pupi ls a t Guy’s also gain , duringtheir course , the cert ificate of the Central M idwives

'

Board , or of the Incorporated Soci ty of Tra inedMasseuses . A l though there is no post-graduatecourse , ye t faci l i t ies are informally granted , on ap

pli cat ion to theMatron by those hold ing the hosp i talcert ificate , for returning for a few weeks to study up

Great Bri ta inand Ireland 1 5

onnew methods . A course of three months Instruction in administrat ive work has also been developed ,not l imited to Guy’s nurses alone . Candidates areeligible if trained for three years in a general hosp italof not less than two hundred beds , and after havingexperience as Ward Sister . They are accepted onthe judgment of the Matron , and pay a fee for thei rcourse

,which comprises : hospital and nurses’ home

housekeeping ; managemen t of k itchen and stores ;ordering and receiving milk , meat , etc . , from tradesmen ; management of servants and their work ; cooking and serving of d iets to pat ients and staff ; laundrywork ; management of l inen stores , including stocktaking ; book-keep ing , and the management of theMatron’s Office , including the engagement of servantsand the accep tance of probationers .When a nurse has gained her cert ificate , her contract with her train ing school usually ceases , and sheis free to take up whatever work is mos t congen ialto her , though some hospi tals s t i l l exact a fourthyear of ward service , in return , i t i s al leged , for thetraining given , the fact being overlooked that , i fpup i ls in training w ere not ut il ised to do a great dealof ward work , greatly increased expense would beincurred for domest 0 serv ice .

The fu l ly-trained nurse has no means of registeringher new ly-gained qual ificat ions , nor is there any professiona l body to which she can look for guidance ,advice , or control . She joins the chaot ic ranks ofthe trained , semi-trained , and untrained workers al lstruggl ing for emp loyment , in which the assurance ofignorance often seems to carry as much weight as theknr

w ledgc w hich ensures the safety of the patien t .


Thi s is , no doubt , the reason which chiefly influencesso many nurses in England to remain in inst i tut ions ; such work is hard , salaries small , and prizesin the way of well-paid posts few , but i t is regular andhighly responsible work , and the nurse

’s profess ionalposi t ion is recognised and respected .

In many hospi tals the posit ion of the Matron ismost congenial . She i s , and always shoul d be , direct ly responsible to the Committee of Managementfor the efficiency of both the nursing and domest icdepartments

,in the same way that the Medical

Board and the Secretary report d irectly on their owndepartments . The committee thus holds the balance of power . Her relat ions wi th the two otherdepartments are , as a rule , cordial . The overs ightof nursing and the training of pupils are both of greatinterest , and her associat ion with pat ients , nursesand staff , and the many people wi th whom , in thecourse of her work , She i s brought into contact , combine to make the li fe of a Matron ful l of humaninterest and sat isfying occupation . Added to this ,for those Matrons who real i se that they have a dutyto their profession as a whole , as wel l as to the hos

p i ta l s which they serve , there is a certain amountof publi c work to claim interes t and support . Theposi t ion of a Matron has both d igni ty and charm ,

and the sol i tariness which was somewhat oppressivewhen the Matrons l ived in “ splendid isolat ion ” andscarcely knew thei r colleagues in other hospitals inthe same local ity , i s now counteracted by the friendlyfeel ing and intercourse developed through profess ionalassociat ions .If the nurse desires to seek her vocation in the

C er t i ' l l ' I t ‘ R i ng ersM a t ron, I i i i i rma rv

I i i -a i r iv e t ‘

u t le I

.\ I . I l f n l l S t. I i a r t lmlu nu I l l -“P U D . I m inI-In

H I“. S i ' l ‘ i l ’ l l I \ Nd ' t ' l lm l I vl l : I I I m l r ! ( I I I ! -I \ l l l i l ( i n l l l i r l l I ln I l l l l l

I z i Lu i cl


larger world outside the hospi tal , there is a varietyof choice for her : fir s t le t us mention distri ct nurs ing ,as Great Bri tain stands first in the perfect organisa t ion of the Queen Victori a

’s Jubi lee Inst i tute .Our nurse , holding her three-years

’ cert ificate , i snow requ ired to take a fur ther six-months’ trainingin distri ct nursing , including the study of hygieneand instruction in san i tary matters . At the end ofthis t ime , i f She passes a satisfactory examination ,her name is placed on the Roll of Queen

’s Nur ses .Because of the importance of this associat ion we shal lpresently give i t some detai led consideration .

Private duty is a branch of work which absorbsmany nurses , and in none is the presen t disorgani sation in their ranks fel t more acutely ; i n none are theeconomi c condi t ions more unj ust . I n the pri vatenursing world we find both the most h ighly trainedand experienced nurses working on the co-operat ivesystem in connect ion with their own profess ionalsocieties , and also those working on the privatenursing staff of hospitals , which regard them as alegi timate and frui tful sour ce of income . The systemof undergraduate private duty is not only unf air tothe self-support ing nurse who has spen t three yearsInpreparat ion for her work , but is also most unjustto the pupil , whose best year in the hosp i tal is sacr ificed and who thus loses the most va luable partof her training .

The private nurse is also exposed to the compet it ion of the hospi tal fai lures , the semi-trained , theuntrained , and a dark substratum of he criminalclass , who find , in the confident ial relat i ons in whi ch

See Ofii cz’

al Reports, T he LondonHospita l , as example.VOL . [ I L— 2


the nur se i s admitted to the household , an excel len tOpportuni ty to pract i se their nefarious business . I ti s undeniable that the confidence of the publ ic inprivate nurses as a class has been Shaken by theconduct of women who assume the un i form for criminal purposes . Well-trained and reputable womenwho render services of the very highest value to thepubl ic are ent it led to the protection and professionalrecognit ion which can only be secured to them by thepubl icat ion of a Sta te R eg ister of Tra ined N urses.

NU R SE S I N GOVE RNM E N T SE RV ICE

That nurses are ind ispensable to the communityi s shown by the fact that most Government offices ,d irectly or ind irectly , find i t necessary to ut il ise the i rservi ces , and amongs t the openings off ering a careerare :QueenAlex andra

’

s R oya l Nava l N ursing Servi ce,

under the Admi ra l ty — Here , in addit ion to herthorough three-years’ training in a civi l hospital ofthe United Kingdom , the candidate mus t possessadministrat ive capaci ty and power to impart knowledge to others , for her dut ies wil l include part of thetra ining of the male nu rses . There are three grades :nurs ing, superintending , and head Sisters . All theSisters rank as officers , and pensions are granted afterten years’ service , or earl ier if incapaci tated for duty .

In 1 900, a Nursing Reserve was formed for this Servi ce , the Admiralty

“ re lying on the Matrons , withthe sa nction of their committees , to select such sui table nurses as they can arrange to spare ” i n time ofw ar .



of each year’s service . Once a year they must reportto the Matron-i h -Chief in her office , and Show thatthey are continuously emp loyed in bona-fide nursingduties . The staff consis ts of staff nurse , Sister ,and Matron .

The Terr i tori a l Force N ursing Scrt'i CC’r —T l l ls serv

i ce i s for the purpose of maintaining a staff of nursesready to serve in general hosp i tals in the event of theembodiment of the forces for home de fence . Therequirements are S imilar to those already ment ioned .

There is an Advisory Counci l of w hich the du ty is toframe ru les and make recommendations such as willprovide for a similar system of control in each hosp i tal .Local committees are appointed in ea ch hosp i talcentre to enrol nurses and revise the rolls annually .

In t ime of peace the execut ive offi cer of each hosp i talis the Principal Matron . For act ive service the staffi s graded into staff nurses , Sisters , and Matrons , anddouble appointments are made for each , so that incase one i s unable to serve the other may be ready .

The full nursing strength of each hospital is 1 20.

of whom 9 1 wil l be actually needed .

Another branch of work in connect ion with thenursing department at the War O ffice i s the nursingOf the M i l i tary F a ini l ies’Hosp i tal s in the ch ief depotsor garr isons . Here there are nurses and head nurses

,

who , besides the usua l cert ifica te , must be certifiedmidwi ves .

QueenAlex andra’

s M i l i ta ry N ursing Service f orI ndia — This serv ice , which was distingu i shed by thetone se t for i t by i ts first and eminently capable LadySuperintendent , Miss C . G . Loch , a St .Bartholomew

’

s Sister , comprises Nur sing Sisters .

Grea t Brita inand Ireland 2 1

Senior Nurs ing SiSt t , and Lady Superintendents .The nurs ing board a t the Ind ia Office requ ires evidence of three years’ training in a general hosp i tal .Colonia l N ursingAssoci a tion

—The Colonia 1 Offi ceengages nu rses for service in Crown colonies , throughthe associat ion founded by Lady Piggot t . Thenurses work both in hospitals and in private houses .The certificate of the Central M idwives’ Board isrequ ired in addition to one of general t raining .

When we turn to the civil government we find tha tnurses are at work under the Local GovernmentBoard in Poor Law infi rmaries and in the hOSp i ta lso f the Metropol i tan Asylums’ Board , w hich rece ivein fect ious eases needing hosp ital treatment in themetropol i tan area ; under the Board of Educationthere are school nurses ; under the Home Of fice theyare engaged in asylums for the insane

,and in prisons .

I n the me tropol i tan area both schoo l nurses andasylum nurses are under the I ondon County Counci l .The Foreign Office engages a certain number ofnurses for service in Bri tish p rotectorates .Nurses also find scope for their profess ional gift s

as heal th vis i tors , san itary inspectors , as lecturerson nursing , and in connect ion wi th creches ; then ,in increasing numbers they are being attracted tothe work of foreign missions , a field in which theyfind abundant opportunities for the exercise of a llthe talents they may possess .

M E NTAL NU R S ING

This branch of nursing i s conducted ch iefly inprivate or publ ic asylums . Those tak ing i t up enter

22 H istory of Nursing

as a rul e , an asylum for traini ng , where they s ign acontract for three years . At the end of this t ime i tis the aim of the more progressive to obtain the cert ifi cate conferred by the Medico-Psychological Associat ion , which has inst i tuted a uniform examinat ionfor men tal nurses , both men and women , throughoutthe country . A very l imited number of nurses ta kethe double train ing in both genera l and menta lnursing , and those who do so are rewarded by theenlarged powers and skil l which they attain .

Trained nurses are also entering largely into theant i-tubercu losi s campaign , and are becoming increasing ly interested in the poss ibil i t ies which l iebefore them as trained workers in social service inconnection with moral prophylaxis . The need ofinstruct ion upon venereal d iseases in the course ofthe i r train ing is now real ised . Hitherto teachers innursing schools have been almost s ilent upon th issubject , yet nurses , when thoroughly al ive to theiropportuni t ies , shoul d be a powerful force in helpingto combat these social plagues and teach mora l hyg iene. I n planning the programme for the Internat iona l Congress of Nurses in 1 909 , the Bri t ish leadersgave this subject a prominent p lace , and the B r i ti shJ ourna l of N ursing has conducted a campaign ofenl ightenment concerni ng it .

QU E E N V ICTOR IA’

S J U B I LE E INST ITU T E FOR NU R SE S

We have already ment ioned the beginn ings of d istriet nurs ing , and for comp lete historical detai ls referour readers to the R eports and P roceedings of the

‘Vol . I I Cha p . v i .


Jubilee Congress for Dist ri ct Nurs ing , which washeld in Liverpool in 1 909 to celebrate fifty years ofdistrict-nursing work . They shoul d also read MissN ightingale’s letter to the L ondon T imes of Apri l1 4 , 1 876 ,

wri tten to get funds for the Centra l Homeof the Metropol i tan Nat ional Nurs ing Association.

now at 2 3 Bloomsbury Square . From this centre ,district nursing spread rapidly through London andthe provinces . I n Scotland , the pioneer of such workwas Mrs . Mary Orrel l Higginbothan , who foundedthe Glasgow Sick Poor and Private Nurs ing Associa t ion in 1 875 .

The gracious act of her Majesty Queen Victoria ,in devoting of the Women’s Jubi lee Off ering to the fur therance of dis tr ict nurs ing , in theyear 1 887 , gave the mainstay from which hasbranched a great national , art iculated organisation .

The provisional committee appointed to help ad

minister the offering (among whom was a nu rse , Mrs .Dacre Craven) decided to apply the interest accruingfrom it to found the Queen Victor ia

’s Jubi lee Inst i tutefor Nurses , both to prepare nurses for work with thesick poor in their own homes , and to extend branchesthroughout the Uni ted Kingdom . The Metropoli tanand Nat ional Nurs ing Associat ion was adopted bythe Ins t itute as i ts London nucleus , and the majori tyof then exist ing associat ions , including the pioneersocie ties in Liverpool , Glasgow , and other c i ties ,agreed to the condit ion of affi l ia tion with the Institute . The Royal Charter of 1 889 connected theI nstitute with the ancient foundation of St . Kathetine 's Royal Hospital , ‘ and the offices were within

‘ Sec Vol . I . , p . 432 .


i ts precincts unt i l 1 903 , when with the need of largerquarters they were move d to 58 V ictoria Street , SW.

In the year fol lowing , the official connect ion wi th St .Kather ine ’s terminated , and Queen A lexandra became patron of the Inst i tute . I t is governed by aCouncil mainly representat ive , on which Scotland ,Ireland

,and Wales have direct representat ion .

Scotland has , as well , i ts own execut ive committee .

In 1 903 Lady Dudley establ ished a fund for prov iding district nurses in the poorest parts of Ireland ,by means of which Queen

's nurses are maintainedin the extreme west and other d istricts where i t i simpossible to ra ise funds . Wi th this are joined twoother societ ies , the Homestead and Manchester Westof I reland Fund . The Women ’s Nat ional HealthSociety for I reland , inaugurated in 1 908 by theCountess of Aberdeen , i s affil iated wi th the Insti tute ,and Queen

’s nurses are taking anact ive part in thework of this socie ty , especially in the prevent ion ofinf ant mortal ity and tuberculosis .Wales has i ts p ioneer central home in Card iff , and

Welsh-speaking nurses are necessary for rural d istri cts, especially in North Wales . The North and

Sou th Wales Associat ions were formed in 1 909 to supply d istrict nurses , and more especially cert ified midwives , throughout the principal ity . Each has acentral committee and co-O perates with educationcommittees and other county and city offi cials . Tothe energy of these new associat ions has been largelydue an aroused publ ic interest in d istrict nursing ,which has greatly increased the number of socie t iesand nurses .The s tandards for the Queen

’s nu rses a re excel lent,


and should be imposed on all d istrict nurses doingsimilar work . Unfort unately , s ide by side with thi ssystem has grown up another of employing womenwho are cert ified midwives , and have had a shorttraining in general nursing , not necessari ly in a hospital— for work in the homes of the poor as “ vil lagenurses ,

” under county nurs ing associat ions , or as“ cottage nurses ” (general help , who l ive in the cottages w ith their pat ients) under what is known asthe Holt-Ock ley system . Thus , after fifty yea rs ,Florence N ight ingale 's minimum standard of oneyear in a hosp i tal has been reduced , for the nursesof the poor , to a few months , with disastrous resul ts ,as the presence of the chea p nurse makes i t increasing ly diff i cul t to ra ise the salary for a thoroughlyeffi cient Queen

’s nurse .

The Queen’s Inst i tute , making the best of th ings

as they are , recogni ses the county nursing associat ions , as told in the following extract

From the beginning of this movement the Queen'sInst itu te has reali sed the importance of nurses emp loyedin country work holding a certificate of midwi fery , andalso that special supervision is essential . Whereverpossible, nurses with ful l hosp ital , district , and midwi ferytraining , inother words Queen’s nurses , are employedincountry associations affi l iated with the Insti tu te. For

areas where ne ither work nor funds permi t the supportof such nurses , the county associat ions undertake totrainwomen as midwives , giving them a l di t iona l in

struction ine lementary sick nursing, and these

“ vil lagenurses " are suppl ied to rural d istricts . The Queen’sInstitute requ i res the appointment of a Queen’s nurseas county superintendent , w ho is respons ible to the

2 6 A H istory of N ursing

county committee for the adequate and constant supervi s ion oi the practical work 5 these nurses .There are some thir ty-two county associa t ions , of

wh ich eighteen are affi l iated with the Insti tute . ‘

The vil lage nurses’ preparat ion for general nursingis thus simply a “ short course ,

” given them , usually ,in the Matern ity , Charity , and District Nurses

’Homein Plaistow , which was opened in 1 889 , under MissKatharine Twining , and is now , with its branches ,the principal tra ining school for the county associa t ion

’

s candidates . Call them what one will , thecottage nurses are not nurses . They may be usefulhousehold help , and as such are badly needed incottage homes , but no last ing good comes from the acceptanceof inferior professiona l serv ice for the poor .

They , more than any others , need the best . Nor i sthat even a genuine chari ty which compels the workerto give the chari ty . The cottage nurses are miserably underpaid and themselves cl ing to the verypoverty-l ine . Help less to help themselves , they butdrag lower the workers just above them . In makinguse of them , the Queen

’s Inst i tute is conscient iouslydoing what seems to i ts offi cers the best poss ible underthe circumstances but as an impart ial h istori an wecan but hold the “ vil lage nurse to be a professionaland economic mistake . England has some thirtyfive county assoc i at ions , of which , in 1 9 1 1 , twentytwo were aff i l iated wi th the Queen

' s Insti tute . Thel ines upon which they work are s imilar throughout

,

and the influence of the Inst itute is to place women

‘ R eport and P roceedings, Jubilee Cong ress Dist rict Nu rsing,L iverpool , 1 909 .



the School Board , who had taken the year’s training

of a lady probat ioner in the London Hospital . Theappointment of M iss Helen L . Pearse as Superintendent of School N urses in 1 908 placed at thehead of the work a woman of abounding energyand intell igence , whose wide view and warm socialsympathies insp i red i t with a truly V i tal force .The school nurses now have their own League .Under the Education Act of 1 907 , the authori t ies

mus t provide medical inspect ion school ch i ldren ,and may provide nursing . The sympathetic att itudeof the Board of Educat ion toward the school nursehas had the resul t of creat ing a growing army for thecare of the chi ldren , the usual mode of recruitmentbeing by agreement with d ist ri ct nur s ing associ at ions ,the educat ion authori t ies paying sums proport ionedto the work they requi re .

Under the Children ’s Act the LondonCounty Cou nci l and Boards of Guardians elsewhereare ent i tled to pay for the servi ces of nurses as Inf an tL ife Protect ion Visitors for Bearded-Out Children .

Queen’s nurses are being thus employed extensively

in both England and Wales , as their knowledge ofthe people of their distri cts and their tactfulness indeal ing wi th the problems of the home enable themto give accurate reports both as to the chi ldr en andthe ir surroundings . In all these new l ines the nurse’sopportunities for educat ing the communi ty to higherstandards of l iving are endl ess .The value of the trained district nurse’s services in

the crusade against tuberculosi s need not be insistedupon . Associat ions are alive to the need of thenurse’s educationa l and preven ti ve w o rk and to the


importance of her observation and her lessons inpractical sanita t ion and hygiene .

Under the auspices of the Red Cross Society ,Queen

’s nurses are gi ving lectu res on home nursingin diff erent parts of England and Wales , their pract ical experience in making the best use of the equipment found in the ordinary home fit t ing them toinstruct others ably on such l ines .A rapidly increasing number of associat ions are

framed onthe provident ” or “ clubs " system , everyone desiring the services of the nurse contributing ona sl iding scale as arranged by the local committee . Inmany industrial centres the people themselves raisethe needed funds and entirely control the associat ion .

M idwi fery and materni ty clubs are also springing upin every direct ion . The whole trend of publ ic op inionis toward encouraging self-respect and independence amongst those to whom the nur se ministers .At the same t ime the interests of those who are umequal to the struggle of l ife are safeguarded , and nocase i s refused nursing because of poverty . Provision is also made for those who are not poor , yet coul dill aff ord the fees of the private nurse . Manyassociations have a daily vis it ing nurse ,

” whoattends such pat ients at a fixed scale of fees .The most str iking feature in the developmen t ofdistrict nursing is the prominence of i ts educat ionalside . A lmost impercep t ibly , yet none the less steadily , has this change progressed . As the value of thenurse’s teaching in the homes rises

,i t becomes more

importan t that she herself should be especially prepared and acquire some insight into those socialquestions which aff ect the genera l welf are of the com


munity . Distri ct nurs ing has found an interpreterin Miss M . Loane , whose wri t ings , The Queen

’

s P oor

and other books , are widely known .

Many nurses qual ify for the pract ice of midwi fery ,to wh ich we canonly briefly refer . We know that asfar back as 1 863 M iss N ightingale des ired to trainwomen - for th is service and had prompted the un

successful experiment a t King’s College Hospital . “

In 1 87 2 , the London Obstetrical Society inst i tutedan examinat ion which , though elementary , wasa fir s t step toward rais ing standards . I n 1 88 1 ,

the M idwives Inst i tute was founded to raise thestatus and effi ciency of m idwives and to pet i t ionParl iament for their recogn it ion . I n 1 89 1 , the firstattempt was made toward legislat ion , and in 1 902

Parl iament passed the Mid ‘ ves Act . The two mostprominent and able workers for thi s reform “ wereMiss Jane Wilson and Miss Rosal ind Paget .

TH E STRU GGLE FOR ORGAN ISAT ION

We now turn back to trace the movement for selforganisat ion and economic emancipat ion in whichthe nurses of Great Bri ta in led the way . We havefoll owed the path through long centuries when therel igious Sisterhood set the pattern of nursing ; wehave seen the ebb and flow of religious societ ies aiming at freer forms and have found the culminat ion oft ime’s changes in Miss N ightingale 's creat ion of asecular profession of women trained to nur se . But

Vol . I I . , p . 2 3 8 .

’For deta iled informa t ion one should apply to the M idwi vmInstitute , 1 2 Buckingham St

,St rand , London.


Miss N igh t ingale’s work , magnificent as i t was , d idnot include the insp i ring idea of self-governmen t inmutual

,voluntary , democrat ic union . This was to

be the service and the contribut ion of her successors, who , in turn , had to struggle desperately , andsubmit to contumely and abuse for the sake of t he irideals .W i thin twenty years after the opening of St .

Thomas ’s , i t was clear that the first need of the youngprofession w as a leader who could form a strong associat ion of i ts members , through which the isolatedunits cou ld be brought together , their views on professiona l quest ions voiced , their economic independence safeguarded

,and some un i formity of educat ion

and pract ical standards establ ished . Nor did theleader delay ; indeed , she had been among the firstto feel the need

,which her own advanced work in

hosp ital had helped to accent . We meet a remarkable personality inEthel Gordon Manson , who,

later ,as Dr . Bedford Fenwick 's wife , maintained a dynamicrelat ion to the nurs ing movement of the whole worldand held electric keys of power , by which she adm ini stered st imu l i in every direct ion . I n an interest ingchara ' ter sketch , to which our readers are referred , ‘

the foremos t features of her complex and versat ilecharacter ,

“ courage and ideal ism , Bri t ish gri t anddogged tenacity of purpose ,

" combined with extraordinary elasticity of spir i t , are recorded , but wewould add that courage is too moderate a word forher intrepid daring in facing difficulty , and that herloyalty to her ideals has been evi denced by twenty

‘ E thel Gordon Fenw i ck : A Cha racter Sketch by an I ntima te,A. J . N . , Sep t . , 1 90 1 , p . 86 1 .


five years of the most nerve-weari ng batt le and umremitting labour s , freely chosen inplace of a li fe ofbri ll iant ease and enjoyment . From our modernpo int of vi ew, her contribut ion to the nursingmovement has been as important as Miss N ightinga le

’

s.

A t twenty-four , Miss Manson , having begun her

tra ining a t twenty-one , became Matron of St . Bartholomew

’

s Hospi tal , and with her appointment anew chapter in Engl ish nursing began . During sixyears she was a path-finder , organ ising the school onthe admirable lines i t has since followed , and earninga reputat ion for clear judgment , unerring intuition ,professional enthusiasm , great organising abi l i ty ,tenacity of will , and publ ic sp i ri t . I t was she whobroke the ground for the democrat ic system of ah igher , universal development of nursing education .

In 1 887 , she married Dr . Bedford Fenwi ck , and , wi thh is active co-operation (for never have nurses andthe ir causes had a more loyal , unselfish friend thanDr . Fenw ick , whose brotherly deeds have been so selfeff acingly done that they will never be ful ly known) ,devoted herself to the advancement of her professionand dedicated to i t al l her unusual gifts and energies .In the year of her marriage she proposed the formation of an Associat ion of Trained Nurses , not l imi tedto those of one school . Coming from her , the proposi t ioncommanded widespread attention and respect .I t also aroused intense host i li ty , for those who , foreconomic or autocrati c reasons , desi red to keep nursesunorganised and in subject ion , knew that the i r champion would be a formidable opponent . Undaunted

,

Mrs . Fenwick called together on November 2 1 , 1 887,


a group of kindred spiri ts at her house in UpperWimpole Stree t (a house where many histori c meetings relat ing to nur sing organisat ion have since beenheld) , and in December the Bri tish N urses Association was formed . Said she in thi s connection“The Nurse quest ion is the Woman question , pureand simple . We have to run the gauntlet of thosehistor ic rot ten eggs . ”

Thenceforth the hospital world of England wasdivided into two camps . The progressives had astheir goal the organisation of nurses through a centraigoverning body appointed by the State , by whicheducational standards could be established , theskilled di ff erent iated from the unskil led , and discipl ine maintained : the reactionaries would not admitthe necessi ty for fixing a minimum standa rd of training and w ere strongly averse to organ isation amongstnur ses . Their stronghold was then , as afterwards ,an obstinate refusal to recognise the question as aneducational one , and an immovable persistence intreating the regi strat ion of nurses as a sor t of in te ll igence office for superior domestic hel p .

Bes ides the hosp i tals which profited by fees fornurses , enterpri sing middlemen made large incomesby the simp le process of engaging trained or halftrained mu ses at small salaries , supp lying them tothe public at ful l fees and pocketing the d ifference .Naturally such persons regarded the preposi t ionforState Registrat ion of Nurses wi th alarm . In manyways nurses were an asset to mercenary ind ividuals .I f i t be asked why inte ll igen t women should have

permi tted others to exp loi t them , the answer may begiven in one word , non-organi sa tion. The p osition


thus came , at last , to be muci . more complex than a tfirst appeared when Bri tish nurses put forth the irplea for s imple just ice to the s ick - that they shoul dno longer be at the mercy of unski l led and unsern

pu lous women who , donning the nurse’s uniform ,

preyed upon the publ ic wi th impunity , since legalevidence of effi ciency could not be demanded of them

-and j ust ice . 0 trained nurses , by provid ing thatthose who had undergone and benefited by an arduous and lengthy training shou ld be dist ingu ishedfrom those who had not taken the pains to equipthemselves thoroughly before undertaking the respons ible duties of pract ising as trained nurses— a neces

sary d iff erentiat ion between ski lled and unskil ledwel l understood by members of men ’s professionsand trades , and vitally important in the case of aprofession on whose ski l l , or the lack of i t , the balancebetween l ife and death may depend . L i t tle by l it t lethe scene shifted ur t i l i t was clear that Mrs . Fenwickhad taken up arms against an arrogant rr onopoly .

For twenty-three years the battle was waged , andi s not ye t ended . During th is whole t ime she hasnot only led without faltering , but has performedincessan t drudgery as wel l , meet ing abuse and misrepresentat ion by the way .

In 1 893 , to have a means of express ion , she assumedthe control and ed itorship of a smal l weekly papercalled The Nursing R ecord , which had taken the pro

gressive s ide from the outset . I n 1 902 , she enlargedthe magaz ine and called i t The B r i ti sh J ourna l ofN ursing . I t rapidly came to be the foremos t nursing journal of the world and is the most comp le terecord in existence of nursing aff airs and progress in



First in 1 874 had the need for legal s tatus forthe nu rse been publicly mentioned by the late SirHenry (then Dr . ) Acland in h is preface to MissFlorence Lees ' (Mrs . Dacre Craven) H andbook forH ospi ta l Si sters. He there said :

The Medical Act of 1 858 allow s women to be registercd as medical practi tioners . I t makes no provisionfor the regi stration of trained nurses , however completetheir education , and how ever grea t their skill , whetheras midw i ves or nurses . Many accompl ishu l womenmigh t reasonably desire the name as well as the functionof Superintendents of Hospi tals or of Ward Si sters or ofNurses . At present they can have no such legal recogni t ion of the i r qualifications in e i ther department , asis obtained b y Sisters w ho become school-mistressesor who are students and teachers of Art . That th is ough tto be remedied canhardly admi t of doub t ; b u t i t restswith the women o f England to decide whether what ishere advocated has the ir support as w e ll as the i r approval .

In 1 885, Surgeon-General (then Surgeon-Major)Evat t sent in to the War Off i ce a memorandum con

taining a proposal to form a corps of “ VolunteerFemale Nurses for Service in the Army Hospi tals inthe Fie ld ,

”

w i th suggest ions as to the incorporat ionof the nursing profession which can be regarded o t~lyas an insp irat ion of genius . In this he stated

I t seems at first sigh t that the formation of such acorps as I propose a b ove , is purely for aM il i tary Reservefor “f a r ; inpoint o f fa ct i t is for more than th is . I t is ,I th ink , the fi rst de fini te at: ‘mp t to Incorporate theNursing Profession . Tha t profession is clearly e volu tingi tsel f ou t of the old disorde r and chaos of untrained a t


tendance on the sick . But up to the present date theNursing Profession has never been taugh t to incorporateitself

, to undertake i ts ownself-government , to endeavourto work ou t i ts own future , to expel unworthy membersfrom its rank s , to define its curri cul um of training , tofound a Dip loma or Certificate of Eff i ciency , or to forma Pension Fund . Bu t a ll these steps follow log icallyfrom the l ines I have laid down .

Suff i ce i t to say that this remarkable document w asp igeonholed by the War O ffi ce and no more w asheard of i t , and when trained nurses began to organi setheir profession two years later they were qu i teignorant of i ts ex i stence .

In 1 886 , the quest ion of reg i strat ion of nur ses wasdiscussed by the N ursing and Domesti c ManagementCommittee of the Hospi tals’Associat ion of which Mr .Henry C . Burdet t was the founder . But so li t tle didMr . Burdett then understand the profe ssional aspectof registrat ion that he wrote that in hi s opinion theSectional Committee [on which were Matrons ofhospi tals]would do well to

“ confine their consideration of Regi strat ion to considering how far i t i sdesirable or possible to establ ish a Register forTrained Nur ses in connect ion with the Hospi tals’

Associat ion , so that the Lady Superintendent s andmedical men may wri te from the country to theAssociat ion , and have a reasonable assurance thatthey will thus be able to ascertain the character of anurse with reasonable certainty , and so protec t themselves from ri sks to which they are at present exposed . The Matrons composing the S ect ionalCommittee then expressed the Op in ion , in connect ionwith this scheme , that no nurse shoul d be placed on


the Hospi tals’ Associat ion’s Reg i ster who had notrece ived three years’ training, but this professionalOpinion was ignored by the counci l of the associat ion ,which put forward a plan for regi stering any nursewho furnished sat isfactory proof that she had workedfor at least a year on the staff of a hospi tal or infirmary , and that she had been trained in the dut ies of anurse . Their recommendat ion as to the professionalqual ificat ions of the nurses to be enrolled thus ignored

,the Sect ional Committee resigned in a body

,

the danger of the control of professional women by unprofessional persons having been forcibly broughthome to and thoroughly appreciated by them . Followi ng on this alarm signal came Mrs . Fenwick’s inv ita t ionto hospital Matrons in London to assemble ather house , and nine , in al l , responded , among them being Miss I sla Stewart , Miss Catherine J . Wood , andMiss M . Mol le tt . Mrs . Fenwick presided , and i t wasdecided that a professional associat ion of nursesshoul d be formed and that the Matrons of the principal hospitals in the kingdom should be called to a

conference to discuss the quest ion . The conf erencewas held , and i t was unanimously resolved that aBrit ish Nurses ’ Associat ion should be formed , i t sobj ects be ing al so agreed upon . In January

, 1 888 ,

the associat ion was permanently organised andH .R .H . the Princess Christian accepted the Presideney . Instantly , TheH ospi la l took up its pol icy ofunremitt ing host i l ity .

The associat ion included medical men as membersas wel l as nurses , and the nurse members had even

generously e lected med ical men as honorary offi cers .[In England the term honorary signifies an unpaid

Great Brita inand Ireland 3 9

offi cer .] No doubt of the w i sdom of this courseoccurred to the founders . They expected to meethonourable co-operat ion from all their members , and,at that ear ly stage , i t was suffi ciently daring to or

ganise at al l . I t was the first t ime in modern h istorythat nur ses had asserted the right to associate together for self-government , and to have ignored themedical profession would have seemed too revolut ionary . On February 1 3 , 1 888 , a pub l icmeet ing washeld at St . George ’s Hall . The chair was taken byMr . (later Sir Wil l iam) Savory , Senior Surgeon atSt . Bartholomew 's , and the objects of the associat ionwere explained to a crowded and enthusiast i c audience of medical men and nurses , after which memberswere enrolled . The first general meet ing of memberswas held at the Middl esex on February 2 4th , i tsobjects being defined as follows( 1 ) To unite a l l qual ified Bri t ish nurses inmember

ship of a recogni sed profess ion . (2 ) To provide fortheir registrat ion on terms sat isfactory to physic iansand surgeons as evidence of their having receivedsystematic training . (3 ) To associate them fortheir mutual help and protect ion and for the advancement in every way of their professional work . Lastlyi t was declared to be the immediate object of the associat ion to obtain a Royal Charter of Incorporation .

The H ospi ta l having strongly advocated a system of registrat ion for nurses when control led bya lay body , now denounced the union of nu rses forprofessional purposes , and advised managers ofhosp ital s and nursing inst i tut ions throughou t thecountry to

“ enact that no member of thei r staffshou ld become a member of the new associat ion .


As The H ospi ta l was the organ of the Hospitals'

Associat ion " i t is probable that i t voiced the sent iments of many Governors . Some of the most powerful of these authorit ies came out individual ly againstthe nurses’movement , notably those of St . Thomas

’sand of the London . I n 1 888 , Mr . Henry BonhamCarter , Secretary of the N ight ingale Fund , publ isheda pamphlet against the registrat ion of nurses , and inthe following year M iss Luckes, Matron of the London , widely circulated one against the Brit ish N urses

’

Associat ion . The H ospi ta l publ ished an anonymous letter , suggest ing that the associat ion woul dinclude the “ scum of the nursing profession ” andthat nurses woul d join i t “ to obtain pseudo-respectabi l i ty ,

” which they cou ld not get elsewhere . M r .Burdet t replied to protestat ions against these chargesthat they seemed “ only a fair cri t i ci sm .

” In 1 889 ,

a memorial was issued , signed by the representativesof ten London training schools , who noted withsurpri se the statement that the main object of theBri t ish Nurses’ Associat ion i s in conformi ty wi th agreat public want and a widespread professionaldemand .

” The point of view of these hospi talauthori t ies was that of many men to-day , who declare that “ women have everything they want . ”

The memorial argues that enrolment in a common

[State] register woul d lower the posi t ion of the besttrained nurses , be detrimental to the advancementof the teaching of nur sing , disadvantageous to thepubli c , and in jur ious to the medical pract i t ioner .These arguments rested on the contention that nursesshould obtain references from their training schoolsthroughout their entire career . The school au thori


t ies undertook neither to employ all their formerpupils nor to be responsible for finding them employment

,yet claimed the power of making or marring

their careers throughout the whole of their professiona l l ife , a suggested domination which , we bel ieve ,has not been claimed over former students by anyother schools , either profess ional or industrial . Thismemorial was signed , possibly under pressure , bythe Matrons of seven of the ten hospitals .In 1 899 , the Bri t ish Nu rses

’ Associat ion invi tedthe advice and assistance of the General Medi calCouncil and the co-operat ion of the training schoolsfor nurses throughout the kingdom , i n establ ish inga system of regi strat ion of nurses , and in forming acounci l in connect ion wi th the associat ion to carryi t out . The General Medical Counci l repli ed in aresolut ion upholding the desirabi l i ty of regi strat ionof nurses , but held that i t should be carried out undera separate Act . Training school committees alsogenerally refused assistance , on the ground that theyexisted for other purposes . In January , 1 890, thefirst voluntary Regi strat ion Board was appointedby the Bri t ish N urses’ Associat ion and regi strat ionOpened in Febru ary of that year . The H osp i ta l

now maligned the personal character of enrolledmembers , warning the publi c against a certain nursewhose name was mentioned , and refusing retract ionwhen i ts statements were proved to be erroneous .Unfortunately

,through d islike of publ i ci ty this

nurse took no legal steps . Had she done so , othersmight have been saved from simi lar persecution .

In 1 89 1 , the B ri t ish Nurses’ Association was

granted by Queen Victoria the righ t to use the prefix


Royal , and in 1 892 i t presented its formal Peti t ionto Her Majesty the Queen in Counci l for the grant ofa Royal Charter of Incorporat ion . The appl icat ionaroused the utmost act ivi ty in the opposi t ion ranks .The method of incorporation by Royal Charter is themost ancient and honourable by which this privi legecan be obtained . The procedur e is elaborate , and atone stage wri tten reasons for and against are calledfor by publ ic advert isements . Peti t ions againstthe charter were presented by the Counci l of theN ight ingale Fund , the Committee of the WestminsterTraining School , and various execut ive Offi cers , medical men , and representatives of training schools andnursing institut ions .On the other hand , l ively interest was evoked , for ,

if granted , i t would be the first t ime that a RoyalCharter had been gained by an associat ion of professiona l women . After royal and eminent medi calsignatures came the names of the Matrons , many ofwhom are st il l leading the campaign for progress andfreedom .

‘

In all , there were , suppor ting the petit ion , 1 2 50

medical men , 3 700 nurses , and 4300 of the publ i c .

M rs. Bedford Fenwi ck , M iss I sla Stewa rt (St . B a rtholomew '

s) ,M iss G. M . Thorold (M iddlesex ) , M iss C . S. Wood (Hospita l forSick Children, Great O rmond St reet ) , M iss M . B rea y (M et ropolitan) , M iss Beachcrof t (L incoln County ) , M iss M . N . Cu reton(Addcnbrooke

'

s, Cambridge) , M iss C . Forrest (York County ) ,M iss L . Hogg ( I l ea d Sister, R oya l Nava l , H asla r) , M iss R ogers(Leicester Infirma ry ) , M iss G. Scott (Sussex County , B righton) ,M iss M . G. Smith

, (Roya l Infirma ry ,B ristol ) , M iss R . F . L umsden

(R oyal Infirma ry ,Aberdeen) , M iss H . C . Poole (Adela ide, Dub l in) ,

I naddit ion, the pet it ionwas signed by a la rge number of medicalpractit ioners, M a t rons, nu rse members of the associa tion, and chairmenand members of hos pital commit tees, etc .



to the maintenance of the Register of TrainedNurses .The futur e now looked bright . The large-minded

women who had thought to bu i ld to the honour andprotection of the call ing they cl early loved , that i tsgood name might shine brightly , were l ifted high inSp iri t wi th hope and fa ith , and at a dinner of rejoicing , toasts and cheers rewarded the intrepid leaders .B u t the forces host i le to women’s progress , defeated inopen contest , plot ted to capture the new associat ionby indirect means . Up to this t ime , while the associat ion had had to meet h i tter onslaught from without ,there had been complete unanimity wi thin the ranks ,but presently a malign influence from outs ide becameapparent wi thin the associat ion i tself , the objectbeing to crush the power of the Charter . Further ,although medical men had supported the nurses’

pet it ion for the Charter , when it became a quest ion o fcarrying ou t the powers i t conf erred medica l opinionwas not by any means unanimous that the nur sesthemselves should exercise those powers . The hardfight ing in the r

e-°tra t ion campaig n had never

centred around the register , but around the controll ing power behind i t . Similarly , a struggle nowensued as to whether the medical men ins ide the associat ion should control i t and i ts pol icy , or whetherthe nurses themselves should exerci se powers of sel f

government . Co-operation between certain medi calofficers and others wi thin the associat ion , and thearch anti-regi strat ion protagonist soon loomed up asa serious menace . N ever has there been a more determined attemp t to subjugate a women ’s associa '

t ion , and the history of the struggle , i f i t has

Grea t Brita inand Ireland 45

answered any purpose , has afforded to the nurses ofthe world a lesson which many of them have takento heart .A seri es of events now occurred , each one marking

an advance in wrest ing power from the nurses bymeans of parliamentary tri cks and subtlet ies andconcentrating i t in th e hands of a small ring of men .

T he Executive Committee had a number of ex -ofi cz’

o

members , who were thereby entit led to seats theGeneral Counci l . Such members were : leadingmedi cal practi t ioners , Matrons of the most importanthosp i tals , heads of Army , Navy , and Indian ArmyNur sing services , and Mrs . Bedford Fenwick , thefounder of the associat ion . So long as these women

,

and especially Mrs . Fenwi ck , with her l ightning-l ikeintui tion, keen judgment , and passion for just ice ,were in execut ive offi ce , to usurp power would be verydifficul t and ways must be found to get ri d of them .

In October , 1 894 , i t was suggested by a medicalofficer that the wording of the Bye-Laws was ambiguous and by reason of this imperfect ion i t was presumed that the founders were not ent it led to seats onthe General Counci l . A number of members thereupon , as w as their ri ght , called for a special meet ingfor the purpose of making the provision clea r andunquestionable . The off i cers never convened thespecial meeting , thus dist inctly violating the members’ rights .In the following June the tension became acute .

A member of the associat ion did not receive the voting paper to which she was ent it led . She called atthe associat ion office and was refused i t . She wrotea perfectly temperate statement of this to The


N ursing R ecord, saying that she was anx ious to

replace the names of the ex -ofiicio Matrons on thel ist , and fearing that other members might have asimilar experience , suggested that any one not having received a voting list should ask for i t at the office .Extraord inary as i t may sound , th is nurse receiveda threatening letter from the associat ion ’s secretary

,

through a fighting legal firm, on the day her let terwas publ ished . This attack upon her was authorisedby the Executive Committee , and Mrs . Fenwick , asthe editor of The N ursing R ecord, received a similarletter from the same firm.

The o ff ending member was next proceeded againstby the Executive Committee (who had power todirect the erasure of a nurse ’s name from the register

,

after hearings) in such a way that she was forced tosecure a legal adviser and to seek an injunct ionagains t the officers of the Royal Brit ish Nurses’

Associat ion restraining them from removing hername . She was sustained in the High Courts

,

and the association was ordered to pay the costs .Thus bravely and successfully were the rights offree speech and a free. press defended bv a nursew ho deserves the g rat i tude of all for her intre

p i t l i ty . A s though to rebuke the court s , the royalpresident now cal led a special meet ing to considera resolut ion condemning the woman who had beenexonerated in a court of j ust ice ; the resolut ionwas offered by the President of the Royal College of Physicians , who wa s not a member of theassociat ion ; aft er a stormy debate , the chairman dcclarerl the resolut ion passed , and . when chal lenged ,would not permit the votes to be counted .


In January , 1 896, came the decisive act of undoing ,—the betrayal of the members of the association onthe fundamental principle for which they had foundedit

,namely , the State Registrat ion of Trained Nurses .

The Brit ish Medical Associat ion had , in the previousyear , passed the following resolut ion , proposed byDr . Bedford Fenw ick :

That in the Op inion of this meeting it i s exped ientthat an Act of Parliament shou ld , as soon as possible ,be passed providing for the registrat ion of medical , surg ica l , and obstetric nurses , and the Council of thisAssociat ion are , therefore , requested to consider thematter and to take such mu . mres as may seem to themadvisable to obtain such legi slat ion .

I n accordance wi th the resolution , the Parl iamentary B ills Committee of the Brit ish Medica lAssociat ion invited representat ives of nurs ing bodiesto confer with i t on the subject . I t was not ,however , realised that to represent the views ofnurses the representat ives must themselves betra ined nurses . Our space does not permit. a ful lresume of this h istoric meeting and i ts prel iminaries . Suffice i t to say that the represen tati y es of nursing bodies present were Mrs . BedfordFenw ick (Registered Nurs a co-operat ive socie ty ) ,M iss I sla Stewart (Ma ons

’ Counci l ) , Dr . B edford Fenwick , Miss M . Breny (St . John

’s House) ,M iss Annesley Kenealy (a nurse ) , w ho voted infavour of State Registration . Against i t were : MissWedge wood (Delegate Mr . F a rdon(H on.

Medical Secretary Miss J . \Vilson (H on.

Secretary Midwives’ Insti tute , not a nurse ) . Mr . H .

48 A H istory of l fursing

C . Burdett (National Pension Fund for Nurses) , M r.

Pri tchard (Secretary , Plaistow House for Nurses) ,and the represent at ive of the Glasgow Matern i ty ,who voted for a resolution : That a legal system ofRegistrat ion of Nurses is inexped ient in principle ,injurious to the best interests of nur ses , and ofdoubtfu l publ ic benefit . ”

The resolut ion was passed by a majori ty of one , Lee.the vote of the Hon . Medical Secretary of the RoyalBri tish Nurses’ Association , since dead . When subsequently taxed with his act ion , he ex rused h imselfby saying that he was not represent ing the assoc iat ionbut the Middlesex Hospi tal . The answer is obvious .As an officer of an associat ion formed for the purposeof obta ining State Registrat ion of N urses , he shouldei ther have refused to represent the hospi tal , or , ifhe decided to do so , shoul d first have resigned hispos i t ion in the Royal Bri t ish Nur ses’ Associat ion .

The delegate nurse might have saved the day , andfor her weak act ion deserves no excuse . From thatda y , the l ine of demarcat ion was deep between thosewho stood for foundation principles and those whohad t ri cked them .

Members of the associat ion were at firs t incl inedto bel ieve that some extraordinary mi stake had beenmade , which the execut ive committee would putrigh t , but events proved that they had no suchintent ion .

I t would seem , looking back , that i t would havebeen better for al l reg istra t ionists to have left the

at this point . But Bri t ish tenaci ty doesnot eas ily yield a cherished cause , and the nurses followed Benjamin Frankl in’s advi ce : Never resign .



pursued by the present Executive Committee , especia llyconcerning the manner in which the p ledges given by theAssociation have been broken ; in which the ex penditureof the Associat ion has been allowed so greatly to exceedits rel iable income ; in which the provisions of the Charterand Bye-Laws have been violated ; and in which a member of the Association has been compelled to appeal tothe Court of Chancery for protection aga inst the E xecutive Commi ttee .

When the resolut ion was reached at the meeting ,the honorary medical secretary rose to a point oforder . The motion , he declared , had not been sentb y registered post but merely in an express packet .He left i t wi th the chairman to decide , etc . Thechair instantly rul ed that the resolution was out oforder and on thi s frivolous technical i ty refused toa l low i t to be di scussed . Miss B reay consequentlyresorted to the courts . In the City of London Cour t ,before Mr . Commi ssioner Kerr and a jury , Mr .Scarlett ap peared for the plainti ff (Miss B reay ) andMr . Muir Mackenz ie for the defendant

,Sir James

Cri chton Browne , chai rman of the meeting . Thejury gave a verdi ct for Miss B reay , but as the casewas held to be of public importance , the defendantwas allowed to appeal and , in the Division Court ofthe Queen

’s Bench before Just ices Wills and Wri ght ,gained a techni cal point , i t being held that MissB reay should not have acted as an ind ividual buttogether with others of the associat ion . As the juryhad rendered a just verdict , the p la int iff fel t sat isfied .

The next step taken by the medical officers wastoward admitting asy l um attendants , who had

worked for thr ee years in asylums of over forty beds.


to the regi ster of trained nurses , but so empha t i ca l lywas the object ion voiced that this woul d be unf airto both , and so eff ect ive a publ ic protest was made ,that the proposal was dropped .

In 1 896—9 7 , came the opportunity to rid themselvesof the fearless and resolute woman whose presenceon the execut ive commi ttee vexed the ir spiri ts . Mrs .Fenwi ck was call ed to Greece as Superintendent ofNursing of the Engl ish contingent in the GrecoTurkish War (where she gave di st inguished serv i ce ,coming back with the Greek R ed Cross) , and duringhe r absence the vice-chairman , hon. treasurer , hon .

secretary , and certain members of the execut ivecommit tee planned to secure the assent of the Lordsof the Privy Council to an a l terat ion in the byelaws which reconst ituted the execut ive commi t teew i thout her name , and she was thus excluded froma voice inthe soci ety she had founded. The reversalof the pol icy of the Royal Bri t ish Nurses’Associ a t ionwas now complete , and , on the resigna t ion of thenurse secretary (a pa id officer) , the execut ive commi t tee selected the nominee of Sir Henry Burdettas her successor . Last of a ll , the addresses of nursemembers were removed from the register , so tha tcommunicat ion between them became impossib le .In July , 1 897 , at the annua l meet ing, protests weremade . Mrs . Fenw ick , in a masterly address , reviewedthe whole si tuat ion . Miss Clara Lee voiced the indignation of I rish nurses . A number of Matronshad appealed to publ i c opinion through the pressand then , there being nothing el se to do , resigned .

The Royal Bri tish Nurses’Associat ion has never fu l lyrecovered from the d isas ters of that period , yet , in


1 904 , aswe shall see later , i t succeeded in throwi ng 03i ts oligarchy sufficiently to declare once more the princip le of registration for which it had originally stood .

The lesson of these events was laid to heart bythe nur sing leaders , and they determined to make afresh beginning , and to cal l into being organisat ionsof nurses on other l ines . Foremost among thesewas the Matrons’ Counci l of Great Bri tain andIreland

,founded in May , 1 894 . I ts founder and ,

unt il the t ime of her death , i ts pres ident , was MissI sla Stewart , whose gr eat part in nt rsing progresswe shal l here imperfectly indicate . Miss Stewartwas of an old Scotch family , and of a most gen ial ,mellow personal ity . She was trained at St . Thomas’sin 1 879 and , while there , was reported to Miss N ightingale as the most promising probationer of herclass . She was Sister of a ward for four years ,and then made a wi der reputat ion by her management of the Darenth Smallpox Camp wi thi ts thousand pat ients and large force of nurses . In1 887 , she was appointed Matron of St . Bartholomew’s , succeeding Mrs . Fenwi ck , and died at herpost of duty after twenty-four years of servi ce ,during which she stood forth as a strong tower inact ive fur therance of every progressive nursing movement . Mrs . Fenwick’s unf ail ing friend and loyalal ly , Miss Stewart carr ied on the training school withthe broad , altruisti c , cosmopol itan spir i t which marksSt . Bartholomew’s nurses wherever they go . Forceful and spiri ted , she never for a moment compromisedon any quest ion of pol icy , but boldly stood forth atevery turn of the struggle as a champion of democrat ic progress , ye t so genial was she that even her

Grea t Brita inand Ireland 53

pol i t ical enemies could not but be personal fri ends .While she l ived , the nursing school of St . Bartholomew’s stood for state regi strat ion , co-operat ionamongst nurses , profess ional emancipat ion , and thehighest standards . The react ionaries waited forher death , and then brought about a reversal of herpol icy which must have been long planned , so suddenly was i t sprung .

We lack space to speak of al l that the Matrons '

Counci l has done . I ts wi sdom inpract ical pol icieshas been shown by the way in which i t has placeditself on record , by resolutions , memorials , and re

quests , in every turn of publ ic events . I ts influencehas been fel t in every phase of nurs ing progress andi t has unf ail ingly stood forth as the defender of therights and opportunit ies of the great rank and fileof nurses . I ts aims have beenhigh , i t s pronouncements sound , and i t may long remain the most i av igora t ing power in English nursing aff airs . Oneof i ts seed-plant ings we must record , for i t i s l ikelyto flower in the near future : i n 1 903 the Matronsmade to the authori ties of Bedford Col lege for Womenthe first proposal looking toward higher educat ionfor nurses on professional li nes . Woul d that ourpages were long enough to do just ice to the manyvigorous personal it ies of the Matrons’ Counci l

,who

have shared in the upbui lding , labours , work and

p lay of that sp lendid body ! To Miss MargaretB reay , who was its honorary secretary during thetwelve most st renuous years of it s l i fe , -it s fighting period— speci al honour i s due. Her laboursbuil t up the Counci l . I ts members are widelyand wel l known. There is a model type of Engl i sh


nursewho leads the w orld by the balance of her soci alcharm ,

gi fts of cult i . e , and professional fibre , and sheshows to the best advantage when holding posi t ionas Matron or Sister , in the cheery wards of the homelike Engli sh hospi tals .When the Internat ional Counci l of Women met

i n London , i n 1 899 , the Matrons’ Counci l took an

active part in securing the inclusion of nursing inthe programme , x which gave the first opportuni tyfor an international gathering of nurses , and i t was atthe annual conference of the Matrons’ Counci l inthat year that Mrs . Bedf ord Fenwick moved thatsteps be taken to organise an International Counci lof Nurses . From her proposal grew the union ,which in ten years’ t ime embraced nurses of nearlyas many countries . “ I n 1 899 , also , the Engli sh Matrons began the format ion of training-school leagues

(alumna societ ies) . The first was the League ofSt . Bartholomew’s Hospi tal Cert ificated N urses ,founded by Miss Stewart . This was quickly followed by the League of St . John’s House N urses , theRoyal South Hants Nurses’ League , and others .Many of the leagues publish their own journals

,

maintaining them on a high plane of excellence .

The vision of a nat ional network of nurses’

societ ies , centring in one national commi t tee anda ffil iated wi th the International Council , had beenclear in the minds of Mrs . Fenwick and herco-workers for some t ime . The international con

‘ Reports, Interna t ional Council of Women, 1 899 . P rofessionalSect ion.

See R eports, Interna t iona l Council of Nu rses, Headqua rters and

L ib ra ry , 43 1 Oxford St reet, W . London.

Great Brita inand Ireland

st i tu t ion had been so devised as to encouragenational counci ls of self-governing nurses’ societ ies ,and in England Miss Stewart had held the honorary posi t ion which implied the internat ional idea .

This 5. rne year , 1 899 , saw the foundat ions la id,

when , in October , at the Matrons’ Counci l Mrs .

Fenwi ck moved that the executive committee actas a provi sional commit tee to consider the or

ganisat ion of a N at ional Counci l of Nurses . Thiswas done , and a draft const i tut ion was presentedthe next year , when Mrs . Fenwick made a plea on theneed of a strong socie ty of nu r ses founded on the const i tu t ional princi ple of representat ive government .In 1 904 , Miss Stewart , as honorary vice-presidentof the International Counci l of N urses , convened ameet ing of delegates of self-governi ng leagues and

societ ies to discuss organisat ion and internationalaffi l iat ion , and a provi sional committee was formedunt il the number of nurses represented shouldreach 3000 . I n 1 908 , the Nat ional Counci l ofNurses for Great B ri tain and Ireland was finally perfected wi th fif teen affil iated societ ies , and the offi

cers elected were : M rs . Bedford Fenwi ck , pres ident ;M i ss Chr i st ina Forrest , honorary treasurer , andMiss Beatri ce Cutler , honorary secretary . Thusthe chain was made complete from the indiv idualnurse to the international group .

We return to the work for regi stration . Unti l 1 902 ,

the Matrons’ Counci l had stood alone for this cause ,and then

,agree ing that the t ime for renewed effort

was at hand , their sub-committee , on Mrs . Fenw i ck’s

mot ion , organised and launched the State Socie ty forthe Regi strat ion of Nurses , composed of individual


members , in May , 1 902 , with M iss Louisa Stevenson, LL .D . of Edinburgh , as president . In 1 904 , thissociety secured the introduction of a Nurses ’ Regi stra t ionB il l into the House of Commons by Dr . Far

quharson, M .P and,at this point , the Royal British

N urses’Associat ion regained control of i ts mach ineryand entered the field wi th another and similar b i l l . Aperiod of high tension and act ivi ty now followed .

Through the instrumental i ty of the State Soci etyfor Registrat ion , a Select Committee of the Houseof Commons was appointed in 1 904

“ to considerthe expediency of providing for the Registra t ion ofNurses.

” Af ter taking evidence during two years ,th is committee reported to Parl iament as fol lowsYour Committee are agreed that i t i s desirable thata Register of Nurses shoul d be kep t by a CentralBody appointed by the State , and that while i t is notdes irable to prohib i t unregistered persons from nursing for gain , no person should be ent i tled to assumethe designat ion of ‘Registered Nurse ’whose name isnot upon the Register . ” Thirty-three persons , inall , gave evidence , fal l ing into the following l i sts

F or Reg istration Matrons and nurses 1 1

Medical men 9

Lay persons 3

Against Reg i stration Matrons and nurses 1

Medical men 2

4

1

2

Lay personsNeu tra l onRegi stration Medical men

Lay persons

3 3x

B lue B ook, R eport from the Select Commit tee onRegist ra tionof Nu rses," 1 904 . House of Commons Papers.


l u mim Su w ns v-n. l . l I ) Sw at la w l

1 i t P 1 0 P“ Sw a n i n : S 'l’l' Rw u

‘m'

i w u I T r t o m l Nu t -i

Grea t Bri ta inand Ireland

Thus , nursing opposi t ion was reduced to one sol itary figure , the Matron of the London Hospital , and ,i t must be remembered , had i t been but one generat ion earl ier , hers wou ld have been the prevai l ingpoint of view .

Whils t the Select Commit tee were s i tt ing , a newcounter-attack was planned , which is known as TheCity Financiers ’Scheme .

” Briefly , i t was an attemptmade by seven financiers of London to obtain fromthe Board of Trade a l icence to form a socie ty to becalled “ The Incorporated Socie ty f0 ' Promoting theHigher Educat ion of Nurses . ” N0 comment isnecessary . Some of our old acquainta nces were behindthis , and only a gift of divination akin to

“ seconds ight ” possessed by Mrs . Fenw i ck , and her promptcal l to arms through the B r i ti sh J ournal of N ursingsaved Brit ish nurses from another defeat .After tne Select Committee had reported , a depu

ta t ionof nurses was received by the President of thePrivy Counci l , the Earl of Crewe , who stated hisopinion that the nur ses’ quest ion was one of nat ionalimportance ; that nur ses shoul d have place on thecentral body set up under any Act , and that i tcou ld not be long before the subjec t occupied theserious attention of Parl iament . In a second deputa t ion of antis ,

"the representat ive of the Central

Hospi tal Counci l for London off ered as an al ternativethe publ ication of an Offic i a l Di rectory , showingsimp ly wha t experienc e nurses had had . Furthercomment on this is also needless . But th is project ,really a negation of all previous ant i ” arguments ,sudd enly , in March , 1 908 , appeared as a bil l beforeParl iament . No publ i ci ty whatever had been given


to i t ; nur ses were absolutel y unsuspicious of anya t tack from the rea r . Two lines , only , in a da i lypaper, saying that a bi ll to provide for an officialdi rectory of nurses had been introduced into the

House of Lords on the 1 8th of March by Lord Balf ourof Bur leigh , might well have escaped not ice , butfortunately did not escape Mrs . Bedford Fenwi ck 'svigi lant eagle eye . Again an instantaneous alarmwas sent forth for nurses to ral ly . But at that t imethey had no champion in the House of Lords . Mrs .Fenwick then appea led to Lord Ampthi ll , who , becoming keenl y convinced of the just ice of theirclaims , consented to take up for them the weaponswhich he has loyally used in their defence from thatt ime on . The facts and arguments were given him ,

and , supported by the Marquess of Lansdowne , hepressed the b il l to defeat . So once more a sma llgroup of women , with no resource but brains andbel ief in the j ust ice of their cause , no mot ive but asense of duty to their profession , defended themselvesagains t a powerful group of men both in and out ofParl iament , and a measure intended for the sub ju

gat ionof nurses and the injury of State registrat ionwas the occasion for one of their greatest victories .Pressing home his advantage , Lord Ampthi l l succeeded, in the session of 1 908 , in passing the Nurses

’

Registrat ion Act successful ly through the House ofLords , but i t fail ed to get t ime for considerat ion inthe House of Commons .The year 1 909 was a notable one , as i t saw the consolidat ion of the State regi stration movement . T he

Royal British Nur ses’ Association , as we have seen ,had againdecl ared i tself ; a bi l l to provide for regi s

Great Bri ta inand Ireland 59

tra t ion in Scotland had been introduced in 1 909the I rish and Scotch nurses ' associat ions were firmsupporters of regi stration ; the F e ver Nurses’ Associa t ion supported it , and the Bri t ish Medi cal Associ at ionhad three t imes passed affirmat ive resolut ions .Mrs . Fenwick suggested that i f all the motive powerof these diff erent societies cou ld be concentrated insupport of one bill , real progr essmigh t be made . Aconf erence was therefore cal l ed by a conjoint let tersigned on behal f of the Soci ety for Sta te Registrat ionby Lord Ampthi ll and the R i ght Hon . R . C . MunroFerguson , M .P . by Mr . Findlay , M .P . , for the RoyalBri t ish Nurses , and by Lord Inverclyde and Mr .Cleland , M .P for the Associat ion for Promotingthe Regi strat ion of Nurses in Scotland . The emiuent ly sat isfactory resul t of this conf erence w as ana greement to draw up one bil l whi ch shoul d haveunanimous support . M rs. Fenw i ck’s motion “ thatthe princi ple of formi ng a standing centra l committeefor the State regis trat ion of nurses be endorsed , thecommittee to be formed of delegates of societ iessupport ing the movement ,

" was accepted and thecommi t tee was formed , uni t ing and harmonis ing a l lregistrat ion workers under the chairmanship of LordAmpthi l l , wi th Dr . Goodal l and Mrs . Fenwick as

honorary secretaries . I t i s thi s representative andinfluent ial committee , and the impor tant societ ies i trepresents , which are promot ing the unified b ill incharge of the Right Hon . R . C . Munro Ferguson ,M .P . , l -

‘

ld here we leave them to the ir fortunes . Thereare those who bel ieve that no woman ’s b il l w il l seemimportant to the House of Commons until women arefu lly enfranchised , but that day cannot be far 06 .


One fact stands out instrong rel ief throughout a llthe hi story of the organisat ion of nur sing in England ,namely , that the opposi t ion is to any form of legalstatus for trained nurses founded on the principle ofsel f-government , and not to registrat ion per se. Thisis ev ident from the proposal of the Hospi tals’ Association to found a regi ster of trained nurses ; thescheme of city financiers to make and maintain aregi ster of persons to whom cert ificates of proficiency ,or of train ing and proficiency , had been granted bytheir lay society , and by the proposal of the CentralHospital Counci l for London to found an offi cial d irectory of nur ses . In each of these cases the registerwould have been control led by the nurses’ employers ,but employers have hot ly opposed the establ ishmentof any form of registra t ion in connection with whichprovis ion was made for any degree of self-government by the nurses themse lves . This was the roo tof the bi tter opposition to the Bri t ish Nurses

’ Associat ion on its foundation , and is behind the O pposit ion of the Central Hospital Counci l for Londonto the nurses’ registrat ion bil l in Parl iament . I ti s the determinat ion of the emp loyer to prevent cooperation amongst the employed . I t says much forthe cou rage , determinat ion , and pluck of the womenwho are in the van of this fight and who have helda watching brief for the profession for al l these years .that they have persistently and successful ly fough tal l proposals for the government of the nursing profession which d id not provide for the adequaterepresentation of the nurses themselves or theirgovern ing body , and that , despite intimidationand insul t , many of the p ioneers of reform are


s t il l to be found working steadfastly for the'

des iredend .

In no other count ry have trained nurses in theirwork for legal status had to contend for so manyyears with the misrepresen t at ions and host i l i ty of thenon-professionally interested nursing press . I f thestory of the struggle for nursing organisat ion inthe Uni ted Kingdom serves as a lesson to the nursesof other nations in showing them wher e their strengthand weakness l ie , the quarters from which opposi t ionwill inevi tably arise , and the tenaci ty of purpose ,courage , and self-sacrifice needed by those who takethe work of women’s organisat ion in hand , th ischapter of nursing history wi l l not have been wri ttenin vain .

On the 1 3 th of August , 1 9 1 0, the long and wonderfu l l i fe of M i ss N ightingale came to an end . By herexpress wish she was buried in the l i ttle churchyardat East Wellow

,Hampshire , w i th her pa rents, while

a whole world paid her homage .

Scotland .— Unl ike England , the hospi tals in Scot

land cannot trace their origin back to monast ict imes . During the Middle Ages the convents , andthose establ ishments connected wi th them , wereoccasional ly employed for the d ispensing of medicines and the recept ion of the sick , bu t at the timeof the Reformation the rel i gious houses were sweptaway , and i t was some t ime before the modernhosp i tals and infirmaries took thei r place . Theoldes t of the great hospi tals in Scotland i s theRoyal Infirmary of Edinburgh , which was onlyOpened in 1 72 9 , though school s of medi cine and


di spensari es for the sick poor flourished long beforethat date . We can trace the incept ion of the firstScott ish hospital in an ear ly history of the Ed inburgh Royal Infi rmary , from which the followingquotation i s taken :

The Royal College of Physicians had attended formany years at the ir turns twice a week at the ir Hal l togive advice to the poor gratis , yet they have very oftenhad the mort ifica t ion to see their advice and rsedicines

prove unsuccessful , by the ir patients not having duecare taken of them , and by their want of proper dietand lodging.

The interest of the publi c having been arousedand sufficient funds collected , a house near the collegew as taken and fit ted up for an infirma ry .

“W hi leth is was being done , they agreed w i th a Gentlewomanto be Mistress or Housekeeper , and allowed her tohi re a servant or nurse for the Patients , both (bes ides having reasonable wages) to be entertained inthe Infirmary .

” The “ reasonable w age ” we find tohave been £4 , increased to £5 for the next Matron .

The name of the gentlewoman engaged has beenhanded down in the minutes as Mrs . N esbi t t ; unfortunately , her l if e as a Matron was a shor t one ; shewas discovered to be gui l ty of great extravagancy ”

and dismissed for “ charging more than she gave thepat ients . "

I t i s interest ing to no te th' inventory w hich the

next Matron , M rs . VVa ldie, took over from Mrs . Nes

bi t t : “The furni ture was del ivered to her conformeto Inventory , w i th 4k? lbs . of small candles , 1 lb .

great candle , containing seven . about 2 carts of



one ch il d dependent on her , for soon after comingshe brought her daughter into the house withoutpermission ; and the greater part of her t ime she wasin monetary diff i cult ies , not being able to meet herown and her daughter’s expenditure out of her smallsalary . The £5 sterl ing had been increased in hersecond year in office to £ 1 00 Scots , i .e. , £8 : 6 : 8 (onewonders why in 1 734 her salary should have beenexpressed in the Scotch currency , which went out ofuse in 1 707 ) Mrs . Waldie remained at her post abouttwelve years , and res igned on account of the infirmit ies of old age . I n seeking a new Matron , themanagers stipulated that she shoul d be a personcompet ent to keep accounts , and they also added tothe infirmary regul at ions a rule to the eff ect that al lemployees should be free from the care of ch ildrenor persons depending on them .

The temporary hospital w as replaced by the oldRoyal Infirmary in 1 73 8 . W i th true Scott ish foresight , i t was planned to accommodate 2 2 8 beds ,though for many years the funds only allowed of fortybeing occup ied . The build ing was a national workfunds were raised al l over the country ; those who wereunable to give money contri buted in kind— t imber ,s tone , l ime , etc . , or gave their labour as stonemasons ,carters , etc . , for so many days .In the earl iest rules , publ ished in 1 749 , we find

mention made of the nurses . There are rules forthe "Matron or Governess ,

” the “ ordinary nurses ”

and the supernumerary nurses . The whol e staffi s quaintly named the fami ly ” in al l the old records .T he

“ ordinary nurses ” were evidently the wardnurses , one in each ward , and the supernumerary

Grea t Brita inand Ireland

nur ses were for those patients who requi red constant attent ion— night as wel l as day- and patients’

friends were el igible to L e thus emp loyed , with thepermission of the physicians . No ment ion is madeof n ight nurses , and i t is probable that the averagepat ient was not supposed to require nurs ing duringthe night .The great princi ples which Miss N ight ingale

laid down as the groundwork of nursing many yearslater were not ent irely unknown, for we find greatstress is put on the necess ity of fresh air and goodvent il at ion . Frequent references to the nur ses occuri n the early reports , and they appear , on the whole ,to have sat isfied the standards of the day . In 1 7 7 7

the “ cares of the Matron , the a ssidui ty of the ordinary nur ses , and the assistance of others when theurgency of the part icular cases requi res them , theat tent ion to the admission of externa l air ,

”are enum

era ted among the circumstances “which conspire toproduce the best resul ts . "

A hi story of the hospital publ ished at thi s dateincludes some very expli ci t and amusing inst ructionsto young physici ans , concludi ng wi th the fol lowingadvice :

There is st ill a ci rcumstance wh ich , however trivial itmay appear to some , is not unworthy the attent ion of ahosp ital physician : that is , t o learn the disposit ions ofthe diff erent nurses . Wh ile one, from a natura l impat ience, canhardl y tolerate the cap rice of pat ients , whosebodies as well as minds are debil itated by the force ofdisease ; another , too sympathising , may be d isposed topall iate fau lts of patients wh ich ought to be reported tothe physicianor surgeon . The physician by attending


to these d iff erences wil l j udge better how to regu late hisconduct .

As t ime passed , the need of stri cter discipl ine inthe household made itself felt , and from the earlyfort ies in the last century , the managers had constant ly under considerat ion the improvement of thenursing department . They increased the wages (froman old h istory , we learn that , in 1 83 2 , day nursesreceived 1 7 : and night nurses 1 5 : per month)and added to the comfort of the nurses (the cont ributors remarki ng on the increased consumptionof groceries , especially of tea , are told i t i s due tothis cause) . Stricter d iscip l ine was exercised andthe Matron was rel ieved of the duty of superintending the nurses , a new off i cial ,

“ the Superintendent ofN urses ,

” being introduced ; thi s off i cial was not ,however , herse lf a nurse , nei ther does she appear tohave been a person of educat ion and refinement , andi t is not surpris ing to find the managers soon againconsidering how to improve the nurs ing department ,while the new offi cial’s name disappeared from thereport . In 1 87 1 , the first medical superintendent ,Surgeon-Major Charles H . Fasson , drew up for themanagers a report on the whole nursing arrangements , and after much consu l tat ion wi th theN ight ingale Fund Committee in London , MissBarclay , the first trained Lady Superintendent ofNurses , was appointed and came with a party ofnurses from St . Thomas ’s (st il l remembered as theN ight ingales to remodel the nurs ing departmenton the most approved system .

There was an awakening in most of the Scott ishhospitals inthe early sevent ies ; the Royal Infi rmary ,


Glasgow , was some yea rs later in adopting the newsystem , but the Western I nfirmary , established in1 874 , started wi th a training school for nurses . I nDundee , act ing on the advice of their medical superintendent , Dr . Robert Sinclair , the managers decidedin 1 873 to introduce the

“ training-school system .

Dr . Sinclair had drawnup a very ful l report in whichhe classified the nur sing systems into : ( 1 ) The FreeServ ice System ; (2 ) Nursing by Sisterhoods ; (3 )The Training Establi shment System . He drewspecial attention to the bad system of ni ght nurs ingthen in vogue , i .e. , permanent night nurses , whocombined the work of scrubbers and watchers , andwere selected not as being capable , but because theywere will ing to attempt an amount of arduous labournot expected of any other class of women at a s imilarrate of remunerat ion .

The managers of the Dundee Infirmary advert isedfor a Matron , st ipul at ing that

“ applicants musthave had a regular nur sing training , and be ful lyable to superintend and train nurses . ” On December 3 1 , 1 873 , Mrs . Rebecca Strong , who laterbecame so well known as a leader in Glasgow trainingschools , was appointed . I t should not be forgottenthat the Dundee managers were able to start thetraining school through the benefaction of a lady ,Miss Jessie G raham of K inca ldrum, who left a largesum , the

“Miss Jessie Graham Nur sing Fund ,” for

the purpose of improving the nursing arrangementsof the infirmary . Mrs . Strong remained in Dundeeunt il 1 879 , and during her tenure of offi ce she t e

formed the nur s ing department and introduced themodern system .

!ANSI and ISO TEST CHART No 2 )

4 L6


The only hospi tal in Scotland which was nursedby a rel igious body was the Perth Infirmary , wherethe nursing was undertaken by the Protestan t Evan

gel ica l Deaconesses of the Tottenham Green Hospi ta l .This body , founded by Dr . M ichael L aseron, wasmodel led on the l ines of Kaiserswerth ; the Sisters ,when trained , were sent to work in al l parts of thecountry , but remained under the central authori ty .

N ine Sisters were sent to Perth in 1 872 on the appl ica tion of Dr . St irl ing , a lead ing physician in thetown who took a deep interest in the hosp i tal . Thei rwork is said to have been excellent . They were al lladies and had had some training ; they did the nursing themselves and did not train probationers . Aftera l it tle , frict ion arose between the managers and Dr .L aseron, the former disapproving of an imper i uminimper io, and in 1 877 Dr . L aserontook the occasionof a demand being made for nurses to go out to theRusso-Turkish war to withdraw most of the Sisters ;the managers first advert ised for probationers ,but found the dual system did not work , andthey then made fresh arrangements and appointedM iss Logan , trained at the Royal Infirmary , Ed inburgh , as Matron . She is general ly supposed tohave been taken as h is model by the poet Henleyfor the “ Staff Nurse , New Style ,

” in h is hospi talpoems .Henley , who was himsel f a patien t for many

weeks in the old Royal Infirmary , Edinburgh , hasleft us a picture of M rs . Janet Porter , a fine specimen oi the o ld schoo l ; she was employed for fortyseven years a t the infi rmary , and died at her postin 1 890.



We cannot gain a bet ter idea of the work of thenurses of those days than by quot ing from Dr .Sinclair ’s report

As a general rule , a large and small ward are allottedto a day and nigh t nurse , w ho have charge of abou t th irtypatients when their wards are ful l . The day nurses areonduty from 7 A . M . , till 1 0 P .M . The night nurses from1 0 P .M . , til l nea r ly 3 P . M . the following day . Each isallowed four hours’ leav e of absence once a week , andtime to attend morning and afternoon service everyalternate Sunday . In the morning they sweep and dusttheir wards , ward furni ture , scu lleries , water-closets ,and bathrooms ; they clean su ch patients as are unableto do so themselves ;make the beds , clean u tensils , changepoultices , and the other dressings entrusted to them. Ineach division under the charge of a day and nigh t nursethere are usually six firep laces , which , when in operation ,have to be cleaned by the night nurses . Each nightnurse has to keep a fl ight of stairs clean , to wash pou l ticecloths , and , in the surgical wards , to wash bandages .In the midst of themorning work , the nurses and patientsbreakfast . The serving up and par tak ing of this meal ,foll owed by the wash ing of dishes , occupies a considerabletime . The day nurses are expected to be neatly dressedevery morning before 1 0 o

’clock , when the medical visitbegins .

The Royal Infirmary , Glasgow , dates from the

end of the 1 8 th century . An early history of theinfirmary by Dr . Moses Steven Buchanan publishedin 1 83 2 i s of great in terest , and enters in detai l in tothe management of the hospital and the conduct ofthe medi ca l school . Mention is made of the Matron

I need not inform any of my readers that on no

Great Bri ta inand Ireland

servant does the wel fare of the establishment so muchdepend as on the Matron , and most fortunately i t hashappened that in no period of the h istory wh ich I haveinvestigated has there been a single faul t laid to thecharge of this department . On the contrary, I have seeneverything to commend . Little family diff erencesthere are occasionally, among so many young professional clerks ; and much good sense and forbearance , Idoubt not , often requi red on the part of the Matron .

The names of the Matrons from the openi ng are

preserved .

A very interest ing reli c exists in the form of a tombstone erected i h the grounds to a former Matron ,Mrs . Lyle . She married the secretary , a M r . RobertLamond , and di ed within two months (Jul y ,The inscri pt ion on the stone commences :

T o commemoratethe virtues and serv i ces

of a Matron of the Royal Infirmary .

This stone has been erected with the permission oftheManagers by onewho loved her andmourns her death .

and a long eu logy of Mrs . Lyle follows . Needlessto say she was buried elsewhere .The Royal Infirmary d id not adopt the training

schoo l system of nursing very early . Mrs . Strong ,who came from Dundee , was the fir st trained Matronand she was appointed in 1 879 . Lectures to thenurses were commenced in 1 878 by Dr . J . W . Anderson and Mr . W . G . Fleming , but no systemat i ctrain ing was attempted before Mrs . Strong’s t ime .Miss Barclay , the fi rst trained superintenden t of

nurses in Scotland , remained less than a year a t the


Royal Infirmary , Edinburgh , and , reti ri ng on accountof her heal th , was succeeded by M i ss A . L . Pringle .To Miss Pringle and her assistant and successor , MissSpencer

,are due the credi t of making the Edinburgh

school of nursing what i t i s to-day . These twoladies were

,between them , for thirty-four years in

charge of i ts fortunes . M iss Pringle at the t ime ofher appointment was st i l l under thirty years of age ,but she had already dist ingui shed herself by the

qual i t ies which earned her the name of“ the l i ttle

general ” i n the accident ward of St . Thomas’sHospital (Old Surrey Gardens) , and she brough t theenthusiasm of a reformer to her task . In 1 887 she

returned to St . Tbemas’s to succeed Mrs . Wardroper ,

and Miss F . E . Spencer followed her in Edinburgh .

The three years’ standard of training was adopted inthe eight ies , and i t has recently been changed to fouryears . The present Royal Infirmary was opened in1 879 , and in 1 892 the new Nurses

’ Home was added .

Th i s home was very much in advance of others ofthat period , and has serv ed as a model to manyhospitals . From the commencement , many medicalmen were warm friends of the new movement , andthe name of Dr . Joseph Bel l , the well-known surgeon ,wil l always be associated with the early days of theschool . He was the first lecturer to the nurses , andwhi le on the staff he held a cl inic for them in hiswards every Sunday morning . He was interestedin everything that aff ected the nurses and was agreat help to the authori t ies in carrying out reforms .I t may truly be said that the development of modernnurs ing in Edinburgh owes much to Dr . Bel l .In 1 9 1 2 the Royal Infirmary is a training school



w i th a staff of 2 70 nurses and over 900 beds . Thereis a board of d irect ion of the educat ion and examinat ion of nurses , and instruction , by meansof lectures and classes , i s given in medical , surgical and gynecological nursing , hygiene , anatomyand physiology , materia medica , pharmacy , bandag ing , instruments , and s ickroom cookery , eachcourse of lectures being followed by an examinat ion .

Candidates must pass an examinat ion in anatomy and physiology on entering , and a fur ther prel iminary examinat ion on the exp iration of the threetrial months , and before signing their agreement .The Royal Infirmary , Glasgow , is the only Scot t ish

hospital which has inst i tuted a prel iminary train ingschool . Mrs . Strong stated in her paper for theCongress of Nurses held in Buff alo , 1 901 , that Professor ‘ Macewen of Glasgow Universi ty was the firstto suggest to her the possibil i ty of an organised uniform method for the technical instruct ion of nursesbefore entering hospital , and she inst i tuted thescheme in 1 893 . The class work is i n connect ionwi th St . Mungo’s College , Glasgow . The t ime oftraining occupies three months . The pupils provideboard and lodging at their own expense , and theyalso pay class fees . The scheme excludes al l c lasswork during the three years of training .

2 Recentlythe training has been lengthened to four years , anda final examination insti t uted .

The Western Infirmary , Glasg i w , i s a moderninsti tut ion , and the training of nurses was kep t inview from the begi nning of the infirmary in 1 874 ;

Now Sir William.

‘ See Transa rt ions, I nt . Congress of Nu rses, B uff a lo, 1 90 1 .


in the following year the regular cour se of trainingwas started . The managers , together with themembers of the medical and surgical staff , unanimously agreed that nothing less than a period ofthree years coul d be entertained as adequate .Lectures and demonstrat ions were given and casesapport ioned to be reported by the nurses , and at theend of the three years , an examination was held .

Miss Clyde was then Matron . Dr . Mackintosh ,the well-known hospi tal expert , became medicalsuperi ntendent in 1 892 . Since then the trainingschool has made rapid progress , and , in 1 898 , theperiod of training was extended to four years . Atpresen t the courses of lectures on medical and sur

gi ca l nursing are given by members of the medi caland surgi cal s taff , Matron and Assistant Matrons .One of the medical e lectri cians lectures on X-rayand medical electri ci ty , and cookery and massageare taught by trained , cert ificated teachers . Aprelimi nary examination is given before the threemonths’ term of probation expires , a junior ex amination towards the end of the fir s t year , and a finalexami nat ion on the completion of three years’ servi ce .Examinations are divided into written , oral , and

practical ; marks are given for ward work , generalconduct , etc . , and nurses must gain an average of atleast s ixty-five per cent . of the total number of marksin each department before obtaining a pass-cert ificate . The cert ificate is granted on the complet ionof four years’ service .

Unti l the year 1 877 there was no trained nurs ingin the modern sense of the word in the North ofScotland . In Aberdeen , the old Royal Infirmary was



Katharine Lumsden , succeeded her as honorarysuperintendent at the Children ’s Hosp ital , where shegave her servi ces for sixteen years .The “ lady probat ioner ” was never a feature of

Scott ish hospi tal l ife , and the schools are genuinelydemocrati c , candidates , provided they are wel leducated and have natural refinement , being acceptedfrom all ranks and classes of society , and nurses aresalaried from the commencement of train ing . Noneof the hosp i tals has private nursing inst itut ionsa ttached . The hospi tals are essent ially train ingschools , and , when qual ified , the pupi l goes out tomake her own way . There are many co-operationsof nurses in the country , and one or two inst i tut ionsst i l l survive which were establ ished inearly days totrain and send ou t private nur ses .Nursing under the L oca l Government B oa rd .

Trained sick nursing was introduced into the Scott i shpoorhouses about 1 885 , and the Local GovernmentBoard (Scotland) have kept a regi ster of Poor Lawnurses since that date . At present , in some of thehosp i tals fully-trained nurses alone are employed ,while , in others , training schools for nurses are establ ished . I n 1 907 , the board inst i tuted a scheme for theexaminat ion and cer tificat ion of trained sick nurses ,which has tended to raise the standard and improvethe training in the poorhouse hospitals . I n Glasgow,

a trained nurse from one of the general infirmar ieswas first appointed to take charge of the hospi tal inParl iamentary Road in 1 89 1 , and she was granted as taff of eight trained nurses ; by the year 1 903 , thestaff of nurses and probat ioners had risen to betweenfifty and sixty . The training of probat ioners in that


inst i tut ion commenced in 1 892 . Lectures weregiven by the medical staff for several months in theyear , and the period of training was for two years .In 1 894 , the Parochial Board of Glasgow CityParish agreed , a t the request of the nurses themselves , that the period of training should be extended to three years , and a cert ificate bearing thename of the hospital was granted on the complet ionof training .

There are now several large poorhouse hospital sunder the Glasgow Parochial Board and al l havetraining schools attached , where an excellent trainingi s given . Since M ay , 1 907 , al l qual ifying examinat ions are conducted by the Local Government Board ,under their scheme . A candidate must pass a preliminary examinat ion in general educat ion , unlessshe holds the leaving cert ificate from school . L ect o

ures are given by the medical staff and the Matronfor seven months each year , and embrace the usualsubjects , plus midwi fery . The ful l course of trainingis three years . At the end of two years , a nurse whohas passed in two subjects in the Local Governmen tBoard examinat ion , and has been sat isfactory inher work , i s entered as a tra ined nurse on the rol l ofthe board ; but she cannot receive the special cert ificate unt i l after passing her examination in the foursubjects and complet ing three years ’ training . Outside Glasgow , a few only of the poorhouse hospitalsattempt to train probationers ; the others— includingthose in Edinburgh—employ only trained nurses ,who must be qual ified for the L . G . B . rol l .The erect ion of separate hospitals for fever patient s

i s of recent date in Scotland . Formerly al l fever


cases were treated in the gener al infirmari es, —withthe except ion of pauper cases , which were sent to thefever wards of the poorhouses . Glasgow was thefirs t ci ty where the Town Counci l undertook the dutyof dealing with infect ious di seases , and in the sixt ie s ” a fever hosp ital was opened in Parl iamenta ry Road . Shortly after , the Belvidere estate wasbought and a hosp ital of wooden pavil ions erected ,

these being gradually replaced by the fine modernbui ldings consti tw ‘ ing the present Ci ty of GlasgowFever Hospital . I n connection wi th fever nursingM rs . Sinclair ’s name stands out prominently as thepioneer in Scotland in this branch of nursing . Shewas herse lf trained in L iverpool , and , after some ex

perience in charge of the fever wards at Barnh il lpoorhouse , she became Matron of Belvi dere in 1 875 ,and remained in off i ce for thir ty years . She foundthe condi t ions for nurses much the same a s thosei n the general infirmaries a few years earl ier , bu tthe nurses were of an even lower class , for servi cein a fever hospi tal w as regarded as a dangerousduty .

Mrs . Sinclair had a very uphi ll task ,— al l reformscost money , and expend iture had to be kept as lowas possible ; but she was unwearying , and after yearsof persisten t appl ication accompl ished al l she desired .

She began by introducing probationers , and soona ttracted a better class of women to train , who helpedby their example to stamp out the old abuses . Shenext improved the cond it ions for the nurses , and bydegrees got proper accommodat ion , and raised thegeneral s tandard of l iv ing . She was greatly helpedby the medical superintendent , Dr . Allan , who i a



pensary system and visi t ing the pat ients in theirown houses . The “Edinburgh system " of d is

pensary work has gained a European fame . Manyforeigners visi t the inst i tution .

Al enla l N ursing — Hospi tal trained nurses werefirst appointed as Matrons in asylums about theyear 1 894 , when M i ss Berwick was appointed to

M urthly and M i ss Irvine to the Dundee RoyalAsylum ; both these ladies had previously held postsas Sisters in general hospi tals . At the present datethere is scarcely an asylum in Scot land in which theMatron is not a trained nurse . In most of the largerones the Assistant Matrons (to the number of sixor seven ) , as wel l as the nurses in charge of thema le and female hospi tals , have also received generaltraining . Dr . Robertson , formerly med ica l superintendent at Larbert and at presen t at the RoyalAsylum , Edinburgh , has been one of the most act iveadvocates of general-trained nurses in asylums , andfor many years he has employed them in increasingnumbers . Hospital-trained Sisters at the head of

mental wards have prov ed a grea t benefit to nu rsesand pat ients al ike , and better d iscipl ine and superiornurs ing have fol lowed on rel iable supervision . Thestatus and training of the asylum attendants haveimproved of late years . They a re encouraged to

become w el l instructed and compe tent in the i r ownbranch of nursing , and the majori ty enter for the.examinat ion o f the Medico-Psychological Associat ion . Many later complete their training in generalhosp i tals .Al idw z

'

f erv— There are severa l good centres forobstetrical tra in ing in Scotland . W i th the excep t ion


of Dundee , none of the voluntary hospitals hasmaternity wards attached , and nurses must take thecourse at special hospitals . The training is on thesame l ines as in England , and pup i ls are prepared forthe examinat ions of the Central M idwives’ Board

,

but as the Midwives ' Act of 1 902 does not apply toScotland , they have to go to England for examinat ion . A t the t ime the act w as framed , medical mendid not see the need for such a measure , and opposedi t be ing extended to Scot land . Since then , medicalOp in ion has changed, and i t i s probable that whenthe new act is framed , Scotland wil l be included .

N ur sing organisat ion is s t i ll in i ts infancy north ofthe Tweed . The Royal Bri t ish Nurses

' Associationnever received wide recognit ion in Scot land , and i t i sonly s ince 1 907 that the movement for state registra t ion of nurses has found anything l ike generalsupport , though there is now a growing feel ing ini ts favour , and two Scott ish Associat ions are represented on the Central Committee for the State R e

g istra t ionof Nurses in London . The apathy in thepast was probably due to there being few pressinggrievances , and Scott ish nurses were slow to recogn isethe benefits of registrat ion . The cond i t ions of workhave been good , and the field not ye t over-crowded ,nor exp loi ted to any great extent by the untrained orpart ial ly-trained nurse . Nurses have been chieflydrawn from a few large hospitals of recognised excel lence, and th is together wi th the early and general accep tance of the three-years’ s tandard has

g iven them a good professional status .Since the beginning of the presen t century many

deve lopments have taken place . We see small loca l


hospi tals mul tiplyi ng in a ll di rect ions , and the speci alhospita l s increasing in importance , and , in order toimprove their status and attract probationers , theyoff er training and grant cert ificates . The Loca lGovernment Board has inst i tuted examinations andcert ificates for fever nurses ; the asylums are anxiousto improve their standards , and they prepare thei rnurses for the exami nat ions of the Medi co-Psychological Associat ion . Each is strivi ng after excellencein i ts own branch . But the resul t for the publ ic isvery confusing ; without any fixed standard , i t i s impossible for them to appreciate the true value of thevarious train ings , and there is no authori tat ive defini t ionof the term trained nurse " to guide themThe need of a central controlling expert body is

gradual ly making i tself widely felt , and the principleof state regi strat ion is becoming generally accepted .

I reland .-The tradit ion of Irish hospi tals and nurs

ing extends far back , almost to prehistoric t imes . I nthe heroi c cycle of Finn and his Fianna , we read ofwarriors covered with wounds and glory being carri edback to the camp , where they were met by bands ofwomen , trained to nurse the wounded ; how thesetook charge of the wounded heroes , and how , after at ime , by the ski l l of the physicians and the care ofthe women , who bu i l t them for battle once more ,

"

they were restored to health and vigour . In theB rehon laws we find d irect ions for the erect ion of hos

p i ta ls : A hospital was to be buil t by every campi t was to be opened to the North , the South , the Eas tand the West— there was always to be a stream ofrunning water flowing through the hospita l . "


‘


d i gn ified , almost human , personal ity . The portraitof i ts foundress , old Madam Steevens, who l ived ini t dur ing her l ifet ime , hangs upon the wall of theboard room , adding to the atmosphere of dist inct ionthat pervades i t . Mercer’s was founded in 1 734 ,

occupying the s i te of the old St . Stephen , and theRotunda and Sir Patri ck Dun’s fol lowed later .While up

-to-date wards , new operating rooms , andother modern requirements have been fitted on tothose of the Dubl in hospitals that were buil t a centuryago , they retain to a great extent their original aspectof great sol idi ty , beaut iful , old-fashioned architectural features wrought wi th cunning craftsmanship ,and a certain state l iness . The rich strong colours inwhich the ir immense corridors and wards , too , arepainted— Indian and Pompeian reds and deep warmblues and browns harmonising perfectly with theouter atmosphere— gi ve them a special character al ltheir own .

During the eighteenth and two thirds of the n ineteenth century , these and similar inst itut ions wereserved by untrained attendants of the “ SaireyGamp” type . So we read in the annals of hosp i tal s ofs t ipulat ions made by the governors or doctors that a l lnew attendants must in fu ture be able to read andwr i te ; numerous complaints , too , of drunkenness andcarelessness of the at tendants , of their washing thei rclothes in the wards , of their re fusal to wear washingdresses , of night attendants sleep ing at their postsoften in vacant beds in the wards , and so on.

Early in the nineteenth century , the rel igious ordersof Ireland resumed their hered itary work in nurs ing ,and have carried i t on wi th signal excellence and wi th

Great Bri ta inand Ireland

continuous progress in method and scope . In 1 82 9 ,

the penal laws by which Roman Cathol ics were forbidden to hold property , and by which they enduredmany other d isabil it ies , were repealed . Six yearslater , Mary Ai kenhead , foundress of the I ri sh Sistersof Chari ty , establ ished St . Vincent ’s Hospi tal inDubl in , the urgent need of such an inst i tut ion havingbeen made plain to her in the course of her ministrat ions amongst the sick and poor of the ci ty . A sumof money given to her by Sister M . O

'

F erra l l enabledher to buy one of the fine Georgian mansions in St .Stephen ’s Green , which had been the town res idenceO f the Earl Of Meath , and there Open a ward for twelvewomen . Before the end O f the year , two more wardswere ready . Then fol lowed one for men ; in 1 84 1

and 1 858 , st i l l others were Opened , the adjoiningmansion of the Earl Of Westmeath having beenacquired . After these came a laundry , mortuarychapel , patholog i cal laboratory , better accommodat ion for the medical and nurs ing staff , and in 1 909

a modern theatre , the beds then numbering morethan one hundred and fifty . The hospital i s a schoolof medicine and i t s pathological laboratory and

chi ldren’s ward were the first in the ci ty .

The nursing inst itute of the order dates as far backas the year 1 833 , when the far seeing foundress sentfour Sisters to the Hopital de la Pi t ié in Paris , wherethey underwent a course of instruct ion in the systemof nursing then in force . On their retu rn they devoted themselves to nursing the s ick in the wards andto instruct ing others in the pract ice O f nurs ing . I t

may therefore be said that the Sisters O f Chari tywere the pioneers in Ireland i n the movement per


fected by Miss N ight ingale , who had herself learntmuch from their or der in Paris . This system cont inned until 1 892 , when , owing to the increasingdemand on the part of the poor for admiss ion to thehosp ital , and the l imited number Of the Sisters engaged in nursing , they began the training-schoolwork to which we shall presently return .

The order of the Sisters of Mercy , founded inDubl in , in 1 83 1 , early attained bri l l iant p restige innursing . I ts foundress

,Mother Catherine M cAu ley

(born in 1 787 ; d ied in was a beaut i ful , benign,

and highly cultured woman Of grea t gifts for leadership . From this order went , in al l , s ixteen nuns tothe Crimean hospi tals , one or two of whom outl ivedMiss N ight ingale . The Sisters un ite the contemplat ive and the act ive l ife , and , though they take per

petua l vows , maintain a vivacious and unaff ectedintercourse w i th those of the lai ty to whom theirwork relates them . They must hav e had hospi taltraining at an early date , for they had ski lled nurseswhen the Crimean War broke out , and in that sameyear , 1 854 , we find them taking over the nursing inthe Jervis Street Hospital , while in 1 857 they assumedthat in the Mercy , of Cork , under Mother Joseph ineWard . I t was housed in a substant ial old mansion ,once the mayor’s res idence . I n the early years theSisters l ived in i t , but later had a small house giventhem for the ir own use .

In 1 867 , the Sisters of Chari ty again took up thethread of h istory , when four Sisters arrived in Corkto take charge O f the North Infirmary . Here therewas room for about sixty patients . The a ccommodation was very restri cted and the necessary equip

NCES L l BRARY


88 A H istory O f Nursing

is therefore proposed to establish , ona very small scale,a training insti tution for nurses , similar to those wh ichhave been found so successful in London and e lsewhere .I t i s intended to provide a house or lodging near thehosp i tal , capable Of accommodating the Lady Superintendent and e ight nurses .

The committee Of the training inst itut ion had a l

ready , a t the instance of the late Professor Haughton ,approached the governors of Sir Patrick Dun’s Hospi ta l with the request that the nurs ing in i ts wardsbe placed in charge Of the inst i tut ion . The governorsrefused the Off er on the ground that there was at thet ime no room to place at the d isposal of the ladysuper intenden t . In Febru ary , 1 866 , the commi t teeapproached the governors of Madam Steevens’s wi tha simi lar request . The appl icat ion was referred bythe governors to the medical officers for cons iderat ionand the fol lowing enl igh tened response was made

The medical off icers would be glad of the adoption ofany arrangement which wou ld improve the present stateof the nursing O f the hosp ita l , wh ich is most defectiveand discreditable to the insti tution . They w ou ld ac

cording ly do everyth ing in the ir power to promote thesuccess of the proposed p lan .

The governors then granted permission to the commi t tee of the insti tut ion to send nurses to the malesurgical ward . Hence the evolut ion Of the trainednurse in Madam Steevens’s dates from the year 1 866,at wh ich t ime the hospi tal had already been receivingpat ients for one hundred and thirty-three years . Inthe minutes during that t ime , one frequently meetswith entries re lating to the conduct of the nurses ,

I nSt . incent’

s Hosp ita l



cleanliness was to be considered , and here a good dealof prejudice had to be overcome ; some actually rebelledagainst having their faces and hands washed ; othersinsisted inrefusing sheets , and lying inblankets ; wh i le asturdy few obj ected to having the ir morning smoke inbed discontinued ; the razor and the scissors were pu tinto requ isi t ion , and before noon a comp lete metamorphosis had taken place. I t is refresh ing to see the unostenta tious qu iet way inwhich everyth ing was done ;no hurry, as migh t ha ve. been expected from beginnersany commands given by the surgeons were accurately andimmediately attended to ; infact , everything showed thatthe systemwas under j udie i 01 ' s management . A lthoughl ittle more than a week has passed since its commencement , a visible and real chang e for the better has takenplace ; and i t w as at once apparent that the fau lts underthe old rég ime were to be attri buted rather to ignoranceand want of direction than carelessness .

Unfortunately, though perhaps natural ly , thereseems to have been considerable and in creasing fri ct ion between the O ld and new systems— the resul tbeing that a t the end of about s ix mon ths the connect ionbetween Steevens’s and the Nurses ' TrainingInst i tute was terminated , and the nurs ing arrangements O f the hospi ta l appear to have returned verymuch to their former condi t ion . But before cont inning to trace the fortunes of the Inst i tute wewil l fol low the co t i rse of events in Steevens’s to

which i t had given direct ion . Though unable to

re tain i ts services , both governors and medica l officers grew more and more d issa tisfied after see in gi ts examp l e set , and many endeavours were made toin troduce order and system , e i ther by the appo in tment of su i table matrons or the framing of rules.


The medi cal staff seem to have had a clearer idea ofwhat was wrong than the governors , for in 1 8 78

they submi tted to the latter the following unusual lysensible report :

The defective state O f the nursing arrangements inthe hosp i tal has for a considerable time attracted theserious attention of the medical staff and has often beendiscussed by them . A lthough the more serious defectshave , from time to time , been remed i ed onapp l icationto the Matron , ye t the same i rregu lari ties have so f requently recurred that the medical committee have , withthe knowledge and concu rrence of the Matron , consideredi t their duty to consider the whole question of the nursinga rrangements and thei r relation to the other administ ra t ive d epartments of the hosp i tal . The committeefind that the nurses are reall y employed as such , andmany of them arevery eff i cient , and all of them appearwell intentioned and will ing to discharge their duties , bu tsome O f them seem unable to do all that should be doneas nurses . The wa rdma ids are supposed to do doubleduty as assistant nurses and scrubbers , wh ich the commi t tee considers a most undesirable arrangement . Theduties o f assistant nurse and scrubber are qu i te incoasistent with one another and should be discharged bydiff erent classes of persons .

Nearly a year later the governors appoin ted atrained nurse as lady superintenden t of nur ses , apost separate f rom that of Matron . T he lady theyselected was M iss Franks , a N igh tingale nurse , whocame d irect from St . Thomas ’s . She was placed incharge of the O ld nurses or at tendants of the hospi tal ,and in 1 880 was authori sed to engage a tra ined nurseas as sis tan t . During the three or more years that

9 2 A H istory O f Nursing

she remai ned at the Steevens’s, the training schoolthat she developed , in conjunction wi th a ladies

’

committee , was the first in which Roman Catholi clay nurses were trained— tak ing precedence of thoseestabl ished by Lady O ’

H agan i n England or theMarch ioness Of Bute in Scotland for train ing lay pupils of the Cathol ic religion . But st i ll the mach inerydid not run smoothly ; the lady superintendent waschanged several t imes , her rela tion in the Matronbeing one that i s always unsatisfactory ; or perhapsthe governors d id not care for the lad ies’ commit tee ,for in 1 890 a commit tee appointed to recommend amethod of remodell ing the nur sing service reported

that the time has come when the hosp ital shou ld or

ganise a training system of its own, prov iding aecommoda t ion on the premises for the probationers wh i letraining, and u ti li sing them , when trained , both in thehospi tal and in private nursing outside . The period of

training to be tw o years , one year as probationer and oneyear as assistant nurse ; examinations to be passed eachyear in practical and theoretical work ; a certificate ordiploma as a qual ified nurse to be granted on sa t isfac

tori ly passing the second examination .

Three years later the nursing w as s t il l not sat isfactory , being expensive and ineffi cient . T he lady

superintendent sent in her resignat ion , and Miss B .

M . Ke lly was elected to the pos t . Miss Kelly i s afascinating and capable woman of s trong personal i tyand great energy . Under her hand the school hasa ttained an important p lace and prestige . Beforetaking i t she had had the d ist inct ion of being chosenas the first secu lar Matron of a training school underrel igious Sis ters .



in 1 883 as Matron of the National Eye and Ear I nfirmary , and in 1 884 accepted the cal l to Dun

’s , whereshe worked without in termiss ion unt i l 1 902— inherownwords :

steady, p lodding hard work , no heroics of any sort , merelyconstant hard work . Before my advent there had beena M iss Johnston and a M iss Turner , both of whom , insome measure , prepared the ground for me . In thosenineteen years I had the honour O f t raining many excel lent women ,

w ho afte r w a rds worked invarious part sof the world . My gre rew ard has been their goodwork and their appreci a t ion of my method O f trainingthem at most all that canbe said is , I gave honestwork and ful l measure .

On leaving training-school work , Miss Huxley devoted herself to “ Elpis ,

” a private hospi ta l of themost peaceful and comforting excellence , with Mrs .Frances E . Manning , who had been trained at Dun

’s ,as her cO-w orker . Her successor in the hosp ital ,Miss Louisa V . Haugh ton , in i t iated the first prel iminary training course in Dubl in in 1 905 . I t i ss ix weeks long and has proved very sat isfactory .

Numerous other hospitals made place for themodern system and ideals in the late decades of thecentury . Two of the early I rish-born and I rishtrained Matrons were s isters , Ell inor and Bess ieLyons , trained at the Meath Hosp i tal , both of whomtook Matrons ' posts in 1 884 , Ell inor in her almamater and Bessie in the N at ional Children’s inDubl in . I n 1 888 , the Adelaide appoin ted a nurs ingcommit tee to bring about reforms , and as a resu l tof i t s act ivi ty a trained superintendent of nurses was


insta l led. In 1 888 , too , the al l ied hospitals R i chmond , Wh i tworth , and Hardwick set thei r house inorder under the vigorous management O f Miss AnnieM acDonnel l , who had been one of M iss Huxley

’sfirst pupils . Miss M acDonnel l

’

s career was long andhonourable . She served with d ist inct ion for twentyone years in her hospi tal post , leaving i t temporari lyfor the superintendency of the Ir ish hospi tal in theSouth African War . where she was decorated wi th theRoyal Red Cross . She has been one of the strongfigures in upbu ild ing work at home , as her sisterwas in I ndia . The training of those pioneers wasexcellent , of the kind that develops character , norw as the intellectual s ide lacking , for the most eminentof medical men poured out lavi shly for them al l thetreasures of their knowledge .The Rotunda Lying-I n, the most famous hospi tal

perhaps O f i ts kind , was founded in 1 745 , and unti l1 878 had the old style of nursing , yet not the wors tGamp type , for most of the women , though O fteni l li terate , were wel l-i ntentioned and many becamecareful and experienced nurses . To the tact andpatience of Dr . At thi l l , who was elected Master ofthe Rotunda in 1 878 , were due the ini t ial reforms .In his book , R ecol lections of an I ri sh Doctor , may befound entertaining detai ls of hi s reconstru ct ive work .

Finally , in 1 89 1 , a trained supe rintendent of nurseswas appo in ted , Miss Sara Hampson , who had beenone of the first group of N igh t ingale nurses traineda t St . Thomas ’s . She was an extremely able woman ,of wide general knowledge , to whom the reorgani

sation of the Rotunda on modern lines i s due . She

gradual ly introduced perfected methods , and as


vacancies occurred on the staff” l led themwi th nurses

having had general training in addit ion to midwifery .

Dublin has two other lying-in hosp i tals , theCoombe

,founded in 1 82 6, and the Nat ional Mater

ni ty ,dating from 1 894 . Both have midwifery

training schools .I t is imposs ible in a short account to trace the evo

lu t ionof modern nursing in all the hosp i tals in Dubl in .

But others were not far behind those described inOpening training inst i tut ions s imilar to the originalones so long associated wi th the name of Archb ishopTrench . The Red Cross Sisters , founded in 1 884 ,

nursed in the wards of the Meath and the NationalChildren’s hospi tals . I n 1 894 , the governors of theformer severed their connection with the Red CrossN urs ing Sisters , and their probationers now workone year in the National Children ’s and three in theGeneral Hospital , B irmingham . Similarly the Ci tyof Dubl in N ursing Inst i tut ion formerly suppl ied theCi ty of Dubl in and Mercer’s hosp i tals with nurses .The former d id not train i ts ownnurses unt i l 1 900,

nor the latter unti l February , 1 9 1 1 .

We return to take up more in detai l the training-school work O f the Cathol i c orders . This extension of the Sisters ’ labours forms a unique phasein their long history . I t brings them into close anddirect relat ion w i th the modern nurs ing movementand the scientifi c outlook O f modern medi z ine , kni tscommon interests be tween the convent Sister and theself-support ing nurse in the wor ld , and brings harmony , mutual interest , and regard where beforethere were w ide separat ion and comp lete absence ofacquaintanceship . Now , united by common labours ,



a peri od of at least two years in the wards ; and probat ioners. A trained Matron supervi ses the nursesby day and an assistant Matron by night . T he

training of probat ioners receives the stri ctes t attention . They serve for fixed periods under supervi sionin medical and surgical wards , as required by the

programme for state examination , receive pract icallessons in domest i c science as app l ied in the care ofthe sick , and attend regular courses Of lectu res onana t rmy , physiology , hygiene , med ical and surgicalnursing . Prel iminary and final examinations mustbe sat i sfactorily passed before they receive the cert ifiea te O f the inst i tute , the ent ire service last ingfour years .In 1 906 , a co-Operat ive bureau was Opened for those

nurses who , having comp le ted the ir ful l four years’

course , desired to remain connected wi th the hospi tal ,and the nurses have shown the ir appreciat ion Of

thi s advantage by join ing the co-Operat ive staff inlarge numbers .St . Vincent 's carr ies on an act ive social service

department in connect ion wi th its out-pat ient work .

Training schools were also c a ened by the Sistersof Chari ty in 1 892 in the Children

’s Hospital , Dubl in ,now in Temple Street , and in 1 895 in the N orthInfirmary in Cork with Sister Angela as Matron .

The former has had a stirring h"story of perseveringgrowth since i ts foundation in 1 87 2 . First managedby pri vate individuals as an infirmary , i t was confidedin 1 876 to the Sis ters , who received i t in deb t , w i tha leaking roof, and no beds wherein they cou ld sleep .

SO low was the exchequer that one day the MotherSuperi or had only three b ad ha lf-pence i n her purse .


But the doctors and patients had met the Sis terswi th such warm welcome that diffi culties werelaughed at . A new bui ldi ng wi th grounds was final lysecured , but before i t was ready the old house hadto be vacated .

The Sisters had to settle in the stables,leaving the um

disputed possession Of the dwelling house to the w orkmen by day . But as the men retired in the evening ,

the Sisters established themselves in the ir places , and

having barred the doors and windows with any furni tureor p lanks about the p lace

,w ent to bed . They l iv ed in

sawdust and confusion , dealt ingene ralities , and left theinner detai ls of housekeep ing to Providence . [Reportfor

A lady superintendent now directs the schoo l , andeach ward is in charge of a trained Sis ter of Chari ty ,

who takes part in all the work , including that of

the operating theatre , and assists i n the training ofnurses .We fol lowed the Sisters of Mercy to the Jervis

Street Hospital i n Dubl in , and to the Mercy , in Cork .

They have also developed training-school work inthe Mat . r M iseri cordiaz , Dubl in , the Mater I nfirm~

orum , Belfast , and the South Chari table Infirmary ,Cork . The Mercy Sisters hav e charge , too , of manycounty and union hosp i tals , such as Sligo and Castlerea , but in these the nuns do not train nurses . Inthe Mercy , at Cork , trained and cert ificated Sisters ,in whose professional preparation no omissions areto be found , perform al l the nurs ing and theatre work ,assisted by lay nurses

,both working harmoniously

together and animated by the common desire to


bui ld up and strengthen the inst i tut ion . Sisters andnurses alike wear whi te uniforms at al l Operations ,the Sis ters assis t at al l , and off er ready and comp le tefulfilment of medical and surgical orders . Theirwork has been commented on as having been broughtto the highest poin t of modern perfect ion . Thehospi tal was recognised in 1 9 1 1 as a medical teachingcentre by the Senate of the Dubl in Univers i ty , andalso as a school for nurses according to the requirements of the Local Government Board , but st i l lmore significant and interest ing from the nursingpoin t O f view is i t to know that eff orts are being putforth to make this a cen tral teach ing insti tut ion whereSisters of various orders may come to obtain cert ifi

cates as trained nurses . A special part of the houseis to be set apart for this central school , and

“ everyeff ort made to supply a long-fel t want by giving themembers of rel igious bodies fu l l faci l i t ies for instruct ion in al l the minut ia of scientific nursing .

”

The Mater M isericordiae, Dublin , opened for pat ients by the Mercy Sis ters in 1 86 1 , has grown fromforty to three hundred and s ixty beds ; and from thefirst six trained Sisters a large staff and a lay trainingschool , Opened in 1 89 1 , have developed . The Materi s a noble se t Of build ings inthe classic style and ispecu l iarly dear to the hearts O f I ri shmen . I t is saidthat the funds for bu i ld ing i t were largely gatheredas a memorial to Mary Mother Aloysius a fter theCrimean War , in recognit ion of her wonderful services there , and that she donated i t immediately fora hospi tal . Mother Mary , who thus appears as thefoundress O f the Mater , l ived to be one of the last of

R eport of M ercy H ospi tal , Cork , 1 9 1 0.


1 02 A H i story O f Nu rsmg

for Nurses . To organise i t came a N ight ingale nurseof unusual abil i ty and talents , M iss Pringle , whomM i ss N igh t ingale had once called a regu lar general ,

"

and who had previously occupied the post of Matronin St . Thomas’s and in the Ed inburgh Infirmary .

The new undertaking was an arduous one , and MissPringle gave five years to i t . Miss May , an Engl ishwoman , succeeded her , and followed closely on hermethods . In 1 909 , Miss Hannan , an Irish w omantrained in St . Vincent ’s , Dublin , was appointedMatron . She is a very progress ive woman , an advocate of a three years ’ course of nurs ing in thewards and six months’ fever training ; a great tem

perance advocate , a bel iever in state regi strat ion ,and she has succeeded in making the Mother Superior(who , like the Sisters , i s a trained and cert ificatednurse ) a: nearly al l her nurses state r stra t ionists

also . She looks forward hopefully to t h e day whena nurses’ registrat ion b il l shal l be passed for GreatBri tain and Ireland .

One of the most important centres of nur sing underthe Mercy Sisters i s the South Chari table I nfirmaryand County Hospital , Cork . The infirmary w as

established in 1 7 73 , and Miss Franklin was ment ioned as Matronin 1 870. Some years later the Ci tyO f Dublin N urs ing Inst i tute became responsible forthe nur sing , terminating i ts connection in 1 89 1 . Anumber of changes took place , in the midst Of whichMiss Frankl in , who had been for forty years in theinfirmary , died , while other Matrons came andwent . Finally , the trustees decided to select onefrom a religious order , and Sister Mary A lbensFogarty , o f the Mercy order , St . Marie

’s of the I sle ,


was placed at the head of the nursing depar tment ,with several assistant Sisters . All of them heldnursing certificates , and had as well the ski ll in household ar ts in which the reli gious orders have alwaysexcelled . Sister M . Albeus and her staff broughtmuch needed order and comfort into the place , whereat first their own quarters were very restri cted .

Soon after taking charge , Sister M . Albeus suggested to the nursing committee an alterati on of thebye-laws , and was authorised to revise them as shefound best . Her new scheme , on being presented ,was unanimously adopted and i s st i l l in force . I ni t the posi t ion of the Matron as head of the nursingdepartment was defini tely recogni sed and her powersclearly defined . The nursing staff has increasedsteadi ly ; in 1 902 numbering thirty-six , eigh t yearslater fif t y-two . The nur ses are of all rel igious denomina t ions. A high standard of educat ion is demandedof probationers , and their training includes servi cein the North Fever Hospital and the House of R ecovery , where salaried members of the South I nfirmary nur sing staff direct the pupi l nurses . Lecturesare given by Sister M . Albeus and the members ofthe medical staff and house men . The Charge Sisters

(head nurses) teach the pract ical work . The greatest friendl iness exists between the rel igious Sistersand the nurs ing staff ; there i s perfect harmonyamongst them , their one aim being the wel l-beingof the inst itut ion and O f the s ick and suffering . Themedical and surgical staff, appreciating the resul tsof ski lful are ready in acknow ledgment of Sister M . Albeus

'

s great interes t in a ll

detai ls relat ing to the patients’ care , and her wi ll


ingness to assist the staff in a l l matters connectedwith the welfare of the hosp ital , while the nurseswork excellently in an atmosphere of ready serv ice .

Among al l her other responsibi l i t ies , Sister M .

Albens i s an armed and loyal ally in the con fli ct wi thParliament over the nurses’ registrat ion act . Shei s a member of the Matrons’ Council of Great Bri tainand Ireland , one O f the execut ive committee of theI rish N u rses’ Associat ion , and frequently lends hername and gives her t ime to committee work on educa t iona l and professional matters .

TH E C IT Y OF DU B L IN NU RS ING INST ITU T ION

To understand the unique posit ion which thi s Inst i tu t ion has occup ied in the evolut ion of trainednursing in Ireland , since i ts foundat ion in 1 884 , onemust recal l the condi tions under which Dublinhosp i tals then laboured , when the modern systemO f trained hosp i tal nursing had bare l y come intoexistence . In those days , indeed , the most di st in

gu ished members O f the surgical staff might often havebeen seen assist ing in the bedmaking O f acute cases .Through the act ion of a group of gent lemen (Governors of the City O f Dubl in Hospital or members ofi ts medical staff , w ho, see ing the necessi tous state ofthe nursing , subscr ibed £ 1 000 as a foundation) , theC ity O f Dublin N ursing Inst itut ion w as established ,the subscribers forming the board of d irectors , withthe late Right Hon . Gerald F i t z Gibbon, LL .D . , LordJustice of Appea l , as the chairman , and the late Sur

geon W . I .Wheeler , i ts first honorary secretary . Thepurpose O f the Inst i tut ion was, primari ly , to aid the


Grea t B r i ta inand Ireland

City of Dubl in Hospital , and also to provide training and emp loyment for I rish nurses . F rom 1 884unti l 1 900 i t suppl ied al l the nurs ing required by thehospi tal and bore all the expenses of the sa l aries andsupport Of the probationers , besides paying the hospital an addit ional sum for the train ing thus aff orded .

At firs t the nurses and probationers onduty werein charge of the hospi tal Matron , the late M iss SusanBeresford , a sympa thet ic and cult ivated Irish woman ,under whose genial rule they were very happy , thoughthe small number of nurses considered suffi cient inthe eighties obl iged them to work very hard indeed ,and with much less off-duty t ime than is , happily ,customary in these days . Later , as the staff of theInst i tut ion increased , i t was found necessary to haveits own Matron , and M i ss F i t z Gera ld, the elderdaughter of the Right Reverend Wil l iam F i t z Gera l d,Lord B ishop O f Kil laloe , w ho had been trained at theCity of Dubl in , and subsequently at the London ,returned to take up its management .In 1 898 , for the second t ime , the nursing in Mercer

’

s

Hospi tal was undertaken by the Institut ion— thelatter bearing al l the expense of salaries , clothing , andvoluntary rep lacement of nurses when il l or onleave ,in addit ion to paying the hospi tal large fees for thetrain ing thus afforded . This arrangement continuedunt i l the spring O f 1 909 , when i t was first mod ified ,and in February , 1 9 1 1 , terminated , and the nurseswithdrawn , the hospital be ing then in a posi t ion toorgani se i ts ownnursing s taff .

T he annual reports show the wide sphere of workentered upon by this p ioneer inst i tut ion from thefirst and the aid i t has aff orded tomany hospi tals and


infirmar ies throughout I re land, by sending a staffof nurses and probat ioners to organise the nursingarrangements in them when required .

An extract i s subjoined from the reports of theyears 1 890 and 1 89 2 regarding the part taken by i tin the establ ishment of the nursing of the s ick poorin Dublin :

The Council of the Queen Victoria’s Jubilee Institutefor Nurses last year inv i ted the co-Operation O f theInstitution in establish ing a system of district nursingfor the poor O f Dublin inthe ir ownhomes . The directorsundertook to devote a considerable sum to th i s Object ,on the terms tha t the Institution shou ld be recognisedas a District Home for Queen’s Nurses for the poor .Fou r trained nu rses w ere assigned to th is duty ; they haveeach received three months’ training in

‘materni ty nursing

’

and two of them have rece ived , in addition , sixmonths’ ‘district training' in London . They are nowaw aiting the a rrival inDublin of Miss Dunn , an Iri shwoman . to be lady superintendent O f dis trict nursingappointed by the council and the assignment of the irdistrict .The annual expense O f maintaining a sta ff of four i i urses,

who will be de voted exclusively to the district nursingof the poor in the ir own homes , is est imated at £240,

of w h ich the Queen’s Institu te will contribu te £ 1 00 ,

the City of Dublin Nursing Institution defraying theba lance ou t O f i ts ownfunds .

The Council of the Queen Victori a’s Jubilee Institutehas made an agreement w i th the Institu tion for

training two Roman Cathol ic probationers throughoutthe year , w ho , when qual ified , a re to be emp loyed as

R eport, Apr i l 3 0, 1 890 , p . 5.



in nur sing the sick poor du ring an ep idemic of typhusfever , which raged in an island O ff the west coast OfI reland in 1 897 . The passage to the island was oneof considerable peri l , and the conditions under wh ichthe peop le were nursed were improvi sed and or

ganised by the nurses with extreme di ff i cul ty , butthough almost al l the popu lat ion (al l fisher folk , andvery poor) of the island contracted the disease , onlyone death occurred , that o f an already tuberculouspatient . T he enrolment Of these— the first nu rsesto be honoured by admission to the Order of St .John— was test imony to thei r fidel i ty and selfsa crifice, of which the directors and staff are justlyproud . A number O f the staff O ff ered their services to ,and were accep ted by , the Army N urs ing ReserveCommittee in London on the outbreak of the war inSouth Africa , where their nursing services to the s ickand wounded w ere highly valued .

The Inst itut ion is se lf-support ing . The earningsO f the nurses are d ivided among them after the upkeep has been provided for , and there is also a pensionfund from which grants are made . During the firsttwenty-seven years of the I nst i tut ion ’s exi stence ,about one thousand probationers passed through itshalls into the world .

District N ursing— Dubl in has two district nu rsing

centres , one Cathol ic and the other Protestant , bothaffi l iated wi th the Queen Victoria Jubi lee Inst i tute .The Protestant Home , called St . Patrick

’s , was thefirs t centre in I reland , and was founded in 1 875.

Prior to thi s the Dubl in Women 's Work Associat ionwas reaching the Protestant poor of the ci ty bymeans of B ible-women

,mothers ' meetings , and other


parochial act iv it ies . As this organisat ion extended ,i t was seen that an enormous benefit would be conferred up on the poor by p roviding them with trainednurs ing in their own homes , and a distr ict nursewas engaged from London . SO s tarted the scheme ofdistrict nurs ing which now covers I reland as a network inevery d irect ion . From the first the nursingwork was carr ied out on strict ly unsectarian l ines .In the early days there were many obstacles to beovercome , some financial , and some due to opposit ion from various sources . However , year by yearthe nurses made their w ay . Ten years after thehome was started , a superintenden t and three nurseshad a yearly average of about eleven thousand v isi ts .In 1 890, the staff of St . Patrick

’s Home was affi l iatedwith the Jub ilee Nurses , and i t was recognised as acentre for training nurses for d istr ict work . Manydist ri cts in I reland and elsewhere have been suppl iedfrom this home .St . Lawrence’s , the second distri c t nurs ing centre

in Dub l in, i s the Cathol ic Home . I t was opened in1 890, the Archbishop of Dubl in being patron . I tsact ive usefu lness i s indicated by a recent report

The year which ended on October 3 1 , 1 9 1 0, was oneof expansion and increase of work The Homeconsists of the lady superintendent , a staff nurse , and avarying number of ful ly qualified hosp i ta l nurses , whorece ive here , in a six months

’ course , that special class oftraining requ ired by those who devote themselves tor ursing the sick poor in their own homes . N ineteennurses were trained here during the past year for thi sspecial work , and , of these , fourteen have been alreadysent to di ff erent p laces throughou t I reland , including

no A H istory of Nursing

eigh t new d istricts w h ich are now served by Jubileenurses Du ring the year, 3 6 1 4 cases have beenattended 1 000more than last year . The greatest ambition of the commi ttee is to be ab le to say , aseach year comes round , that no app l icant for a nurse,provided i t comes with in ou r rules, has had to be refused ,and at the same time to be satisfied that each particu larcase i s efficiently treated .

’

The pioneer d istr ict-nurs ing journal , the Queen'

s

N urses'

fil a ga z z'

ne, owns Ireland as its b irthplace .

I t was mothered , ed ited , and long financed by LadyHermione Blackwood , who gave i t d ist inct characterby interpret ing all current events , both social andpol it i cal , which could aff ect nurses and their work ,and united in i ts pages I rish legend and romance ,district news , and intellectual taste . I n 1 9 1 0, the

Queen’s Inst i tute adopted i t as i ts official publ icat ion

and became responsible for i ts bus iness end .

2 LadyHermione

,who is herself a Queen

’s Nurse and act ivein Irish organ isat ion aff airs , comes natural ly by heraltru ism and spir itual ity , for she is a daughter ofthe Lady Duff erin whose work in bringing medicaland nurs ing rel ief to the women of India we shal ltry to tell in another chapter , and of the late Marquisof Dufierinand Ava , whose mother was the daughterof Sheridan .

The I r ish N urses’

Associ a tion— As the training ofnurses became systemat ised and nursing acknowledged as an honourable profession or cal l ing , theneed of organisat ion became felt . The first idea that

R eport of 1 909—1 9 1 0.

I : may be ob t ained a t 58 , Victoria St London, S. W .


1 1 2 A H istory of Nursing

ledge the generous and valuable help always given toany of our proj ects by the press of Ireland .

I t was qu ickly rea l ised that the amount of associat ionwh ich we had had in th is connection w as so helpful andp leasant , that we decided to continue i t , i f possible :ou r committee was again summoned , a secretary ap

pointed , and a Nurses C lub launched in a couple of

rooms ina central position inDub l in, w i th M iss Huxleyas ou r fi rst president .From th is simp le beg inning w r f a ve now the Irish

Nu rses’ Association , w i th a w ide membersh ip , embracing

the Irish Provinces , and forming a bond of union withthe many countries in wh ich our Irish nurses trave l .The rooms of the association are a pleasant meetingp lace , amp ly provided w i th professional and other li terature . Lectures are g iven b y eminent members of themedical profession , and upon many other interestingsubj ects by friends of di stinction in the world of art andph i lanth ropy .

Here also is a centre and an executive , through wh ichthe association has rece ived help and counse l fromeminent I rish members of Parliament , inbring ing ma t

ters of importance to nurses before the Local Government Board of Ire land , the Board of Trade in London( ina recent wel l-remembered crisis) , and the House of

Commons . Where our nursing interests are concerned ,

generous and ready aid is accorded us by Iri shmen .

United b y such a bond , we canhope for eventual success ; w i thou t comb inat ion w e are powerless to forwardany proj ect . Bu t above all does association help thenurse to cheri sh tha t sympathy w h ich is so humanisingand valuab le to her of all people , for w i thou t some commoncentre such as our associa tion aff ords , each group ofMa trons and nurses migh t continue to ex ist wi th in the i rown perfectly organised hospi tals and institu tions ,comp lc tcl xr absorb ed by their own rules and dut ies

,

Grea t Bri ta inand Ireland 1 1 3

but i t would be a narrowing process , and a ltogetherlacking opportunities for that friendl y compar ison andemulation which are so helpful to Matron as wel l asnurse .

From the associat ion has now sprung the Dubl inN urses

’ Club , and a N ur ses’ Hostel

,managed on co

operat ive principles . The associat ion and its pol icyare voiced in the I r ish Tra ined N urse and H ospi ta l

R evi ew , whose printed t i tle i s transfigured by the oldGael i c lettering , suggest ing romance and poetry ,and revi val of the nat ional spi ri t— that indefinab lespiri t which gives each country its own personal i tyand charm . The leaders of I ri sh nurses are alert andkeen-eyed on pub l ic and pol it ical quest ions aff ect ingthe status and wel l-being of self-support ing women ,and the spiri t of the associat ion as a whole is a freedom-loving one , ready for self-defence at a l l points .Throughout the whole of the struggle of Bri t ishnurses to obtain regi strat ion from Parliament , theI ri sh nur ses have been keen and qui ck of action . Atthe t ime when , in 1 908 , through some obscure playof governmenta l po li t i cs , Iri sh nurses were threatenedwith exclusion from the regi stration bi ll then beforeParli ament , they uprose in vi gorous resi stance .Notable aid was brought to them then through thecommanding abili ty of the late Lord Justi ce Fi tzGibbon

,and at al l t imes they may count upon the

chi valry of Wi lli am Field , M . P both in and out ofParliament . A visi tor to I ri sh nursing circles i simpressed by the atmosphere of brotherhood andequal i ty between medical men and nurses and thegenerous att i tude of the former toward the nurses’

problems . Their spi ri t of l iberali ty i s shown i n thei r

VO L . m.—8


atti tude when trained nursing was first i ntroduced,

which is in pleasing contras t to the story of someother countri es .I rish nurses have often , doubtless , resented the

encroachment of outs ide influence in hospi tal trainingand nursing aff airs , when this influence is shown as anal ien one , bent upon oth er pol icies than those bel ievedby Irish women to be vital : How , indeed , could apeople so high-spiri ted do other than resent thi s ?Bu t s trangers who , coming sympathetically and wi thunderstanding , enter whole-heartedly into the problems of training and associat ion , meet loyal comradeship from the warm-hearted and democrat i cinhabi tants of the Green Isle .

I f space al lowed , i t wou ld ) e a pleasant task to l is tthe noteworthy figures among the Dublin Matronsin the early part of the 2 0th century— Miss NoraCunni ngham , Gaeli c Leaguer and S i rmFez

'

ddhe and ,l ike most of the group , a keen suff ragist ; Miss CarsonRae , strong and staunch , advocate of special prel iminary training in special col leges tofit youngwomento enter nursing , who brought about the affi l iat ionof several hosp i tals in one training group ; MissLamont , tactful Superintendent-General of theQueen

’s Nurses in Ireland ; Miss Haughton , who wasdistinguished by being cal led back to Guy’s

,her

alma mater , as Matron of that hosp i tal in 1 909 ;

Miss Ramsden and Miss Reeves , also of the youngergroup ; or the nurses , who , in off-duty time

,sing the

wail ing songs of Ireland in soft moaning voices , ortransform themse lves with red pett icoat and shawlinto the bewi tching , clog-dancing col leen .

But we must turn for an instant from the ci ty to


CHAPTER I I

T H E GROWTH OF NU R SING I N TH E U N IT E D STAT E S

F i rst S teps— Af ter the success of traini ng schools

had been proved , the pioneer inst itut ions wi f e calledupon to send their graduates far and wide to ini t iatesimilar methods . The time between 1 873 and 1 895

was a time of active renovation in hospi tal s . W i th inthis peri od , in by far the majori ty of instances , thework of reconstruct ion was taken up and carried tosuccess by volunteer training-school commi ttees ,composed largely or entirely of women ; over andover again , as in the case of the three first schoo l s ,they pushed their way in the face of opposit ion andd isbelief . Although , in some instances , separatecommittees of women were d ismissed wi th thanksby hosp i ta l d irectors as soon as their work was runn ing smoothly with value proved , yet such share asw e see women taking in hospital management arosefrom the vantage-point gained by this demonstrat ion .

On general hospi tal boards , usually of the smal ler ormi ddle-sized institut ions , they are somet imes foundin positions of equal ity with men, some t imes hold ingauxil iary posts . But too few are the inst itut ionsof largest s ize where they occupy the place to w hichtheir ea rly services enti tled them . While i t was

1 1 6

T he United Sta tes

natural that large hospi tals should wish to bri ngthei r training schools under their centrali sed government , a broad and just policy wou ld have invi tedto the d irectors’ boards women whose training-schoolwork had proved their administrat ive abi l i ty . Onthe whole , the steady general tendency has been formen to take control out of the women’s hands .To follow the experience s of our pioneer nurse s i n

hospital explorat ions is imposs ible . They founddirt and disorder to be almost uni versal . Verminand infect ion were common even in pre tentiousbui ldings . Immoral i ty was frequent . Coarsenessand vulgari ty they often met , and went wel l armedwith moral force and intrepidi ty . Extraord inarycustoms and condit ions existed . In one beaut ifuland wealthy hosp i tal , the morgue table was usedfor operations , though L is ter had announced hi stheories. I n another , al l the small rooms bui l t forspecial free cases w ere fil led with the mistresses ofthe ci ty board of aldermen . Management was poor ,often , even when good intentions p revai led ; nur ses

’

working hours were from four in the morning unt i lten a t night , wi th resu l tant slovenliness of deta i l ,and night duty was almost always so defect ive lyorganised as to be pract ically non-existent . Thetrained women who p lunged into this publ ic housecleaning were so absorbed in i t that to them

,for a

t ime , the outer world ceased to exis t . I t was qu i teas adventurous , quite as exacting , as war nurs ing .Nurses from diff erent parts of the country met asveterans meet— no other introduct ion necessa ry thantheir identi ty of experience . When order had beenrestored and t ime came for constructive work , they ,


wi th one accor d , the country over , took u f. h e pro

blem of giving their pupils ampler teaching and amore careful preparation than they t hemselves hadhad . I t may be confidently as serted , that never ina modern country has a more disinterested and usefulcivi c service been perf ormed by women than thi sregeneration of hospitals by women ’s boards andnurses during the three last decades of the nineteenthcen tury . In al l estimates of the value of ski l lednursing by women of educat ion , only half the subjectis considered if the immense moral upl ift that theyhave given to inst i tut ions be forgotten or ignored .

Gladly would we cal l a ful l rol l of meri t if spacepermit ted , but at leas t those who first d ied in theservice must be ment ioned : Louise Darche, who ,assisted by Diana C . Kimber , remodel led the trainingschool on Blackw ell’s I sland , in the hospital thennamed Chari ty , losing reason and l ife through the

terrible struggle with the “ spoi l s ” system ‘

; MaryRogers , who re formed the Children

’s Hospita l i nWash ington , opened i ts training school , and affi l iatedi t with that of the Columbia , this being the firs t instance of affi l iat ion between two d is tinct groups ofnurses for a more complete training ; L i l la Lett , wholaboured in St . Luke ’s , Chicago, and FlorenceHutch inson , who followed her there , having first bui l tup the school in the Ci ty Hospi tal of Indianapol is .All these women were Bel levue nurses , and , exceptMiss Rogers , al l Canadians .Our pioneer authors , too , must be remembered

Harrie t Camp (now Mrs . Lounsbery) , then head of‘ After M iss Da rehe’

s dea th M iss K imber ret i red to England,her na t ive c ount ry , and entered anAng l icanSisterhood .



first attempt made by American nurses to form ana ssociat ion : th is was called the Philomena Society .

The names of i ts founders have not been preserved ,but i t seems to have ar isen in 1 886—87 in New York ,and to have died a natural death a year or so afterwards . Foundat ions for the fir st permanent un ionwere lai d in 1 889 ,when a group of Bellevue graduates ,meet ing at the annual recept ion o f the school , proposed to form an alumna society . I t was formal lylaunched in Apri l of that year , wi th a rigid andcramp ing const i tut ion which . under a conservat ivepres ident , hindered growth mos t eff ectually forsome years , bu t was really not express ive of the wil lof the majori ty and was l iberally amended andbroadened in 1 896—9 7 . The next society of this kindwas the alumnae group of the I ll inois trainingschool , founded in 1 89 1 , whose promoters had tocombat the same diffi cul t sp i ri t of exclusiveness .The Johns Hopkins alumnm was formed in 1 892 ;

that of the Massachusetts General in 1 895 ; of theBoston Ci ty in 1 896 ; of the New England Hospi talfor Women and Children in 1 898 . These were thefirst . To-day , there i s probably not a training schoo lwor thy the name that has not i t s society of alumnae.

The att i tude of aloofness at first maintained by training schools towards one another was ludicrous , theclan sp i ri t having been so sedulously fostered that i twas almost held to be b ad form for the pupi ls in oneto know and visi t those in another . I n general , ad i gnified unconsciousness that there were any otherhospi tals than one ’s “ own ” was considered the correct thing . I t w a s a natural ou tcome of the highlymi l i tarv formal d iscipline imported from the old

T he United States

world into the early schools , but as nur ses began discovering one another inthe world outs ide , they foundthat hospitals and the women in them were muchali ke , and the superci l iousness ari s ing from nonacquaintance faded away . Leaders in organi sat ioncombated vigorously the narrow point of view andvis ion fixed on sel f . Who has not heard the quest ion :“What good wi l l th is society be to me ? ” L i t tle byl i t tle , through co-operation in work rather than byargument came the percept ion that the individuali s best helped by that which raises and strengthensa l l . The fact that American nurses were thrownwholl y upon their own resources after receiving theirdi plomas helped greatly to bring them into closefraternal relat ions and to promote their own in

dependent societ ies . They quickly real ised thei solation and forlorn i ty of l ives cu t off from thecommuni ty , and understood that they must subst itute another helpful mutual bond for that whichthey had left behind them in the hospital .Up to 1 890 , i t may be said that the general tenor

of nurs ing act ivi t ies had been ind ividual ist ic and

intense ly pract ical , while the ideal was expressed inwork only . In that year , a new standard was se tby the opening of the Johns Hopkins Hospi tal andTra ining School . The trustees of the hospi ta l hadde termined to make i t primari ly a centre for libera lscient ific teaching and a model of good methodsin work . The entire administrat ion was infusedwi th this purpose , and the emphasis thus laid uponthe inte l lectual side of hosp i ta l work , the defin i tea ssertion of a generous spiri t of ideal ism . had a great ,not eas ily est imated infl uence , rad iat ing far and


w ide , and greatly encouraging al l those unnumberedsi lent workers who had been fulfil l ing thei r daily tasksin th is sp iri t wi thout meeting its ful l recogn it ion .

The open ing of the train ing school was looked forwardto by nurses with the greatest interest . Mr . King ,then pres ident of the trustees , went to England andhad a two-hour interv iew with Miss N ight ingale ,who went over al l the detai ls of i ts organisat ion withh im. To the fai thful observance of her preceptsmust be ascribed much of the prest ige which theschool subsequently attained .

Prominent nurses at home and abroad were interv iewed , and the superintendency was off ered toIsabel Hampton , then in charge of the I ll inois training school in Chicago . This appointment placed ina posi tion of great advantage a woman whose influence upon the educat ion and general progress ofnurses wi l l long cont inue to be fel t , and whose recentcalamitous death just ifies us in giving fuller detai lto her l ife than might otherwise be possible . IsabelAdams Hampton was born in Welland , Canada ,in 1 860, and received a teacher

’s education in St .Catherine’s . In 1 88 1 , she entered Bellevue fortraining , advised thereto by M i ss Snively , as off eringlarger opportunit ies than teaching . F or severalyears after graduat ion she held nursing appointmentsof a p ioneer kind , one in St . Paul

’s House , Rome ,for private duty among American patients . In 1 888 ,she was selected by Miss Perkins to fil l the vacantposi t ion of head of the I l l inois school , which hadcal led i ts first superintendent from Bel levue . Shewas then only tw enty-six years old . There M issHampton made a reputation not only as an execut ive

,



future which was l ike that of a sibyl . She had vi sionsof nurs ing growth , organisat ion , and activi t ies , whichcame first as hazy , indefini te p ictures , gradual lytaking form unti l al l was clear and vivid , fil l ing herwith joy and enthusiasm , eager interest , and untiringenergy . By this impressionist ic qual i ty of her mindshe forecast or perceived the goal that was to bereached and consciously wrought to reach it , whereothers

,working from day to day , hardly real i sed

whither they were tending . This power of see ingd istant vi stas of achievement , as one sees landscapes ,made her compani onship most st imul ating and fascinat ing . Such w as the woman , warm-hearted and

respons ive , simple and almost chi ldl ike in her directness , having some faults of l ikes and dislikes and someimperfect ions as al l must have , but fil led wi th thehighest belief in the mission of women as the superiormoral force , and in the possibil i ty of universal hap

p iness, who became a be loved leader and held th isplace unti l her death .

Having amplified and graded the course of instruct ion through the two years , she then advocated andprepared the way for the three years ’ course and , aswe shal l see , thought out , proposed , and brought topass the creation of a special course of higher instru ct ion at Teachers’ College , for nur ses intending tobecome teachers and administrators . Her firs tbook was written at the Johns Hopkins .In organisat ion Miss Hampton ’s work w as large

and st imulating . The Johns Hopki ns under herleadership was the first to set the example of analumnae society into which each successive class of

g raduates entered as a group wi thou t except ion . She

T he Uni ted S tates 1 2 5

had grea t visions of the mi ss ion of alumna societ ies ,and shaped the whole possible future of a nat ionalorganisat ion long before i t took form . The World ’sFair year in Ch icago , 1 893 , gave the Opportuni tyfor a nat ional movement . Congresses were as numerous as blades of grass, and the associat ion idea was

in the a ir . In every l ine of interest and of work people from the four corners of the earth were comingtogether , and nurses shared in the st imu lus . Mrs .Fenwick , then intensely absorbed in her great workof organisat ion in England , came to Chicago to

arrange the Engl ish nu rs ing exh ib i t sent from GreatBri tain to the Woman ’s Bui lding . She inquiredwho w ere the American leaders in nurs ing , suggestedto the Chicago women on the World ’s Fair boardsthe ut i l i ty of a nursing congress , and came to Bal t imore on her way home to vis it M iss Hampton .

Diff erent as were these two in temperament , theone a ll l ightn ing-l ike rapidi ty and fire, the othertranqui l and serene , they were s ingularly ali ke intheir enthusiasms , ideals , and professional demands .When the Congress of Hospi tals and Dispensarieswas finally promoted , wi th Dr . John S . B i ll ings aschai rman , a nur sing sect ion was arranged for and Dr .B il lings off ered i ts chairmanship to Miss Hampton .

I n the programme of this sect ion , of which thearrangement was to her a devoutly serious p iece ofwork , may be found the seedl ings of almost all thelater l ines of gr owth in the nursing profession in theUnited States . Nor was i t accidentally so , bu t theresu l t of most earnest thought and divination . Oftenas she planned to whom certain themes shoul d be

g iven , di d she describe the whole poss ible future that


might arise from the ideas she hoped to have broughtout . I n the main congress , Miss Hampton read herpaper on the three years’ and eight hours’ course ,in which she urged the possibil ity of the affi l iat ion ofvaried inst itut ions for the instruct ion of nurses . I twas called “ Educational Standards for Nur ses ,and, at that t ime , she regarded i t as the cul minat ionof her teaching work . Miss Edi th Draper , thensuperi ntendent of the I l l inois school , had been giventhe subject ,

“The N ecess i ty for an AmericanNurses’ Associat ion . This was M iss Hampton ’smost cherished vision , and in her letters to M i ssDraper , who was a close personal friend , she hadpoured forth her hopes about i t . Miss Draper , however , made her paper suggest ive rather than construeti ve ; she spoke of the need of state associat ions andof a journal ; she did not arri ve a t s tate registrat ion , but said :

“A system of registering , (for a standard of equal i ty would be exacted) shoul d be devised ,so that all members of the associat ion would be consi dered equal ly competent as far as technical knowledge went Miss A ls ton , superintendent of the Mt .Sinai school , in New York , had a paper on the needfor alumna associat ions . I n the d iscuss ion , MissHampton said : “We must in t ime , evolve alumnasociet ies , an American associat ion , and super intendents’ conventions ; our meeting here is the firs t s tep ;before this congress adjou rns we should have a meeting to form a society of superintendents of train ingschools . ” Miss Irene Su t l i ff e, then and long after ,as head of the New York school , one of the mostbeloved of the early leaders , read a paper on thehistory of American nurs ing

,in which she said :



her v i ews carry . An altru ist i c band of leaders andteachers , encouragi ng their alumna groups to selfdevelopment , the superintendents

’ soc iety has beena lmost self-eff acing in the par ent-like w i sh to bringi ts children forward , but wherever hard work even todrudgery was to be done in any good profess ionalcause , i t s members have always be en found a t the

fron t .Impossible as i t i s to mention al l i ts most notable

members , some of whom wi l l appear as we go on ,Miss Lucy Drown must be singled out for honoursfor her long years— more than a quart er-cen turyas superintendent of nur ses in the Boston Cityschool , and for her classi c New England type : so

high-minded , so scrupulously submissive where she

thought her duty lay , so gentle , so immovable , withsuch an unexpected l i t t le flash of revolut ionarysp iri t ! W i th her ret irement went one of the cheri shedfigur es of her t ime .

In February , 1 896, i twas fel t that the t ime had comewhen the young alumna societ ies might be un itedinto one national body . A paper had been read atthe Philadelphia meet ing that winter , embodyingMiss Hampton’s vision of nat ional union , and af terwards a committee was appointed to call together aconvent ion to form a nat ional associat ion .

The convent ion met in September , 1 896, at the

Manhattan Beach hotel , near New York , and wascomposed of delegates sent by al umna socie t ies ,and of members of the superintendents’ soci ety ,chosen and sent by that body . The name a t firstchosen was “The Nurses’ Associated Al umna of

the Uni ted States and Canada ," but , wi th incorpora

The Uni ted Sta tes 1 2 9

t ion later , Canadi an and American nurses had toorganise separately , a thi ng they had at first beenunwi l l ing to do because of the strength of t ie be tweenthose having the same alma mater . At thi s convent ion , wi th M iss Hampton , then married to Dr . Robb ,absent inEurope , much of the leadership was MissSophia Palmer’s . She made the most pract icalsuggest ions , and caused the delegates to be formallyvoted in as charter members . The work of theconvent ion was comp l eted in February , 1 897 , inBalt imore . Mrs . Robb , radiant and beautiful , wasthen present and was elected pres ident . Miss Walden from the New York alumna , and Miss Ambrose ,Presbyteri an , fir st and second vi ce-pres idents ; MissBarnard , Johns Hopkins , secretary ; and Miss Healy ,Brooklyn City , treasurer .The associated al umna a lso began in a t imid way ,

wi th a certain amount of unf amil iari ty wi th democrat ic principles . The first const itut ion was a cumbersome structure , provi ding for an elaborate machinerywhich never , in fact , mater ial ised . Instead , a spont aneous natural organi sat ion went on swiftly , ignoring the const itut ion , which was presently amendedto fit facts as they were . Another piece of uselesstrouble was taken over a code of ethics . A vast dealof seriousness was spent in poring , bewildered, overthe Code of Ethics of the American Medical Associat ion . The wri ter sought out Dr . John S . B i l l ings inconsul tat ion , and recalls her shocked consternat ionwhen he said , in a dry , off -hand way , that the medicalcode had been the cause of untold wrangl ing in themedi cal p rofession .

“Be good women ,” h e

. added ,but do not have a code of ethics . ” This emed l ike

VOL . ( I L—9


blasphemy , but the ready-made ethical code was pu taside by Mrs . Robb in her president ial remarks .The first annual convention was held in New York ,in Apri l , 1 898 , when Mrs . Robb gave a h istory of theformat ion of the society and told of the aspirat ions ofthe superintendents for the ir graduates , concludingwith these words

W ith the presentation of this report ends their t esponsib il i ty toward this organisation , a responsibili ty so

generously assumed by women , already crowded withwork, in the best interests of the nursing profession ingeneral and w ith absolutely no personal motives inview,

other than the good that may come to the individuallyas members of the i r several societies . A : one of the irow 1 members said in the discussion Superintendent swill form a very small part of this organisation . I t

will be an association of independent women , who hepeby uniting to work ou t many reforms . ” I t seemsl ike a brie f dream as to time since that June of 1 895 , bu ta dreaming true as to resul ts . So splendid have theseresults been thus far that I look forward into the futureof the associated alumna with joy and certainty thati t will ach ieve greater and better things by nurses andfor nurses than have ever yet come to pass . And withsucl . a fee l ing and in such a sp iri t do I invite you to

consideration of the work be fore us at this meetingA code of ethics i s the first object mentioned in theconstitu tion . B u t i t cannot be among the first to berealised , for such a code shoul d be the central point ofthought of the association , reaching ou t in i ts insp i rationand influence to ou r most remote branches , and towardw h ich ea

c h individual member may look , vibrant witha sense or personal responsibili ty toward the associationand toward the highest standard attainable b y nurses.



papers , Mrs . Robb was appointed chairmanof thecduca t iona l committee of the superintendents’ soci ety,and in this capacity vis ited Teachers College

, saw

Dean Russel l to exp lain her ideas , and then,wi th

Miss N utt ing , Dean Russel l , and Miss Kinne of thecollege , worked out a plan for the nur ses

’ course . ‘

These steps . reported back to the society , werewarmly endorsed , and Mrs . Robb was authorised tocarry the plan through . Her firs t committee wascomposed of women who have buil t the beginn ingsof many importan t things : Miss M . E . P . Davis

(then superintendent of the Un iversi ty hospi tal ,Philadelphia) , Miss Lucy Walker , an Irish womanand Engl ish-trained nurse (then superintendent ofnurses at the Pennsylvania .) Miss Maud B anfield, anEngl ish woman , trained a t St . Bartholomew

’s (thensuperintendent of the Polycl inic in Philadelphia) ,Miss Linda Richards , then beginn ing her remarkable work inthe hospitals for the insane , and MissM . Adelaide Nutt ing , the g ifted Canadian, Mrs .Robb’s pupil , who had succeeded her at the JohnsHopkins . The committee was later enl arged , andhas included many of our foremost super intenden ts .The two first pupil s entered for the course , MissAnna L . All ine and Miss Al ice A . Gorman , both ofwhom had been at the head of training schools .The superintendents’ society became respons ible forfunds needed for the new department of “Hospi talE conomics ” ; subscri pt ions were read ily promisedby individuals and associat ions , while a sp iri t of

z ea l and exh ilaration pe rvaded the nurs ing ranks .When finally launched the commi ttee recommended

S ix thAm eal Report, AmericanSociety of Superintendents, 9 53 .

T he Uni ted S tates 1 3 3

that a nurse should be placed in charge of the classand course , and in 1 90 1 Miss All ine consented t otake the work at a purely nominal salary , because ofher faith in i t . For several years she pract ically gaveherself to i t , with gr eat unselfishness, making i t possible for the early stage of growth to be safely passed .

The professional lectures were given by nurses , headsof hospital s and tra ining sc hools , often withoutpayment . One course of special interest was thaton the History of Hospi tals and N ursing deliveredby Miss Nutt ing . The syllabus of th is course afterwards formed the framework of the publishedH istory of N ursing . A later pamphlet by MissNutting gi ves in a few words the basic idea of theplan for extended educat ion at Teachers College .She says

The object of this course was to g ive some preparation for the higher and more responsible posi ti ons inhosp i tal work , a s superintendents of hosp i tals or schools ,and as teachers and instructors in various branches ofnursing . The idea of establ ish ing such a course was theoutcome of years of continual eff ort to improve theeducation and training of nurses and to promote uni formity in cu rricu la and inmethods of teach ing . I t wasclear that l ittle improvement in methods of teachingcou ld be hoped for until nurses had been taught how to

teach.

In 1 904 , an appeal was made for an endowmen tfund of wi th an annual guarantee of $2 500to pay instructors su i tably . The need of an extensionof the course to two years was also put forward . I n

1 907 , Miss Nutt ing was called from the Johns Hop


kins training school , which she had directed wi thconspicuous abi l i ty since Miss Hampton’s marr iage

,

to Teachers Col lege . Her work in developing theprel iminary cour se of s ix months at the hospital haddrawn the at tent ion of educators to her and she w asgiven a chair under the t itle of Inst i tut ional Mana gement , with the idea that students should be prepared to manage not only hospitals but ins t i tut ionsof a l l kinds , or homes , great and small . In 1 909 ,

on the advice of Miss Wald , a noble gift was made tothe college by Mrs . Helen Hartley Jenkins , for thepurpose of so extending the nurses’ course as to addfacil i t ies for special training in al l the new l ines ofsocial serv ice . The practical s ide is to be developedthrough affi l iat ion or co-operat ion with the settlements , the board of heal th , social and philanthrop i cfoundat ions , and , in short , wi th al l exi st ing agenciesof betterment . The fu l l meaning of this most generous and helpfu l gift may not be real ised for somet ime to come . The t i tle now given to the chair is“N ursing and Health .

”

In the w inter of 1 9 1 0, Mrs . Robb’s ri ch and fru i tful

l ife was instant ly cut short by a most shocking accident , and at the ir first subsequent meeting the nursesof the country test ified to the i r devot ion to hermemory by founding the Isabel Hampton RobbScholarship Fund for advanced s tudy by nurseswherever they might best use i t . As

,wi thout a

doubt , for years to come at leas t , Teachers Col legewil l be selected by most of the beneficiaries , IsabelRobb ’s memory wil l be cherished long in the environsof the univers i ty where her vision was real ised .

With in the training schools the three-year course ,



l uetance of d irectors to begin an era of expansionwhere their staff was concerned , or by sheer i nabi li tyto see the reason why : somet imes , too , by the fai lure of the superintendent of nurses to carry off the

honours of war . The foremost training schoolsdeveloped advanced teaching in the third year ,brought in social problems and subjects on the li neof civics , gave pract ice in class teach ing and hosp ital housekeep ing , and , if no formal prepa ratorycour se was existent , arranged for the j uniors coursesi n dietet ics under domestic-science teachers , for whichmodel d iet kitchens were developed .

The custom of sending out undergraduates toprivate duty was early d iscredi ted . From the first ,American superintendents set their faces firmlyagainst i t , and alumnae societ ies have cont inued thepol icy of unqual ified opposi t ion to i t . I t is a purelysord id custom , unjust al ike to the pupi l , who losesthe systematic instruct ion which she has a ri gh t toexpect , to the pat ient , and to the graduate nursetrying to support herself . The argument of beneficialexperi ence to the pupi l sent to private cases is reallya plea that the student can teach hersel f nurs ing , and

y i e lds the whole case to the correspondence schools ,whose claim i t also is that , with theoret ical inf ormat ion given , the pupi l can go into homes and teachherse lf . T he considerable sums of money earnedfor hospi tals by this custom give i t tenaci ty , and ,

even as late as 1 9 1 1 , i t was est imated that aboutthree hundred train ing schools in the Uni ted Statessen t pupils out to earn this money . These schoolsare not in the first , perhaps not even in the third,rank , but many of them will improve and ri se to a

The United Sta tes 1 3 7

higher grade, when , we may hope, they wi l l di s

continue this custom .

I n 1 906 , a medical pani c , termed a react ion,

occu rred in New York , and a t a meeting at the Academy of Medicine “The Overtrained Nurse " was discussed . Several hosp i tals inthat ci ty , largely throu ghthe agi tat ion of one anxious man , soon a fterwardreturned to the two years’ course . As at least twoof these had never shortened their hours nor increasedthei r instruct ion faci l i t ies , no great harm was done .Outside of New York the movement was regardedas retrograde and found no followers . I t seems ,indeed , to have had l i t tle basis except in the fearthat the private-duty nurse might presently emergeas an independent pract i t ioner . The ch ief thesisof the oppos i t ion actually took as i ts tex t a que ryfound in a non-professional journal , viz . , Is nurs inggoing to sever every connect ion with med icine andset up as an ent irely separate science or art ? ” H ad

th is quest ion been asked by a nurse in a jour nal edi tedand controlled by nurses , i t might have been trulyalarming , but , as the ease stood , the panic seemed tohave been groundless . No doubt the content ionthat nurses were too much stuff ed with technicalphraseology was true , and i t i s precise ly for thatreason that i t i s des irable to have nursing educat ionregulated largely by nurses . Following the New

York react ion , a number of weighty protests weremade . The New York nur ses and the superintendents of training schools off ered resolut ions deprecat inga change backward ; the New York City Vis i t ingCommittee of the State Chari t ies Aid Associat ionsubmit ted a report in a le t ter addr essed to the De .


partment of Publ ic Chari t ies in 1 907 , in which theyupheld the three years but recommended shorterhou rs , good condi t ions , and a general , varied service

(A . J . N Feb . ,Dr . D . B . St . John Roosa of

NewYork came out squarely inopposi t ion to the backward step in an art icle wri t ten in 1 908 . The most effect ive reinforcements were marshalled by Dr . HenryM . Hurd , then Superintendent of the Johns Hopkinshospi tal , who in the Hosp i tal Superintendents

’

Associat ion ski lfu l ly contrived to have a committeeso composed that i t cou

'

d be rel ied upon to makea s tatesmanl ike report , thus eff ectually disarmingcertain interests whose plan had been to have areport for lowered standards brought in . He alsoread a classic paper at the Canadian Hospital Superintendents’ meeting , in defending the highests tandards , and pointing h is moral by the tale of theyoung minister whose bishop knew him to be asecond-rate man , but bel ieved there were second-ratesouls to be saved . The American Hospi tal Superintendents’Associat ion Committee on Training Schoolsreported in 1 909 , in a broad , comprehensive , and

l iberal document , well presented and ably summedup . I t d id , in eff ect , simply record and endorse thebest exist ing condi t ions , which had been brough tinto being chiefly by the labours of nurses as headsof training schools . One of these a fterwards said ,“ I t i s mort ifying that we have left i t for the mento produce such a weighty report upon what thes tandards of our work should be .

" But the womenhad done , were doing , the work , without wh ich the

R epri nted inA . J. N . , June, 1 908 , p . 67 1 .



near Boston , and the medical d irectors of the statehospi tals for the insane in New York . Dr . Cowlesbegan as early as 1 877 to bring trained nurses intothe asylum from general hospital servi ce , and from£880 to 1 885 he worked toward the development fa school . Th is early experience , however , showedthat the hospital trained nurse needed much addit iona l equipment before being fit ted for the care ofthe insane .Between 1 883 and 1 893 , a number of the state

hospi tals of New York establ ished training schools ,the first one being that of the Buff alo inst itut ionunder Dr . Andrews . About 1 896 a minimum standard of teaching with uni form entrance and finalexaminations was adopted by a l l of the New YorkState hospitals for the insane : they , therefore , ledthe w ay to state examinat ion , and perhaps becauseof thi s record the medical superi ntendents d irect ingthese vast establi shments took a fri endly and magnanimous att i tude toward the later eff orts of nursesfor legal status , especially as they perce ived thati t must bring co-operat ion and a closer relat ionbetween the general and special hospitals . Eachneeds , for its nurses , what the other can give . Thewomen who have given the most valuable serv icein adapt ing train ing-school methods to the workwith the insane are Miss Mary E . May , Miss L indaRichards , and Miss Sara Parsons . ’

ih e pioneer

work has been most d iffi cul t , and the problem ofobtaining the necessary numbers of des irable proba t ioners i s , and wil l long remai n , a vex ing one .compl icat ing every educational eff ort , and retarding ,doubt less , the general advance. Yet the onl y real

T he Uni ted S ta tes

solut ion l ies in the slow upli ft ing of the whole massby educat ional requirements which wil l s lowly reacton the every-day family and ind ividual .An E thica l Question— The rapid mult ip l icat ionof training schools du ring a couple of decades shouldsoon slow down to a more moderate pace .

x Thenthe first growth made , an era of structu ral improvement should follow . The remark of a member of astate examining board , that

“ the mul t ipl ici ty ofsmal l hospi tals owned by med ica l men , where tra ining schools are maintained for strictly commercialpurposes , i s the greatest problem that confronts us ,gives room for wonder whether i t i s not t ime for themedica l profession to add a new art icle to i ts code ofeth ics , to the eff ect , namely , that pr ivate speculat ionin nurs ing educat ion more or less bogus should beconsidered as no more honourable than the sametraffi c inmedica l educat ion . In every one of thel i t tle private hospi tals of the medica l men , goodnurses are needed , but they shoul d be trained co

Operat ively , with a view to the publ ic good , notsweated for private ind ividual profit . ’

T heUni ted Sta tes Bureau of E ducationfor 1 909 has the following:T raining Schools Pupils

1 880 1 5 3 2 3

1 890 3 5 !.SS2

1 900 43 2

1 907

1 908

1 909

These figu res include hospita ls for the insane where t ra ining schoolshave beenopened . T henumber of schools ingenera l hospita ls, 1 909,is givena s 1 006 .

‘ A report from a p riva te hospital owned by a medica l manshowed a

“t ra ining schoo l o f six teennu rses. No teaching was


STATE R EGISTRAT ION

We have seen that Engl ish nurses— led by M rs.

Fenwick— awoke before Americans to the need oflegal status , because the economic pressure was fe l tmore acutely by them . Upon the kind and eff ect iveness of the educat ion one receives depend the working effi ciency and , largely , the social usefulness ofthe individual— also abi l i ty to meet opportunity andto maintain a good standard of l iving . While stateprotect ion of the nurse’s train ing is , at top , an educa t iona l , i t i s at bot tom an economic , quest ion .

N urses as a whole , however , were long unconsciousof this close relat ionsh ip , and Americans , with theirmore abounding opportunit ies , came more slowlyto real ise i t . t en, in June , 1 899 , at the LondonCongress , Mrs . Fenwick said to the wri ter : Why donot the Amer ican nurses go in for state registrat ion ?the words fel l on unh eeding ears . There had beenmany others , however , who , solely from the educat ional standpoint , had long beenanxious and watchful by reason of the rapid increase of train ing schoolsand the resultant dilut ion of ideals . Many were theindividual nurses who , di sturbed by the tendenciesthey perceived , said vaguely now and again :

“Thereought to be a law against " th is and that . Thisundercur rent was later voiced and i ts significancein bringing organisat ion to pass expressed by IsabelHampton Robb , in 1 899 , when , as pres ident of thesecond annual convent ion , she said

a l low ed ; the nu rses did a l l the servants' work , including their owni roning ; evena monthly allowance was not g ivenon ground of the“dip loma .

"A . J. N . , M ay , 1 903 , p . 62 7 .



of the City hospi tal inRochester , and Miss Sy lveenNye, who , in Buff alo , had organised a nurses

’

club ou t of very diverse and isolated elements . I n

Buff alo , too , was Miss Annie Damer , who afterwardstook a lead ing part in nat ional or ganisat ion . I t

wou ld perhaps be impossible to say to whom thecred i t of the firs t thought is due , but the first one ofthe series of s teps leading to the final resul t was thepaper read by Miss Palmer before the State Federat ion of Women ’s Clubs on November 9 , 1 899 . I n

th i s paper she said :

The greatest need in the nursing profession to-dayis a law tha t shall place training schools for nurses underthe supervision of the University of the State of New

York . Such a l aw would requ ire every training school tobring i ts standard up to a given point , woul d requ ireevery woman whowi shed to practise nursing to obtain adip loma from a training school recognised by the Universi ty , to pass a Regents

’

examinat ion , and to register herl icence to pract ise . I t is of vital importance thatexamining boards shall be selected from among nurses inpractically the same manner that medica l boards arechosen from physicians , that pharmacists, dentists , andteachers are examined, each by members of the ir ownprofession .

At the same meet i ng Miss Eva Allerton , afterwardsd ist inguished by her br i ll ian t w ork in gu id ing thenurses ' act to success , explained the funct ions ofthe Regents . ‘

The University of the Sta te of New York cont rols. so to speak ,

the ou tpu t of 66 8 instit utions of lea rning in the sta te a ca demies ,col leges, universi t ies , professiona l and technica l schoo ls , bu t u oes

not include schools of nu rsing . I t reg isters educa tiona l plants a ll



States . Because of the standing of the Regents ofNew York , the importance o f the state as a nurs ingcentre , and the novelty of the idea of a board ofexaminers composed whol ly of nurses , i t seemsproper to give some space to the details of thisundertak ing .

At the th i rd annual convention in 1 900 , the needof broader , more elast ic associat ions was fel t i n thea ir . Expanding growth and ind ividual act i vitywere again recorded by Mrs . Robb in her president iala ddress , as she summed up the important th ingsbefore the nursing profess ion at that moment .

we trust steps may soon be takento form stateassociations , beginning in a l l probabili ty w ith New

York . As many of us know , the question of registrationfor trained nurses has been long inour minds , bu t wewere also aware that to advocate legislation eight or tenyears ago wou ld have been to pu t the cart before thehorse . The fulness of t ime brings us to the vi talquestion of reg istration for nurses- only so will i t be possible for trained nursing to attain its ful l dignit y as arecognised profession and ob tain permanent reforms .As regards the schools , the introduction of a legal isedreg istra tion would naturally stimu late both schools andgradua tes to reach the requ ired standard . I f we do

not take care of ou r own aff airs , rest assured that ou tsiders w ill undertake the task for us , to ou r everla stingundoing and to the detriment of the publ ic , to whosesick we have the privilege of ministering . Canwebe still and le t th ings just take the ir ownw a y , as longa s the stamp of mediocrity marks a work to w h ichshould be g iven the best and h ighest that the hands ,hea rts , and minds of w omencanb ring

? This is no worktha t can be tak en up ligh tly or laid aside ea rclessl v bv

T he Uni ted S ta tes 1 47

the first comer, bu t one that shou ld be entrusted onlyto women , each one of whom should be ordained apriestess , as i t were , before she presumes to enter thetemp le to perform her ministries unto sick and su ff eringhumanity.

The force of democrat ic tendencies was next voicedby M iss Damer , who said :

“The Buf falo Nurses’

Associat ion organi sed five year s ago , taking in a l l

graduate nurses in the c ity , from smal l and largeschools . We feel the necess ity of s tate organisat ion for legislat ive purposes — we th ink the stateassociat ion should be an independent body

,but

aff i l iated with the nat ional . In the d iscussionMiss Palmer , w hose ideas of legislat ion were fullymatured and definite , said :

When we come to organise a state society, the principa l motive being to i nfluence legi slation , we take anentirely new depar ture from the mot ives actuating us inupbu ilding ou r associations for educational and soci alpurposes . We go before the legi slature , not as graduates of any one school , bu t as ci tizens of the state .I n regard to the county society we ha ve organised inRochester—and I think we are the p ioneers in countysocieties—our principal motive has been to assist in theformation of a state society .

A t the end of th is meet ing a conference was held atthe Presbyterian train ing school to consider ways andmeans in founding a state society . The movementthus begun was to sweep successfully from east towest , but New York , the leader , did not firs t win herlegal status .New York .

—A general call to the nurses al l over


the state went forth on February 2 6 , 1 90 1 , and or

ganisa t ion, quickly eff ected , was fol lowed by intenseact ivi ty and concentrat ion upon legi slat ive work .

Instantly there stood forth two opposing standardbearers

,and a duel typically i llustrat ive of al l subse

quent struggles began . The first president of the statea ssociat ion , a strong , capable , and earnest woman ,well deserved the posi t ion by reason of her arduouswork . Her bel ief , however , was that , i n organisat ionand legislation , as wel l as in the sick-room , nursesshould be subordina te to medical associates . Thefirst rounds of the duel were , therefore , upon thecomposi t i on of the society and i ts offi cers . ‘ Aroundthe one word “ nurses ” went on a l ively contest .The determinat ion of the majori ty , to avoid al l entangl ing all iances and to restrict membership tonurses , became clear . On the floor of the legislaturethe duel recommenced . There appeared the commercia l man , and the one who curr ied pol i t i ca lfavour . The chairman of the nurses’ legislat ivecommittee was M iss Eva A l lerton , a Massachuset tsGeneral graduate and head of a Roches ter hospi tal ,the Homeopathi c , a w oman of the utmost abil i ty andremarkable magne t ism , whose exert ions and greatresponsibil i t ies in this legislat ive campaign no doub thastened her premature and lamented death . Associa ted with her was Miss Palmer , whose strongwil l and forceful character braced other , less confident , fighters , and Father Hendricks , at that t ime

' See pa per on Organisa t ion and R egistra tion, by Sy lveenNye, Transart z

'

ons, Interna t iona l Cong ress of Nu rses , B uff a lo, 1 90 1 ,

p . 3 43 , rt sea , and , inconnect ionw ith i t , read p receding paper byM rs. Bedford Fenw i t k .



When , however , the character of the opposi tionbecame plain , these two chivalrously entered thel ists in the nurses’ behalf . The host ile forces centredin A lbany , and four nurses sat wi th them at the hearings ; —one of them , be i t confessed , a training-schoolsuperintendent . The attack concentrated on theprovision creating a board of nurse examiners nomimated by the nurses’ society and appointed by theRegents , while the defence was that nurses couldnot come up for examinat ion wi thout having comeunder the teaching and supervision of physicians ;that they could not receive thei r diplomas withoutmed ical approval ; that as three of the Regents werephysicians the medical e lement was thus suffi cientlyrepresented ; and , finally , that the nursing professiondesired to keep clear of medical pol i t ics , which wasevident in the fr ict ion betw een the three schools ofmedicine recognised by the state (regular , homeopath i c, and eclect ic) , as the diff erences in medicinewere outside of nursing cognisance and nurses hadno intention of being drawn into them . As a lastattack a bil l was introduced by Assemblyman N yeasking for registrat ion under the Secretary of State ,without any educational s tandard s wh atever . Dr .Frank Van Fleet , Dr . Wi

’

l iam S . Ely , Dr . Hartman ,and others spoke strongly and wel l i n favour of leaving the nurses to manage their own educat ionalaff airs , wh ile eff ect ive support w as given by thespeeches of Miss Margare t Dreier , Mrs . FrancisScot t , Mrs . Cadwalader Jones , al l of whom wereprom inent on tra

'

a ing-school boards , and Mrs .Montgomery of Rochester .The nu rses secured their own board of exammers

T he United S ta tes 1 5 1

and the equally important detai l of the r ight of nomina t ion by their s tate society for these pos i t ions .Th i s is the keystone and safeguard against pol i t icalmachinat ion . From the l ist of nominees the Regentsselect five. There is noth ing to prevent phys iciansfrom being nominated , as both men and womennurses have stud ied medicine , and such nominat ionshave been made . Appl i cants must be over twentyone and possess a diploma from a train ing schoolconnected with a hospi tal or sanitarium giving atleast two y ears

’ training, and registered by the

Regents as maintaining in this and other respectsproper standards , al l of which shall be determinedby the Regents . In order to determ ine standards

,

the Regents have their inspectors . The very moderate demands of the New York bil l count for morethan shows at first glance because of the powers ofthe Regents .The examining board was instructed to decide the

minimum of practical and theoret ical work thatshould j ust ify recognit ion by the state , and to send asyllabus to train ing schools . I n addit ion to the fourregular branches (medical , surgi cal , gynecologicaland obstetrical nursing) , speci al emphasis was laidon dietet i cs , the management of contagions , and thecare of s ick chi ldren , whi le private duty was limi tedto the las t three months of a three-years’ course .

In the winter of 1 905—6 anattempt w as made toamend inj uri ously the New York act ; a bi ll w as i atroduced by one Cooper to repeal the exis ting lawand subst i tute a “ nursing commission " composedof physicians who were to draw high salaries fortheir services . The attempt was defeated , a strong


delegat ion of nurses and medica l superintendentsof hospi tals appearing against i t . I ts promoterspromised to come back every year unt i l they gainedtheir purpose , claiming that their action was in theinterests of nurses . Following this , an attempt w asmade to abol ish the board of nur se examiners andsubst i tute a board composed of medical men . Thisalso failed . In Apri l , 1 9 1 I , the act was again threatened by harmful amendments which were successful ly warded off by the state society . Back of theseat tacks were dissat isfied medical men interested insmall hospi tals . I n June of that year the nurses’

legislat ive commit tee was enlarged , and met thed issat isfied medical delegates in conference . I t wasagreed that methods of administrat ion might rel ievethe tension , and a truce was declared . I n 1 9 1 2 ,

nurses were astonished by a set of resolut ions adoptedby the men direct ing the large hospitals in New York ,which , in eff ect , demanded the practical nu l l ifica t ionof the whole educat ional st ructure of the act . I t i sposs ible that when this H i story appears , our poorl itt le provis ion of one year in high school may havebeen swep t away as an intolerable restri ct ion .

‘

Importan t incidents in the his tory of the act havebeen the appointment of a nurse as inspector oftra in ing schools in 1 906 , and the later format ion of acommittee of nurses from the state society and theirinclusion on the Regents’ Advisory Counci l , which i scomposed of the deans of professional schools . Thefirst nurse inspector was Miss All ine . She wasfollowed three years later by M iss Annie W . Goodri ch , one of the younger superi ntendents . A New

See A . J. N . , April and M ay , 1 9 1 2 , E ditori a ls.


(ANSI a nd ISO TES I CHART No 2

as III!I2 .2

L6

A P P L IE D IM AGE


same year , Miss Wyche , sti l l act ive as a superintendent of nurses and member of the state socie ty ,wrote an admir able letter to the president of theState Normal and Industrial Col lege at Greensboro ,asking for a thorough-going course of prel iminarystudy to last n ine months and give anatomy and

physiology,personal and household hygiene , eco

nomic and domesti c science and die tet ics , elementarybiology and chemistry , physical cul ture and classroom demonstrat ion in practi cal work , with lecturesand read ing courses ; the whole to count for s ix monthsin a cou rse of three years . This wil l no doubt comebefore long .

New Jersey .— New Jersey gained a registrat ion

act in the same year and month , but a l it tle beforethat of New York . I t was , however , scarred bybattle and by treachery . New Jersey was unfortunate inhaving as a near neighbour one of the mostpowerful and act ive of corporat ions that have invented their ownmethods of teaching nurses . Aftera desperate struggle the nurses lost the examiningboard , a l icence to practice “ the profession of agraduate nurse ” be ing given by the clerk of thecounty on presentation of a dip loma awarded by atraining school connected with a hospital of thes tate where at least two years pract ical and theoret iea l training w ere required before graduation . Thesociety , how ever , rightly fel t that i t had gained apoin t against great odds in securing the requirementof a two-years’ hosp i tal course with theoret ical andpract ical training . T he words “

of the state pro

tected a gainst correspondence school s outside . and

the influence of the New York requ irements , with



lost in the senate . In 1 9 1 2 , they were finally successfu l , and secured an examining board of nu rses ,and a requirement of one year in high school .Vi rgini a . Organised a s tate society in 1 90 1 , i ts

moving sp i r i t and first , now honorary , president ,being Miss Cabaniss , a Virginia woman of nobleheri tage of character and inte l lect . The Virginiabill was introduced in 1 903 , and had an exci t ingcareer . For a time i t w as seriously threatened , not onany defini te grounds , bu t simply by

“ cranky M .D’

S

and young, i l l-in formed delegates to the state legislature .

” By the lat ter i t was vehemently denounced as a “Trus t ” and a “ Firs t Step towardWoman Suff rage . ” Violen t opposi t ion of this k indwas gradual ly subdued by tactful handl ing and goodlobbying , and by the opportune appearance of fortyodd nurses upon the floor , when a ch ivalrous memberdeclared : “ I have me t the enemy and I am theirs ,

”

and the victory w a s won . T he bil l was signed inMay , 1 903 , and has never been attacked or weakened . I t gives a board of nurse examiners , nominated by the state society and appoin ted by thegovernor ; requ ires a tra in ing of a t leas t two years ,with genera l instruct ion , in the wards of a generalhospi tal , and leaves the preliminary education and

the s tandards to be required from train ing schooland hosp i tal to be fixed by the board . After one yearof grace , Virginia made i t unlawfu l to p ract ise professiona l nursing without a l icence , but this d id notapp ly to women earning thei r l iving as nurses whodid not assume to be tra ined . This was the firstexample of a mandatory act . The Virginia act hasbeen admin is tered with wisdom and patience

, t e

T he United S ta tes 1 57

su l t ing in steady educat ional progress . Those es

pecia l ly deserving of honours for work in i ts behalfwere Dr . George Ben Johnston and Dr . Will iam S .

Gordon ; Jean Macara Glasgow , a married nurse ,and her husband , a lawy er , w ho free ly gave inva luable services , whi le among the nurses those of theOld Dominion and the Nurses

’ Settlement wereun t ir ing .

M a ry land came next . Her state society was or

ganised in 1 903 and a bi l l presented to the legislature and passed wi thout injuriou s amendments in thesame session . The striking efficiency of the Maryland s tate society , then as afterwards , was a test imonial to the. great energy and high aims of M issNutt ing , i ts organiser and first pres ident , and herco-workers , and the act showed the good influenceof the Johns Hopkins hosp i tal . A whole-heartedsupport was given by the nur ses and the med icalprofess ion , opposi t ion only comi ng from one source ,a smal l hospital whose d irectors w ished to send theirpup ils to private duty for the gain of their fees . Theywere defeated . The nurses obtained an examiningboard appointed by the governor from namesnominated by the s tate society , fixed the age of appl icants at twenty-three years , and set an entrancerequirement of h igh-school educat ion , and a threeyears’ training in one genera l hospital , or in twoor more under the d irection of a central school .

(This provision is intended to facil i tate the afli l ir t ionof several hospi tals for purposes of tra ining . )The stand taken by medical men of the h ighest

rank is i l lustra ted by remarks made by Dr . Will iamWe lch a t one of the mee tings :


You have to consider exactly how to proceed to

secure the state examining board . I noticed that inseveral of the states the law w as almost imperilled byeff orts to secure the presence of physicians upon theseexamining boards . Now I am qu i te sure that i t is notthe function of the physician to examine the nurses .The nurse shou ld not go forth w i thout having come underthe gu idance of the physician , but your profession is askilled profession w h ich requ ires special know ledge possessed by the trained nurse and not b y the physician .

Akin as the professions of medicine and nursing are,they are sti ll distinct professions , and there isnonecessity,in my op inion , and there are certain disadvantages ,in the requ irement that physicians shoul d be membersof the nurses’ examining board .

In 1 906 , an attempt was made to secure an amendment aiming at lower standards which would permitthe explo i tat ion of pupils , but i t was promptly metby the state society and de feated . After the act

went into effect Miss Georgina Ross , then MissNutting’s assistant , and one of the most pract icaland efficient of women , was asked by the state socie tyto undertake an inspect ion of school s , and , so acceptably did she fil l th is unofficial role that an agreementwas arrived at among the hosp i tals of the state bywhich a uniform minimum of training was arrangedfor the junior year .Four s tates , I ndiana , Cal ifornia , Colorado , and

Connect icut , passed regis trat ion acts in 1 905 .

Indiana — The nurses ’ state society was formed in1 903 . When i ts b il l was introduced two years later ,Open opposi t ion came only from one, the Epworthhospita l , which took the stand that there w as no



gi ven no sign of thei r intent , swiftly launched an

opposi t ion bil l of lower educational requi rements.

Though th is d ied in commi ttee , i ts sponsor succeededin amending the original bil l from a high-school togrammar-school standard , and in reducing the ageof appl icants from twenty-one to e ighteen years . Anunexpected difficul ty now arose in the unwill ingnessof the Regents to administer the law , though President Wheeler o f the un iversi ty approved of doingso . However , a new governor recommended thatthe Regents take up the bil l . They did so , and

appointed an examining board of five nurses and

two phys icians , the names of the former being suggested by the state associat ion . The delay hadbeen so protracted that the t ime of grace had thenelapsed , and fresh legislat ive action will be necessarybefore the mach inery of the law can be set in mot ion .

A feature of the campaign was the excellent organisat ion of nur ses throughout the state , and with therecent woman-suff rage v ictory progress in nursingaff a irs may be expected . Many phys icians lentloyal support , especially Dr . Charles D . Lockwoodand Dr . H G . Brainerd , and among the manynur ses may be especially ment ioned the work ofMiss Theresa M cCarthy , M iss Genevieve Cooke ,Miss Sophie G . Rutley , Mrs . C . D . Lockwood , andDr . Helen Crisw ell .Colorado formed a state society in 1 904 . In 1 905,

a registrat ion bil l w as presented to the legislaturepassing in the same year , withou t d ifficulty and a l

most wi thout opposi t ion , excep t from the man whohad a train ing school in Pueblo , who knew how totrain nurses in s ix weeks . ” Though the doctors

T he United Sta tes

helped very l i t tle , they made no object ions and theunamended bil l w as s igned in April . The nur ses hadreason to feel that they were treated with great consideration by the lawmakers , as a gubernator ial contest was in progress , which took jus t one-half of thelegislat ive hours , and caused many b ills to d ie nanot iced . An interest ing feature of the campaign w asthat the chairman of the senate committee was aChrist ian Scientist , y et h is commit tee voted unanimouslv to report the b i l l favourably . A full nurses ’

board was granted , appointed by the governor , bu tnot nominated by the society . Members of the boardmust have had a three years ’ course in a genera lhospi tal or sani tarium giving a systematic training .

Requirements for examinat ion obl iged appl icantsto show diplomas from such hosp i tals as have astandard of instruct ion and training conforming tothe rules prescr ibed by the nurses’ board . The lawalso provided that after 1 906

“ i t shal l be unlawfu lfor any person to practise nursing as a trained ,graduate , or registered nurse without a cert ificatefrom the board of examiners . Those who do notcall themselves trained are al lowed to pract ise wi thout interference as untrained or simply experiencedwomen . The nur ses did good campaign work , MissLouie Croft Boyd carrying off chief honours . 1

Connecticu t organised a state society in 1 904 and

presented a b il l in 1 905. I t met wi th strong opposit ion from physicians who were conducting train ingschools in small sanatoria

,but in spite of th i s i t passed

in the same year wi th no injur i ous amendments , atribute to the eff ect ive work of the nurses , whowere staunch and sol id in i ts support . Especially

7 0l o l i l o


deservi ng of laurels were Miss Charlotte Brown,Miss

Mary Gorman , Miss Emma Stowe , Miss R . IndeAlbaugh , and other members of the state society . Aful l board of nurse examiners was secured , but thestate society does not nominate . The members areappointed by the governor . The requirements were :age over twenty-one , a dip loma from a train ing schoolgiving a two years’ course and connected wi th apubl ic or p rivate hosp i tal where medical , surgical ,and obstetr ical cases were cared for ; or such pre

para t ion as the board should consider equivalent tothis . The law specified seven subjects in whichexaminations were to be passed .

I n 1 906 several s tates presented b i l ls , but nonewas carried . 1 907 had a better record .

District of C01umb ia .— The nurses formed a society

in 1 903 and had an exci t ing legislat ive contest .Before organisat ion was complete , a meet ing washeld at which the heal th officer of the d istr ict readto them a bil l of h is own preparat ion , which waslater introduced into Congress by the d istrict Commiss ioners . But the nurses , then on the alert ,real ised that i t d id not sat isfy them , and enteredso act ively into opposi t ion that they succeededin kill ing i t . In 1 905, they prepared another and

presented i t themselves . The Commiss ioners andheal th officer , eager to retal iate , attacked i t , and thenurses final ly wi thdrew their bi l l as being unsa t isfactory . The Commiss ioners , in 1 906 , brough t ina third bi l l which the nurses again ki lled in theHouse of Representatives . Following up this ad

vantage , they wrote thei r own bil l , reject ing a l l

other advice , looked up thei r own man to presen t i t .



nurses were surpri sed by a veto from the Execut ive ,on the ground that the bi l l was unconst i tut ional ,d id any one real ise that the const itut ion of WestVirgin ia forbade a woman to hold publ ic office . Theboard of nurses was , there fore , impossible . As noneof the men concerned knew this , i t is not surpris ingthat the nurses did not . Mrs . Lounsbery wrote

I took i t wh i le in preparation ,to the governor’s own

legal clerk , w ho did not see the error, and as there wasnot one sena tor or representa tivewho knew that a board ofw omen was unconsti tutional , i t w as passed and went tothe governor . A fter h is veto we hastily altered the text ,prov iding for a board of physicians , and it was repassedat A . M . , on the last nigh t of the session .

Several senators , when asked afterwards if theyhad ever read the const itut ion of the state , laughedand said “

No The nurses of West V irginia have ,therefore , a ful l board of medical examiners ap

pointed by the governor . The qua l ifiea t ions are asfol lows : age twenty-one years ; a high-school educat ion ; a two years

’ training in a general hospital , theresidence in hospital to be cont inuous and instruct ion systematic . This pecul iar wording shows theintention of guarding the pupil ’s educat ion againstcommercial private duty outs ide . Among the mostable campaigners was a Virgin ia nurse then li ving inWest V i rginia , Miss Naomi Si 'nmons.

I n 1 909 , an at temp t was made to weaken the privateduty clause by amendment , without the nurses

’

knowledge . I t cannot be regarded as insp iring confidence in medical boards that this injurious amendment was introduced by two of the examining

T he Uni ted Sta tes 1 65

physici ans , one of whom directed a private sanitariumand the other a hosp ital for the in sane . T he secretary of the board , Dr . Lounsbery , was , however ,loyal ; the nurses , led by Mrs . Lounsbery , were v ig ilant , and the aggression was discovered and decis ivelyrepel led by energet ic protest from the s tate society .

Subsequent eff orts at construct ive improvement haveshownthe d iff erence between a nurses’ and a med icalboard . A prominent West Virginia woman said in1 9 1 1

As yet we have not been able to bring our board to

consider the subject of a uni form curricul um for training schools . We are unfortunate in not be ing able tohave nurses on the board . They are excluded becausethey are not voters , and we have been unable to insp ireour board with enough interest in nursing matters to goforward .

New H ampshire formed a state society in 1 906

and a regi strat ion act was presented and passed in1 907 . No opposi t ion nor injurious amendment wasoff ered , and no unusual incident occurred . Theboard , with one except ion , i s composed of nursesnominated by the society and appointed by theRegent of the State Boards of Medical Examiners .The Regent h imself has the final place on the board .

Appl icants must be twenty years old , wi th diplomasfrom training schools of at least a two years’ course ,and in other respects approved by the Regent asmaintaining proper standards . Miss B . M . Truesdell , superintendent of the Portsmouth hosp i tal ,bore the chi ef responsibil i ty of the successfulcampaign .


M innesota .— The state society was formed in 1 905

and the b il l presented and passed in 1 907 . No in

j urions amendments were off ered , and no ser iousop posi t ion w as shown . Some object ion w as off eredby the S t ate hosp i tals for the insane , whose nurseswould not be el igible without further train ing , butthese protests were made in a reasonable spir i t andthe project of a ffi l iat ion was accep ted as meet ingthe difficulty . The examining board consis ts offour nurses and one physician , al l appointed by thegovernor . A woman physician was chosen for thefirst board . The

. state society does not nominate .T he requ irements w ere twenty-one years of age ,educat ion admit t ing to high school , and a three years

’

systemat ic course in a general hospi tal , or in thosesui tably a ffil iated for the purpose .Iowa — The state society was formed in 1 904 and

a bil l presented in 1 905 . I t was at first defeated ongeneral grounds of oppos it ion to the demand for aboard of nurses . In 1 907 another attempt was made ,but the nurses found that Iowa was host i le to newexecut ive boards . Not only were they told that theycould not have it , but that they couldnot be permittedto withdraw thei r bil l ; they must either mod ify theirown demand , or a bil l wou ld be passed giving theent ire control to a board of medical examiners a lready inexistence . Confronted with th is al ternat ive

,

the state society accepted the inev itable , and W i tha board consist ing of two nurses selected by theS tate Board of Health , two phys icians belonging tothe same board , and i ts secretary , the bi l l was successfu l ly passed in the session when presented . Thoughd i sappoin ted in the composit ion of the board , the



taki ng the ground that the large school s were t ry ingto “ put them out of business ,

” also natu ral ly heldi t proper to defeat , i f poss ible , the nurses

’ bil l .Having no substant ial ground for opposi t ion , asexaminat ion was not compulsory , they looked aboutthem for support and gained that of the GermanLutheran Synod of Missouri . The novel and in

genious argument w as then advanced that , by havingstate supervision of training schools , there was re

sa l tant a union of State and Church , which , underthe federal const i tut ion , i s forever forbidden . Theirproposit ion was that the simple diploma of a (any)training school should suffice for registrat ion . I ti s surpris ing that none of this opposi t ion , determinedand even b itter though i t was , was able to defeatthe nurses’ b il l in the legislature . Tw ice i t waspassed amidst rejoicings , and was sent to the governor for h is s ignature , and twice the governor

’s vetofel l upon i t . What the remote force was that movedhim will never be a matter of more than widesp readsurmise . At last , in 1 907 , after i ts th ird successfu lpassage through the legislature , Governor Deneensigned the bi l l , and i t st i l l stands . In 1 909 ,

an amendment to increase the examining board to seven wasoff ered by a physician operat ing a small countryhospi tal , but was defeated .

N umerou s and val iant was the regiment of energet ic , big-hearted , breezy , and steady-headed womenof the M iddle West who won th is v ictory . Chiefamong them were the presidents of two years ,Mrs . Anne Hu tchinson and Miss M cM i l lan, thelat ter the head of the Presbyterian t raining school ,and Miss Adda E ldrege . who s tumped the. state


to explain publ icly the meaning and need of regist ra t ion; Miss Carol ine D . Seidenst icker , chairman ofthe legislat ive committee during all four sess ionsof 1 903 , 1 905, 1 907 , and 1 909 ; M rs . FrederickTice , who served on al l the legislat ive committees ,and , next to the chairman , attended more lobb iesthan any one else ; Miss Minnie Ahrens , superintendent of the Provident , and Sister Ignat ius ,of Mercy hospi tal , who gave unt iring services .The Sisters of Mercy w ere from the first in the vanof progress ive action to attain legal recogn i t ion , astheir art icles in the nursing journals show . Mento whom especial grati tude is due are Dr . GeorgeW . Webster , presiden t of the State Board of Heal th ;Dr . George F . Kreider , ed i tor of the I l l inois

Af edica l J ourna l ; Dr . Jacob Frank , who brough tthe nurses d irect t id ings of the enemy ' s doings in1 905, Francis Donoghue , Robert M cM u rdy , andSenator A . C . Clarke . T oo many to ment ion h erewere those nurses

,physicians , and laymen w ho gave

work and influence , bu t they wil l be found recordedin the nursing journals .T he board of nurses i s chosen by the governor

but is not appointed by the s tate socie ty . Ap

p l icants must be tw enty-three years old , and ,a fter July 1 , 1 9 1 0, must have had a three years

’

systemat ic course in a general hosp i tal , or inaffi l iated special and general hosp i tals . (Thisarrangement met the w ishes of the managers of thestate hosp i ta ls for the insane . ) The board maymake further rules for qual ificat ions to be demanded .

Georg ia .—T hc nu rses of th is s tate formed the i r

society in 1 907 , presented a bil l to the legislature


three months after organis ing , and passed i t in thesame year , an example of rapid act ion unequal ledelsewhere . Georgia nurses met a sad lack of chival ryfrom medical men. None helped them and the s tatemedical society appointed a commit tee to amend thebil l . During the campaign a circular letter was sentto al l the physicians of the state , urging them toOppose or de feat i t , as

I t wil l work a great deal of inconvenience to themedical profession , and to the general public , by cu ttingoff the supply of available nurses ; b y putting them in aposition where they canbe very independent and refusework when they wish to, and by increasing prices . I twill also interfere with the training of young w omen fromgood families in the state , that have been unfortunatein their education— thus shutting off the supply of

pupil nurses to sanitariums . The latter will , therefore ,be forced to employ expensive nurses , thus increasingthe ou tlay of each of them to several thousand dollarsa year .

Georgia was also assai led from abroad . In that yearthe enemy in Pennsylvania was act ive , and a Phi ladelphia physician made a pilgrimage to al l s tateswhere legislat ion was pending , distribu t ing widelya pamphlet composed of misunderstandings . Hewas met and refuted by Mrs . A . C . Hartridge ,a woman of abil i ty , character , and social posi t ion .

A good bi l l was secured wi th an examining board ofnurses nominated by the state society and appoin tedby the governor . Appl icants must be tw enty-oneyears o f age and graduates of regu larly charteredtraining school s connected wi th genera l hosp i talsor sani taria with medical

,surg i cal , yneeo lOg ica l ,



by the board as maintaining sat isfactory standards ,and giving at least two years of systemat ic training orthree years in affi l iated general and special hospi tals .Oklahoma , then the youngest of states , also d i d

well . The stat e society was formed in 1 908 , and

the nurses got to work at once on a bill which w aspresented and passed in 1 909 . This victory w as

carried in the face of formidable oppos i t ion fromcorrespondence schools , the Philadelph ia pi lgrimarriving in t ime to scat ter leaflets and make speechesagainst registrat ion . The society secured an examining board of nurses nominated by the societyand appointed by the governor . App l i cants forregistrat ion are to be twenty-one years old , and afterfive y ears are to present a high-school cert ificate andd iploma from a general hosp i tal giving a two years '

systematic course of training and instruct ion w i thcont inuous residence in the hosp i tal . Here again ,i s the sa feguard agains t exploi tat ion .

Washington formed a state society in 1 903 and

carried i ts bil l successful ly in 1 909 , with l i t tle or noopposi t ion , but w i th two undesired changes . Theexamining board of nurses is appointed by thegovernor , but the righ t of nomination by the societywas refused , on the ground that i t wou ld then b e aclosed corporat ion and ou t of harmony with thes tate law s . The nurses had asked for an age l imi tof twenty-three, but th is w as altered to twenty bythe legislature on the frivolous ground that some oldmaids w anted to bar out the younger women . No

waiver or t ime of grace for untrained nu rses wasgiven , but al l a ppl ican ts for registrat ion must havehad two y ea rs in a gene ra l hosp i ta l , or at least the

T he United S ta tes I 73

same kind and extent of service , al l of which is leftto the board to decide . T en subjects for examinat ion are named . The Washington nurses did verysystemat ic campaign work through their countyassociat ions . Every man in the legislature waspersonally interviewed and local influence brought tobear on h im . The latest inciden t of note has beenthe appointmen t of a train ing school inspector orState Superintendent . One year after the nurses '

bill was passed , Washington enf ranch ised its women ,giving a [then]fifth equal-suff rage state to the Unionand making four where nurses had both organisat ionand pol it ical equal i ty as wel l . ‘

Neb raska .— Here , too , the exten t of terr itory and

comparat ive sparseness of populat ion made theini tia l work of organisat ion difficul t for the nurses .A state society was formed in 1 905 , bu

t not unti l1 909 was i t strong enough to enter the legislat ivefield . When. i ts b i l l was presented , i t was at onceattacked by a fact ion represent ing a six-months’ commercia l course of train ing , and so strong was this host ile force and so sympathet i c the legislature towardthe Opposi t ion that , in order to maintain their posit ion and prevent another group from passing a muchworse bi l l , the nurses accepted w eakening amendments , trust ing to t ime and the growth of populareducat ion to upbui ld i t in the fu ture . The examiningboard i s o f nurses , while the S t ate Board of Heal th ,of which the governor is one member , i s the supervisory power . I t appoints the nurse examine . s , who

U tah , the fi fth , has no organisa t ionof nu rses, nor is the influenceof her weird polit ico-relig ious hiera rchy favourab le to such development . C a l i fo rn ia is no w th e. si x th .


are cal led secretaries , from an el igible l is t preparedby the nurses ’ society . T he b i l l does not indicatethat the society nominates , but by the rules of theboard i t does so . The board of heal th prescribesthe duties of the examiners and makes regulat ionsunder the act . The rules of the nurses ' board requirethe examiners to inspect al l train ing schools annually .

App l icants mu s t be twenty-one years of age , wi th aneducation su fficing for entrance to h igh school , anda training-school course of two or three years in ahosp i tal , sani tarium , or sanatorium with general service and giving systemat ic inst ruct ion . Graduatesfrom special hospi tals giving a two years ’ cour se maycome up for registrat ion after taking six months’

work in a good general hospital . Seven subjects arespecified for examinat ion . The legislat ive committee of the state associat ion , Miss Anna Hardwick ,Miss H . J . Fisher , and Miss L . B . Stuff , devotedthemselves ass iduously to the cause , and meri t fullrecognit ion for their abi l i ty in holding their groundunder difficul t circumstances .Texas.

— T he immense extent of th is s tate with i tsfew scattered nurses gives special prest ige to theval iant work they did in organ ising a society in1 906 , at Fort “forth Medical Col lege , with twentyfivemembers . At this very first meet ing the draft ofa registrat ion act was drawn up , and Miss Bridges ,Miss Jenn ie S . Cottle (now Mrs . Beaty) , Miss VanDoren , and Miss M . M . M cKni gh t , represent ing thelarge towns , took up w i th energy the task of makingknown the cause and bu ild ing up the associat ion .

Three years were spen t thus , unt i l in numbers andfinances the society was able to carry the b i l l into



few except ions , conduct ing training schools . The

largest directory in the state had long been control ledby physicians , who discouraged united act ion amongnurses . An association for training pupils in shortterms was strongly organised . On the other hand ,Pennsylvania has a large number of excellent schoolsfor nurses , thank s to the labours of women whosereputat ion as nurses and execut ives is honourable .In the winter of 1 904—5 , the nurses presented an a ctto the legislature . Though moderate in i ts scope ,i t was promptly defeated by the influence of medicalspecial i sts . I n 1 907 , the nur ses off ered concessions ,but st i l l met opposit ion . Counter organisat ionswent so far as an existence on paper . The AmericanJ ourna l of N ursing sa id in July , 1 908 (p . 750)“The Pennsylvania State Committee of Nurs ing isagain working vigorously to frustrate the nurses’

eff orts to obtain registrat ion . I t plans to establ ishnot only a State but a N at ional Board of Regents

(medical men) to control registrat ion .

” But theseeff orts fel l flat , for the state medical associat ionhad sent Dr . W . L . Es tes to the nurses wi th apromise to help them . I n 1 908 , renewed eff ortsto th is end were made ; the nurses travelled throughthe state giving addresses of explanat ion as to

what they real ly wanted and what i t meant tothe publ ic weal ; and in 1 909 , at the end of thesess ion , their b il l went through and was s igned . I tgives an examining board of five, al l to be appointedby the governor ; three are physic ians , of whom twomust be connected in an official capaci ty with publ i chospitals having tra ining school s for nurses , and twoare. nur ses , of whom it is only required that they shall


I 78 A H istory O f Nursing

declared that nurses carried ki ts ," “ tried to walk

l ike doctors , were “Officious meddlers in the s ick

room ,

" read medical papers , and reversed medicalorders . Dr . Taylor said : “ If thi s th ing keeps on Ido not know what will happen ; I see a solut ion intaking a half-trained nurse and training her in myown way , under my own orders . He added : “ Sheshoul d be a servant . That is her sphere , and i t isan honourable one . I f she is a servant amenable toorders , Obliging , tactfu l , considerate , there i s no faul tto find with her . " Dr . Beates p roduced a letter ,wri tten to the Physicians’ National Board O f Regentsby Dr . Wampler , O f Indiana , w i th this dreadful test imony : “The suprema cy and autocracy O f the trainednurse in Indiana confront Dr . Beates shuddered at the “ hard-visaged , i ron-j awed , close-fisted ,selfish leaders O f the nurse-Opa th ic crowd , andlooked for the day when R . N . should signi fy“ Retired Nurse — occupat ion gone .The medical members of the examining board sen t

manly , dignified , and emphatic protest to the papers ,Dr . Higbee , the president , being especially expl ic i t .Part of his reply ran as fol lows :

It is the policy of the boa rd to take the broades t viewof the wording o f the la w and to regi ster the graduatesof all the training schools O f the state wh ich are connected with hosp itals . I t is the opinion o f the boardthat a pupi l can acqu ire a know ledg e of nursing onlyby actually hand ling and waiting upon the sick and becoming practically acquainted with the appl iances necessary for their treatment and comfort .

See the Phi ladelphia Ledger and other da ily papers for Ap ri l 23.1 9 1 0 , and therea boets.


He then went on to state that appl icants from a certain inst i tut ion having presented themselves— “

i t i sthe judgment O f the board that the school does notgive a course which fits a person for the responsibi l i t ie sOf a nu rse . T he board i s convinced that theprime object O f the school is ent irely of a mercenary

Dr . Higbee then cont inued with theplainest possible statement of facts , as to the organi sa t ionand methods Of the corporat ion in quest ion ,so that , during th is newspaper war a t least , thewholequest ion of tra ining was thoroughly thrashed ou tfor the benefit O f the publ i c in general . Perhaps themost extraordinary thing said in this connect ion wasa statement of Dr . Dul les in a printed pamphletcul led from the P ubl ic L edger of October 1 6 ,

1 908 ,

as follows : “The traini ng schools for the educat ionOf women are sp lend id things , but after al l i t must beremembered that their purposes are only educa tiona l .E labora te tra ining inthe a rt of nursing i s not essent ia l to the pa tient . I t i s only gra t if y ing to the nursesthemselves.

M issouri . —The state society was formed in 1 906

and a registrat ion act was presented in 1 907 . NO

Opposi t ion was met nor amendments O ff ered , bu t thebil l d id not reach i ts th ird read ing before the adjournment O f the legislature . In 1 909 , i t went through ,practical ly wi thout opposi t ion , except for some l i tt lefrom the country district s . There is an ex amin

ing~

i ard of nu rses appointed by the governor , but

I n 1 9 1 1 , a nurse from this inst itut ionp resented herself for reg istra t ion, and was refused . She b rought suit aga inst the boa rd, bu tthe courts ruled aga inst her and upheld the examining boa r-(LI ta l ics a re ou rs.


not nominated by the society . Applicants mustbe twenty-one , with a grammar-school educa t ion .

After 1 9 1 2 , the diploma must be from a tra in ingschool connected with a general hosp i tal , sanator ium ,

or special hospital having a two or more years ' courseand giving systematic instruct ion , or from one ormore affil iated hospitals giving an equ ivalent course .Dr . Herman Pearce and Dr . James Stewart , withMiss Charlotte B . Forrester , M iss E leanor Keely ,Mrs . Gertrude Gibson , and Mrs . Mabel LongFreytag w ere the leaders in t i movement . Theirsect ion Of the country i s one O f great promise , andgives a fine type of woman to the nurs ing profession .

M ichi gan’

s society was formed in 1 904 , and abil l presented in 1 905 , but tw i ce defeated beforepassing in 1 909 . Medical oppos i tion was here alsothe obstacle . I t seemed to centre in Detroi t , whencecame a committee of physicians to argue agains tthe bil l . While i t was in for the second time , a subst i tu te was unexpectedly introduced by Dr . L . L .

Keely provid ing for control by the state medicalboard . The nurses wrote : Had w e bel ieved thenewspaper art icles at th is t ime , we would have givenup the fight as hopeless . We did not do so . I t wasshown that , in spi te Of the fact that the state med ica lassociat ion , through i ts legislat ive committee , op

posed the nurses’ claims , the majori ty of ind ividua lphysicians were our friends , and many were workingfor us . ” The nurses ' committee d istricted the state ,appoint ing local chairmen to interview personallyevery senator and assemblyman ; pet it ions werec ircu lated among p hysicians , nurses , and the generalpubl ic , and resolu t ions obtained from county medical



l ike a pol i t ica l appointment , for remonstranceshad no eff ect . The nurses had , therefore , no alternat ive but to carry on a legal contest wi th thegovernor Of the state . They did so , without hes i tation , and won i t too , at a cost O f three hundreddol lars , which seems , after al l , a modest sum for defeat ing a governor .M assachu se tts — The state society was formed in

1 903 . From its incept ion and even earl ier thoseunder taking the task before them knew i t would bea knotty one , because of the structure of the Wal thamschool and the firm determinat ion O f i ts head , Dr .A l fred Worcestc'

c to alter i t . The core of itssystem was the tra i n ing of pupils whol ly in pri vateduty under the oversigh t of the physic ians in at tendance . In recent years some hospital serv ice has beenadded , and a most excellen t prel iminary course inall the pract i cal domest i c arts w hich woul d make i ta des irable member of an affi l iated group . The pers istency with which Dr . Worcester reta ined the d iscredited feature O f private duty , however , preventedthe recognit ion of the school in other s tateswhere registrat ion had been attained , and broughtabout a long and obst inate contest . One year afterthe s tate society was formed , he led in organ is ingthe “

New England Association for the Educat ionof the Nurse ,

” to which hospital d irectors and su

perintendents, training-school superintendents , andnurses in the ranks were bidden . The examp l e towhich he pointed in advocating th is m ixed socie tywas the similar one in Holland , which , as we shal lsee , has real ly st ifl ed free speech and retarded thenurse ' s education .


The Massachusetts nurses introduced thei r b i l li n 1 904 , and again in 1 905 . Each time the Opposit ion was so overpowering that they withdrew ratherthan submi t to amendments . Defeat w as brough tabout in 1 905 by men represent ing the New EnglandAssociat ion , though Dr . Worcester h imself d id notappear . Again in 1 906 an attempt was made withthe same resul t . I n 1 907 , a fresh eff ort was made .

This t ime the b il l was reported favourably to thelower house and passed , only to be unexpectedlydefeated in the senate by the defect ion of a supposedfriend . In 1 909 , having gathered fresh forces andrenewed energy

,the nurses came forward again .

At this t ime the Ameri canJ ourna l of N ursing saidN0 group of nur ses , in their eff orts for regi strat ion ,have had to meet such bi tter opposi tion from physicians of high standing .

‘The opposi t ion was ,indeed, form i dable—not abusive and vulgar , as inPennsylvania , but astute and skilfu l . At las t , a t

one O f the hear ings in 1 909 , a subst itute b il l based onthe Waltham method of traini ng having been Off eredby Dr . C . H . Cook , Dr . Worcester appeared in personto complain that Wal tham nu rses were excludedfrom examination in other s tates and to cla im t e

cogni t ion for them in Massachusetts . Ex-GovernorBates , who was in charge Of the nurses

’ b il l , askedi f he did not think the wisdom Of sixteen other s tatesworth more than h is own? But the b i l l fai led again .

In 1 9 1 0, always under the leadership of M iss M . M .

Riddl e , who , as pres iden t of the society , had bornethe bru nt O f work and responsibi l i ty from the outse t ,and whose patience and forti tude had never wavered ,the Mas sachuset ts nurses ' bil l final ly passed $9 . .e


through both houses Of the leg i slature , and wassigned by the governor on Apri l 2 9th . I t is by nomeans the bil l that they w ould have had i t , but givesa vantage-point to work from . The careful moderation of i ts text would seem to leave the d ispute wi thWaltham st i ll unsett led , had not the experience Ofother states shown that in the powers of the examining boards there is somet imes a reach not indicatedi n the bare wording of the text . The governorappoints a board Of five, three of whom shal l be nursesholding d iplomas from diff erent training schools fornur ses , giving at leas t a two years

’ course in the theoryand practice of nurs ing in a hospital , and who shal lhave had eight years’ experience i n nursing the sick ;one member shal l be a physician who is a superin

tendent of a hospi tal having a training school fornurses , and the fifth member shall be the secretary ofthe State Board Of Registrat ion in Med icine . Ap

p l icants for examination are simply to prove tha tthey are at leas t twenty-one years O ld , and of goodmoral character . Then i f , upon examinat ion , theappli can t shal l be found qualified , she shal l be registered . Examinat ions are to be in part wri t ten , andin part pract ica l demonstrat ion , and shal l includethe principles and methods of nur sing .

In 1 9 1 1 , at the end of the legislat ive session andafter the foregoing pages had been wri t ten , fivemore States gained registrat ion victories : Idaho ,Oregon , Vermont , Tennessee , Wisconsin . T he firstsecured an excel lent bil l . An interest ing point isthat the president O f the board is also made the inspector Of schools , and i t i s also noteworthy that ,the examining hoa rd being composed of two nu rses



After a three years’period of grace appl icants shall beadmi t ted to examinat ion if over twenty-one , and

graduated from schools giving an adequate and

systemat ic course of training of three years . Thiscourse may have been taken either in a good generalhospital , not more than three months of the sen ioryear having been given to outside nurs ing , or in aspecial one during t wo years , with a third spent in agood general hospital . To the usual l is t of subjectsfor study there i s added N ursing Ethics . x

In giving th is summary of the registrat ion cam

pa ign, i t has not seemed needful to repeat detai lswhich can be found in the given sources of reference ,but s imply to ind icate i ts character as a part of theeducat ional movement of our day , and as a featureof the advance of women toward legal equal i ty . If i tbe asked ,

“What has registration done ? ” i t may bedefini tely said that even in this short t ime i t hasproved to be a potent st imulus to hosp itals to improve their methods of train ing by laying aside theirind ividual ist ic att i tude and conferring together . A

tru ly remarkable process of affi li at ion between inst i tu t ions began almost immediately after the passageof the first act . The most prominent example ofthis may be found in the report of the Bel levue schoolfor 1 9 1 1 , showing that twenty-three hospi ta l s i n otherplaces , including New York State , Massachuset ts ,New Hampshire , Long Island , Vermont , District ofColumbia , and Rhode I sland , were sending the irpupi ls to Bel levue for afi‘i l iated training , the numberof these pupils runn ing into the fift ies , and tha t post

The full text of a l l b ills canbe '

found inthe fil es of theA .

'

J . N,

See al so 5 14 46 R eg i stra ti onf or N u rses, by L ou ie C roft B oyd, 1 9 1 1 .


graduate pupi l s from a l l over the Union numbered asmany more . I t has been found that many schoolsare glad to have a standard given them , whil e otherscoul d never have been reached except by stateofficers .Pract ical arts have been quickened by state exam

ina t ions, for nur ses’ boards lay especial emphasis on

dietet ics , the personal comfort and skil led handl ingof the pat ient , and general management . But thereare sheer mountains to be moved , for, wi th pupi lnur ses now numbering thousands , the problem oftrain ing nurses has become the problem of the hometra in ing and early educat ion of the average gir l .

The R el i gious Nursing Orders— The history of

the religious nursing orders in the Uni ted States isone of ready adaptat ion to modern medical and socia lcondi t ions . Soon after the training-school movement was launched , the Sisters of the various hospi ta lorders began providing instruct ion for thei r own

novices , and next Opened schools for the trainingof secul ar nurses . In this new field the first werethe Sisters of Mercy in Chicago and the S istersof St . Mary’s in Brooklyn . Their school s wereopened in 1 889 . Next came St . Vincent’s in NewYork , 1 . ader the Sisters of that order , and wi th whichMic s Sanborn , a New York hospi tal graduate ofwinni ng and dignified presence is closely ident ified ,and that of the Carney in South Boston . Bothwere opened in 1 892 . At the present day i t i s probable that every act ive hospi tal order in the countryhas a more or less wel l developed training school fornu rses , and that each provides. also some degree of


training for the Sisters who are to engage innurs ing ,even though this may not always be as thorough asthe preparat ion of the secular nurse . The S istersof Mercy , however , are fu l ly trained , taking theirhospi tal cour se before the complet ion of the ir vows ;therefore , l ike the members of Angl ican orders , theseSisters take the personal di rect ion of al l branchesof hospital work , and act as head nurses , operat ingroom Sister , and superintendent of train ing school .The standing of the Sisters’ schools keeps pace w i ththe others of the communi t ies where they are found .

The graduate nurses from the Sisters’ schoolshave their alumna associat ions , join larger groups ,and take part in every profess ional movement . Thesuperintendents are act ive in their state and nat ionalsocieties , and the Sisters themselves come forth effecti vely in educational campaigns . The whole registra t ionwork owes much to their help . Indeed , therehave been no except ions to the uniform supportthey have given i t . I n certain ones of the mostact ively contested struggles , as I l l inois and New

York , their al liance has been of a defini te and emphat ic character , which helped greatly to save theday . The Sisters of Mercy wrote t imely art i clesadvocating regis trat ion . The Sis ters of St . Vincen tsubdued uncouth legislators . In Maryland , wherethe orders are strong and have numerous hosp i tals ,their eo-Operation in the h igh standard se t by theact was general . Miss Ross was admit ted to theSisters’ schools in her tours of inspect ion , and

the nuns conferred freely wi th the members of theexamining board .

I t i s a st irri ng sequence that brings the Sisters of



these first pup il nurses have followed the ca ll of theGood Shepherd and entered the Sisterhood to continuethe good work then begun .

In 1 889 the school for nurses was r gu larly organisedand a charter w as secured from the State in 1 892 . Achange was made in 1 901 from the ol d two years

’ coursewi th one month’s to a three years’ course with two

months ' probation . In 1 905 the school affi l iated withNorthwestern University . Since then the nurses graduate wi th the students of the university . Aff i liationwith the university gi ves to the student nurses theadvantages of the laboratories of the medical school ofthat institution and they rece ive their theoretical courseunder the direction of the faculty .

x

An Anglican order that here rose to promi nence innur sing is that of St . Margaret’s , 2 whose work inthis country began in the following way : About 1 869several physicians of Boston , des ir ing to found ahospita l for ch i ldren , and having vi s i

‘ ed the one inWashington recently developed from t h e work 0 St .

John’s Sisterhood , secured the interest and pract i cal

a id of Mrs . Tyler , a deaconess well known in NewYork and Balt imore , who , as a fri end of Dr . FrancisH . Brown , off ered her servi ces for the undertaking .

After beginning in a small way with a few associates ,Mrs . Tyler proposed applying for help from one ofthe Engl ish Sisterhoods , and eventual ly the Super iorof St .Margaret ’s , East Grinstead , sent S ister Theresa ,who had been thoroughly trained at the Westminsterand the Children’s Hospi tal in Great Ormond Street

,

to look over the new field. Upon her arrival she was

R eport f or 1 9 1 1 .

See Vol . I I . for ea rly history .

T he Uni ted Sta tes 1 9 1

given ful l charge of the nursing , much of which wasdone under her own hands , and was final ly e lected su

per intendent . In 1 873 , two more Sisters came fromEngland , and the Communi ty of St . Margaret’s inBoston then came into being , with Mother MaryLouisa as i ts venerated Superior . The first pr ivatehospital in Boston was the St . Margaret ’s I nfirma ry ,which was begun informal ly in 1 88 1 with a singlepat ient who was taken at her own urgent request .This grew to a large service , and was nursed ent irelyby the Sis ters unt il i ts d iscont inuance five years ago .I n 1 883 , the hospital for ch i ldren was moved to i tspresen t extensive quarters , a convalescent homeopened in connect ion with i t , and a new era ofgrowt h and effi ciency began .

The train ing school for nurses is establ ished ona sol id educat ional basis , providing a scient ific andpract ical cour se of instruct ion for three or moreyears , and is recognised throughout the count ry aso ne of the select group whose methods and standardsare unquest ioned . A high-school d ip loma is re

quired of each appli ca nt , with the added requirement of four months of academic work at SimmonsCollege successfully completed before they a re

formally enrol led pupi ls . The course includes a

compulsory four months of adult nursing at theMassachusetts General , with three months of

priv ate nur s ing under instruct ion at Corey Hilland six months at the Lying-I n as elect ive courses .The academic work ranges from the preparatoryinstruct ion in anatomy , chemistry , and materiamedica

,through ad unced lectures and clini cs on

speci al subjects , and the pract i cal work keeps pace


through every department of expert nurs ing and

ex ecu t iv e work .

The Sisters have act ive branches in N ewark , N . JMontreal , and Philadelphia . One who knows themwell wri tes :

I f i t may ha ve seemed to any that , inthe developmentof nursing , the Sisters of M ercy belonged only in the i rmedi zev a l environment and had no p lace in the modernscientific world , to them a brief survey of the w ork doneby the Sisters of St . Ma rgaret in the very fore front ofp ioneer reform , and maintained to-day at the highestmark of eff i ciency , may we ll be a notable enlightenment .I f we go farther, and seek the inner psychological significance as w ell as the outward material accompl ishment ,i t is not indefensible to suggest that science and re lig ioneach find their complement inthe other , and only when sojoined together do they reali se the ir comp letest fulfi lment .Souls must be cared for as well as bodies , and the ahsolu te consecration and devotion of the rel ig ious li fe mustleave i ts stamp upon the work of nursing— nu infl uenceof silent power greatly needed , and too often greatlymissed ,

in the relentless t ide of modern hosp ital l i fe .

Besides i ts admi t tedly model character as a tra ining schoo l , the Children

’s of Boston exerts a salutaryin fl uence in genera l nursing aff airs . The Sisters arepubl ic-sp i ri ted , and Sister Amy , the superintenden tof nurses in 1 9 1 1 , i s a leader in educational matters .I t may seem strange , but is none the less t rue , thatthe Sisters are more free to define and maintaineducationa l standards than are some other trainingschoo l h eads in Boston hosp i tals , whose posi t ions a retoo far subjected to the hospital su perintendents .Amer ican-I rad i an N urses — Could the Canadian



trained in aff i l ia t ion wi th ci ty hosp itals . The

J ourna l of the Carli sle school says :

A thorough course in nursing is being formul atedwh ich will comprehend recitation work, lectures , demonstra t ions, and actua l practice . Arrangements arebe ing completed w i th the best hosp ital training schoolsinPh iladelph ia , such as the German , that of the Universi ty of Pennsylvania , and the hosp itals of other easterncities , whereby our nurses wil l be admitted to advancedstanding inthese schools , after comp letion of our course.Indians make sp lendid nurses . By nature they are

adapted to th is work . The are deft with their fingers ,patient and sympathetic with those who are il l . W ithour well-equ ipped hosp i tal , a limited number of carefu llyselected young womenwill find ide a l opportunities forstudv ing th is noble profession . Carl isle is fortunate inbe ing situated near Phi ladephia , the greatest medica lcentre in the Uni ted States . A number of Carlislegraduates are already successful ly fol lowing this professionin all parts of the country, and from the ausp iciousbeg inning wh ich has now been made the number wil lbe continually increased .

Miss Juliet te Two-Ax e, an Oneida , wri tes fromChicago : “ I wish more Indi an girls woul d tak e thecourse in nu rsing . I find i t fascinat ing , upli f t ing ,and beneficial .

” Mrs . Z ippa Skenandore is a marr iednurse , and finds her train ing useful in fami ly l ife .She writes from Wisconsin

I think nursing is the grandes t thing for gi rls to know.

how to take care of the sick inthei r own family or inothers . I know I never regretted that I did learnnurs

The Red M an, a monthly magaz ine by Indians. October . 1 9 1 0.

p . 87 . Ca rlisle IndianPm


ing, though I 1 not take it up af ter my graduation atthe Connecticu t training school , except one year . Thenhousehold duties came on and I have a family of

seven to take care of . I t is a great help to me .

Mrs . Betty Wind Driven , a Methodis t Episcopalgraduate , says :

“ I li ke nur s ing in al l i ts branches ,and my opinion of i t for the I nd ian gir ls i s that theyare gifted with the art of nurs ing .

”

A number of the Carl isle nurses have married , andsome of the best have died , while others , scatteredover the country , are busy , successful , and happy inthe ir work .

Ameri can-Negro N urses.

— I n the rapid progress ofNegro women in nurs ing may be seen another st ri king example of the eff orts made and ach ievementsa ccompl i shed against fearfu l odds by a people firs tsubjected to the most cruel Oppression and thenturned loose , as i t were , to fend for themselves . Ne

gro appl icants to r a ining schools found the w ay

barred to them in most hospi tals , though in somestates an occas ional N egro probationer was takeninto good schools , the pioneer coloured nurse , MissM . E . P . Mahoney having gr aduated in 1 879 fromthe New England Hospital for Women and Ch ildren . To meet the need of tra ining , therefore , thefirs t school was opened in 1 89 1 in the Providen tof Chicago , an insti tut ion which was founded and

partly endowed, and is entirely control led by colouredpeople . In the announcement of i ts incorporat ion ,i t is stated that “ a number of men imbued wi th a

d esire to be usefu l to others decided to organise a

hospital and training school for nurses . The school

1 96 H istory of Nursing

was to be the feature of the inst itu t ion,and it has,

indeed , worth i ly attained its p urpose . The firstsuperintendent of nurses was M is s Weaver of theI ll inois train ing school , and with in twenty yearsafter i ts foundat ion the hospital had sent forth morethan a hundred wel l-taught nurses . They comethere from every part of the Union and Canada

,

and many have taken charge of other train ingschools which have grown up with rapid i ty in manycit ies . Philadelphia has the Mercy and the FrederickDouglas Memorial hospitals ; Washington , D . C . ,

has the Freedman’s ; New York Ci ty , the Lincoln ;Tuskegee and Hamp ton have their hospital nurs ingschools , and hosp i tals in Montgomery , Alabama

(Hale Infirmary) , New Orleans (Straight Univers ity) ,T a ladega (the same name) , Savannah (GeorgiaSan itarium) , Augusta (Lamar Hospi tal and Burner Sani tarium ) , Macon (Li ncoln Memorial ‘ Atlanta

(Atlanta School of Medicine) , with others for whichSpace fails , are striving to meet the problems ofmedical care , and medical and nursing education .

L ike other Southern races , the N egro nurses havebeen chiefiy lcd at first by those of a more experiencedrace . White superintendents have done some excel lent work in coloured training schools . Perhapsthe I llinois t raining school stands firs t in the numberof efii cient leaders i t has given to Negro women , andthe devotion they have shared with their pupi ls ;Miss Minnie Ahrens , i n the Provident , Miss SarahEbersole , in the Freedman

’s , have records to beproud of, while thei r alma mater also claims MissLena M . Topping , whose work , even more thanthe i rs , w as anexplorat ion into the unknown .



Coloured women make excellent nurses . To theirnatural gifts of tact and ski lful handl ing are addedsoft , melodious voices , sympathet i c natures , and

idealism . They are especial ly successful in privateduty and in district work , and are on the staffs of anumber of vis i t ing nur se associat ions . In t ue NewYork Nurses’ Settlement the Negro nurses are heldamong the most valuable members , not only forgood nurs ing , but for intell igent altruism . The

N egro nur ses of the country formed a nat ional associat ion in 1 908 , which is a vi tal force for the irprofessional progress . These women have all theusual problems of the nur se to meet , with an addit iona l one— the cruel handicap of race prej udice ,springing , i t must be , in the whi te race , from a senseof gui l t . While the nu rs ing commun ity was small ,i t w as free from thi s ant isocial feel ing , but as i tgrows , here and there barriers are put up , ca ll ingfor pause and thought , tha t injust ice shal l not bedone , at least , in the impersonal realm of educat ionand state examination .

N urses’

J ourna ls— TheAmericanJ ourna l of N urs

ing and the yearly meet ings of the AssociatedAlumnae together have suppl ied the central e lectri cpower which , at once feeding and be ing fed by thesources of energy in act ive groups and zealous ind iv idua ls the country over, made possible the veryadmirable ach ievements in col lect ive act ion nowstand ing to the credi t of American nurses .Without co-operat ion , the journal could have had

l i t t le influence ; withou t the journal , the informing ,insp iring monthly vis i tor , union would have been de


layed and weak . The journal was first proposed byLou i se Darche at the meet ing of the American Society of Superintendents of Train ing Schools forNurses in Boston , 1 896, and before the next , MissM E . P . Da vis and Miss Palmer had made an exhaust ive inquiry into ways and means , in terviewedpubl ishers , and collected data of cost . But when ,at Ph iladelphia , the plan of founding a nat ionalassociat ion of nurses took shape , i t was fel t that anat ional journal shoul d be the firs t task of this morerepresentat ive body . The Associated Alumnae tookup the task at i ts first meet ing in 1 898 and MissNutt ing , Miss Palmer , Miss Harr ington , and Mrs .Robb were appointed as the first j ournal Committee .At the next meet ing , Miss Davis , Miss Stevenson ,and Miss Fulmer were added , and in January , 1 900,

the project was completed , the pract ical businessdetai l s be ing ca rried through by the indomi table willof Miss Davis .A stock company was formed , no one outside the

profession being al lowed to hold shares , and i t wasdetermined that , as the nat ional body became strongenough financially to buy over at least a control l ingshare of the stock , i t would do so . The journal appeared in October , 1 900, i ts ed i tor , Miss Palmer ,and her col laborators giving their serv ices unt i l i tshoul d be on a paying basis . At the end of oneyear i ts financial soundness was certain , and a ll

doubt as to the ab il i ty of nur ses to control and edi ta nat ional journal was past . ‘ T

en years after i ts

Short H istory of the Founding of the Amer ican Jou rnal ofNursing ," by M . E . P . Davis. R eporls, Interna t iona l Conf erenceof N u rses

, Pa r is . 1 90 7 .


appearance i ts ownership by the nat ional body wasan accompl ished fact , due ch iefly to the sustained andgenerous gifts of loca societ ies and of ind ividualswhose shares of stock were turned in as gifts or whogave sums of money to the Journal Purchase Fund .

I n 1 904 , the nurses of Californ ia , encouraged bythe success of the nat ional journal , and feel ing theimmensity of their own sect ion , establ ished theN urses

’

J ourna l of the P a cific Coast , which rapidl ybecame the special organ of nur ses’ societ ies in thefar West . I ts first editor , pilot , and , we may say ,creator , Miss Genevieve Cooke , started i t , rescued i tfrom the ruins of the earthquake , and se t i t upon astrong foundat ion . I t upholds the highest standardsand takes an advanced posit ion on the Woman

Quest ion .

Another journal of nat ional importance i s theVi si ting N urse Quarterly , publ ished by the Visi ting Nurse Associat ion of Cleveland . Among thequarterl ies or monthlies of more local character ,important ones are the Quarterly of the I l l inoisState Society and that of the Johns HopkinsAlumnae Associat ion .

The Na tiona l Society .

— I n i t s b rief existence thenat ional society of nurses , now the Ameri can Nurses

’

Associat ion , ‘ has accompl ished some fairly largeth ings in a very d irect and simple way , with few wordsand no strife , decid ing importan t undertakings asbriefly and qu iet ly as orders in the wards are givenand taken . To the Jou rnal Purchase Fund and theI sabel Hampton Robb Memorial i t has added another

‘ T he articl es were amended and name changed in 1 9 1 1 .



the new profess ion that must ever be grat ifying toi ts members .The nurses themselves had some share in the afli l i

at ion that resul ted , as we shal l briefly ind icate .

At the ir national meet ing in 1 898 , Mrs . Robbbrough t the subj ect before them in her open ingaddress , say ing :

I wish to speak ona serious and unexpected question i t is the attitude that th is association shalltake toward the present war . we all know that certainfacil i ties are off ered for secur ing care for the sick andwounded soldiers in connect ion w i th the Red Cross .A t the same time we a l l appreciate the fact that , wh ilei t is an organised society, i t does not represent the greatest or best skill innursing in the country . We do knowthat our association represents numbers and skill , consequently i t becomes your duty as delegates to decidewhether you will off er the serv ices of th is association tothe Government of the United States , to care for i ts sicksoldiers at any time y ou may be ca lled upon during thecontinuance of the w a r .

Last spring when possibili ties of war menaced thenation , individual nurses off ered their services ; bu t , unfortunately, trained nurses were not the only women so

impelled , as app lications and offers to do army nursing poured into the Surgeon-General 's ofli ce from a l l

manner of women , from the well-meaning “ born-nurseto the enthusiastic patriot , from sisterhoods and fromadventuresses .This association having offered its services , the v icepresident and I went to Washington and had a persona l interview wi th the Surgeon-General . But our

mission was a failure , as we were told that the nursingdepartment had been given into the charge of the

T he Uni ted Sta tes

Da ughters of the American Revolu tion , with a womanphysician as di rector (Dr . Anita N ewcomb M cGee) .Visions of what splendid systematic work might be donei f the nursing migh t only be in the hands of the nursesthemselves , supplemented by the extra supp l ies so

generously provided by the D. A . R . , the Red Cross ,and other societies , floated before us , bu t i t w as not tobe. The chaos and confusion that re igned supreme atfirst , owing to the suddenness and greatness of the emergeney, were intensified and prolonged by the l ack of

experience on the part of those into whose hands thew ork w as entrusted . Th is , and the appointments madefrom all varieties of women mentioned above , resu ltedinmuch bad nursing, a worse morale , and in a total lackof standard or system . [T he first nurses employed bythe American Medical Department were sent to F loridaonMay 1 0 , 1 898 . Thereafter there were from one hun

dred to twelve hundred nurses in the employ of the

government .] H ow long such a condition wou ld havecontinued to exist i t is hard to say , had not the situationbeen saved by the assistance and admirable work ren

dered by Red Cross Auxil iary No . 3 .

A brief word inexp lanationof these auxiliaries . Theydid not form a permanent part of the American RedCross , bu t were made up of a number of patriotic men

and women w ho organised for the purpose of raising fundsto assist the government in any way, and to rel ieve theneeds and su ff ering of the sick soldiers . A fter the warwas over, they di sbanded . Auxiliary No. 3 was organisedfor the express purpose of supp lyi ng and maintainingtrained nu rses in army hOSp i ta ls. Too much cannot besaid inpraise of the work it accomp lished , hampered asits members were by be ing only auxiliaries and not thecontrolling head . I t was through this auxiliar y thatthe best nursing was done . I t pu t itsel f at once intouchw i th tra ined nu rses of experience and abil i ty, and con


t inued to co-operate with them to the end . Bu t withlack of experience at the head of the service and w i thnurses recru ited from a variety of sources , there wasnecessari ly much chaff among the wheat .A certain amount of good nursing w as done , but not

hal f of w hat cou ld have been accompl ished with propermanagement . Many good nurses who went into thearmy hosp i tals in the summer returned home , becausethey cou ld not tolerate the lack of discip line and the

looseness of work and conduct , or because they cou ldnot conscientiously serve under the young, inexperienced ,and indiscreet women placed over them . Do not

understand me as saying that all was unsatisfactory ,for , just w hen the stress was greatest , the superintendentsw i th the i r nurses , chosen by the Red Cross Aux il ia ryNo . 3 , did much to minimise the lamentable state of

aff airs w h ich had existed at that time .

Superintendents of note who took charge of armynursing during the war were M iss I rene Su t l ifle,then at the New York hospital , who went to CampBlack ; Miss Anna C . Maxwell , who was given leaveof absence from the Presbyterian to organ ise thetyphoid camp at Chickamauga ; Mrs . Lounsbery ,who fol lowed her there ; Mrs . Quintard , who had along service in Cuba and elsewhere , and others . x

Miss Maxwel l , whose record was especially dist ingu ished , but who rarely speaks or w ri tes of herwork , has been persuaded to contribute for th isvolume the fol lowing account of her army experience .

T he Order of Spanish-AmericanWar Nurses was suggested byD r . M cGee and formed in 1 898

—99 . T he commit tee onorganisa t ion

was M rs. Lounsbery , M iss H ibba rd , and M iss Hodson. T he firstmeeting was held a t the New York hospita l, when five hundredmembers enrolled.



While I was wondering where I was to find a trainednursing force to care for the ma ny serious cases , M issCromel ine (now Mrs . Lee) came to Chickamauga as

the representative of the Red Cros s, and requested permission to supp ly the nursing staff for the new hosp i tal .

Th is w as indeed a relief to my mind , and with the approval of the Su rgeon-General the off er of the Red Crosswas accepted .

“ I can only add that I shal l never be able ful ly toexpress my sense of rel ief , when you. and your nursestook charge of the serv ice at Sternburg hosp i tal . ”

As a matter of fact , the mortality rate at Ch ickamaugabears test imony to the good professiona l work done therein sp i te of the adverse circumstances . The popu la t ionran close to men, many more than inany othercamp . The death-rate from al l causes was e igh teenper thousand . The rate at Jacksonville was twentysix , and at Alger andMeade twenty-one and e ight-tenthsper thousand .

T he Surgeon-General's report gives a word abou t

Sternburg l i OSp i ta l : capacity seven hundred and fiftybeds , fifteen medical offi cers , one hundred and sixtyseven tra ined nu rses , seven non-commissioned off i cers ,and one hundred and seven private hosp ital corps .T he first instalment of the nursing stafl

’

, tw enty-sixin number , went to Chattanooga , Ju ly 2 6 th . Vi

'

hi le

waiting the comp letion of the hosp i tal , we visi ted thedivision hospi tals at Ch ickamauga , and the horrorsthat met our eyes will never be forgotten . Sick anddying men lay unattended , exposed to the sun ’s rays,beyond the l imi ts of the tents , covered with fl ies , surrounded by unwashed u tensils , dust , and dirt .The situation w a s desperate , bu t delay inopening thehosp i tal w as due to the fact , tha t only one railwaycompany was employed b y the government to bring insupp lies . We found dishes , lamps , medicine glasses,

—

T he United States 2 07

and a ll bed supp l ies , excep t rubber sheeting. Aboutha lf the necessary amount was secured from the commissary. Soldiers ' ponchos had to be pressed into servi ce,and when these were exhausted , the infected mattresseshad to be burned .

The beds made ready, the car s containing utensil s arrived , and it was decided to rece ive two hundred patientson the second of August . They came , two in an ambu lance ; the black procession could be seen stretchingthrough the park for over a mi le . Most of the patientswere started hours before , and their condition onarrivalcan better be imagi ned than described . Many werewildly del irious , the ir bu rning bod ies in a filthy condition ,dead fl ies were found embedded in the coatings removedfrom their mouths , and there were numbers with bedsores of a magnitude unknown in the present day .

When these two hundred sick men were deposited intheir beds , what was my horror to find the supply of

milk and nourishment insuffi cient for the nigh t (we su pplemented i t by the foods we had brough t inour trunks) .But one sink for the disposal of discharges had beendug ; the bed-pans and other u tensils were not yet unloaded fromthe train that brough t them . I was in formedby the commissary that i t w as after six o’clock , that a llwork was suspended for the day, and the utensils cou ldnot beunpacked until the next ;moreover, that inventoriesand requ isitions would be requ i red before they could beput into use . I

‘he authori ties were then informed thatI wou ld openthe cars by force , i f necessary , rather thanexpose our already over-worked nurses to the dangersof infect ion . They yi elded , the cars were unloaded , anda line of nurses formed to ca rry the suppl ies to thei rtents , so tha t ou r pat ients could rece ive the proper care .No adequa te water facil i ties were prov ided ,

al though Iwas informed that the governmcr t could have secu reda pure water supp ly for the entire camp . b y paying for


the use of the water of C rawfish spring, just outsidethe park . For da y : the water was brought in figs

heads insuffi cient for our needs . Cold water was taterp iped into the camp , and after three week . I learncd,through a member of the engineer r orps, that a hotwater p lant could be readily constructed : this w as donewith in thirty-six hours after the requ isi tion was signed .

The laundry work for the camp was contracted for bya firm in Chattanooga , and so li ttle concep tion had theyof the work before them , that they sent a boy with amu le and cart to remove a tent fu ll of soiled linen . Ipersonally listed these clothes (over eight hundred p ieces) ,the condition of which was indescribable .

Only one pound of carbol ic was found , chloride of l imewas secured at Chattanooga , and linen was much damaged by i ts use . The trenches between the tents , andthe ground , saturated with typhoid bacill i , where thebuckets stood , were fina lly disinfected , bu t not unti lthe entire camp had been exposed to the infection fromthe millions of fl ies that gathered abou t these spots .The equ ipment , except that there was no crematory,was generous , and after the sixty-cent rationwas declared ,the food for the patients was suffic ient .The chief diffi cu l ties arose from lack of proper admin

i stra t ion. As anexample of the hopeless confusion , no

provision was made to record or p lace in safety themoney and valuables of the sick soldiers . The bedswere not numbered , the sections were not lettered , a l

though numbers and letters w ere prepared before w e

arrived . T he valuables w ere dif ficu l t to trace , and thepatients got lost , because there w as nomethod of idea tifica t ion. Sentinels had to be p laced over the l inen

,

because o f the slow return from the laundry .

The nu rses w ere sent to the camp by Dr . Ani ta Newcomb M cGee, appo inted b y the Surgeon-General asC h ief of the Nursing S taff . On requ isi tion. made to


T he Uni ted S ta tes 209

Washington , quarters , maintenance , and travel l ingexpenses were provided by the Third Auxil iary of theRed Cross . Every part of the Uni ted States w as represented

,and I cannot speak too warmly of the sp lendid

sel f-forgetfu lness , self-sacrifice, and devotion shown bythe nurses whoworked uncomp lainingly through the longhours , amid many physical discomforts , under a broil ingAugust sun , unrel ieved by even a passing breeze .

As each detachment of nurses arrived , the conditionsof hosp i tal and camp l i fe were exp lained . A head nursewas placed in charge of each section ( 1 0 tents ; 40 beds) ,and day and night stafis provi ded as the severi ty of thecases demanded .

All being graduated nurses i t was urged that we workharmoniously under authority, that we set standards bywhich we cou ld prove ou r fitness to undertake patrioticserv ice for ou r country, that our best effort was expectedas the public wou ld judge us cri tically, that we must“make good ," as the future of army nursing lay in ourhands . I must t ruthfu lly record that there were failures , as in all human lives . T o our deep regret , somewere not strong enough to withstand the temptations ofcamp li fe .

One of the greatest p riv ileges was help ing to fit ou t thehospital trains that carried the regiments back to the irhomes . The New Hampshire regiment took homeour sickest men, many of them at the point of death .

I was not permitted to furnish nurses from our own

corps , so off ered the services of three sick nurses “goingon furlough " til l others could be procured en route .As no rel ief was secured , these nurses worked constantly ,forty-eight hours , and helped to bring every man throughto his home alive .Unfortunately , fourteen of ou r corps contracted t y

phoid fever. They were sent at once to their homes ,and all rc L 'O v crcd save one.


La te inAugu st the reg iments were ordered away , andas they departed , ou r hosp ital corps men were dailybeing thinned ou t . Washington was asked to supply

,

and declined . The commanding offi cer, when appealedto, laughed , saying : You have had everything you haveasked for ,

" and although he had previously cri tici sedmy over-working the nurses , he refused to give us help .

He was informed that the nursing staff could not be lefthe lp less , with over five hundred sick men to care forwithout orderlies , and that several mill ionaires stoodready to furnish orderlies to the camp i f the governmentwould permi t . Otherwise I wou ld be obliged to ask tohave the nurses withdrawn at once . W ithin twentyfour hours the commander sent the orderlies, who provedthemselves most eff i cient .The fine courage of the soldiers , who gave up theirl ives without tasting the glory of battle : the courtesyand kindness shown us by the officers and medical staff ,the generosi ty of the mu l ti tude of societies and friendswho overwhelmed the camp with suppl ies , filled us withadmiration , and I regret that space forbids a more fittingtribute .

[M iss Anna Maxwe ll , Senior Superintendent ofNurses in the United States , organiser of the St . Luke 'sand Presbyterian schools in New York City , has beenat the head of the latter for some twenty years . We l lknown and just ly famed for her perfect ion of standard andmethod in training , she is even more exemp lary in thegenerous wealth of helofu lness toward the individualswho come within her radius . M iss Maxwe l l was traineda t the New England Hosp ital for Women and Chi ldren .

In collaborat ion with Miss Amy Pope , one of her assistants , she has written a standard text-book onnurs ing ]

As a resul t of the war experience , the lead ingsuperintendents of the country determ ined to make



her ownalma mater . After two years , Miss Delanowithdrew to give her serv ices to the Red Cross .The army-nursing b il l had met the opposit ion ofthe older leaders of the R ed Cross, but the supportof those who held to the newer ideas , and after reorgan isat ion an inf ormal commit tee of prominentnurses went to Wash ington to visi t i t s offi cers , andask that some sound basis for Red Cross nursing besought . Thei r suggest ions were wel l rece ived and,

an informal conference was held in New York inFebruary , 1 904 , between Red Cross offic ials andnurses . From these meet ings grew a final closerelat ion , and on December 2 0, 1 909 , the Red CrossWar Rel ief Board appointed a Central Commit teeon Nursing Serv ice , on wh ich ten nurses were placed .

Miss Delano was made chai rman of th is centralcommittee , the R ed CrossB ul letinfor October makingth is comment

By this arrangement the whole system of the Regu larArmy N ursing Corps and Red Cross Nursing Corps wil lbe placed under one head , so that in case of war the p lansfor Red Cross nursing assistance will fall into completeaccord with the demands of the army medical servi ce .Miss Delano will , therefore , be not only fully advisedas to the regular nursing strength of the army corps ,bu t wil l know exactly the status of the volunteer a idof the Red Cross Nursing Corps .

Under the new p lan state groups form branchesof the Red Cross , and in each state a committee , on

See N ursing inthe U . 5 . Army , by Dita H . Kinney , Superintendent , Army Nu rse Corps. R eports, Interna tional Council of Nurses.Berlin

, 1 904 .

T he United S tates 2 1 3

which leading nurses are placed , is cha rged with theenrolment of nur ses for serv ice . I t wi ll be seen , bycomparison w ith foreign provis ions for the nurs ingservi ce of the R ed Cross , that in no other countryhave nurses been met upon a higher plane or morehonourably treated with as al l ies and co-workers byRed Cross officers .Following the example of the army , though slowly ,

the navy establ ished a nur se corps by Act of Congressin May , 1 908 . Five years before , Medical D irectorBoyd had drafted a bi l l wh ich , had i t passed Congress ,would have secured advantages that must now begained slow ly . I t fa i led , and the b i l l of 1 908 owedits success largely to the eff orts of Admiral PresleyM . Rixey , who , when i t final ly passed , was SurgeonGeneral of the Navy . He was a firm advocate ofnursing serv ice , and for s ix years worked stead ily toovercome the prejud ice against i t that was cherishedby many of the older naval offi cers and , also , manyof the naval physicians . The first Super in tendentof Nurses for the Navy , Miss Esther V . Hasson , wasappointed in Augu st , 1 908 , and the first twentynurses were soon af ter deta i led to duty at the NavalMedical Schoo l Hosp ital in Wash ington . I t is notant icipated that nurses wi l l ever be placed on warships , though i t is expected that , in t ime , they wil lbe assigned to duty on al l hospital sh ips . They wi llserve in the shore hospitals , of which there are

eighteen or twenty in the navy .

‘

Socia l Servi'

ce.

— The most prominent v ariat ionfrom the old to the new type of nursing is tha t ca l led

a “The Navy Nu rse Corps, A . J. N . , M arch , l 9°9 ~


social serv ice (the word serv ice being a currenttechnica l term in use in hospitals) , as dist ingui shedfrom inst i tut ional serv ice . The term arose natural l y ,

yet we may ask whether Miss N ight ingale’s express ion “ health nursing i s not truer and more selfexp lanatory . For the new , rapidly multiplying l ineswhich are broadening the nurses’ hori z on and en

larg ing her fields , set t ing , at the same t ime , a newstandard by which she is to be measured , al l tend tothe prevention of i l lness and i ts ensuing wretchednessby the intell igent nurture of health and healthmaking condit ions . Under this influence the nursei s rapidly being “ social ised ” ; made a part of a communi ty plan for communal health , and , i n addit ionto her professional equipment , which now , more thanever , must be of the best , she is called upon to showmuch knowledge of a very diff erent , yet relatedk ind , attainable only through a truly h igher education .

” Besides her techni cal skil l , dexter ity , and

p ract ice in observing and interpret ing physi cal symptoms , she must acquire a social ski l l in observingand interpret ing social symptoms , d irectly l inked asthey are w i th the physical dest iny of the i ndiv idualpatient .All d ivis ions of social serv i ce are found in embry o

inthe dai ly round of v isi t ing nurses , and i t has beenchi efly due to their in i t iat ive that many now h ighlyorgani sed special t ies have been developed from theirdai ly tasks . We have said that the nur se i s rapid lybecoming social ised ; i t i s good to know that she hashad much to do wi th bringi ng this about . I t i ss ignificant that , in countries where the dist rictnurse i s closely subord inated as the arm of a con



ments . Now the one that has grown from their l i t tlefif th-story flat i s as notable in i ts d iff e ren t way as

Hull House .

The first t ime that Miss Wald described her workto nurses was in 1 90 1 , and from that earliest accountwe quote those parts wh ich especially interest them :

About eigh t years ago tenement-house l i fe in i ts mostp i tiable aspect was presented to me . I had been givinga course of lessons in home nursing to a group of proletari ans from the older world— a people who find a t e

newal of hope inNew York , i f not for themselves , atleast for the ir ch ildren . One morning , one of the womenof the class was not present and her l ittle daughter cameto ask me to call upon her mother , as she w as i ll . Desp itemy experience in a large metropol i tan hosp ital , and thesubsequent knowledge gained through a year's residencein a reformatory and asylum for the wai fs of New York ,the exposure of that rear tenement in the lower EastSide was a most terrible shock— a shock that was atfirst benumbing.

Upon further acquaintance with the house and neighbourhood , I learned that kindly intention from the ou t~side had no t been w holly absent . The visitor from amedical dispensary had called , and . touched by the

poverty of the place , had sent a bottle of beef extractwith the directions for use printed on i t , but there wasno one in the house who cou ld read English . Othercharitable persons had sent coal ; bu t my nurse

’s instinctrevol ted at the know ledge that nobody had washed thewoman , made her bed , 01 performed any of the officesthat every human creature should feel entitled to in likecondition . I w il l not take time now to describe all ofthe circumstances , nor my reflections on the responsib i l i t ies of the community , as they appeared to me , to

T he Uni ted S ta tes 2 1 7

this one family . T o me , personally, i t was a cai l to l ivenear such conditions .T o a friend the p lan was suggested : Let us twonurses move into that neighbourhood— let us give ourservices as nurses— let us contribute our sense of citizensh ip to what seems an alien communi ty in a so-calleddemocratic country .

" Having formu lated somenecessary details of the p lan , we proceeded to look forsu i table quarters, and in the search discovered the“ settlement . "

The li fe possible through making our home amongthe people in a simp le, informa l way , led us easily andnaturally into al l the quest ions that aff ected them .

Through our visits to the children and our interests intheir genera l welfare , we learned of the unsatisfactoryschool conditions and of the absurdity of a compulsoryschool law when there was not adequate school aecommoda t ion for the children . Such knowledge as cameto our notice, such eff ective protest as wou ld illustratethe conditions of our neighbourhood , was brought beforea su itable public, indivi duals , or societies especiallyconcerned , whenever occasion could be found or made .The women on the lower floors in the tenement wherewe lived were employed in the needle trades , and un

bearable treatment at the hands of a foreman had movedthem and their fellow-workers to ag itate for trade organisa t ion. In the search for some one of their own sexwho cou ld speak for them , in what they called “ betterEnglish , they came to us , and that was our first introduction to the protest of the workers wh ich is expressedinTrades-Unionism .

A semi-off i cial recognition by the Board of Healthgave us the privi lege of inspection of the tenements , andvaluable information was thus stored up toward thehousing problem . The experience thus gained had itsShare of infl uence in the general education of the p t’


which later led to the Tenement-House Exhibit ; to theappointment of a Tenement House Commission underGovernor Roosevelt , and a final creation of a separatedepartment for the city of New York . One of themembers of the settlement [Miss Wald], took activepart in the movement , and was one of the two women on

the j ury of awards for plans of model tenement houses .Through her eff orts to obtain a legacy that had beenbequeathed fer a founta in somewhere in the ci ty , theSchiff fountain was erected in the neighbourhood of thesettlement , and was the strong influence in deciding anadjacent site for a park and public p layground , to makep lace for wh ich no more congested and unsightly rookeries cou ld have been demolished .

To meet the right fu l demand of the children for p lay,

we conduct ed in ou r yards one of the first playgrou i inthe ci ty . I t w as an experimental station , in a way , aswell a s anenlightenment of the general public , and wasinstrumenta l inhelp ing to develop publ ic feel ing in thematter .The workers of the settlement can look wi th gra t ificat ion upon the increasing interest in public-school mattersaff ect ing their neighbourhood as in part the resu lt oftheir eff orts to bring public attention to the lack of roomfor the ch ildren inthe schools and to bring the inter estsof the i r localit ies directly to school boards . One of thehousehold w as for a time a school inspector , but , whetherin offi cial relat ionship or not , the members have beenfrequently consu l ted by those inauthority onthe Boardof Education .

From the needs of the neighbourhood has sprung theservice that we cal l “

first aid rooms ." in severalcrowded quarters . In each one a nurse i s in attendanceat certain hours of the day , and ca ses that requ iredressings . fresh "i ts, old wounds , simple eye cases , ccsemas , etc. , are treated . These are such nursing cases



mind . From what we ca l i the settlement point ofvi ew , we bel ieve that the patients shou ld know thenurse as a social be ing rather than as an offi cial vis itor ,and that al l leg i timate relationsh ips which follow fromher introduction as nurse shall be allowed to take p lace.

I t i s good from this point of view that the patient shou ldknow the home of the nurse , and that the latter shou ldbe intelligent abou t the housing conditions , the educat iona l prov isions , and the social l i fe of the neighbourhood lnwhich she works and lives . From this motivehas come the Opportunity for he settlement to showwhere the neighbourhood has been neglected , and to

bring into communication the diff erent e ‘ zments of societythat go to make up a great ci ty . We think and fee lsincerely that the relationship is reciprocal , that we arepartaking of the larger l i fe , that society in general hasclosed the avenues that lead to this knowledge , and thatthe di ff erent e lements of society need one another .

The part that Miss Wald herself came to take inpubl ic aff airs of moment and the remarkable prestigethat she gained as a leader in al l manner of civic ,duca t iona l , and humanitarian movements can hardlyyet be told in ful l , even d id our space permi Bu tthere is no doubt that , in the future , her name wil lrank w i th those great nurses of the past , whoseactiv i ties far ou tran the single se rv ice of a id to thesick . For, beginn ing as an obscure vis it ing nurse ,she has come to be cal led into consultat ion with themembers of one city admin istrat ion after another ;has sat on varied publ ic commissions ; counselledw i th a governor abou t the immigrant ; in terferedsuccessfu l ly w ith a President and h is Cabinet in behalfo f a Russian refugee ; and addressed a committee ofCong ress onthe need of saving the nation

' s ch i ldren .


Perhaps , as nurses , we may take especial pride inknowing that the suggest ion of a Federal Ch i ldren ’sBureau was firs t hers , as well as much of the mos tpersuasive work carried on in i ts behalf . ‘

I n 1 900 , a sim ilar group was led by M iss Cabanis sand Miss M inor inRichmond . The sett lement w hichthey bu il t up there is a rare example of co-operat ivework . The rent of a sui table house was covered bylet t ing rooms to private nurses ,— they , in turn,

promising to give certain port ion of their t ime to thed istrict nurs ing , whil e the add it ional call s were atfirst met by the members of a class of pupils in theOld Dominion hospital , who gave al l the ir hou rs andafternoons off duty to the d istr ict pat ients . MissCabaniss , during her years in the hospital as superintendent of nurses , had so thoroughly imbued herpupil s wi th al tru ism that , when she withdrew to thesett lement , her graduates were rea dy to help in anyand every w ay . L it tle by l itt le a permanen t salariedstaff has been bu il t up and the work developed inevery d irect ion . Here , too , the residents a imed attaking a share in civ ic affa irs . The character andsocial stand ing of the two founders , their seriouspu rpose and trained judgment , qu

'

ck ly gave themgreat infl uence , and they have made the se tt lement acentre for progressive movements of al l kinds . Therewas brough t about the first affi l iat ion of the variouschari ties , and a room given for a Chari ty Organisat ion office .

The i r first large undertak ing was the improvementof the almshouse nursing service . This , indeed .

For full deta ils see ”andk of Settlements, pub . by R ut sel l Sa geFeu ndnt i im 1 9 1 1 , pp . 2 05

—2 1 1 .


had been projected by Miss Cabaniss in her hosp italdays

,and now they persuaded the authori t ies to let

them engage good , rel iable women as attendants , forwhose train ing in the wards they would themselvesbe responsible . I t was hoped that by beginn ing inth is way a definite improvement might be graduallyattained . The exper iment went well enough unt ili t came too close to pol it ica l interests . “When wesol ici ted the comm i ttee from the City Fathers forthe ir support of a regu lar code of hospital regu la t ions

”

(wrote Miss Caban iss) ,“ a perfect howl went up , and

we were remonstra ted with for cast ing slurs upon abranch of municipal government wh ich , up to thet ime of our speak ing , had escaped al l suggest ionof corrup t ion ; when the physician-ia -ch ief retracted his agreement to assist h is jun iors , our internes , in instruct ing our class of pupils , our planscollapsed .

”

During the first year , a d ie t k itchen and loa nclose t w ere opened , cla sses in home nursing started ,and a number of clubs for working women anu boysformed . We cannot t ry to describe the la ter growthin al l d irec t ions . Nurses’ se ttlements have nowbecome firmly establ ished in Orange , San Francisco ,Hartford , and e l sewhere , making themselves fe l t inhousing and l iving problems , quest ions of publ i csan itat ion and hygiene , and bringing nurses intod irect con tact with the modernworld of indu stria l ism,

and th e w orkers who inhab i t i t .On the Western coast , visi t ing nursing was first

suggested by M iss Eugenie Woods , a nurse who wentinto i t herse l f , followed by Octav ine B riggs . Thelatter first started a se t tlement , which has taken in a



inspect ion , and the opportuni ty to introduce the

nurse came in 1 902 , when Dr . Ernst Lederle wasappointed Health Commissioner , for he came almosta t once to her to ask how the service m ight be improved . Her instan t reply was : “ Put the nu rsethere to round out the doctor’s work , and th is answerwas accompanied by an off er to loan a settlementnurse on salary for a month ’s experiment . Thestory of th is trial , carr ied out by a gif ted and tactfu lwoman

,Miss Lina L . Rogers , from the Toronto

Hosp i ta l for Sick Ch ildren , has been fully told el sewhere M iss Wald and Miss Rogers were sooncalled to other c i ties to tel l of school nur s ing , and thev is it ing nurses of Ph iladelph ia , Balt imore , Chicago ,and other places qu ickly formed in l ine to help starts imilar work .

Of the many instances where ass istance has owedi ts incept ion to the v isit ing nurse must be ment ionedthe recent first undertaking of a l ife insurance company ' to supply v isit ing nurses to the holders of i tsindustrial pol icies . This prov ision , though st il l ini ts experimental stage has spread to the largerc i t ies of many of our sta tes , and to several in Canada ,and has mult ipl ied the cal ls upon vis it ing nurses bythe thousands . The original idea as wel l as the planof execu t ion came from Miss Wald , who laid the proj cet before Dr . Frankel , one of the ch ief o fficers of thecompany . I t was by her advice that the nursingserv ice was secured by contract made with existingv is i t ing-nurse organ isa t ions , rather than by the in

Vi si ting Nursing in the United S tates, by Yssa bc l la G. Wa ters,1 909 , and A . J. N . files for 1 902

- 1 903 , ct seq.

The M et ro mi te r. L ife .

T he Uni ted Sta tes 2 2 5

sta l lat ion of a separate staff . Whether th is connect ion will be permanent is a matter for t ime totell . I t i s enough now to remember that , in drawingup th is project

,M i ss Wald had the largest poss ible

view of bringing the nurse to a v ast body of smallsalaried people who needed her . The l imi ta t

'

ons

incident upon the compet i t ive system and privateprofits are at present the only shadows upon thebright possibil i t ies of a comprehensive scheme forprovid ing skil led nursing for people of moderatemeans . I t i s clear that a danger lurks in privateinterests , for , as the nurse used to be exploited tolead pat ients into the church , now she might obv iously be used to decoy cl ients into thi s or that hugefinancial concern . However , the presen t \ as t extension of inst ‘ance nurs ing suggests a f uture whenal l such service may be carried on by the peoplethemselves . under pub l ic ownership .

For a number of years , nurses in this as in othercountries had been mak ing ind ividual excursions offthe bea ten track of professional work . I n 1 900 ,

Mrs . Von Wagner , of St . John’s hosp ital , Yonkers ,

w as made san itary inspector , under the Board ofHealth in that 1 i ty . The Civ ic Leagu e and Woman’sInstitute there had first employed her in th i s capaci tyas a demonstrat ion , and their spir i t and determ inat ion carr ied her finally into the official posi t ion , forwhich she was rarely fit ted by capacity and enthusiasm . She won i t after a stubborn contest , and wrote“ Landlords , pol i t ic ians , and employees (of the de

partment ) all fought against the woman inspector ,and bu t for the members of the board and M issM . M . Butler , president of the Vi oman

’

s I nst ituteVOL . l l l . —l


who overcame al l opposi t ion , the appointmentwould not have been made .

”

In 1 904 , Miss MaryM . M cvean , a nurse from St . Luk e

’s , New York ,was appointed as a tenement -house inspector .Miss Annie Damer of Bellevue and Miss M ildredM cKnight , of the I l l inois training school , wereprobably the first nurses to take posi tions as agentsfor Chari ty 0 ganisa t ion societies . Miss Menia S .

Tye , of the Toronto General , was the first to take adomestic science degree . M i ss Annie E . Kennedywas the pioneer in pure-milk-stat ion work , havingbeen selected whi le s ti ll a pupi l in the RochesterCity hospital to enter a municipal mi lk stat ion , underthe d i rect ion of Dr . Goler , who has since becomeknown over th e world for his work in this d irect ion .

The instructive care of expectant mothers was firs ttr ied out in Boston , while a nurse to watch and teachmothers after confinement was appointed by Dr .Goler

’

s eff ort s in Rochester in 1 9 1 1 . Supported bya voluntary society , she has headquarters in a pub l icschool , and co-Operates with the hea l th offi cers andall other agencies . In 1 90 1 , nurses firs t begantaking the summer course of the School of Philanthropy maintained by the Chari ty Organisa t ionSociety of New York City . Whole groups enteredinto the crusades against preventable d iseases ; theChicago visi t ing nurses , one of the largest and mostimportant of such groups , were endowed by thecourt s with powers of san i tary inspectors and prob a t ion off i cer The Johns Hopkins alumna tookup the ant i-tubercu losis work , and Miss Reiba Thel in

Nu rse's Work inM ilk Stations . George W . Goler, M DAmeri canJou rnal of N ursing , M a rch, 1 904 , p . 4 1 7 .



from i t have grown the regu lat ions of the HealthDepartment relat ing to midwives and the municipalt rai ; g, school for them .

Almshouse nursing reform was successful lyfounded inMichigan in 1 906 . Under the leadersh ipof Carol ine Bartlett Crane , the wel l-known civicreformer , the nurses

’ state society , in co-operationwi th the women ’s clubs of the state , carried on asystematic inquiry into almshouse cond it ions . Mrs .Crane ’s fearless exposures gave electri c power to theadvance of the women , and nurses were placed in twoalmshouses . A report ‘ of th is invasion made in 1 907was the start ing-point for the format ion of spec ial“Almshouse Committees" in almost every stateassociat ion of nurses . These committees are readyto al ly themselves with women’s clubs , and somehave already accompl ished defin ite th ings in almshouse reform . Even more than other inst i tut ions ,however , almshouses are in the grasp of petty andvenal pol i t icians . Unt i l women attain ful l c it izensh ip no thorough-going improvement can be made inthem .

Instances of affi liat ion between women’s clubs andnurses’ societ ies , in the interest of social reforms , arenumerous , and in many cases the state federationsand associat ions are un ited .

With the growth of v isi t ing nursing , cal ls came fastfor nurses to take posi t ions in mil ls , factories , anddepartment stores to gu ard the health of employee ;and keep— rather than make— them well .Hospita l socia l service was first placed upon the

basis of a d ist inct spec ialty a t the Massachusetts'A . J. N . , Au gust , 1 907

T he Uni ted States 2 2 9

General , though there has probably never been ahospita l where personal “ fol low-up work has notbeen done at some t ime by superi ntendent , or nurse ,or physician . For years members of the superin

tendents’ society have emphasi sed the human valuesin visi t ing nurs ing as an extension to the hosp italservice , and , i n 1 904 , a most useful and pract ical de

partment of th is k ind was inaugurated . through theeff orts of M i ss Maxwel l , at the Presbyterian in New

York . Here , from the first , social service was madea part of the nurse’s work . In Boston , Miss I sabelGarnet Pelton , a nurse , and Dr . Richard Cabottogether began and developed the well-known de

partment with which Dr . Cabot’s name is especial ly

l inked . Miss Pelton , a woman of delicate ins ightand rich compass ion , had already fel t keenly al l theunfulfil led needs of the d ischarged pat ient . Dr .Cabot had long desired some bridge between thephysician and the domest ic and social condit ionsbearing on the d iagnosis and treatment of cases .

"

I n 1 905 they began experimentally the departmentwhich now employs a large s taff of special ised assistants . Dr . Cabot stood back of the work financiallyunt il i t had become thoroughly established and supported by voluntary contributions . When MissPelton 's heal th failed , she was succeeded by MissIda Cannon .

Bellevue fol lowed the example in 1 906 . The suggest ion that a socia l service department be openedthere first came from Mrs . John Wi lk ie , one of theboard of managers of the training school . She hadconsulted Miss Wald , who encouraged the idea , andsuggested M iss Mary A . Wadleigh as the nurse bes t


fit ted to carry i t out . The plan was approved and

set in motion by Dr . Armstrong , then med ical superintendent of the hospital , with the greatest goodwill .The Bel levue social serv ice department rapidlybecame one of the most highly developed and extensive in i ts scope in the country . I n September ,1 9 1 I , Miss Pe lton , wri t ing to The Survey (vol . xxvi . ,No . 2 4 , p . 843 ) , reported forty-three hosp i tals developing social service , and many more p lann ing to do so.

Swift ly fol lowing on came ind ications that theremight soon be cal ls for the nurse to teach pract icalhygiene in the publ ic schools , and thi s the more urgent ly as the crusade against venereal d isease beganto raise its banners. here and there . I n Cleveland ,Mrs . Robb gave a series of heal th talks to pupilsand teachers in the publi c schools , and was shockedto find how vast was both their uninformedness andthei r indifference . She urged nurses to prepare toteach the hygiene of sex . I n the Charleston schools ,Mrs . Lounsbery d id the same th ing . In Pi ttsburg ,the nurses carried the teaching on tuberculosis prev ent ionto the chi ldren in the pub l ic school s . In thefar western states , some of the first defin i te teach ingin the schools on sex hygiene was init iated by nurses .The nursing profession as an organised body tookup seriously the campaign agains t venereal d iseasein 1 909 , and began it s own educat ion on th is subj cet , includ ing the history and social aspects of theevi l ; for , in a rude awakening , i t was real ised thathospital d i rectors and med ical staff s were leav ingth is whole vi tal quest ion almost entirely in obl ivion ,so much so that the pupils of train ing schools , goingout presently as profess ional women , were almos t as



obtain such equipment became an urgent one innat ional convent ions . Lead ing women , such as thosein sett lement s and at heads of hospi tals

,were em

harrassed by the many demands which they couldnot fil l . How th is cal l was finally met has been toldi n the pages upon educat ional progress , but i t i snot yet sat isfied . I t wil l require l i terally hundredsof women

,of cul ture , imagination , and the h ighest.

professional skil l , to sat isfy i t .The changing status of the nurse is indicated by

the growing tendency to make her an employee ofthe c ity and the state . The most striking examples of th is are found in the publ i c school work ,and in the ant i-tuberculos is campaign . Pennsy l

van ia has i ts enti re terr itory covered by a harmonious system of d ispensa ry stations and san itar iafor tuberculous pat ients , and the lar ge staff ofnurses employed by the State Health Department ,with a ch ief nurse in her off i ce in the Capitol , v is i tover the whole Commonwea lth . I f epidemics ofother d isease , as typhoid , threaten , some of themare at once deta i led to duty on the spot . Inth is d irect ion the nurse has , at present , outrunthe physician , but in the social is ing process i t i scertain that both w il l take even larger places a spubl ic servants . Ameri can M edicine recogn isesth is , in comment ing on serious fore ign d iscussion ofplans for making al l medical men publ i c offi cials onsalary . I t says : “ Social ism ’s demand for free medica l care is a phenomenon bound to exert a profoundchange in the dest iny of the med ical profession ,

and condemns the present demand that doctors shal ldonate their se rv ices to the poor as “most un just .


I t i s coming to be seen that to throw the burden ofchari ty on the shoulders of a few overworked privateind ividuals is not only unju st , but unintell igent ,and that society , as a whole , must finally assume i tsresponsibi l i t ies to al l i ts members . The t rue solutionof the nurs ing of pat ients of moderate means , so oftend iscussed by nurses and physic ians , must be lookedfor in th is gradual extension of service under thed irect ion of the community as a whole . I t cannot beeffectually atta ined by the chari ty of pr ivate persons ,the generos ity of indiv idi ' ,t l physic ians , or the underpaying of nur ses . But it can be done co-operat ively ,and there is every reason to hope that , i n the future ,armi es of State-paid and State-pensioned phys ic iansand nurses wil l replace our outworn armies of war assold iers of heal th and defenders of publ i c well-be ing .

Indicat ive of the possibi l i t ies of co-operation is arecen t report ( 1 9 11 0) of the Cleveland Visit ing N urseAssociation , showing that , of fif ty-seven nurses atwork

twenty-four are in the emp loy of the city , and tw entytwo serve private organisat ions and institutions . Al l

of these nurses have been engaged through the off i ce ofthe Visi ting Nurse Association , wh ich makes itsel fresponsible for thei r prev ious training , gives them .

whenever possible , general district work , and tri es tofurnish each organisation with the nurses best fitted fori ts pecu l iar needs . The nurses in the employ of outsidebod ies are responsible to their ownmedical directors ,bu t they al l w ear one uni form , they all mee t once a weekto discuss thei r problems , and as nurses they preservea unity of ideals in their wo rk . The nine district nurseswho are sa laried directly from the treasury of the V isiting Nurse Association take care of the sick poor under


the direction of district and private physicians . Whennone is present , they insist that one be called , becausetheir relation to the doctor in the homes of the sick pooris the same as it would be inthe homes of the well-to-do .

I nCleveland , the social dispensar ies w ere the firstto employ nurses who had had district training , and nowhosp itals , factori es , boards of health and education , daycamps , day nurseries , —al l have visiting nurse service .

In almost every case the V isitingNurse Associationhas paid from its treasury the salary or salaries of visiting nurses for outside organisat ions , unti l the need of

trained work in the home has been so wel l demonstratedthat the other bodies have been mor e than wi l l ing tocarry the expense themselves .

The rap id growth of vi si t ing nurs ing in this countrymay be real ised by read ing the first and the latestspecial studies of th is subj ect , both wri tten by nurses .That visi t ing nurses often become rad ica l in thei r

convict ions i s only a natura l resul t of what they seein their work . Some such women have entered theSoc ial ist party to work for a new social order . Othershave thrown themselves into the movement forwomen’s enfranch isement . The d iscon tent they feelhas been expressed by Miss Mary E . Lent , superintendent of the Balt imore Visi t ing Nurses , in apaper read at M inneapo l is , in the fol lowing words :

When dist rict work was begun in this country thirtyodd y t ars ago , i t was solely for the purpose of g ivingnursing care to the sick poor . The nurse brought relief

The H istory 0] Vi si ting N tt rsing in the U ni ted States. by

Ha rriet Fulmer, superintendent of the ( .niengoV isit ing Nu rse Associa t ion, A . J. N . , M a rch , 1 902 , p . 4 ! 1 . Vi si ting Nursing inthe Uni tedS ta tes. Yssa bel la G . Waters, member o f the Nu rses’ Set t lement,New York . R ussel l Sage Founda tion, l g l o.


2 36 A H istory o f Nursing

Whatever d irect ion the future of nursing may take,

i t i s certain that never before has i t held such op

portuni t ies for women of a noble stamp , broadlyeducated and al ive to civic dut ies . And such wor en

are coming forward , young and vigorous , overflowingwith energy , in every state of our broad land .

We could wish no bet ter end ing to our chap terthan the suggest ion given by the fol lowing letterfrom the secretary of our foremost medi ca l association to a nurse member of her state examining board .

May we not bel ieve that i t sounds the key note ofthe future ?

The American Medical Association , through its H osp ital Section , has undertaken the task of standard isingand classi fy ing the hosp itals of the country w i th a viewto the ir u ltimate improvement in step with scientificmedica l progress . Such work must of necessity includea consideration of the nu rsing branches of hosp i talservice , and I am wri t ing to ask your cooperation andadvice . The Hosp ital Sect ion is starting ou t with avery definite determination to accep t the trained nurseas a member of a learned profession , and contradistinctfrom a labour union , and its work will be to he lp e levatethe nursing profession in ideals , and its members inefficiency to perform th e du t ies of the ir h igh cal ling inconsonance with the best thought of our t ime . Wi l lyou help us do that ? I am just now needing badly acopy of your state law and your commission's interpretat ion of that law indetai l as to length of course intraining schools, subject matter of studies , and cu rricu lum .

May I hOpc that you wil l send me these , and in additiongive me your v iews on the present trend o f th e proi ession , the correctness of that trend , and your pred ictionas to the future of the profession . Signed

CHAPTER I I I

NU R S ING I N T H E COU NT R I ES OF NORTHE RN E U ROPE

Col labora tors : A Commu ne or SWED ISH Nva ses ; TH EDAN I SH NU RSES ' ASSOC I AT I ON ; M M E . SOPH I E

MANNE RHE IM , F I NLAND

Sweden. In Sweden , as in other countries , nursingthe s ick under various systems has been general sincethe beginn ing of Chri st ian ity . The rel igious ordersinthe Roman Cathol ic Church ch iefly undertook thecare of the sick and the poor , bu t on the decl ine ofthat church in our count ry , s ick-nursing was eitherneglected or undertak en by people who lacked boththe spir i tual and pract ical qual it ies necessary for thenurse ’s call ing . I t was not unti l the middle of theninet eenth century tha t a rev ival of nursing was

brought about .The first impul se to a new era emanated from theDeaconess Inst i tut ion at Ka i serswerth , after whichmodel the Swedi sh Deaconess Insti tut ion was

founded .

Florence N ight ingale’s great work among thewounded during theCrimean war , and the subsequentwork she carr ied on in England , made her influencefel t in Sweden as elsewhere .

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Interest in the train ing of nurses and in thei r workw as also awakened by a number of art icles in theT i dskrift f or I I cmmet (H ome M aga z ine) , and thees tabl ishment of a systemat ic course of nursing foreducated women w a s seen to be highly desirable .An attemp t to real ise th i s scheme was made bythe Red Cross Society in arranging a six month s’

course in nursing under the direct ion of a Matront rained a t St . Thomas’s in London . However , asu fficien t number of specially trained nurses wasnot forthcoming . The Queen Dowager , at that t ime

Queen Soph ia , who always took a grea t interest i nwork among the sick , perceived how important i twas that educated women should devote themselvesto s ick-nur sing , and founded for th is purpose theSoph ia Home , which has now attained a remarkableefli cieney and is the principa l tra in ing home fornurses in Sweden .

During the last quarter of a century the work ofra i sing the standard of nurs ing has made greatprogress . From being anobscure and un importantoccupation , nursing i s now considered to be a sphereinwhich educated women , i f i n other ways fitted fortheir task , find the best opport uni t ies for the employmen t of both their physical and mental capab i l it ies . The fol low ing is a short rev iew of the principalwork which has been done in our country in th isd irect ion .

The I nst i tution of Deaconesses in S tockholm was

founded in the yea r 1 35 1 , when a few sympath iserscol lected a sum of money and rented a small housein w hich they establ ished a nurs ing home . Herethe first pupils were rece ived and trained

,the Matron



equipped modern hospital , buil t in 1 906 . In 1 909 ,

there were a 6 deaconesses at tached to the inst i tut ion . Their tra in ing takes about four years , and

includes a course of cook ing and sewing , from a yearto eighteen months’ pract ical training in the s ickwards , and other useful work connected with diflerentbranches of the in st itut ion . Every deaconess wearsa un i form . The only requirements necessary foradmiss ion are : to be wi l l ing , for the Lord

’s sake , totend the poor and sick : to profess the Protestantfai th ; to produce a doctor

’s cert ificate of soundhealth , and to be between the ages of twenty and

forty years . One year 's training i s given to pay ingpupi ls , who , presumably , wish to undertake nursingwork in their homes or for ph i lanthropy’s sake .Such pupi ls work in the hospi tal d ivision and are

theoret ically instru cted .

The Swedi sh R ed Cross Soci ety— As far back as

1 864 , Sweden joined the Red Cross Convent ion whichwas founded in tha t yea r inGeneva . The Dukeof Ostergotland of that t ime , afterwards Oscar I I . ,became the first presiden t of the society . Pri nceCarl , Duke of Westergot land , held that posi t ionwhen these words were w ri t ten . Sweden was i ortnnate enough to have a nurse trained in the N ight ingale school to organ ise nursing under the Red Cross .When the society was first founded , four months

'

t raining was thought to be enough , but in a shortt ime the need of thoroughly taught , cul t iva ted , capable women was fel t , and Miss N ightingale was

appea led to . Through her i t was arranged for a

Swedish lady to be entered at St . Thomas ’s , and

Miss Emmy Rappe was chosen and sent , returning

Dea coness Hospita l Sisters , Stockholm


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AP P U E D IM AGE |nc


event of the nation bein g involved inor threatenedwi th war .Besides train ing nurses , the Red Cr oss Nurses

'

Home undertakes to engage other nurses who havegone through a complete theoret i ca l and practica ltra in ing cour se of at least one year , with s ix months

’

serv ice afterwards at a larger hospi tal . Of thehundreds of R ed Cross nurses , the greater numberare always ready for mobil i sat ion .

A number are engaged at various regimen ta lhosp itals during field manoeuvres , in order to ass is tthe physicians in their medical at tendance and

in any instruct ion in nurs ing given to the soldiers .The society has a benevolent fund for i ts nurses .The Sophi a H ome— I t has been stated that the

idea of a more general and effect ive reorgan isa t ion ofnurs ing in Sweden arose about 1 880 on the in it iat iveof Queen Sophia . Her Majesty had long cherisheda desire to provide regu lar instruction in nursingbased on Christ ian principles , for educated women ,in wh ich train ing special care should be taken thatthe work be ca rried out in a personal , and not merelyin a profess ional

,way .

In 1 884 a small home was opened in Stockholmwith four pupils , a number which stead ily increasedas t ime went on . The d irect ion of their instruct ionwas intrusted to Proken Al fh i ld E hrenborg , who hadrecently returned home a fter having stud ied at St .Thomas’s in London , and having also spent somet ime nursing e l sewhere in England . The pupi ls received the ir pract ical tra in ing at the hosp ital in Sabba t sbcrg . A sma l l nursing department was arrangedin connection with the home. The management of



hygiene , wi th inst ruct ion in elementary nur sing , inpreparing food for the sick , and in gymnast ics . I n

add it ion to these there i s a B ible class conducted bythe chaplain of the home . After one year 's pract icaltrain ing, a month

’s theoret ical course is given , comprising lessons in medicine , surgery , etc . , and , a t theend of th is , al l pup il s are examined in the var ioussubjects they have stud ied .

The pract ical tra in ing i s given partly at the Soph iaHome , and partly Lt the Serafimer , one of the princi

pa l and most up-to-date hosp itals in Sweden , of

which the head surgeon and director , Professor JohnBerg , i s a member of the board of the Soph ia Home .The pupi l s a lso go through matern ity , children

’

s,

and fever hospitals , and i f they w ish they may alsotake a course of work in the asylums for the insane .The whole tra in ing lasts three years , with a sa laryduring the th ird year . Upon sat isfactory complet ionof th is course , the pupil i s qualified as a nurse and mayenter the s isterhood of the Sophia Home , and remaina t tached to i t as long as she wishes to do so . I f sheleaves she devotes herself to some other work , orto nursing in other inst itut ions . Opportuni ty isa lso given to pupils to go through a year ’s tra iningon payment of a monthly fee , and a great numberof women from Finland , Norway , and Denmarkhave taken advantage of this .I t i s the duty of a ll Soph ia S is ters to go to whatever

post the Matron may choose to send them . Theyrece ive the ir salary from the inst itut ion , have a

pension fund of their own, and a Home of Rest forthose who are i l l and overworked , as well as a homefor the aged . All Sophia Sisters wea r unif orm, a

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nurse 's badge in the shape of a brooch , and an armband wh ich each one receives on join ing the s isterhood . Since the foundat ion of the Sophia Home ,435 young women have gone through either theshort or the complete courses of training . Manyhave regis tered as members of the Red Cross or theFredrika Bremer associat ions , or have taken up

social or m ission work . Teach ing S isters who havebeen especially valuable in perfect ing standards areSis ter Sal ly Petersen , Sister Valborg Nord in, and

Sister E l i se Linder .The Sama ri tanH ome in Upsa la was founded by

F rokenEbba Bostrom , who , after a v isi t to Englandin the years 1 878—79 , when she stayed at the Pennefather Inst itutes a t Mildmay in London , started a

home for fallen women in Upsala . From th is beginni ng a complete inst itute gradually deve loped , with aservants ' home , a chi ldren

’s home , a hospital , etc .Then the whole was handed over to the Samari tanInst i tut ion for tra in ing dea conesses and pari shSisters . The train ing of deaconesses there is basedonthe same princ iples as the Deaconess Inst i tute inStockholm , with but a few sl igh t d ifferences . I ttakes from three to four years , of wh ich from eighteenmonths to two years are spent in a course of sicknurs ing .

Parish Sisters are tra ined here ch iefly in order to beable to tend the s ick and poor in the country d istricts. Their course only takes eighteen months ,and their tra in ing is somewhat s imilar to that of thedeaconesses , though simpler and shorter . The pupilshave to study pract ica l nursing for a period of tento twelve months . the res t of the t ime be ing occu pied


by a theoret ical course , the nursing of chi ldren, and

practical parish work among the sick and the poorin the town

,under the d i rect ion of experienced

deaconesses . Throughout the training more stressis laid on the Christ ian side of the work and thedevelopment of the nurse’s character than on meretechnica l ab i l i ty , though th is i s by no means neglected , and the inst itut ion does a l l in i ts power tomake i ts nurses thoroughly efficient .The South of SwedenNursing H ome was founded

inmm for the purpose of tra ining nurses for hOSp i ta lsand pri vate work in southern Sweden . The home ,which is si tuated in Lund , off ers a residence for pupi lsduring the period of tra in ing , and has a regi stry offi cein connect ion with i t . In th is off i ce are rece ivedh ighly recommended nurses who have gone througha theoret ical and pract ica l course at other inst itut ions . The course at th i s home is of two years'

duration , partly at the large hospital in Lund , partlya t that in Malmo, as wel l as a t fever and matern ityhospi tals , and lunat ic asylums . The pupi l b indsherse l f to remain in the serv ice of the home for oneyear after her training i s complete . Here , too , therequis ite qual ifications for admission are good healthand ample educat ion .

At Sabba tsberg , one of the larges t hosp i tals inStockholm , with abou t seven hundred beds , a twoyears' course of theoret ica l and practi cal tra in ing isgiven . At the Sahlgren, the general hospital of theci ty of Gothenburg , with about three hundred andfif ty beds , a s imilar course i s a rranged comprisingeigh teen month s’ train ing . Shorter training coursesfor nu rses a re, moreover , arranged at the A cademy



herse lf a tender and lov ing nurse to sick dependentsa t her home in the country , and in her writ ings shehas shown how h ighly she valued the work of nurses ,and how much she considered i t to be the fit t ingwork of an educa ted lady to help and tend the s ick .

Soph ie Lejonhu fv ud-Adlersparre, who took up andcarried out the ideas started by Fredrik a Bremer inso many d ifferen t d irect ions , was also an ardentf ri end of nursing , and in the H ome M aga z ine,

(Ti dskrzf t f b'

r H emmet) , ed ited by her , a number ofa rt icles have appeared , all bearing test imony to herkeen interest in nursing reforms . I t was thereforew i th the greatest joy that she received , in the earlysix t ies , an offer from Florence N ight ingale to find a

vacancy for a Swedish pupi l at the then recentlyopened N ight ingale school , and she immed iately setabout find ing an educated young woman who wouldl ike to avai l hersel f of such a good opportun ity ofbeing trained as a nurse . Thus , in 1 866 , through hermediat ion , Sweden obtained her first trained nurseinEmmy Rappe .

When Sophie Adlersparre founded , in 1 88 1 , theUnion that bears the name of Fredrika Bremer , i twas qu ite natura l that i ts work should embracequest ions pertain ing to nursing and nurses . Theobject of the Fredrika Bremer Associat ion is to t ryand better the posit ion of women in moral andintellectual , as wel l as social and economic , matters .With regard to the nurses , the association has tri edto fulfil it s purpose in the following way . From i ts

funds , collected by means of contribut ions throughout our count ry , the associat ion has supported youngwomen desirou s of be ing trained as nur ses . Since



and managed by diff erent committees . As early as1 893 a specia l board was formed

“ to watch careful lythe development of pract ical nursing and , wherepossible , to apply the princip les of the association .

"

Th is board takes the lead in al l matters concerningquestions of nur sing or the interests of nu rses withinthe associat ion 's sphere of work . The nine members of the board include three physician s and twonurses.

QueenSophia’

s Society f or .M a inta ining Nursinginthe Army and Navy was founded in 1 900 , and asi ts name shows , is intended to support field nursing .

The society trains no nurses of i ts own, but i ts working st aff consists of deaconesses , Sophia Sisters , anddistri ct nurses (tra ined at dis trict hosp i tals and

allowed by the help of the Union to go through a sixmonths’ supplementary course at a larger traininginst i tute) . The soc iety has also formed nursingcolumns of members of the Y . M . C . A . , and othersin several of the larger towns , provi ded ambulancecarts and sick-transport equipment , and a rrangedcourses of pract ical training . On the ini t iat ive of

Queen Sophia’s Society , nurses were first engaged in

1 905 at encampments .There are inStockholm four associat ions for nurs

ing in the homes of the poor ; the oldest was foundedin 1 888 by Mrs . Ebba Lind a i Hageby (née H ierta) ,who has given large donat ions to it .The general pension fund for Swed ish nur ses w as

founded in 1 896 , in order to prov ide pensions fornurses at the age of fifty (in except ional cases fif tyfive years) , and after at least eight years

' work . Thelowest single payment must be 500 kroner , or at least

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2 5 kr . a year . A si tuat ion in the service of the stateor of a parish ent i tles the nurses to a st ipend fromthe state of not more than 2 5 kr . a year . The fundpossessed , at the end of 1 9 1 0, kr . , and had8 1 1 associates . In 1 905 the Benevolent Society forNurses was founded . I t is open to al l nurses whohave gone through a complete train ing course , having for i ts object the giv ing of re li ef in case of shorti llnesses .In 1 909 , the Swed ish nurses started a paper of their

own , cal led TheSwedi sh N urses’

J ourna l . I t appea rsonce a month and has been received with the grea testinterest al l over the country . I t is ed i ted and publ ished ent irely by nurses . I ts beautiful ly art i st iccover of white and blue gives the keynote to it s fine,h igh tone and po int of view in nursing matters . I tsed itor was Miss Es tri d R odhe, a strong , true , loftycharacter of most winning personal ity . She wasdeeply absorbed in all the work of organ isa t ion go ingon among nurses over the world , and was ful l of thejoy of shar ing in i t to the full , when , in August , 1 9 1 1 ,she was suddenly taken away by death , who camepeacefully to her as a sleep . Her loss is a grea t one ,and she wil l long be truly mourned by nur ses at homeand abroad .

A per iod ica l for voluntary nurses in t ime of warhas also been started by a mil itary doctor ; i t a ims tospread among the publ ic a gr eater interest in, andknowledge of

,mil itary nursing .

The want of un ion between the nurs ing inst i tutesof Sweden graduall y made itself keenly fel t amongSwed ish nurses as a d isadvantageous cond it ion , leaving them more or less separated from one another .


and by 1 909 th is feeling had grown so strong that thefirs t steps had been taken toward bringing into oneassocia t ion the members of the various nursinginst i tu t ions , as well as al l nur ses who had gonethrough a course of not less than eighteen months ,and who had added to this at least e ighteen monthsof pract ical work inhospital or inprivate duty . T he

lead ing motive of such an associat ion woul d be touni te i ts members for mutual help and encou ragement , yet withou t al tering the ir posi t ion with regardto the train ing inst i tu ' ms to which they belonged .

A comm ittee was appointed to dra f t the outl ines andrules of a centra l un ion , and its proposals were la idbefore the members of the various insti tut ionsmeet ing with such general approval that , on March1 4 , 1 9 1 0, a N at ional Counc i l of Swed ish N urseswas formed, in perfect harmony with the manydiff eren t mother inst itut ions , and with the mostl ively interest of the nurses to insure i ts success.

The firs t presiden t of the assoc iation was Miss EmmyL indhagen, Sister in the Serafimer hospi tal , S tockholm , an admirable leader and strong , well -balancednature .

Sweden carries on an act ive anti-tuberculosis cam

pa ign, which rece ived specia l impetus from the act ionof King Oscar I I . , in devot ing a large sum presentedto h im by the nat ion on h is twenty-fif th anniversa ry ,

to the erection of three State Sanatoria . F or thecomple t ion and maintenance of these public inst i tut ions the Swedish Parl iament made l iberal grants

,

and the earnest crusade thus inaugurated was reinforced by the active assistance of the Nat ionalSoc iety for Combating Tubercu losi s , formed in 1 904 .



of a H ome f or the Aged, another for epi lept ic and

id iot chi ldren , and is also , whi le we wri te , a Guard ianof the Poor in the parish where she l ives

, bes idesbeing in touch w i th the international organisa t ionmovement .

Denmark : TheDea coness I nsti tute.

— The honourof having fir st in troduced an organised nurs ing system into Denmark is due to the Dani sh DeaconessInsti tute , which owes i ts found ing to the CrownPrincess Louise , consort of the Crown Prince Chris tian , who during a v isi t to Mecklenburg had hadoccasion to see the great work wh ich was ca rr iedon from the mother inst i tute , Ludwigslust . Lou iseMart in ie Laurette Conr ing became the first S isterSuperior of the Danish Deaconess Inst itute . Du ring the first Danish-German war she came toCopenhagen , began early to work in the serv ice ofph ilanthropy

,and in 1 855 was Matron of the Royal

Hospital .In 1 862 Princess Lou ise sen t her to Stockholm

that she might study the Swed ish Deaconess I nst i tute , and she later v isi ted d iff erent mother-houses inGermany and France . In 1 863 the Danish Deaconess Inst i tute was founded , and managed by her unt ilher dea th in 1 89 1 . The start was very modest . Ahouse on the outskirts of the town was rented , and acouple of the largest rooms were made into wards .The Si ster Superior and two Sisters had their dwell ingupstairs . The next year thei r numbers had r isen tos ix . The smal l inst itute was soon heav ily bu rdened .

I n 1 864 Austri a and Pruss ia waged war againstDenmark . I t was the first w a r where deacon essesshared in the nu rs ing of the wounded . The army

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staff -surgeon at first had h is m isgivings in accept ingthei r ass istance , but after the war he expressed hismost s incere pra ise of their work . I t very soonbecame evident that the accommodation of the smal lhouse was inadequate , and a larger house was acqu ired in 1 865. The number of S is ters had increased to seventeen . I t thereby became poss ibleto commence private home-nurs ing , at first in thecapital , la ter on in the count ry .

But much other work was carr ied on : the care ofreleased female prisoners , of women addicted todrink , of servant-girl s out of employment , ch i ldren

’sinstruct ion , and other usefu l serv ice . The demandfor a build ing of i ts own had grown stronger andstronger , and in 1 877 the large group of bu ild ingswh ich is now the home of the inst itute was inaugura ted . In 1 888 , the insti tute had s ix branches wherethe Sisters were at work under central superv ision ,and sixty-two stat ions where the work was carriedon under the d irect management of loca l boards ,acting in harmony with the mother inst i tute ,which retained the final authori ty . The numberof S isters was then one hundred and fif ty . Afterthe death of Miss Conring , the posi tion of SisterSuperior fel l to Miss Soph ie Zahrtmann, and greatprogress was achieved under her superv is ion . Onehundred Sisters were employed in 1 907 in par ishnurs ing . Others

‘

were working in infirmari es and

in almshouses,ch i ld ren 's homes , asylums , infan ts

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asylums,convalescen t homes , heal th resorts for

female inebriates , a pleurisy sanatorium a t Odense ,i n the i sland of Punen , and an educat ional homefor ep i lept ic girl s on Zea land. I t was no t only


to the home country , but also to the remote possessions of Denmark that the Deaconess Inst itu teca rried i ts work . The Sisters have star ted con

grega t iona l nursing in Thorshavn in the FaroeI slands ; a ch i ldren

' s asylum was opened in 1 906 in

the Dan ish West Ind ies on the i sland of St . Cro ix ;and the year after a s imilar asylum was started inthe wes tern part of that island . In 1 907 the Sis tersnumbered 305, and yet the management has oftenwished for a greater increase .

The S t. L ucas I nsti tute— Another dea coness inst i tu te grew up later in Copenhagen . In 1 886 MissI sabell a B rockenhuu s L awenhjelm began work ingamongst the poor of the north end of the capi tal .In 1 893 she started a cl in ic wh ich , through the d ist ingu ished surgeon , Professor Kaa rsberg , acqu iredsuch a patronage that , in 1 90 1 , i t had fif ty

-six

beds . A t the same. t ime she had work ing rooms forone hundred ch i ldren . The house , w hich was latermade into a hospital , now bears the name of the St .Lucas Inst itute . I t had , in 1 904 , th irty novices who ,after their apprent iceship , are consecrated as deaconesses , and is an important and growing inst it ut ion .

Before the end of the nineteenth century nursinghad progressed greatly in Denmark . In 1 876 thehumane and enl ightened system of modern nursingafter the Brit ish model had been introduced intothe largest hospi ta l of the capital , the Mun icipal ,by Dr . C . E . Fenger , h imself a physic ian , but onet ime minister of finance and later burgomaster ofCopenhagen .

The R ed Cross.

—I n 1 876 there was started inCopenhagen “ The Soc iety for N u s ing the Sick and


2 58 A H istory oi Nursing

country , with 43 7 1 members . The eff orts of th isbranch have been d irected especial ly toward col lecting resources in case of war , and hold ing Samaritancourses (First A id) for women and men . In 1 909

the Red Cross amended it s laws , and for the firstt ime a woman joined the board , on which , in 1 9 1 1 ,

two women held seats . In 1 9 1 2 a nur se , M i ssCeci l ie Lutken,

was on the board and was sentas delegate to the internat ional conf erence .The demand for a better tra ined class of nurses

had become ever greater , especial ly in Copenhagen .

The pari sh nursing employed many , but the ir tra ining was frequently very deficient , as every pupil orcharwoman from the hosp ital could , without beingprevented , cal l herself a nurse . In the countrythe want of better cond it ions was also felt . Therethe pioneer reformer of early t imes was Dr . T . M .

Trautner , in the smal l town of Bogense , i sland ofF unen, who in 1 88 1 became government physic ianfor the i sland . He wrote a gu ide for hygiene andnursing for country folk , and founded local nursingsoc iet ies al l over the prov inces , which gradually ,partly wi th help from the government , attainedgreat importance . The Central Soc iety , organ isedin 1 909 , and of wh ich Dr . Jacob i was chai rman ,d id great work in the country by unit ing the so

ciet ies, improving the cond i t ions of the nu rses , andgiv ing the publ ic a clear understand ing of howvaluable a wel l-trained corps of nurses i s to the

social order .The Dani sh N urses

’

Union— This associat ion orun ion was organi sed in 1 899 with the obj ect of promot ing the in terests of the nurses , both profession

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a ll y , and inmaterial th ings as well . Every nursebetween twenty-five and forty years of age , who hashad a three years’ apprent iceship in a hospital orinfirmary , may be admitted as a regular member ,whi le proba t ioners may be admi t ted as associatemembers . Other persons are admitted as passivecontributing members .

In the early, un formed stage of the association i tsaff airs were warmly taken to heart by Mrs . CharlotteNorrie (née H arbou ) , who, an ardent , l ife-long su ff ragist ,noted the budding strength of the new profession in theli ght of the Woman’s Movement , and fel t also the sympathetic interest natural to a woman , who , the wi fe of apubl ic medical officer had in her younger days entered ahosp i tal as anexplori ng volunteer , long before the daysof secul ar training, and there spent several months prev ious to her marriage . As a delegate to the LondonCongress of the International Counci l of Women in 1 899 ,

Mrs . Norrie was present at the inception of the International Counci l of N urses , an organisation wh ich ap

pea led strongly to her and of which she became a chartermember . She was the first chairman of the infant Unionof Danish N urses . As i t gathered strength its membersfelt the need of a full y tra ined nurse to lead their steps,and chose Mrs . Henry T scherning (née Schultz) , a womanof great abil i ty and energy , who has continued as president of the associat ion to the present day and ha s bu ilti t up in every direct ion with sagaci ty and single-heartedness , never giv ing way before difficul ties , but with un

flagging zeal holding to her aims .

Mrs . T scherning had been trained in the med icald iv is ions of the Municipal Hospi tal of Copenhagenin 1 878 . She was afterwards appointed lady su per


intendent there , and won deserved repute by ex tending the nursing serv ice into the surgi cal d iv is ions .Real is ing the need of further study , she went in1 883 to St . Thomas

' s,and , as a guest for a number

of weeks in the N igh tingale Home , fam i liarised herself with i ts principles of management and becamedeeply convinced of the necess ity of entrustingtra ining and d iscipl ine to a t rained , ex pert , and

educated gentlewoman .

An excellent help and support has Mrs . Tschern ing found in the two ladies , Miss Bod i l H el l fach

and Miss Cec il ie Lutken, who have taken theirshare of the work since the Uni on was started .

Miss H el lfach came in 1 887 to the Municipala s head of a d ivision . For e ight years she was

vice-cha i rman of the Danish N urses’ Associat ion ,and then a member of the board of representat ives.

Miss L utken worked for some years in hospi talsabroad , but came in 1 896 to the Municipal Hosp ital as assistan t operat ing-room nurse , and thenbecame chief nurse of the Mil i tary Hosp ital of Copenha gen , besides being a member of the board of theRed Cross . For nearly ten years Miss Lutkenwasa member of the board and secretary of the Dani sh Nurses’ Associat ion , and has i n that capacityrendered i t excellent serv ice .The number of members of the associat ion in

creased rapidly . The year after i ts organisat ion i tcounted 2 9 1 regular and 1 07 associate members . I n

1 9 1 1 , there were 1 1 82 regular and 2 1 7 associate members . I t has been agreed that al l ordinary memberswhen on duty shal l wear a badge ind ica t ing theirmembersh ip , and the R ed Cross a llows i ts members



agreements to have i tsmembers received . I nJanuary ,1 90 1 , the Union founded i ts off i cial journal , Ti dsshrif t for Sygeplej e, which has been of the greatestusefulness i n i ts upbui ld ing work . The first ed itorwas M iss E lise Fied ler , a superintend ing Sister , whocarr ied the journal through its first five years . Sincethat t ime i t has been ed i ted by Mrs . A . Claudiu s ,who , before her marriage to a physician , was a nursein the Kommunehosp i ta l . At first a monthly , theTi dsskrif t is now issued b i-monthly . I t i s sent toeve ry member of the associat ion and has a largeci rculation , being h igh ly esteemed for i ts excel len tprofessional articles .The oldest of the regular hosp itals in Copen

hagen was the Roya l F riederi c’s, buil t in themiddle of the e ighteenth century and now quiteant iquated . I t was resolved to rep lace th is one by alarge modern hospi tal to be bui l t onone of the Commons , where i t would get suffi cient l ight and a ir .

The Nurses’Union frequently pe t it ioned the MedicalCouncil and the M in ist ry to grant that a modernnurs ing school should be made part of the hosp ital ,where the pupils by rotation in serv ice would get anal l-round three years ' tra ining , and where a l l thenurses should be placed under the authority andd irection of a tra ined woman head .

‘ Even thoughthe associat ion has not yet seen al l i ts demands compl ied with , st il l great improvements have taken place ,and will finally lead , without a doubt , to a ful lysat isfactory train i ng of nurses . I t is also to be hopedthat the proposal for an act , whereby the nurses

T he M a t ron or head of the whole nursing department is nonex istent inla rge Danish hospita ls.

NorthernE urone

shal l obtain governmental l icense and which has beensubmitted to the M in istry of Just ice , wil l be carriedin the near future .

I t has been the great aim of the Danish Nurses'

Union to insure the nurses against an inadequatetrain ing , and out of chaot ic condit ions to establi shregulated and legal cond it i ons for a class wh ich duringthe last th irty-odd years has grown to compr ise threeto four thousand members of the Danish populat ion .

F inland.— Nurs ing in Finland has always been

done ch iefly by women . Excep t in the men’s wardsin asylums for the insane , syph il i t ic men

’s wards,

and in our army , while i t ex isted, we have neverhad any men-nurses.

In olden t imes , before the day of hosp itals , theso-cal led “wise women comb ined the functions ofdoctor and nurse . Their methods cons isted chieflyof wet-cupp ing , hot vapour baths , and massage , andeven nowadays there are people , mostly belonging tothe peasant class , who have greater faith in theprescript ions of “wise women and “wise men,

”

than in those of any medica l man , and , as theirmethods largely appeal to nature’s own curativepower

,the resu l ts they obtain are often very sat is

fact ory . I n the darkness of the M iddle Ages , i t wasnot always without danger to be a w ise woman .

"

Many,espec ially i f their cures had been successful ,

were tried for w i tchery by the Church , which considered the nursing of the sick one of i t s prerogatives .The first hosp itals in Finland were , of course ,

founded by the Church . The hospital St . Geran ,(St . George) buil t in 1 3 55 , was a leprosarium ,

”and


that of the Holy-Spiri t , buil t in 1 396 , was , l ike severalof the same name in Sweden , an infirmary for

“ thes ick and poor . ” Both of these hosp ital s were s i tuatedin Abo , the oldest town in F inland , and the firstcentre of the Swedish civi l is ing inf luence . I t wasnot unt i l 1 475 that another hosp ital was bui l t inFinland in the town of Wiborg , then the Swedishbul wark against Russia . This hosp ital was also a

leper house and was s ituated a l i t t le ou tside the town .

The order of St . Dominicus (the“ black brethren ” )

ruled over these first hospitals . At the head of eachWa s a pr iest-superintendent , and in connect ion wi ththe hosp ital there was always a chapel , div ine serviceoccupying , of course , much more t ime than nurs ingproper . Stil l i t was the members of this and of othermonast ic orders which later on founded communi t iesin F inland

,who were then the only people who knew

anyth ing of d isease and the cu rat ive propert ies ofplants and herbs . A copy of anold book , which atthe end of the fif teenth century was in u se in themonastery of Nadendal tell s the manif old propert iesof e ight herbs : thus ,

“ juniperu s , mirra , s inap , castoreum, ma ly rt , urt ica , and mirtus,

” and one caneasi ly imagine the brave l itt le nuns receiv ing the sickand wounded and trea t ing them after the prescript ions of th is precious book , which had come with thenuns to Nadendal (the Valley of Grace) , from themother convent Wadstena in Sweden , founded bythe Swedish saint B irgi t ta , after whom the order wasnamed the B irg i tt ines.

With the Reformation many th ings were changed .

The supremacy of the monast ic orders was gone ,though the clergy st il l had something to say about


.\ l f l'

i‘

. l l ] : 1 “ L inn

NorthernEurope 265

the management of the hosp i ta l s . In an old regu lat ion of 1 558 we see that the hosp ital of St . Goranwas then directed by a superi ntendent or tutor whohad under h is orders a chaplain , a bel l-ringer , a manservant , and a ma id . The las t was the nurse , properlyspeaking ; at leas t she had to help the pat ien ts tomake their beds . The regulat ions of this hosp ital ,as of al l others a t that t ime , were most probablywri tten by King Gustavus I . of Sweden , who musthave been a wonderful man , j udging by the organ isingcapacity he showed in so many di ff erent matters .He even understood nurs ing in a way quite surp risingfor those t imes . In 1 555 when , during the war withRussia

,the Swed ish troops in Wiborg were suff ering

terribly from typhus and dysentery , the King wroteto the commandant of the fortress tell ing h im toprocure some elderly women to nurse the sold iers ,and he even went so far as to prescribe what theyshould do for the s ick . Of course w et ~ cupp ing wasthe most prom inent feature of the King’s prescr ipt ion , and one may hope that among those poor peop lethere were some of iron const i tut ion who may havesurv ived .

In the t imes fol lowing the Reformat ion , the hospitals , so fl ourish ing under the monast ic rule , led arather m iserable existence . They were always askingthe government for subsidies and complain ing thatthey did not get them . Those were t imes of bloodywa rfa . . and peop le had not t ime to th ink of the sick

and suff er ing . In 1 759 the first general hosp i tal inF inland was founded in Abo by the Swedish government . This hospi tal , st i l l ex ist ing as theAbo Countyhospi tal , was p laced under the superv ision of the


Serafimer Knights , as had been also the Serafimerlazaret in Stockholm , which had been found . d al it tle earl ier . Th is general hospital in Abo beganw i th only s ix beds . I t w as en t irely subsidised by thegovernment , and to th is day al l county and generalhospital s in Finland are government inst itut ions .Those supported by towns and communit ies , aswel l as those small hospitals and nursing homessupported by private means , of which , besides thedeaconess hosp ita l s , there are a goodly number nowexi sting in Finland , w ere al l mnded much later .That the nursing in the beginn ing of the last centu ry was of the poorest descr ip t ion is p la inly shownby the report wri t ten in 1 809 , shortly after the war ,by a member of the F inn ish Senate , ’ who , beingsent on a tour of inspection to variou s inst itut ions ,thus describes an asylum he had visi ted

The inmates had scarcely any clothes (they had to

wear the ir own) . The w indow s , although insummer ,w ere all shut , and the a ir was pestilential in the l i ttledens , where not even straw was provided as bedding forthe pa tients , who had to l ie on the hard wooden boards .Oneman servant and one maid looked a fter forty-threepatients under the supervis ion o f a superintendent , w hoseemed to employ themmore for h is owngardening thanfor the needs of the po or patients . than whom no moremiserable crea tures cou ld possibly exist .

The maid or nurse was, according to the regulat ions , also the one w ho had to do al l the wash ing andmend ing o f the hospital . She had to sweep anddust and , i f need be, wash th e floors . Hers was the

This sena tor wa s M me . M annerheim'

s g rea t-7 randfa thsr.



Cajander , the widow of a doctor , had been tra inedin the Deaconess House in St . Petersburg , foundedsome years earl ier . She was the first woman fromthe educated classes in th is count ry to take upnursing and , as she was a very superior person , shesucceeded , in spi te of much opposi t ion , in rai singthe standards of the nurs ing profession and makingi t respected . Her eff orts were d irected toward infusing into the work a sp i ri t of devot ion and self-forgetfulness , which we have ever s in ce tried to retain .

Her successor , who has carried on her work in thesame spiri t and done much toward elevat ing themoral standards i rsing , was Miss L ina Snel lman ,— “ Sister Lina , — w

‘

i o from 1 883 has been themother of the Deaconess House in Helsingfors up tothe t ime at wh ich this i s wri t ten .

The tra in ing given there lasts about two yearsand comprises pract ical work and teaching in thetheory of nursing , anatomy , and physiology , together with a short course in therapy . The nurseshave had an importan t work to do among the suff ering poor , the eff orts of the inst i tu t ion having alwaysbeen d irected toward train ing nurses for the verypoorest peop le . Nearly a l l the d istr ict nursing exist ing in Finland , in towns as well as in the country—as yet there i s very l ittle of i t— has been done bydea conesses . I t i s not more than just ice to say tha tthe work thus done has been beaut ifu l work andtha t w e nurses feel we ow e the deaconesses a placeof honou r in the h istory of nurs ing , so far as i tconcerns Finland .

When the Deaconess House started , a period of

great su ff ering w a s. ju st se t t ling down over ou r

NorthernEurope 2 69

country . A famine year wi th i ts accompan imentof typhus and smallpox was reap ing thousands ofv ict ims . The li t t le hospital was crowded at once ,and its staff of devoted young Sis ters had an opportuni ty of showing what they were worth . In comparison with the nurs ing pract ised up to that t ime ,the work done in th i s l i tt le hosp ital was a revelation ,and achieved for the deaconesses a reputat ion forgood nurs ing wh ich they have kept ever since . Thehosp i ta l began with only eight beds . In 1 896 th isnumber had risen t o forty , and after the house wasmoved to i t s presen t si te and rebu il t on a larger scale ,the number of beds was more than doubled , so thati t now counts one hundred , and the hospital wasd ivided into three wards , a med i cal , a surgical , and agynecological , a smal l surgical hospital for th irtyfour ch i ldren be ing added in 1 906 , to the build ing ofwhich one of the present Sisters devoted a legacy leftto her . In add it ion to t his the house has founded asmal l sanatorium in the country for twenty tuberculous women .

Besides the Sisterhouse in Helsingfors there arenow three others in Finland : one in Wiborg , onein U lcfiborg , and one in Sordavala . In the beginningof i t s existence that in Hels ingfors was often requiredto send ou t nurses in pri vate pract ice and as assi st ~

ant S isters to the secular hospi tal s , where , a s hasalready been said

,the standard of nursing was at

that t ime very low indeed .

The impu lse to a better order of things in Finlandwas given by Dr . F . Sa l t zmann, the first surgeonattach ed to the House of Deaconesses , and afterwards head of the med ical board , in which capaci ty


he d id much towards raising nursing in th is countryto a h igher level . H e took the first step forward in1 884 by start ing a course i f lectures on“First A id tothe Injured ,

"which w a s attended by many young

girls from the upper classes , for several of whom thismeant the open ing up of a new perspect ive and theawakening of an interest w h ich sought to expandand to find a field of w ork . Dr . Sa l t z mann, a lw av s

keenly aware of the need of educated women in thenurs ing profession , fel t that a proper tra in ing mustbe prov ided for the girls who w ere eager to take upthe work . The w ish ed-for opportun ity came at lastwhen , in the autumn of 1 888 , the Surgical Hosp ita li n Helsingfors was inaugurated . Th is hospital , oneof the Universi ty group (the others are the Med ica l ,the Children ' s , the E ye . the Skin , and the Gynecolog ical hospitals) , conta ined 1 52 beds . Dr . Sa l t zmannwas i ts first p re fect and , in the spring of 1 889 , startedwi th six pupil s the first course of train ing for nurses .Those w ere the firs t women of the educated class tobe tra ined in Finland , and one of the ir number , M i ssFanny T igersted t . afterwards became Matron of theMed ical Hosp i tal , a post wh ich she held at the t imethis w as w ri tten .

This first course of training was pu rely surgical . I tlasted only six months , w i th teach ing in the practiceo f nurs ing in the w ards and lectures on the theory ofnursing , given by the res ident and the Matron ofthe Surgica l Hospital . Dr . Sa l t zmann had succeeded in get t ing for the new hospital a Matron o f

great intel lect and capacity . She was an educatedw oman , or rather a gi rl , Miss Anna Broms , who wasonly twenty-five when she was given the post . She



ing p ract ical work in the wards and lectures by theMatron on the elements of nursing , but lately , in thehosp ital of Wiborg, a one-year curr i culu mhas beenestabl ished

,and at the end of the course there is an

examination . Those shorter courses have been inst itu ted to tra in nurses for the small country hosp itals ,and for d istr ict work in the coun try , and because , asyet , the need for nurses is so great that the supplyfrom the hosp i tals of the univers ity is by no meanssufficient , these shorter courses of tra ining have hada mission to ful fil , though i t is to be hoped that beforelong only a few of the largest hosp itals w il l retain thetra in ing of nurses in their hands , and that the Universi ty Clinics wil l remain a kind of high school , wherenurses can get special , as w el l as general , train ing .

In a fu ture w h ich the early part of the century wil lsee , they are al l to be rebui l t on a site reserved forth is purpose , and to that t ime nurses look forwardfor the introduct ion of a better training all over thecountry .

One train ing course of two years had been developed in the ci ty hospi tal of Hels ingfors , calledthe Maria , by Miss Koreneff , a graduate of theUniversi ty Cl in ics , and , to the great sat isfact ion ofFinnish nurses , early in 1 0 1 2 ,

she succeeded in herpu rpose of advancing this course to three years .The Maria i s a small hospi tal , but i ts examplein founding the fir st thr ee years’ training will best imulat ing .

The Univers i ty Clin ics , the largest tra in ing schoolin F inland , takes yearly forty-eight students innursing , some of whom (about s ix per natural lydrop ou t . However , abou t forty-five. comple te the ir


2 74 A H istory of Nursiug

advantage often taken of the freedom accorded . Thepupi ls who went to theatres or balls in the eveningwere not fi t for the ir morning' s work, and the othershad to do doub le tasks . Then , as i t w as impossible tocontrol the p laces where the nurses lived , cases of contaLfJ us disease not infrequently broke ou t in the hosp ital

,from infection brough t by careless pup i ls .

“ I t was at th is juncture that one of ou r nurses , whohadtaken a course of tra ining inEng land [th is was Mme.Mannerheim herself],

“had the great privi lege of meeting . M iss F lorence N igh t ingale , who, with the l ivelyinterest she alw ays fel t for everyth ing connected w ithnursing , at once grasped the situation and told ou r nursethat wemustmake remaining in the home compu lsory forthe probationers . She was even kind enough to give asum of money to be spent in the home ‘

so soon as i tshould contain a ll the probationers . ’ This was brough tabout in 1 906 , and we are very proud of M iss N igh tinga le

'

s interest in our work, and feel i t as a consecrationand a st im ulus to new e fforts .We have devoted her g i ft to a fund 1 . 1 l ibrary , and

the portrai t of the donor , the mother of all nurses , smilesfrom the w all on her F innish ch i ldren . The house hasnow accommodation for forty-eig h t probationers , and thew ork of course goes much better since all are oblig ed tol ive together . ” 1

The first and present superintendent of theprel iminary sch ool is Miss E llen Nylander , whowas tra ined at Tredegar House , London . Theprel iminary course lasts two months and comprisesteach ing in the p ract ice and theory of nursing , bandaging , cooking , and the theory of foods

,w i th the

elements of massage, anatomy , physiology , and hyR epo rts, Interna t iona l Conference of Nurses, Pa ris, 1 907 .

NorthernEurope 2 75

g iene. At the end of the course there are wri ttenand oral examinat ions , and the probationers whopass go over to the home and begin work in thewards of the d ifferent univers i ty hospitals . Thehome

,w hich in the beginning was very small , was

so as to accommodate al l the probat ioners in tra in ing . The course of tra in ing grew to

compr i se th is p rel im inary course of six months , andone year 's probat ioner w ork , during which t ime therewere lectu res given on therapeut ics and surgical andmedical nursing

,with repeti t ion classes . The staff

nurses had y et no definite courses of lectures , but aplan of train ing was worked ou t by a committee inthe beginning of 1 909 to be submit ted for approva lby the government . This plan advocated a two years’

course w ith three months ' prel iminary train ing .

The association of nurses founded in 1 898 has donemuch towards fostering a tru e spi ri t of good feel ingand comradeship between i ts hundreds of members ,and st il l more has been accompl ished by our l it t lenurs ing magaz ine , E pione, to the beginning of wh ichthe impetus was given by Sister Agnes Kar l l ’s word sut tered in 1 907 in Paris :

“Only get a nurs ing paper ,and al l the rest wil l come .

The nursing associat ion in F inland , besides managing the prel im inary school and home for proba t ioners ,col lected money in 1 909 for a fund to help si ck nurses ,and prepared to start th is ca i sse de secou rs withoutdelay . A couple of years later , i t la id plans toin i t iate d istrict nurs ing , and in 1 9 1 2 the firs t v isi t ingnurse under the ausp ices of the soc iety was put inthe field . I t i s intended to extend th is serv ice , andto make propaganda fo" publ ic school nurs ing .


The entrance of F innish nurses into organised relat ionswith those of other countries w as largely the work of

M me. Mannerheim ,w hose Eng l ish training had ac

qu a int ed her wit h the nursing movement in general .She came t o the Pa ris Conference in 1 907 , where shetook all hearts b y storm, and retu rning home , so suc

cessfu l ly inspired th e nu rses of F inland with the idea ofinternat iona l co-operat ion that in 1 909 , inLondon , thenationa l associat ion was represented b y a Splendid delega t ionand came into membersh ip in the internationalgroup .

Norway .— I nN orway , as in Sweden , the Red Cross

is eminent in nu rs ing work . Here , indeed , i t seemssup reme , as al l nursing educat ion and nursing extension w orthy the name are ev idently carried onunder the auspices and by the eff orts of the soc iety .

Norw ay was one of the first countries to adhere tothe treaty of Geneva . Her society was formed in1 865 , but though rel ief was gen erously given in thewars of 1 870 and 1 87 7 , and though the scope ofactiv i ty was enlarged in 1 892 , the soc iety then undertaking to d istrib u te grants of financia l aid made byParliament to the parents of men kil led in war , i twas not unt i l 1 894 tha t the Red Cross Society ofNorway began the sy stemat ic train ing of nurses .A home was estab l ished in 1 895 and , wh ile in tra in ing ,the pu p il s are sen t , after a six to ten weeks

’probation,

to d ifferen t hosp i tal s for general nursing , con tagiousd iseases , obstetrica l serv ice , and su rgical experience .

They a re also given a serv ice in a tuberculosis sanatorium. T he course o f train ing lasts for one yearand a half and i s completed by a serv i ce as st aff nu rsein the home of the R ed Cross Socie ty T he firs t yea r



women for the i r cal l ing that one cou ld wish to see ;tall , fa i r , and fine-looking , their faces beaming withgood and gent le st rength of character . I f the sto rieso f thei r p rofess ion seem short in compari son withothers , one must wonder i f i t i s not because a un iformly high standard of educat ion and characteramong the people of thei r count ries , result ing in achosen class of w omen as nurses , gives less to be d issat isfied w i th , creates an ethical atmosphere , wherefriendly eo-operat ion thrives and st ri fe is needless ?

CHAPTER IV

T H E R E VOL U T ION I N FR ENCH HOSP ITALS

N January ,1 908 ,

a dramat ic episode took p lace inthe courtyard lying hidden between the grey and

gloomy w ards of the Hotel-Dieu of Paris . A litt legroup of nuns of the order of St . August ine , the lastones left in the hosp ital , w ere about to leave i t , as faras they knew , forever . A long-expected decree ofthe Municipal Counci l had made known to them theterminat ion of thei r twelve hundred years of servicethere. For some t ime the laicisat ion of the hosp i tal shad been going on , and t he last ones to leave w ere theSisters of the H etel-D i eu . In s ilence they l i st enedto the decree of banishment . Wi th cou rt eous kindness and real sympathy , the Director Genera l of theAssi stance publ i que of Pari s addressed them in farewel l

,endeavou ring to l ighten the heavy moment with

concil iatory w ords of recognit ion for thei r long yearsof faithfu lness . Those among them w ho chose togive up thei r vows , he said , migh t remain in thei rposts , du e regard be ing had for the i r fitness , age , andlength of service . Outside the walls a crowd hadgathered . Some possible disturbance was feared andthe pol ice were there . Sympath isers wished to t akeout the horses fr om the Sisters ’ ca rriages and drag

2 80 H istory of Nursing

them themselves , bu t this the pol ice forbade .Present ly the Sisters came ou t , entered the carriages ,and drove away . One or two cries of “ Down wi ththe Republ ic !” were heard and several arrests weremade before the groups dispersed .

More than one revolut ion had taken place in then ineteenth century , bu t , passing over those of pol i t ical import , le t u s pau se to acknowledge one of thegreatest the world has seen— the revolut ion in medic ine . In the fai r land of France , in the year 1 82 2 ,was born an infant w ho later , as a

“ grave , s incere ,almost shy you th of unobtrusive manners came toParis to study chemistry . This was Lou i s Pasteur ,whose l i fe-work w as to be the reconst ruct ion of med ical science , though he himself never studied for amedical degree .

There w ere st range opinions held in that day,such

as , for instance , that physiology w as of no ut il i ty inmedicine , but w as only a sci ence dc l z tx e which cou l deasily be d ispensed w ith . The discoveries of Pasteu rlaid the groundwork of modern prevent ive medicine .

H e fel t th is , and wrote in 1 8 77 to Bast ian ,one of

his opponent s : “ Do you know why I consider i t soimportant to combat with and to defeat you ? I t i sbecause you a re one of the special be l ievers in th emedical doct rine of the spontane ity of d iseases , whichis , in my Op in ion , fatal to the progress of the heal ingart " ' Pasteur 's studies in spontaneou s generat ion ,

begun in 1 860 , resu lted in h is famous dictum : No

l i fe except from previous l i fe . Whatever w ondersscience may yet have to d iscover , th is d ictum willa lways hold good in the pract ical detai ls of the t rea t

L if e of P a sleur , by R eneVallery -Radot , Vol . I L , p . 3 1 .


A H istory of Nursing

designed to do real nursing . I t s members were to beselected from among the rescued foundhngs, andthey were to be dedicated to poverty but to take noother vows . Their training was to be given themby the August in ians . Founded in 1 840, th is ordergave good service for a t ime , but fel l into decaybecause of internal dissensions . By 1 890 only twoof it s members were left . Another st ri ct ly nurs ingorder founded in 1 840 was that at Troyes , the Saz ursde bon Secours. Their work w as to be thoroughlypract ical and unhampered , but , l ike most orders witha sol id bas is of t rain ing , these Sisters were ent irelytaken up w i th pri v ate duty .

W i th in the grea t publ ic hospita l s a series ofchanges took p lace , as described in the followingart i cle by the Director General of the Pari s hos

p i ta ls, M . Mesureu r

I t w as in the eigh teenth century , that the first attemptwas made to organise a graded service in the generalhospi tal called La Sa lpétriérc . [Th is hosp i ta l , foundedb y Saint Vincent de Pau l , had always had a secu lar staffof a ttendants ] The superior posts were to be assignedto young women or widows devoid of fortune , or retiredfrom the w orld . The regu lation of the service was qu i teremarkable and still deserves consideration . The dif~forent w omen heads [of departments or wards]were tobe under the direction of a woman Superi or, she be inginturn responsib le to the hosp i tal directors , a majori tyof whom w ere members of Parliament . Under thecontrol of w omen supervisors there w ere p laced two setsof attendants : the w a rd maids (fil lcs dc servi ce) and thenurses (fil les de ma lades) the latter be ing attachedespeciall y to the serv ice o f the sick .

The. d i fficu l ties o f rec ru i tment a t first experienced

Revolution inFrench Hosp ita ls 2 83

were soon rep laced b y others of the opposite kind . Thepersonne l became too numerous , and the profession , i fsuch i t cou ld be called , became the refuge for all who w eredestitute or morally w retched , and instead of nursesthere w ere only hosp i tal hangers-on of a special kind .

During the fi rst hal f of the nineteenth century , from 1 802

to 1 840, no one knew how to obviate the physi cal ,intellectua l , and moral inferiori ty of the hosp i tal attendants . The suggestion w a smade that these paid servantsmight be rep laced b y orphans from the asylums , bu t th isw as not acted upon . I n 1 836 a reorganisation w as

e ffected wh ich created a hierarchy of attendants and

superv isors , e igh t grades inrank being established , w i thwages rising according to the grade . Th i s reform had

l i ttle eff ect . Medical committees continued to registercomplaints of th e unrel iabi l i t v , incapaci ty, and immor

ali ty of the w ard nurses , and the nuns w ho were incharge of the hospi tals made no attempts to instruct ordiscipl ine them .

[Here , in ju st ice to the Sisters , i t must be noted that ,as they had l it tle authority over the servant nurses ,these being selected ,

placed, and paid by the civ icau thori t ies , they could not poss ibly d iscip l ine them ,

a i though discipl ine was always the Sisters’ cwn

st rong point . And , with no real control , teach ingwas also imposs ible , even had they possessed theknowledge ]

I n 1 845 a more definite attempt was made . Theengagement of employees w a s regul ated b y statu te ;premiums were gi ven to nigh t watchers for length of

serv ice,and old-age pensions or a nome w i th l iv ing

expenses were provided for a ll . Unfortunately w a geswere not raised , and the attemp ted reforms had l ittleresul t .


The lawof 1 849 , w h ich i s still inforce inthe Departmentof Public Chari ties , effected a comp lete central isation ofpow er and p laced the aff a i rs of the hosp i ta ls under oneresponsible head . Th is new organisation had an immediate influence upon the hosp ital service . Individualrecords of the emp loyees were now kept , and each one

’scharacter and fi tness were noted . N evertheless , theevils so often pointed ou t persisted . T he nursing staff ,lacking special aptitude , and devoid of professionaltra ining ,

remained insubordinate , unstable , and immoral .T he necessity of reorganisation was brough t before thesuperv i sory committee of the budge t of 1 86 1 , and athoroug h-going alteration of ru les , covering all the detailsof service , resul ted . I nthe tw enty years that followed ,these regu la tions have been modified or elaborated by aseries of reforms, all having as their obj ect the improvement of the nursing personne l .

Be fore going fu rther with M . Mesureur’s story , wepau se here to do honour to a woman whose l i fe.

redeemed the untrained s isterhood , a nurse of the oldorder , one o f the uncanonised saints . In 1 89 1

Freneh and Engl ish jou rnal s noted the ceremoniesheld at La Sa lpet riere i n observance of the fift iethann iversary of hospital service of M l le . B ot t a rd .

On th is occasion , great physicians and officers of thegovernment vied with one another in eulogising ap lain and unp retending woman of nat ive genius andgoodness . Charcot himsel f arranged the programme .M . Montreu i l , the director of the hosp i tal , read apoem of his own compos it ion lauding her beneficentl i fe, and she was deco rated with several medals ,including the coveted cross of the Cheval ier of theLegion of Honou r . Short ly be fore , the French



We return now to the interrupted narrat ive of M .

Mesu reur .

T he Municipal Council of Paris , after repai ring thed isasters of the war of 1 8 70, undertook to reorganise a llthe ci ty departments . That one called the Assi stance

publ ique, inwhose care w ere all the dependents of thecity, w a s the object of the i r special sol icitude . A group ofprogressive men, ch ief among whomwas Dr . Bou rneville ,rea l ised that the true reform needed was to teach andtra in the staff of attendants in the publ ic insti tutionsand to eleva te the ir moral standard : F or th i s purposethe first schools for ward attendants were established .

Regulations framed in 1 903 raised the wholescale of wages , l imi ted the hours of work to twe lve daily ,with meals provided by the hospi tal , allow ed yearlyvacations of from twenty-one to tw enty-five days , free‘

. l C( l lCl trea tment for all , and leave , w i th wages , forw omen before and after confinement , and for men duringmilitary service . Those su ff ering from tubercu losis mayreceive sick pay for almost three years , and ou r womennurses have a sanitarium and convalescent home .

F ina lly , retirement on pension is assured to all . ‘ We

a re steadily improving the nurses' food and quarters ;

the old dormi tories a re be ing abol ished , and nurses livingou tside the hosp i tals have an allowance for l i v ing ex

penses ; the moral dignity of the staff i s safeguarded and

encourag ed by the presence of i ts representatives onaCouncil of Discipl ine , and by the award of honours fromthe Republic for devotion to i ts sick— namely, medals forserv ice in epidemics , and the medal of honour of theA ss istance publ ique. A t the present time , ou r efforts

After fifteenyea rs of service, the pensionpa i d is 3 1 0 francs, or

a bou t $60 , yea rly ; a fter thirt y yea rs or more , 650 francs ; or , thosep referring a w a rd bed and b oa rd fo r l ife a re thus ca red for, the

xxu i zi en inthe Sa lpé t riere and men in the B ie-Z‘tre .

Revolut ion inFrench Hosp i ta ls 2 87

a re b ent upon a better system of selection of our femininepersonnel . We have institu ted a prel iminary training a tthe Sa l pétriere and , fina lly , we are abou t to Open our

School for Nurses . Upon the threshold of th isschool I will end this bri ef summary .

The out l ine thus drawn is now to be fil led in byapp roaching more closely to ind iv idual characters

,

and first to appear is the vi ri le and picturesque figureof Dr . Bou rnevi l le , one of the most d ist inct ive andeasi ly the most mil itant among medical p ioneers ofhosp ital reform . A p rominen t special i st in nervousd iseases

,he w as an ardent republ ican and free-th ink

ing,even revolut ionary , radical . As scient ific medi

cal man his l ist o f achievements i s long and notable .

A s radical c ivi l ian he was , in h is prime , an act iveworker for municipal sanitat ion and hygiene . Heheld a seat on the city counci l of Paris , and w hile inthis office succeeded in having the municipal nu rsingschool s opened which he had earl ier t ried to securethrough T a landier , another counci l lor . His batt lecry , indeed his rel ig ion , was that educat ion should befree , universal , and secular . Bu t he idealised instru ct ion and comprehended less wel l the subtle essenceof t raining . He w as fu lly sympathet ic with nurseson the economic side. For over thirty years he madethe cause of the downtrodden and opp ressed attendants men and women , of the Paris hospitals , hisSpec i al cru sade , champ ioning them in and ou t ofseason , with unfail ing energy and disregard of al l

L'

G uvre de I’

Assi stance P ubl ique de P a ri s dans I ’E nsei genementdes I nfirmi évcs. B y M . G. M esureur , D irec to r Genera l of the

Depa rtment ; inR eports, Interna tional Conference of Nu rses, Pa ris,1 907 .


personal sacrifices . The muni cipal schools in the

hosp itals w ere his dearest l ife-work , but in h is passionfor inst ruct ion he threw open the classes , lectures ,and cert ificates to al l the subordinates of the hosp i tal ,so that the cart-drivers , st retcher-boys , orderl ies , andmen in the store-rooms might and did study for thecert ificate of the nurse . He welcomed also studentsfrom the outside la i ty ; women of leisure , desi ringsome medical not ions for private l ife , or wage-earn ingwomen , hoping to take up private nurs ing . Manyprivate nurses in Pari s have had no preparat ionfor their w ork save the theoret ical course of themunicipal schools and the brief indefinite pri vilegeof “ walking the wards that went with i t . Butrudimentary as these schools were , the di ff icult iesunder which they were ca r ri ed on make them uniquein hosp ital h istory . Wh en they w ere founded , fewof the pup i l s coul d read and w ri te ; thi s must be firs ttaught ; then the courses were not compulsory , sothat only moral suasion and appeals to ambit ioncoul d be resorted to , in bringing out the w eary , overworked ward staff in the eveni ngs ; final ly , as therewere only four centres of inst ruct ion , pupils had tot ravel long distances from one hosp ital to another .Under such circumstances , both pupils and teacherscommand admirat ion and respect .T O the Paris nurs ing conference came Dr . Bournevi l le in person , venerable , but st i l l mi l itant , to readthere the story of his long and often s ingle-handedwarfare for nurs i ng reform . From this somewhatprol ix narrat ive , l istened to at the last with someimpat ience by those of the younger generat ion

, w e

take what fol lows :


A H istory of Nursmg

to the sick, the medical s taff , and the administrationto take their h istory just. as we took those of our patients .

These observations may be summed up as followsThe nuns : l i ttle time gi ven to the wards ; much spent inrel ig ious exercise . Little or no personal care g iven topa tients , especia lly as concerned necessary attentions tothe geni tal zone ; refusal to nurse venerea l cases , lying-iawomen , and unmarried mothers . These w ere left en

t i rely‘

.o the servant nurses . Meagre respect foradministrative rul es . T he Superior o r prior came before the physician or the d irectors ; the soul was moreimportant than the body . Thence the necessity of

la icisat ion . Rel ig ious services we re undertak enhvthe parish priests and every care was taken that patientsdesiring the solace of rel igion shou ld be fully satisfiedunder the new system. My observation of the nunsshowed me that the majori ty of them , aside fromcertain wealthy convents w i th a large dowry requ irement , were recru i ted from the bourgeoisi e, had had onlya very limited primary education , and that thei r training for nursing was l imi ted to amore or less bad routine ,accordingly a s they had been trained under a more orless intell igent Superior . T he Sisterhoods were oftenboth teach ing and nursing orders , and the less intel l i gent , less wel l-educa ted Sisters were retained inthehospi tal .The nurses : observation of the attendant nursesshowed me that many, both men and women , wereill i terate , that a very few had had some l ittle instruction ,and that the material circumstances of their l ife inthe hospitals were deplorable inmany respects . I assured mysel f o f the abominable state of their rooms ,the insu fficiency or bad quality of their food , and ,

inaddi tion to the idea of creating schools of instruc

t ion , I framed a programme for amel iorating all thema terial , moral and intellectual ci rcumstances o f the

Revolu t ion inFrench Hospita ls 2 9 1

entire secondary personnel— the under employees , andthe nurses , menand women . This programme included :

Improvement of the way they were lodged , doingaway with dormi tories and providing single rooms ,comfortably furnished in conf ormity with hygiene , so

tha t they would prefer them to the saloons and the streets .Improvement of their food . Improvement of

wages , which , in 1 8 78 , the Municipal Council raised from1 5 to 2 5 francs . Better provision for pensions .F inally , the schools of instru ction .

I t was though t best to place them at first in thosehosp itals having secular head-nurses and supervisors ,and the choice fell upon B icetre , with 2 3 5 nurses , and Salpetriere wi t h 393 ,

w here there were already primaryteachers for the retarded ch i ldren . The services of theseteachers could be utilised , and thus the argument ofexpense , advanced by the opponents of instruction , wasmet . The school at Sa lpét ‘ iere was opened onApril 1 ,

1 8 78 ; that of B icetre onMay 2 oth and Pitié onMay 2 4 thin the same year ; that of L ariborsiere onDecember 1 1 ,1 894 .

Six months after the first course was started . anEnglish physician who had taken Dr . Bournevil leabout in London came to Pari s and described hisimpressions of the problem to be solved . His generaltone is pessimist ic , but he adds :

“ I w ent to the

lect u re . The class w as earnest , the lecturer enthusia st ic . They feel i t a t ru ly missionary w ork .

An int erest ing thing was the response of the nunsthemselves . When the school s were first sta rted ,

sa id Dr . Bourneville ,“ they avo ided the instruct ion

courses ; then some came in civi l d ress , unob t ru si velv ,

andat last they came openly , o ff i cial ly . Every year ,E . H . inB r i t ish M ed. Joann, Sep t . 7 , 1 8 78 .


from 1 898 , a group of from eight to twelve cloistere-tnuns from the Hotel-Dieu came in carriages to -.e

Sa lpétriere.

The cou rse of instruct ion comprised simple outl ines of anatomy and physiology , hygiene , mi norsu rgery and dress ings , materi a medica , obstet ri cnursing and care of the newbor n , massage , and thecare o f the insane . The teaching of anatomy wasseverely cri t ic ised , though Dr . Bournevi ll e sa id thatwhat was taugh t should be known by every schoolch i ld . Much cri t ic ised too were the lectures cal led“ hospital administ rat ion , t reat ing of hospital rules ,ward housekeeping , detail s as to patient s

' clothing ,hosp ital l inen and equipment , disinfectants , the

ordering of ward supplies,the general dut ies of

nurses , what to do in case of death ,etc . I t seems

qu i te incred ible that inst ruct ion of this ki nd shouldhave been objected to as unnecessary for nurses .Dr . Bournevi l le right ly ins isted that i t was indispensable .There were also lectures on the organs of spec ia l

sense and thei r d iseases ; nutri t ion and diet ; the S i gnsof death ; modes of bu rial ; infant feed ing ; and thepe ri l s of tuberculos is , venereal disease , and alcoholi sm . Bri ll iant and enthusiast ic med ical teachersb rought the i r best to these d i scourses , pa instakinglylavi sh ing onthe unlettered pup i l s a scien t ific nomenc la tu re that they could not understand . The cou rseswere given with blackboards

,manikins

,skeletons

,

and objects . With in certa in bounds,Dr . Bourne

vi l le must be fu l ly credited w i th uphold ing the teach s

ing of nurs ing by nurses , for pract ical lessons weregiven daily by selected hea d-nurses in the wards , the



land . I t was usual , for instance , for the nurses inParis to be called by their first names .The annual reports of the municipal hospi tal

schools show that for fu l l thirty years he insisteds teadi ly on the need of rotation in serv i ce for thepup i ls , reform of night duty , bet ter rooms , food ,

and pay for the nurses , and that he always urged theimportance of si tt ing-rooms , l ibrari es , and museumsof nur s ing app l iances , a long record for which hedeserves last ing recognit ion . His weakness was thatl ike many reformers he was hosti le t o every advancethat went farther than hi s own . Sincere and m il itan tas he was , he had a ch i ldl ik e vanity that made h imsensi t ive to cri t ici sm , and he died wounded by theevidence that hi s work had been but one stage of

progress and not i t s complete real i sat ion . After h i sdeath Dr . Hamilton wrote of h im :

He was a conv inced p ioneer . Though we have di ffered widely from him as to methods we recognisethe sinceri ty of his convictions , his perseverance , rendiness incombat , and the nobil ity of h is essentially democratic ideals . T he bitter warfare which he carr iedonwi th theChurchwas detrimental to him , as i t caused h isadversari es to regard h im rather as the apostle of athe ismt han as the physician desirous of providing the sick withcompetent attendants . It is infinitely regrettable to

bring questions of rel igion into the reorganisation of

hospitals , which shou ld be undertaken solely w ith theaim of giv ing the sick the best care . Bournev i lle seemedrather to wish to drive the Sisters ou t of the hosp i talsbecause they were nuns , than to subst itute secular nursesbecause they were competent .

To his story of the beginnings must be added that

Revolu tion inFrench Hospi ta ls 2 95

of Mme . G illot , a kind and sweet woman who , ashead teacher of the chi ldren on the hosp ital domain

,

was put in charge of the p rimary educat ion of thenurses .

F i fteen years ago the Salpétriere was entirely unl ikeany other of the hosp itals of Paris . I ts distance fromthe centre of town , its important bu ildings , i ts immensegardens and its beautifu l avenues of old trees , gave one,

onentering, the impressionof a pretty little provincialtown where the mind could repose inperfect calmThe staff was composed of two distinct elements . Thefirst consisted of young girls from the provinces , Bretonsfor the most part , who had been cal led to the Sa lpetri ereby their friends or relations already employed there . Thesecond element was composed of those famil ies , parentsand chi l dren , w ho during perhaps three generations hadal l been continuously in the servi ce of the hosp ital . I tis easy to imagine the profound dissimilari ty between th isstaff and that of the other hospi tals . Trained by tradit ion , onemigh t say, the nurses of the Sa lpétriere followedin the steps of their predecessors , attached themselvesto the institution and often refused al l preferment ratherthan leave i t . I n 1 835 an elementary school had beenestabl ished for the nurses , bu t i t had been discontinuedin 1 845 . When , in 1 8 78 , i t was decided to open aschool for the professional instruction of the nurses , i twas realised that few of the staff wou ld be capable ofp rofiting by the. lessons . The elementary school wastherefore reopened in April , 1 8 78 , w ith sixty pup ils .Classes were held every evening . T he pupi ls werediv ided into two g roups , and these , again , b y reason of

the inequa l i ties intheir education , w ere each subdividedinto se veral smaller ones . Most o f the g irls cou ld nei therread nor wri te , and a good many of them , b y reason of


their Breton origi n, coul d not even Speak French . I n

1 888 , of seven hundred and twenty-eight pup ils who hadtak en the professional course , two hundred and ninetythree had acqui red all their elementary instruction inthehosp ital . In 1 89 1 , the organisation of the schoolremained the same . But the law oncompul soryeducation had now begun to show resul ts . Ill iteracywas diminish ing, and a more general foundation of studyenabled us to prepare the better pupi ls for the certificateof primary studi es . The programme followed in theseschools was the usual primary instruction for adul ts .Bu t we endeavoured to make this a preparation for theprofessional instruction by taking the dictations , readinglessons , etc. , from the M anua l of Nursing whi ch Dr .Bourneville had prepared , and by selecting the samesubj ects which were be ing treated by the professors in thelectures . The primary studies thus served , to a certainextent , as “quizzes

”

for the professional lectures , andthe teachers were often enabled to explain points notclearly understood by the pup ils . This teaching, however, would have seemed very incomplete to us i f i t hadnot included mora l instruction . Al l the teachers , including mysel f, took advantage of every opportunity toinculcate in our pup ils’ minds a high ideal of theirmission , to insp ire them with an absolute professionalp robity , and to encourage them to maintain a bearingthat w ould command confidence and respect . Weimpressed upon them the importance of the sp iri tualqual ities of the nurse— and often a naive reflection and

apt comment showed us that our words were taken toheart .

Toward the end of the n ineteenth century , the

quest ion of finding Openings to s elf-support for refined young women was one that gave much thought



report of the associat ion . ) Or the doctors may nothave reali sed the need O f hospi tal experience . Dr .Rist , one of the lecturers at the Rue Amyot , said inone of his addresses that the Pari s hospitals were notsuitable for tra ining . Bu t above all was the management at fault , in be ing sat isfied to gain permi ssionfor thei r pupi ls to “ walk the wards ” l ike medi calstudents , for a few hours dai ly . This , O f course , wasmore than useless . An Observer , seeing a group O f

these pup i l s one day in a large hospi tal took themfor medical externes . One sat dow n to read whi lewai t ing for rounds to begin ; several others chattedtogether ; w hen rounds began they attended and

heard d iagnoses made , watched operations , andexamined patient s who were d irty , il l-kep t , and i l lcared for .

The Rue Amyot school has , wi th t ime , developedinto a p rivate nursing inst i tut ion rather than into atraining school . I ts own students form but a smallgroup , and cert ificated nurses from other countri esare taken on for p rivate duty .

As,in England , a long series of slowly advancing

steps had been tak en before M iss N ight ingale cameon the scene , so in France the standard-bearer ofcomplete and t riumphant nursing reform appearedat the end Of a generation of tentat ive effort . At thePari s Conference O f 1 907 , the foreign visi tors lookedwith deep interest at a sl ight , simply-clad, quietyoung woman of few words and reserved manner ,who was accompanied by a group O f nurses dressedin uniform and of i rreproachable refinement of bearing and appearance . When her turn on the programme came . she read the briefes t possible accoun t

Revolu tion inFrench Hospita ls 2 99

of the B ordeaux train ing schools for nurses . I t wasDr . Anna Hamilton , author O f the famous thesis onnursing wh ich had been publ i shed in 1 900, and hadhad almost the eff ect O f a bombshel l in French hosp i tal , medical , and admini strat ive circles . This wasthe woman who had qu ietly introduced the “

N ighti ngale System " into Bordeaux and set the boundaryl ine between two eras Of nursing . Unassuming asshe appeared , the extraordinari ly keen steadiness ofher eye declared an indomitable spir i t , and when , intranqui l tones , she pronounced the words :

“Theschool of nurses is at tached to a hospital and const itu tes i t s nursing staff . A woman directs the hosp i taland train ing school . We hold that the value O f

t raining depends on these two points , every oneknew that a gage of battle had been thrown downbefore the assembled hosts .Dr . Hamilton had studied medicine with high

e thical,even rel igiously serious

,purpose , but the p rae

t ice of medicine as she saw i t in the w ards of hospi talsso revolted her that , shocked by the callousness ofthe med ical s tudents and the coarseness , evenbrutal i ty,

of hospi tal procedure , she had almost g i veni t up

,w hen

,arriv ing by her own reflect ions a t the

conclusion that the care given to the patient migh tbe organi sed ona moral , intell igent , and sympatheti csystem , and that medicine might then become trulybeneficent , she decided to take the subject of hospi talnursing for her thesi s when going up for her medicaldegree . This thesis , for which she travelled far andwide and , with personal research , vi si ted and examined hospitals in other countries and at home , i s acomplete history of nursing orders , systems , pri nci


ples, and standards , ri chly i l lustrated and contain ing

a copious bibl iography . Beginning with an outl ineO f the care given to the sick in pagan and in ea ~ly

Chr i st ian t imes , i t mak es a thorough cri t ical andcomparat ive study O f al l the varyi ng systems ofnursing in exi stence. at the t ime of i t s wri t ing , themeri ts

,shortcomings

,and defects of each being

examined and pointed out wi th scient ific accuracy .

Judgment i s fearlessly pronounced , no matter howdangerou s the ground trodden upon . Constru ct iverecommendat ion is clearly put forth . The book i s alandmark in French nurs ing h istory .

Dr . Hami lton’s ownstory i s now to be told

I was born in May, 1 864 , in an Old country house onthe slope O f the hi l l near F lorence , whi ch had been aconvent belong ing to the Medici . I have a small bronzebell w h ich was found by my father when some digging w as being done , with the coat-O f-arms , the six p i llsunder a crown , of the Medici princes . Oddly enough ,the one brother and myself who w ere born in that housebO Lh studied medicine . In 1 8 76 ,

w e went to l ive inBordighera . My father lost h is fortune , and I learntall kinds of household duties from my mother, who wasFrench . For many years economy w as the w atchword ,and of four daugh ters ( two e lder at school or more orless away and a younger one) I w as the onlv onewho wassupposed to be responsible for housekeep ing and all sorts

Cons idera ti ons sur les I nfirmzeres dcs ”Opi um . T h is e presentéct pub l iquement S ou tenue a la Facu l tede M édecine de M ontpel l ier .3 3 5 pp . Imprimer ie Cent ra le du M idi M ontpel l ier , 1 900. As a

thesis is not sold and canbe found onl y in lib ra ries, D r . Hamil ton,la ter , incollabo ra tionwi th D r . Fel ix c nau l t , p repa red a somewha tsimila r bu t sma ller book ca l led L es Ga rdes-M a lades Congrégam

’

sles,

fif crcéna z'

rcs, P ref a sz'

anneflrs, Amal curs. Vigo t Freres, Pa ris , 1 901 .



nu rsing books . F lorence Night inga le'

s Notes onNu rsingI most admired . Then in 1 898 , when I went toEngland ,I w as deep ly impressed by all that I saw in the Londonhosp i tals .

Oddly enough , Dr . H ami l ton,w ho was to introducethe N ight ingale system into France , was not permi t ted to use the wards at S t . Thomas

’s for herObservat ions , as she had hoped to do . But at S t .Bartholomew ’s she found in M iss I sla Stewart agenerous hostess who gave her the freedom O f thewards , and ,

that she might not seem like an int ruder ,a broom te carry about with her . Let us pause tosay that th i s was most characteri st ic of M iss Stewart .

My studies had been constantly interrupted .

My father had died after some l ittle t ime I cou ld goon. When I took my manuscript to the president Ihad chosen more than two years before (because he w asa good Roman Cathol ic , so that people shouldnot be ableto say my ideas w ere only a quest ion O f rel igion) , he wasdreadful ; people had no doubt told h im to beware of me .

H e said i t w as all w rong ; th is had to be taken away andthat also , and he cri ticised and grumbled and at lastproposed to let me have a thesis prepared by some oneelse , so that I migh t get my medical degree as qu icklyas possible and then be free to pursue my studies innursing . I refused , and told him I wou ld not hear ofsigning a thesis wri tten by someone else , and that I wasdetermined to keep th is subject . “Then y ou must do i tal l over " ; said he. I f I must

,I will . ” Seeing that I

was firm he told me to leave the manuscript and come toluncheon five days later . The day arrived . He wascharming , bu t the meal was almost over before he men

t ioned the thesis . At last he said : “Well , I have looked

R evolut ion inFrench Hospi tals 303

at your manuscrip t and after all I th ink i t may do w i thj ust a few ch anges . ” He had crossed ou t abou t th irtylines— some remarks about the Sisters and an anecdoteabou t Pope Pius ca ll ing in a non-Catholic physician .

Bu t tw ice he said tome, “Whowrote that thesis for you ?You did not w ri te that al l yoursel f ? " I was greatlyamused, for no one had in any way helped me .

I did indeed feel the val ue of independence wh i le preparing i t . Many people would have been happy to

prevent my publ ishing such a book , bu t they cou ld notget holdof me . Professor declared that i f I dared towalk into his wards againhe would sendme away . I didnot g ive h im th is opportunity . I had been there manytimes , and had noted in my diary many of the disgu stingth ings that could be seen there . I stopped going to thehosp ital and worked hard at my thesis . Bu t my friends ,too , tried to discourage me . One day I had been so

annoyed that I was foolish ly shedding tears onmy manuscrip t when a f émini ste lady came in , and tci dme that al lmy trouble was a proof that my work wou ld not beworthless .I handed inmy thesis in June, 1 900 . I had worked all

year on i t , and i t was gossiped abou t that I wou ld neverfinish i t ; that i t w as absurd ; that i t would not be acceptedonaccount Of the menial subject . Th is brough t a smallcrowd , abou t two hundred , to listen . The time was noon ,and such proceedings usually took abou t fi fteenminutes .Bu t that day the four judges were shut up inthei r counci lchamber and everyone got impatient . I t was one O

’clockwhenthey came ou t inthei r scarle t silkenrobes , look ingexci ted and red in the face . I t later got abroad thattheyhad beendiscussing my thesis . I t hadbeen expectedthat the president I had chosen and one of the j udgeswould be favourable , and the two others hosti le . Butone of the latter, receiv ing my thesis on the eve of thatday , had told some students that he coul d not lecture to


them because he meant to demolish i t comp letely and sowould have to read it carefully . As i t was qui te long,i t was known that he had spent most of the night inreading it , bu t was , as it turned ou t , entirely convi ncedby i t . Qui te enthusiastic, he argued for i t with theremaining hosti le judge , and they all forgot that theaudience was w aiting . The discu ssion was hot , andthe most controversial statements were made by thejudges to oneanother . I passed , but the obstinatejudg e would not agree to my having a

“ very good ,"

being determined that I should not gain the thesis prize ,which would probably have fallen to me , as my thesiswas the ful lest ever presented to the facu l ty of Montpel l ier , and based on personal research . The papers ofthe day had much to say about i t , and urged the i t bepubl ished fo r sale .

I looked for a post ina hospital , as I meant to put myideas into practice . But inParis I met only with eritici sm. I t was said I had angered al l the Protestantrel ig ious party (on account of my cri ticisms of thedeaconesses) , a l l the Roman Cathol ic party (by what Ihad said of the nuns) , al l the Paris authori ties (becauseI cri t icised the lay nurses) , and all the good patriots ofFrance (because I praised foreign ways) —therefore , nowonder I got no post . But later I was called to B ordeaux to reform this hospital , and took charge O f it inMay , 1 90 1 . I t had been for th i rty-six years inthe handsof a lady, the w idow of a clergyman , and ladies wi th ahobby for nursing came here for lectures and to a ttendinthe out-pat ient department . The wards were in chargeof rough male servants for the men, and six young girls ,who were much less considered than the porter ' s wi fe ,for the women . T hey had no uni form, O ften slept inthewards , thei r fc V i was coarse , and there was no ru le as tooff-duty time or attending of lectures . The larg est wardof the hospi tal . formale cases , had three w indows , two of


Revolution inFrench Hospita ls 305

which had blinds that would not open , therefore neithersun nor air could easily get through . T he beds were ofall heigh ts , some with straw mattresses , the bedding wasrevoltingly dirty , with brown blankets and stiff oil clothfor mackintoshes . On the tables near the beds wereearthen j ugs for the tisanes (medicinal teas) , mostlybrok en , patients drinking ou t of them; chambers or urinals , food , and iron spi ttoons once painted g reen , nowall worn ou t by rust . Several night-chairs stood permanent ly inthe wards and were very unpleasant as to odour .Under the beds were parcels and bones ; around each bed ,

in the morning , burnt matches and expectoration werefreely scattered . The beds had posts and cross-bars ,once used for curtains , then to hang trousers and jacketson. Small qu ilts made of rags lay at the foot of the bedsover the brown blankets . Everyth ing was dirty , dark ,and untidy . Now al l is changed , and our school andhosp ital qu ite up to the plane of the Eng l ish ones . Thepatients of olden times , when they come again , are surprised and pleased . A great many people were shock edat my changes , and said all kinds of th ings against thenew nurses , bu t after almost nine years

' work , the worstenemies have been conquered . Those w howere the mosthostile now send for the “new nurses " when they are i l l .

The hospi tal O f which Dr . Hamil ton now tookcharge , —the Ma ison de Santé Protestante , —and

where she was determined to introduce the modernsystem as soon as possible , has an interest ing hi story . Founded in 1 863 , under voluntary management

,for Protestan t sai lors , i t grew rapid ly into a

free general hospi tal , including al l branches of service . From the out s et i ts founders had wished todevelop a nursing insti tu te in connection w i th i t .In 1 884 , the superintenden t , Mme . M ommeja , u rged

VO L . I l l—20


thi s anew , and a yea r later the managers Off ered a

course of training,but no pupi l s presented them

selves . The only result Of the effort s made was thatcourses of lectures were started which were at tendedchiefly by mothers of fami l ies . Pleased by theselectures , women of lei sure persuaded the Soci ety toAid Wounded Soldiers (one of several which laterun ited under the R ed Cross) in 1 887 to grant themdiplomas after an examinat ion in theory given byphysicians

,and in the next three years twenty such

diplomas were gi ven , only three of which fel l towomen who w ere actually working in the wa rds .In 1 890, the managers determined to give thei r ownd ip lomas , and to create a

“Free and GratuitousSchool for N urses . (The word

“ free meant nonsectarian . ) The superintendent was now Mme .

Gross-Droz , who had taken the R ed Cross lecturesand believed herself to be trained .

The new school was a typical one accord ing toFrench R ed Cross methods . The pupi l s were a ll

externes . com i ng three t imes a week to lectures, and

the only serv ice exacted of them was to assist in thed i spensary (out-patient department) and at Operat i ms, where they used to come in trail ing lacet rimmed gowns , wi th fingers full Of rings, expect ing todo only the interest ing things and hav ing no intentionwhatev er o f cleaning up . Mme . Gross-Droz , havingno comprehension of what nursing real ly was

,rarely

went into the wards . By 1 90 1 , though the schoolhad given diplomas to one hundred and t hi rteenexterne amateur pupi ls , there were only sixteeninternes , or those who had actually worked in thewards , who had received i t .



superintendents of nursing and Matrons of hospitalswi thout ever havi ng served ina hosp i tal ward . If w arwere to come , there woul d be chaos . F or instance , acontract dated 1 890 exists between the Protestant Hosp ital and the Red Cross , whi ch entitles the latter, in caseof war , to take charge O f one-half of this hosp i tal asHosp i tal Aux il iary No. 1 6 , and to take wounded Ofl‘icersthere . By the contract the regular personnel of thehospi ta l wou ld have to wi thdraw, and the mil itary caseswould be attended by a superintendent , Sisters , and

nurses , trained in th is absurd manner by the Red CrossSociety . This is one instance of what woul d happen a l lover France .

Reorgani sat ion now went on fast . The di plomawas given only to those who had spent two years inthe wards . The men attendants were di smissed .

The nurses were put into uni form , new quartersa rranged , and a si t t ing-room provided for them— thefirst one in France . Ladies were al lowed to come tocertain lectures , but wi thout recogni t ion . F inal lyth ings were so ordered that a trained nurse coul d becal led in to organ ise a school , for Dr . Hami l ton hadinsi sted from the first that physi cians coul d notteach nursing . A Dutch Sister was first cal led ; thentwo Swedish Sisters , but without success ; final ly ,the entente cordia le hav ing been establ ished , she

was free to b ring in an Engl i sh nurse— thi s havingbeen at first refused her as impossible— for the BoerWar had had a mal ign influence even in nursing work .

In 1 893 , a young Engl ishwoman wi th a strain ofFrench blood w as studying in Pari s . Hearing a

fri end ’s anxi ety over a severe operat ion case and thedi ffi cul ty of home treatment , she said natural ly , as

R evolut ion inFrench H OSpita ls 309

anEngl i shwoman would : Why not send the patientto a hosp i tal ? ” The reply ,

“We never send our

fri ends to the hospi tal in France ; even the poor spendtheir last penny before doing so ,

” made a deepimpression upon the l i stener , and she thought toherself , in the half-myst ic way wh ich doubt less inearl ier days would have been called a vow “ I f Iever become a nurse , I shall work in France . T he

young Engli shwoman was Catherine E l ston , and inthe same yea r she was in train ing at the LondonHospi tal .I n subsequent work from t ime to t ime , vagu e

rumours of Miss Hamil ton came to her as if to

keep ali ve the semi-involuntary wish . One day ,

carelessly turning over the pages of a magazine , hereyes fel l on th words “Dr . Anna Hamilton , EcoleH osp i ta l i ére, Bordeaux . She immediately wroteto her to tell of her wish to work in France . Bya curious coincidence , Dr . Hamilton had just wri tten to M iss Luckes at the London to ask for ahead for her train ing school , the Swed ish Sisterhav ing gone . Miss Luckes evidently hadnot real i sedthat dest iny intended Miss E lston for the Frenchnursing revolut ion , for she had repl ied that she hadno one to send . Three weeks after receiv ing a personal off er from Dr . Hamilton to take cha rge of theschool , Miss E lston was in Bordeaux .

The career of unbroken success and bri l l ianta chievement that fell thereafter to her lot , graciouslyand most modest ly met as i t was , should be a sourceof pride and sa tisfact ion to her alma mater . I t

would have been hard to find anyone bet ter adaptedfor the work in hand . By birth and envi ronment a


wel l-bred and cultured lady , O f charming personal i ty ,at once winning and dignified , with no l i tt le sense offun and humour combined with anexcellent di seret ion

,a very able executive and a gi fted teacher

,

cheri shing independence of thought and freedom O f

wi l l w ithout egot ism , she has in appearance andmanner as much that i s French as Engl ish , and th i shappy combinat ion mak es her an ideal leader for theyoung gentlewomen who come to enter the new profession. W i thin the bri ef span of three years’ t imethe ent ire order of work and teach i ng in the Protestant nursing school was transformed , and broughtto as high a level as that found in any country , fornot only do the Bordeaux schools show a completegrading and rotat ion of serv ices , gi ving the nursesspecial as wel l as general branches of nursing , but thetheoret ical p rogramme has been elaborated to un

usual harmony and fitness . Miss E ls ton,however ,

was al lowed to remain with Dr . Hamilton only longenough to train her successor .The course of events now brings us to one of the

medical fratern ity who , among al l those who haveinterested themselves in nursing progress

,holds a

place at the very forefront for what he did , and

meri ts a uni que regard for the way he did i t . Dr .P . L . Lande , of Bordeaux , was a very determinedand very l iberal man , who wielded much powerand influence . At the t ime of wri t ing he occupiedthe chair of Medico-Legal Juri sprudence in theUniversi ty of Bordeaux , was the Med ico-Legal Juri stfor Southern France , a member of the N at ionalCounci l of P ub l ic Chari t ies , and a member of theAdmini strat ive Committee of the Civi l Hospitals of



brought 1 ‘ "ck a Matron who had been highly recommended b y a physician ,

but who proved to beunequal to the extraordinary amount of adaptat ionneeded . After three months she gave up the st ruggle and the Protestant Hospi tal then came nobly tothe rescue , by lending Miss E l ston to cont inue thetri a l .I t may be imaginedwhat she found confront ingher

when , i n Apri l , 1 904 , she entered St . André, wi th i tsincompat ible mixture of elements , authori t ies , purposes , and prejudices . The resident medical studentswere furious at the oncoming of a school for nur ses .They had wri t ten a pamphlet of fifteen pages , declaring that al l a nurse needed was to be clean andintel l igent ; al l the rest was in the doctor

’s prov ince .“ I s a school needed to produce such nur ses ? NO .

Any intell igent and zealous young man (medicalstudent) can gain easi ly and quickly , under thedirect ion of an elder comrade , and with the instruct ion of the ch ief of staff and the house men , theknowledge necessary for the care gi ven to the sick .

”

The young men contended that the nurses wouldsurely go into pri vate duty in the town , taking thisalso away from the students of medicine and thatthey woul d also as surely pract i se medicme unlawfu l ly . The male secu lar attendant s at St . Andréwrote a badly spel led , menacing let ter to Dr . Hamilton , threatening her w ith vengeance , and ob scee .

art icles were publ ished in the publ i c press . T he

S isters natural ly enough could feel no sympathy w i ththe new reg ime, yet many of them absorbed a gooddeal of the pract ical teaching , and thei r ownnursingimproved material ly inmany instances .

Revolu tion inFrench Hospita ls 3 1 3

The d iary of one of the nurses gi ves a li vely account Of the opening days :

At two o’clock in the afternoon the Préfet of the

G ironde , M . Lutaud , accompanied by M . Lande , Mayorof Bordeaux , and the members of the hosp itals committeecame to inaugu rate the nursing school in one of thewomen’s wards of Saint André . In h is short address ofencouragement , he said he would uphold the school atall costs : “

j e soutiendra i l’ E cole envers at centre tou t .”

This is now the motto of the school .The ceremony qui ckly over, the assembly dispersesand we begin work . There are three cheftaines (headnurses) and seven probationers , two of whom know something of hosp ital patients ; the others had never set footina hospi ta l . A cheftaine and two probationers are togo onnigh t duty ; our ward of thi rty-e ight beds , call edSalle Premiere , is allotted to two surgeons , both of

whom are opposed to the introduction of lay nurses . T he

patients , after the first curious interest is over , begi n tosob and moan . Who know s what they had heard of us ?We begin by putting the ward tidy ; the cheftaines i aspect their new services ; the evening dressings and trea tments begin ; we want some boiled water— no signs ofany nor means of preparing it ; the ward ma id exp lainsthat i t must be fetched from behind the pharmacy,which is five minutes away along endless corridors andpassages . A pupi l goes for i t wi th a huge enamel j ug,but on her return the jug is empty ; i t has a hole in it .At last we get some boiled water and begin the work .

New di sasters ; in gi ving the douches all the beds arefound sopp ing ; the douche tins leak . About fouro’clockwe see water running from the bathroom into theward ; onexamination we find the overflows p lugged withwool . At five o

'clock we are trying to wrest le with the


dinner , when the ward maid announces her departure.

She goes and is not replaced . But we do not lose heart .We manage to get the washing-up done , although to ou r

horror we discover the new pup ils wash ing sputum cupsand tea-cups together . The ward swept and more orless in order (principally less) , we give over the patientsto the night nurses . The pup i ls go home , scared anddisp iri ted .

The next day we go onduty at six -th irty . The cheftaine has a few surprises about the l inen . Yesterdaythe l inen cupboard was well fil led and seemed very tidy ;but when the p iles of clean shirts , distributed among thepatients are opened , they are all found to be in rags.Everything is in the same condition . While the nursesare making the beds we hear many unpleasant remarks ,comparing us very unfavourably with the nuns . Severalof the beds are wet and themattresses have to be changed .

We are at a loss to account for th is accident , unusualin a surgical ward , bu t later, when the patients becomefriendly they confess to us that they had emptied the irhot-w ater bottles into the beds , thinking that the mattresses would not be changed and that the nurses wou ldbe discredited in the eyes of the doctors .At come doctors ' rounds . The drawbacks we hadmet had belated us . The temperatures arenot even taken .

The nigh t before we had qu i te forgotten them , bu t in themorning , when the cheftaine went to her dressing closetshe found only a row of empty cases . The new staff hadnever been present at rounds . No one knew the doctor 'sways . There are practically no dressing bowls ; thedrugs and instr uments which they expected to u se havevanished .

” The few instruments at hand are ou t of

date or broken . When rounds begin all the studentsfrom the w hole hosp i tal meet in our wards to see “ LesBleues ” [the nurses were blue uni forms]. The confusionis indescri bable . We have l i tera l l v to fight our way to



balls inthe game of pol i t ical st rif e , and feel ing ran sohigh that he lost his re-election as mayor of Bordeaux ,

but st il l , qui te quiet ly and with few words , he hascontinued to use his influence to put trained womenwhere they belong , and to secure for them themecessary footing . I t i s in this that he i s unique , and hedeserv es , for h i s frank ly f émz

'

m'

ste att i tude the h ighesteem and grat itude of the nursing professi on he hasdone so much to foster . He has wri tten very di scrimina t ing ly of nursing , and with weight , oftenentering the l i st s when some publ ic controversy overhospi tal quest ions was going on . In the J ourna l deM e

'

decine of Bordeaux (2 3 Oct . , he said :

I t is through M lle . Hamilton that I came to appreci ~ate thoroughly the urgent necessity of a transformationin the seconda ry personnel [the nurses]of hosp itals . Iam glad to off er her th i s recognition . To her belongsthe credit of ha ving pointed ou t the imperfections ofreforms attempted in ou r coun t ry since 1 882 and of

having proved that it is easy to obta in , in France , resul ts compa rable to those which she holds up asexamp les .

The school s of the Protestant and the Tonduhospitals are, i n general outl ines , so al ike , that theycan be described together . They are both qui teideal in the i r atmosphere of ea rnest aspirat ion and

sinceri ty . In refined and home-l ike surroundings , asweet and cheerfu l sp i ri t rei gn s

, and the youngWomen who present themselves are of a h igh order ,educated , gracious , and compe tent . The ProtestantHosp i tal accen ts the educational character of training by charging i ts pupils tui t ion fees , and by taking

R evolut ion inFrench Hospi ta ls 3 1 7

day scholars who l ive in the ci ty . The hour s , dut ies ,and responsib il i t ies of the day scholars , however , a reprecisely the same as those of the residents , includ ingnight duty . The Tondu , being a publi c hospital ,requires in l ieu of tuit ion fees e i ther a contract fortwo addit iona l yea rs’ servi ce a fter training , or thepayment of a sum represent ing the cost of the pupi l 'sl ivi ng expenses in the hospital . Both schools areexcept ional ly admirable in the carefu l thoroughnessof the training . In each one every department of thehospi tal i s ut ili sed as a pract ice field and the pupi ls

pa ss through th housekeeping and admini stra t

i ve departments , learn ing every branch of hospitalmanagement by actual doing . Each has a trainedhousekeeper or “PJconome ” whose posit ion is equa lto that of the hea d-nurses , and pa rt of her duty i s to

g i ve the pupil s a pract ical service in buying , accounting , and general management , including dietari es .Dr . Hamil ton is wha t we cal l superintendent of thehosp i ta l , responsible to the tru stees , and is the onlyresident med ical officer . Miss E lston’s posi t ion i sl ike that of the Engli sh Matron . She i s the chiefresi dent officer , d irecting thewhole housekeeping and

general internal management of the hospi tal as wel las being pr incipa l of the training school , but certainparts of hospi tal admini strat ion onthe business sideare car ried on by non-resident officials , the secretary ,

comptroller , and économe , wi th whom she is expectedto co-operate , as a lso of course , wi th the med ical stafl.

The head-nurses are called chef ta ines; the d irectressof nurses a t the Protestant the Chrfla z

'

ne Gc’

néra lc.

The word i s Old French , and was d iscovered by Dr .Hamil ton in ancient documents . I ‘. had been qui te


forgot ten ,and when she revived it , i t drew forth quite

a l i ttle indignat ion , as i t was supposed to be an Engl ish ti tle . There are a certain number of permanen tnurses

,and the pupil s’ course covers two years . No

pr ivate duty for under-graduates i s allowed . Theuniform i s very attract ive : a clear blue l inen , w i thfu l l white shoulder-strapped aprons , cap , and whi tecol lar and cuff s . Graduates wear a blue and whi tebrassard with the device of the school . Nurses arenot perm it ted to go out in their l inen dresses , buta neat and pretty street uni form is opt ional .The hospital routine gives the pupil s eight hours

of day and twelve of night duty , the lat ter beingarranged in periods of two weeks at a time . Theday duty

,beginning at in the morning , i s over

by the same evening hou r , and the contrast in ef

ficiency wi th the mediaeva l system of hours as wehave seen them under the rul es of the rel igious orders ,beginning with four A . M . and last ing unti l ten PM

i s indescribable . The requirements for entrance aresimilar to those of the best school s everywhere , andthe course of study i s mu ch l ike our own . At theend of the two years’ course the pupil , having passedher examinat ions successfully , i s free to l eave thehosp i tal and to take up any line of work that appeal sto her.The vital ity of a movement i s proved by it s spread .

From the outset Dr . Hamilton set the regenerat ionof hospi tal s to the forefront , and she has ever heldthi s ideal before her nurses , encouraging them , as didM i ss N ight ingale wi th t he first Engl i sh nurses , to gointo reform work .

She and Miss E lston , c ct i v cly supported by Dr .



save beds and chair s . Deliver ies were conductedby a dame of sixty , the pat ients si t t ing in a large armchair to be confined and af terwards wal king to theirbeds . Everything else was on a par w i th thi s .Water for the smallpox pat ient s ' baths had to becarri ed a quart er of a mi le in buckets , and in themidst of everything else mil i tary rounds and inspect ion , formal and bri l l iant , took place at a morn inghou r not long after the dawn . The general-inchief , i t i s said , suffered a severe shock on beholdingfor the first t ime , at rounds , a Matron of tw entyfour in blue l inen and whi te cap , to whom his inval ided sold iers were to be confided for care anddiscip l ine . He bel ieved they would not obey herorders , but , needless to say , they did .

After some six years’ work there , M l le . Lu igi tookcharge of the Hotel-Dieu in Rheims

,an even more

diffi cult problem .

In rapid succession nurses from Bordeaux havebeen drafted into the municipal or prov incial hospital s of Albi , Alais Castelnau-du -Médoc , Cambrai ,E lbeuf , Dijon , Lori en t , Constant ine , Pau ,

Paui llac,

Tuni s , St . Quest in , Rueil , I ssoi re , and other towns .Dr . Hamil ton w ri tes :

You would indeed be interested i f you knew a ll thedetails of those hosp itals where our nurses have gone towork , and every day I rea l ise more how important isthe good practi cal training inthe wards . What mostsurpri ses the doctors (all more or less prejudiced againstlady nurs es) is the fact that they do for the pat ients somany th ing s the nuns would obj ect to do , and thatthey do not discuss and meddle with the doctor 'sorders .

Revolution inFrench Hospi ta ls 3 2 1

The transi t ion a t Al b i was especially dramati c , a sthe nuns left the hospi tal at twelve o ’clock , whi le thenurses entered i t an hour later . Three hundred

pa l ients here awai ted M l le . Nectoux , a serene ,capable and not easi ly daunted di rectress , who

came W i th a group of head-nurses in the midst of anep idemic of scarlet fever and measles . They soonlearned as they said ,

“ to lose the sleep habi t whi lepreservi ng t hei r gaiety and energy . A strong senseof soci a l responsibi l i ty was ingrained in these fineyoung women . I t i s no l ight matter to be sent tosubsti tute. for the members of a nursing system thathad lasted some fifteen hundred years and had,

duri ng the long centuri es , stood for the pat tern ofself-sacrificing devot ion in the eyes of the world .

The new nurses felt th is , and took their posi t ionseri ously .

Long after they had quelled the scarlet-fever outbreak , a poster st il l hung on the doors of the Cathed ral , protest ing against the la ici sat ion of the hosp ital ,cal l ing i t undemocrat i c , and adjun

'

ng the ci ty counci lto grant “ socia l j ust ice .

” Yet i t would seem thatto teach women thei r work and pay them for doingi t i s nei ther undemocrat i c nor unjust .I t would be impossible in one short volume to

fol low the nurses in al l their p ioneeri ng , but a fewextracts from let ters wi l l suggest their experi ences .

(From a hosp i tal of beds) ; May, 1 905 :I would l ike to describe the first day we spent here , bu t

i t defies description . The concierge , nurses , servantsi a short , the entire personnel of t he hosp i tal entered thep lace for the first time . The économe was the solemember of the former staff who rema i ned . Whenwe

VOL . urn—ax


reached the hospi tal at five o’clock in the morning , he

gave me a large box of keys heaped pell -mell wi th notags to them , and I spent the day running from one p laceto another tryi ng to find the righ t keys for the keyholes .He had no idea at a ll of how things had been run , as hehad left everything to the Superior, and did not evenknow where the sugar was kept . F inal ly the sick t e

ceived the care they needed , and fortunately all demonstra t ion outside was , by good management , avoided .

I knew that the captain of the genda rmerie had telegraphed for re inforcements and we were told thatsoldi ers patrolled al l the apprc aches to the hosp i tal .

A Bordeaux nurse , who had been placed inchargeof a ma l e d ivision wi th s ixty beds in a laicised hospita l , wr ote in 1 906

The ward for a time had been left to the care of ayoung ma le servant , and the patients did exactly as theyp leas ed. They smoked , morning, noon , and night , andI have seen one cooki ng an omelet on his bed . The

young woman who for three years had been head-nurseof th is ward was on terms of great familiari ty with the

patients,and at nine o

'clock she was accustomed to

seat hersel f with her crotcheting beside her favouri te,

a chronic case who was her servant , man of aff airs , andconfidant , and who had a whole ou tfit of domestic utensilsin h is bed . H e cleaned and mended her clothes , filledher lamp , waxed her shoes , pol ished the instruments ,broke up loaf sugar, cu t and made dressings and bandages ,w i thout ever getting ou t of bed or wash ing his hands .

I n ano t her place the nurses found the main drainpacked fe z “ a di stance of forty feet w i th old shoes ,pans

,bot tles , broomst icks , and aprons , as a protest

against their coming .



The visi tors’ books at the Bordeaux schools conta in the names of almost a ll the prominent men inpubl ic l ife , especially those in the administrat ionof publ ic chari t ies (including hospitals) under theDepartment of the Interior . There came the Préfetsfrom many di st ri ct s ; deputat ions from city governments ; offi cers of the French Medical Assoc iat ionand universi ty professors ; statesmen especial ly interested in phi lanthropy and soci al reform , such asStrauss and Riviere ; pol i t i cal economi sts , such asM ab i l leau ; a former governor-general of the coloniesof Indo-China ; an inspector of chari ties from Algeri a ;and Casimir Peri er , an ex-President of the Republic .

The King of Spain stopped one t ime on his way homeand was tak en all about by Dr . Lande . He expressedgreat pleasure at all he saw , compl imented the nurses ,and took a bunch of flowers to the Queen from M lle .Yparragu i re, a young Span ish probat ioner . F inally ,an important development was heralded by theappearance of emissaries from the Department ofState and the War Office . M . E t ienne , when M inister of War , made rounds in the Tondu accompaniedby the whole mil i tary sta ff of Bordeaux ; GeneralPicquart , when occupy ing the same office , appearedat Cambrai , where Mme . Ga rdiol from the ProtestantHosp i tal was in charge ; one under-secretary of statedescended upon Ml l e . Luigi at Bez iers ; another ,Chéron, whose surpri se vi sit s of inspect ion becamefamous , came unheralded one evening in 1 908 to theTondu , and , accompanied only by Dr . Lande andM i ss E lston , went into every nook and corner , crossquest ioned the patients and nurses , who d id notknow who he was , got l ight on every deta il from M i ss

R evolu tion inFrench Hospita ls 3 2 5

E l ston , even looking into cupboards and bureaudrawers , and flew away as swift ly as he had come .The War Department was on the eve of creating astaff of army nur ses .The shortcomings of army nur sing were many , for ,

a fter the nuns had gone , thei r p laces were taken byorderl ies . In 1 907 , the army med ica l paper Caducéevoiced the demand for sk i l led nu rs ing and has cont inued an energet ic propaganda . In 1 908 , the announcement was made that a compet it ive examinat ion w asto be held for the admission of nurses to the armynursing staff . I t took place inApri l , 1 908 , and , of

4 2 1 candidates who came forward from al l parts ofFrance to take i t , three Bordeaux nurses , Mlles .Chaumont

,Labadie , and T ey ssi ére, passed first ,

two of whom received the first army appointmentsthat were made . Dr . Hami lton wrote

M iss Elston and I went to the exami nation , and we

w ere much amused to see how pleased the military doctors seemed at the good pract ical knowledge of our

nurses . In themorning they had a written examinat ionand in the a fternoon i t was oral and practi cal . Thenurses appeared in the ir blue dresses and ca ps , whichseemed to p lease the offi cers very much . They hadp robably never seen nur ses in uni form .

After some delay andwaiting for Parl iament to passanappropriat ion , the nurses were finally off ered thei rchoice of posts , and the twenty-nine successful oneswere placed in the mil i tary hosp i ta ls on January I ,1 909 . Our space forbids going into more detai l onthe army nursing service and the preliminary skirmi sheswi th the Red Cross societ ies , whose infl uent ial


members desired to obtain the prestige of first p lacein mil itary hosp itals for their lady amateurs . T he

events as they occurred were full y and ably deal twi th by L a Ga rde-rl l a lade H ospi ta l i ére for 1 908 ,

whose edi torials d id much to s hape construct iveact ion . The Boer W

'

a r had thrown l ight on therelat ive value of amateur versus trained nurs ingmethods , and a number of French physic ians addedtheir voi ces to the demand for wel l-trained nurses inthe army , referring back to the warn ings given bythat experience . Dr . Hamilton , always on the alertto plant a t imely idea , had , shortly after the war,wri tten to the International Committee of the R edCross at Geneva , to suggest

That , upon the initiative of the international commi t tee, every central (national) society of the Red Crossshou ld be called upon to state whether, inthei r countr ies ,they possessed organisations analogous to the EnglishArmy Nursing Reserve service—that is to say , of nursesof superior education who in time of peace are in dailyand nigh tly charge of the sick , to the exclusion of a l l

other nursing bodies , and who, in time of war, are entire]yat the disposition of the mil itary authorities . (B u l letinI nterna tiona l des Socie

’

te’

s de la Crol x -R ouge, 1 90 1 , p .

N0 answer came to this letter .At present the French army service

,st i ll in i ts

forma t ive stages , gives ground for cri t ici sm and

admonition . I t has no woman placed a t the headof the nursing serv ice , and no grading in the wards .I t has decreed an ugly and insanitary un iform

,and

st i l l contemplates the admission of married women ,mak ing prov ision for their fami ly cares with al l the


M ICROCOPY RESO LU TION TEST CHART

(ANSI 0nd iSO TEST CHART No 2 !

I .QS L6


ory of thei r only son , who had died in a mil itaryhosp i tal from a gunshot wound , and whose suff eringshad been great ly increased by bad nursing . Dr .Hami lton wrote : “This sum , sent to

‘ rel ieve thosewho suff er ,

’ came at a moment when the necessi tyof having a nurse to vi si t the s ick poor had madei tself fel t w i th special force at the Protestant Hospital . The first nurse appointed was Mlle . Amory ,one of the Protestant graduates , and the work hasbeen carried on with the most signal success as anextension of the d ispensary service of the hospital .From the first i t has been made a combinat ion ofgood nursing with that fri endl y care for the upl iftof the ind ividual s and famil ies which has come tobe known as soc ial serv ice , and economic and indust rial condit ions have been fai thful ly recorded in thenurse’s note-book along with the nursing notes .In January

,1 9 1 2 , through the persistent eff orts of

Dr . Lande , the first publ ic school nurse in Bordeauxwas placed under the c i ty government , to make a

demonstrat ion of her usefulness . Mlle . Rol land wasentrusted wi th the care of 2000 chi ldren in the

largest publ ic school s in a crowded quart er and Dr .Lande undertook to rel ieve the admini strat ion of thecost of the experiment .In October , 1 906 , the journal of the Bordeaux

nurses and their branches was founded . I t appearsmonthly in a blue cover and i s called L a Ga rdc-M olade

H ospi ta l iero (L a l-

Veurse F ranga z'

se) , with the sub-t i tleOrganedosEcolesdoGa rdes-M a lades, Sy sténrc F lorence

N i ghtinga le. Animated cont roversies have ari senover Dr . Hamilton’s bold introduct ion of a new wordinto the French language , some regarding

“N curse



were appointed to the hosp i tals who were openlyunfriendly . not indeed to laici sat ion , but to thecourses of instruct ion or to any pro fessional teach ing ;of how the p rofessors w ere hampered by finding thehead-nurse teachers arbi trari ly changed in the middleof the term , and how they had to endu re the

“ bi tterderision " of having head-nurses given them to teachclasses who had never themselves been taught .Many hosp i ta l di rectors Openly declared the expenseof the courses unnecessary and useless . ‘ The rotat ion in service w hich he had always demanded he hadnever been able to obtain .

But progress in publ i c sent iment was evidentwhen the Congrés I nterna ti ona led

'

Assistance, meet ingin Pari s in 1 889 , after heari ng from Dr . Bournev il lea h i story of hi s eff ort to teach nurses , passed anexcellen t set of resolutions urging bet ter teaching

, and

an improved economi c , moral , and social status forthem . These resolut ions w ere sent to the M inisterof the Interior . The Cornel l Snpéri eure do l

’

Assis

tance publ ique, the nat ional department of publ icchari t ies , next took up the quest ion . In 1 898 , Dr .N ap i as made a report to this influent ial body ,

inwhich he urged the creat ion of schools for nursesthroughout France , and suggested the appointmentof a special committee to prepare a programme oftheoret ical instruction . The committee appointed ,Drs . Letulle and Faivre presented i t wi th a programme d iff ering l i tt le from that of the municipalschool s . The i r materi al , somewhat elaborated by

Cong res Interna t ionale d '

Assistance pub l ique et dc B ienfaisancep rivee, Pa ris, woo . I fnsvr

'

gm'mcnt prof essioml da personnel sorond

a r'

rc dcs hépr'

ta ux , vol . i i i .-iv .

Revolu t ion inFrench Hospita ls 3 3 1

the committee , was adop ted and promu lgated, in1 899 , as a part of the Ci rcu la r on N ursing of M .

Henri Monod , then president of the Consez'

l S u

pérr'

eure do l’

Assi stance publ z'

que.

This weighty recommendat ion,coming from the

highest authori ty in the land , committed the FrenchGovernment definitely to the princip le of educat ingi ts nurses ; the only debatable poin t remain ing was ,what method to use . I t was the year before Dr .Hamilton made her first appearance in publ ic . Therewas no one to bring forward Miss N ight ingale 'sprinciples . The directors had ful l power over thenursing staff s ; the doctors knew that they wantedeffi cien t nurses but d id not understand the methodsby which to at tain their end . Of this

,however

,they

were unaware , and theoret i cal inst ru ct ion administered by bri ll iant men to young people of the workingclasses was accepted as the way to bring ona nursingmil lennium . The phrase “ lecture courses " becamea sort of magic formula . Several towns respondedto the ministeri al ci rcu lars by estab li sh ing or t ry ingto establ ish the miracle-working courses . Quitenaturally they fai led of eff ect . In Rheirns, Alger,L i l le , and A ix , i t was admi t ted that the schools ofin struct ion had been unsati sfactory . M . Sabranintroduced the courses in to the hosp i tals of Lyon

,

and maintained that they were successful . Thekind of nursing that prevai led was , however , notal tered . I n 1 902 another ci rcular was sent out byM . Combes .But now Dr . Hamilton was a t hand to urge the

cla ims of the N ightingale system with al l the t renchancy of M iss N ight ingale herse l f . I t was not a l i t t le


annoy ing to prominent and weighty offici a l s to hearth is dari ng woman tel l them that their methods wereobsolete and thei r results fai lures . Her potentweapon , the pen , i s a sword that i s never sheathed .

N0 misrepresentation is a l lowed to pass ; no misstatement escapes her ; no s l ipshod nursing methodgoes unchal lenged . Keen in logi c , exact in statement , always armed with documentary ev idence ,gi ving neither praise nor blame except as the serv iceof t ruth as she sees i t demands , she had many a t i l tw ith the powers that be . The l ivel iest skirmish onthis l ine took place a t the Th ird N at ional Congressof Publ i c and Private Chari t ies , at Bordeaux , in1 903 . On thi s occasion several of the most importan t of hosp i tal di rectors and physic ians read papersupon the tra ining of the nurse , and Dr . Anna Hami lton appeared to smi te them hip and thigh . Afteran experi ence of twenty-five years " she began , w e

a re able to assert posi t ively that professional instruct ion alone has not improved the qua l i ty of hospi talnursing . She closed her paper w i th a summing upof points , each one of which was a d irect b low to thelaborious conclusions of the others

1 . Good resul ts in traini ng nurses can be obtainedonl y by selecting women of cu l ture .

2 . The professional education of a nurse cannot begivenby lectures only ; i t consists pre-eminent ly of trainingin hospi tal wards , where , under the direction of skilledhead-nurses , the pup i ls perform the entire task of nursing while passing regu larly from one service to another.3 . Theoretic instruction shou ld be simple and should

accompany practice .

a . The di ploma should not be g ranted for theoretic



of May , 1 903 ,elaborat ing the detai l s of a general

reform of the nursing serv ice [of Pari s] drew a l ineof dist inct ion betw een the nur sing staff and wardmaids by creat ing a recrui t ing centre destined toprepare hosp i tal nurses .The government thus advanced in the ri ght di rec

t ion . M . Montreui l , then Director of the Salpetri ere

,was sent to England to report on hospi ta l

nursing,which he did w ith unders tanding . This

scholarly , old-school gent leman was deeply sympathet ic with the modern nu rsing movement . Pos

sessed of a ri ch and mel low culture , he held frank lyprogressive v iew s as to the work and place of women .

I t was a real loss to the cause that h i s ret i rementonp ension should have come just at the O pening ofthe new era , and those nurses who were pri vi leged toknow himwill not forget h is k ind l iberal i ty of opin ion .

When M . G . Mesureur became Director-Genera lof the Pari s Department of Publ ic Chari t ies , he foundamong his predecessor’s notes plans and est imatesfor a School for N urses . He determined to completei t , and thereafter the improvement of the nurs ingservice was one of h is cheri shed objects . A kindlyand tactful offi cial , sincerely desi rous of elevat ing themorale and technique of nursing in the hospi tals , hehas erected a sp lend id memorial of h i s administrat ion in the new school and i ts h igh purpose . In thesummer of 1 907 , the finished structure stood extens ive and beaut iful , bui l t upon a plan of great d ign ityand seeml iness , i n the ample grounds of the Salpet

' L a R e'

forme da P ersonnel ”aspirat ion, 1 903- 1 909 . I fcole dc :

l nfirmi r‘

v es de l’

Assi stance publ z’

que dc P a ri s, 1 909 . B erger-Levra u l t ct Cie . , Pa ris .

”I“. l l l l t l t ‘ L e t tu t ing t o t he'

I'

t-nt l t t Nu rses

P ro tes t ant Hospi ta l Nu rses Dre s s ing the (‘

l tris tmus T ree



tive is suppressed . Strangely enough,however

, the

nursing remains outside of this orderly plan . Thereis no nursing department ; above and over all thenurses is no onewoman . Within the hospitals , manyof wh ich receive one and two thousand patients

,

there i s no woman superi ntendent . All supervisingand head-nur ses are directly responsible to the hosp ital director , who delegates the oversight of detail sto a male ofii ci al called the chief of nurses . T he

incoming nurses , who cannot be called prob ationers ,as they are engaged on a diff erent basis , are selected ,assigned to duty , disciplined , dismissed , or retainedby men . B esides the grievances of which we haveheard , there i s another which even Dr . B ournevilleoverlooked— they are badl y overworked . The wardsare understaff ed . Where E nglish hospitals wouldhave a head-nurse with six assistants , the Pari s wardshave two , or at most three, women to do everything .

Probably nowhere in the world can a more cheerfully hardworking

,willing , and uncomplaining set

of women be found than the infirmi éres of the Parishospitals , and , with the wonderful ab ility andexquisite manual dexterity of the F renchwoman

,

they learn great skill and speed of action and procedure— but all the niceties and refinements of nursing are lacking . The total absence of screens givesthe keynote . Dr . H amilton , with her usual fearlessness , attacked the prevalent methods of hOSp i ta lsin an article from which the followi ng extract isquoted

I t is a positive fa ct tha t in the hospital the patient isentirely deprived of moral protection, noma tter whether

R evo lu t ion i . ~

enenH os p i ta ls 3 3 7

the hospital has beenlaici sed or not ; he is considered as anon-humanbeing absolutely subject to the needs of themedica l students and a t the mercy of the attendants ;anindecency reigns there to w hich , because it is constant,al l become finally obliv i ous except the patients , who,constantly changing as they are, are painful ly surpriseda t the w ay they are treated . Is it necessa ry to havemore money inorder to remedy these things ? Not atall to introduce trul y competent womeninto hospitalw a rds not only banishes all immorality , but contributesto the prosperity of the hospital , as the English examplesshow clearly such w omen, distinguished and essent ially professiona l , are placed betweenthe pa tients and thephysicians ; they surround the one with their constantsolicitude and their moral protection; they give theothers their intelli gent help and often facilitate theirdifficul t tasks . ‘

The most delicate and difficul t problem of all l iesinthe unprotected state of the nurses , whose equipment of character is not always equal to self-defence .“The nursing staff is our harem said a younginterne frankly one time , and in the novel written in1 907 by M . B ru , the D i rector of Saint Antoine , oneof the largest hospital s , called The R omance of a

H ospi ta l N urse,the cold-blooded attitude of the

young medico is tak en for granted in the baldrealism of the sordid tale . I t is not evident that theliterary director intended pressing any moral , nordoe s i t appear that he i s conscious of having broughta damning indictment against the unhindered rule ofmen over uneducated and undeveloped gi rls , never

' Dans no: H dpi taux . B y Dr . Anna H ami l ton, in Le Si gnal ,August 1 6, 1 907 .

VOL . [ I L— 2 2


theless his book is the strongest argument yet pu tforward for the need of M atrons in hospital s .Into this uncongenial environment comes the new

school for nurses . In October , 1 907 , the first proba t ioners entered its doors . One must wonder thatD r . H amilton , M iss E l ston , and their capable graduates were ignored in the organisation of th is school ,and yet , in the atmosphere of the Paris hospitals onemay gather suggestions why this was so . Theywould insist on changes too radical . The lady firstp laced in charge as Principal , th )ugh of superiorab i l ity and character , was not a nurse , but held thedip loma of a trained midw ife . She had no rep resent a t ives in the w ards where her pupils went daily fortheir practice in nursing , nor could she herself followthem about the hospitals . “’hen the two years '

training was over and the certificated nurse s left theschool , they were placed in vacancies wherever suchoccurred , and it was made plain tha t the internala rrangements of wards was not to be altered— theold system was to be tried with a new type of nurse .

B u t so great a change as remaking the nursing ofPari s must come slowly ; when complete i t will betremendous . There will needs be a vast departmentof nursing , with. the Principal of the School forN urses at its head ; in each hospital a trained Directress , and in the wards head-nurses , the most able

T he first report of the school (La R ef orme da P crsomwl H osp ital i érc, 1 903

- 1 909 . E cole des I nfirmi eres de I'

Assi si anr c puhl iquc de

P a r i s. Berger Levraul t c t te . , Pari s, 1 909 ) g i i cs a deta i led descript ionof the school , the plans adopted inthe internal organisat ion, therea sons for every step taken. and the po int of v iew of the administrat ion inshap ing the whole.


A H istory of N ursing

plan , and she is able to select probationers of a highlydesi rable class .Our chapter began with the tragedy of the Augus

t inians ; but a renewal of life has come to the ancientorder . I n one of the most beaut iful of the Pari shospital s , the B oucicaut , the terms of a ph i lanthrop ist

’

s endowment required that the Sisters of theH etel-D ieu should be placed in charge of the wards

,

and though the hospital remains under the Assi stancepubl ique the administration accepted the gift withth is condition . The Sisters’ hospital h istory istherefore not ended , and they have an opportunityto modernise their methods . I t is of interest

,too , to

see that in the hospital of the Pasteur I nstitute nunshave been placed by similar request , for th is hospitali s solely governed by its own trustees . The orderplaced in charge was a branch of the I ri sh Sisters ofM ercy . The Sisters do all the nursing

,having no

servants about the patients , w ear the prettiest wh itel inen habits , and explain freely the orders and treatment of the cases in the F rench language with a softtouch of I ri sh brogu e . So progresses the revolution

,

and over every hospital stand the glorious words :L iberte

’

; Ega l i té; Fra terni lé.

E ND OF VOL U M E I I I .

Augusanciente Pari santhroof thewards ,si stance

ft withzory isrtuni tytoo , tote nunstosp i ta l

3 ordersters of'ing not wh ite1 treat1 a softi lut ion,words :

Microcopy Resolution Test Chart Lansl 0nd 150 Test Chart No 2l 5 III ...

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