X3
i


$
1
«'HV-*i'l '<'l''' 'lk; i <*'■ « • '' 1  '■ > ■•-.■'
AH
*M
sil# P'P"-*;:;; :'■■<;■;; ■••■■ 
U-UNMi LIOKAKI  \Jt MtUILINt
NAMUNAl
WY 11 G653o 1916




53730160R
NLM052823499 
US Department of
Health,  Education,
Heolth Service
Bethesda, Md.
>                     >-                     >                    >■
»  U.S.Deportment of  "J  Health, Education, * and Welfare, Public °;
-<                     <                     <
Heolth 
 
OUTLINES
of
NURSING  HISTORY
                  By

      MINNIE GOODNOW, R. N.

Author of "First-Year Nursing," "Ten Lessons in Chemistry
for Nurses," "The Nursing of Children"; Formerly Directress
of Nurses, Milwaukee County Hospital; formerly Superin-
tendent of the Woman's Hospital, Denver, and of the Bronson
  Hospital, Kalamazoo; Specialist in Hospital Equipment
ILLUSTRATED
        PHILADELPHIA AND LONDON

W.  B.  SAUNDERS  COMPANY
                 1916
 
f\-nyieX
   xvy
     It
Copyright, 1016, by W. B. Saunders Company
PRINTED IN AMERICA
     PRESS OF
W. B. 8AUNDERS COMPANY
    PHILADELPHIA 
     DEDICATED TO
THE NURSES OF AMERICA. 
Gbe IMgbtinsale  ple^e
                    (©rigin  "Unknown)

   11  solemnly pledge  myself before <0od and  in  tbe
presence of tbis assembly:
   Go pass my life in purity  and to practice my pros
fession faitbfully.
   11  will abstain from whatever is Deleterious  ano mis*
cbievous, and will not take  or  knowingly administer  any
barmful drug.
   11  will oo all in my power to elevate tbe standard of
my profession,  ano will  bolD  in confidence all personal
matters committed to  my keeping  ano all  family,  affairs
coming to my knowledge in tbe practice of my profession.
   Witb loyalty will 11 endeavor to aid tbe  pbysician in
bis work, and  devote  myself  to  tbe welfare of tbose
committed to my care. 
PREFACE
  Trained nursing is  now more than a generation old,
and nursing itself is an ancient profession.  Its history
is of definite and legitimate interest to those engaged  in
its practice.
  This volume has been prepared  in response to the de-
mand  for  a  short,  comprehensive  history  of  nursing,
suited to the average pupil or graduate and to those who
wish to know  something of the men and women  who
have developed nursing up to its present point.
  The  design has been to give  the main facts of nursing
history from  the beginning to  the present time.  Some
details have been  added to give color and interest, and
to present to the reader a picture of the times described.
  Paragraph headings  and chapter summaries are given,
setting forth what seem to the  writer the chief events  in
each period.   These are  designed as  a  convenience  to
the reader and as a suggestion that the  book  may be-
come some day a text  for teaching.
  The  chapters on Registration, Nursing  Organizations
and Magazines, and Vocational Opportunities for Nurses
are intended chiefly for reference.
  In the  preparation  of this  work  frequent  reference
has been made to the large History of Nursing by Misses
Nutting and Dock.  For much of  the  material, however,
the writer has herself  gone to the original sources  of
                                              l 
2
PREFACE
information.   Interested persons the  world  over have
furnished  material.   Mr.  Richards  Bradley and  Dr.
Alfred Worcester  have  written  portions  of chapters.
Dr. John Berry, Dr. Edward Cowles, Miss Ida M. Cannon,
Miss Charlotte A. Aikens, Miss Jane C. Delano, Deaconess
Mary  Elizabeth,  Miss  Julia  Gulick,  Mrs.  Margaret
Hamilton, Dr. Laura A. C. Hughes, Dr. Christian Golder,
Miss  Mabel McCalmont, Miss Sara  Parsons, Mrs.  W.
W.  Yaughan,  Mrs. Annette  Sumner  Rose, Miss Linda
Richards,  Miss Cora Simpson, Miss Myra Sawyer, Miss
E. E. White, Rev.  W. H. Sloan, the Sisters of St. Joseph
of Montreal,  and  others have furnished valuable  data;
while persons from many places have responded cordially
to requests for information  and for pictures. Without
these the book would not have been possible.
  Thanks  are due to Miss Charlotte A. Aikens and Miss
Frances Stone  for reading and  criticism of  the manu-
script.
                                Minnie Goodnow.
  Boston, Mass.,
  November, 1916. 
FOREWORD
  It seems important that women who undertake nurs-
ing, a work as old as the world, yet new in its relations
and  prophetic  in  its possibilities,  should know some-
thing of its history.
  Nursing  is  not merely an occupation, temporary and
superficial in  its scope.  It is a great vocation.  It is so
well  known to be difficult  that it is seldom undertaken
by any woman who has not, in the depths of her con-
sciousness,  an earnest purpose to  serve humanity.
  Women of  this type ought to know, and usually want
to know, how their vocation came to be what it is. When
they learn something of  the struggle,  centuries long,
always hard,  and often bitter, which has been necessary
in order to  bring nursing thus far on the path of progress,
they not only appreciate more keenly their own oppor-
tunities and find more readily their inner meaning, but
shoulder their own  task  with greater alacrity and more
hopefulness.
  History  tends to  make  us humble.  It  many  times
shows  us that work which we think original is only  a
repetition of that which has been  done before.   It shows
us how our predecessors  struggled with problems almost
exactly like those which we meet.  It makes us  see that
the conditions under which they worked were markedly
similar to those  of  today;  that their methods were not
                                              3 
4
FOREWORD
wholly  unlike  ours;  and  that  their  results resembled
ours,  being no  less conspicuous than those which  we
today laud as remarkable.
  History  discourages by  its habit of repeating itself,
evincing how tenacious the race is of outworn ideas and
methods.  It encourages by revealing the  progress which
has been made, and the part which earnestness and per-
sistence have played in the advance.
  If this book may serve to give a modicum of knowledge
of and insight into  our honorable profession it will have
been worth the  writing. 
CONTENTS
Nursing in Ancient Times.............................  11

                     CHAPTER II
Early and Medieval Nursing..........................  21

                     CHAPTER III
The  Deaconess Movement and Its Contemporaries.....  42

                     CHAPTER IV
Florence Nightingale and Her Work in the Crimea. ..  55

                     CHAPTER V
Florence Nightingale's Later Work...................  71

                     CHAPTER VI
The Establishment of Trained Nursing in Great Britain  84

                     CHAPTER VII
Early Nursing in America............................ 100

                    CHAPTER VIII
The Red Cross Society. Nursing in the Civil War...... 114

                     CHAPTER IX
The First Training-schools in America................ 129

                     CHAPTER X
The Work of Great Scientists as Related to Nursing. 144
                                              5 
6
CONTENTS
                    CHAPTER  XI                 PAGB
The Development of Trained Nursing in America......  157

                    CHAPTER XII
The Development of Trained Nursing in America  (Con-
  tinued) ...................... ........................  180

                   CHAPTER  XIII
The Development of Trained Nursing in America  (Con-
  cluded) ...............................................  196

                   CHAPTER XIV
State  Registration  for Nurses........................  214

                    CHAPTER  XV
Nurses and Training-schools in Europe...............  222

                   CHAPTER XVI
Nurses and Training-schools in Asia..................  249

                   CHAPTER XVII
Nurses and Training-schools in Many Lands..........  275

                   CHAPTER XVIII
Great Movements in Which Nurses are Concerned ....  296

                   CHAPTER  XIX
Nursing in the Recent European War.................  317

                    CHAPTER XX
Nursing Organizations.  Nursing Magazines...........  337

                   CHAPTER  XXI
Vocational Opportunities for Nurses..................  349
Index
355 
LIST   OF  ILLUSTRATIONS
FIO.                                                      PAGE
 1.   Surgical Instruments Found in Ancient Pompeii........   19
 2.   Surgical Instruments Used by Ambroise Par6...........   32
 3.   Sairy Gamp........................................   38
 4.   Gertrude Reichardt.................................   45
 5.   Friederike Fliedner..................................   46
 6.   Caroline Fliedner...................................   47
 7.   Kaiserswerth Twenty-five Years Ago..................   50
 8.   Florence Nightingale in Her Early Years...............   57
 9.   Map of the Dardanelles and the Crimea...............   62
10.   The Lady of the Lamp..............................   66
11.   St. Thomas' Hospital, London........................   74
12.   Florence Nightingale Late in Life.....................   81
13.   Medal of St. Barnabas' Guild for Nurses...............   90
14.   Miss Amy Hughes..................................   95
15.   Mrs. Rebecca Strong................................   96
16.   Mile. Jeanne Mance.................................  101
17.   Hotel Dieu of Montreal in 1821.......................  102
18.   An Old-time Nurse..................................  Ill
19.   German Red Cross Nurses in War Time...............  117
20.   American Red Cross Nurses' Pin.....................  119
21.   Memorial Statue to the Nurses of the Civil War........  125
22.   Mrs. Rebecca Price.................................  126
23.   Dr. Valentine Seaman...............................  130
24.   Dr. Marie Zakrzewska..............................  132
25.   Dr. Susan Dimock..................................  133
26.   Miss Linda  Richards in Her  Prime....................  141
27.   Lord Lister........................................  147
28.   Louis Pasteur.......................................  148
29.   Ignatz Semmelweiss.................................  151
30.   The First Use of Ether as an Anesthetic...............  153
31.   Dr. Robert  Koch....................................  155
                                                    7 
8             LIST OF  ILLUSTRATIONS
FIG.                                                       PAGE
32.  Roman Catholic Sister Nurse, America................  160
33.  American Deaconess Nurse..........................  161
34.  Class of Colored Nurses.............................  164
35.  Dr. Edward Cowles.................................  165
36.  Composite Picture of Nurses at McLean Asylum........  166
37.  Miss Sara E. Parsons................................  169
38.  Miss Norah Livingstone.............................  172
39.  Miss Louise C. Brent...............................  174
40.  Mr. John Ross Robertson...........................  175
41.  Before and After....................................  175
42.  Before and After....................................  176
43.  Emblem of the Victorian Order.......................  177
44.  Mrs. Isabel Hampton Robb..........................  181
45.  Miss Mary L. Beard................................  187
46.  Spanish-American War Nurses' Pin...................  192
47.  Mrs. Clara Weeks Shaw.............................  201
48.  Miss Charlotte A. Aikens............................  202
49.  Miss Charlotte Macleod.............................  208
50.  Map of Europe. ...................................  223
51.  German Deaconess Nurse............................  224
52.  Dr. Anna Hamilton.................................  228
53.  Ward in Rigs Hospital, Copenhagen, Denmark.........  237
54.  Ward in Children's Hospital in Vienna.................  239
55.  Austrian Midwife...................................  239
56.  Ward in Woman's Hospital in Russia..................  243
57.  Miss Kleonike Klonare..............................  245
58.  Map of Asia........................................  250
59.  Miss Linda Richards in Japan........................  252
60.  Japanese Graduate Nurses in the War of 1915..........  254
61.  The China Nurses Association,  1914...................  258
62.  Chinese Registered Nurses...........................  259
63.  A  Chinese Training-school in 1915....................  261
64.  Miss Cora Simpson and Her 1913 Graduating Class......  262
65.  Training-school, Nellore  Hospital,  Nellore, India........  265
66.  Visiting Nursing in Jerusalem........................  271
67.  Dr. Grenfell and Staff at St. Anthony's Hospital, Labrador.  277
68.  Patients and  Deaconess Nurse Superintendent at Indian
      Sanitarium, Fort Lapwai, Idaho.....................  280
69.  American District Nurses in Honolulu.................  291
70.  Miss Ida M. Cannon................................  304 
LIST OF  ILLUSTRATIONS             9
^IQ-                                                        PAGE
71.  Mr. Richards Bradley.........................       308
72.  Operating Car of German Hospital Train.............. 319
73.  German Red Cross Nurses in Hospital Car............. 320
74.  Training-school at the Protestant Hospital of Bordeaux. . 321
75.  Belgian Red Cross Nurses........................... 322
76.  Japanese Red Cross Nurses.......................... 323
77.  Miss Rosa Vecht.................................... 326
78.  Miss Mary Magill................................! ! 327
79.  Miss Edith Cavell.................................. 328
80.  Medal Presented to  Miss Thurstan.................... 329
81.  Polish Nurses in Winter............................. 330
82.  Mrs. Hankin Hardy................................. 331
83.  A Ward in the Kragujevatz Prison, Serbia............. 332
84.  In the American Hospital, Nish, Serbia................ 333
85.  English Nurses and  Hindoo Soldier-patient............. 334
86.  Russian Nurse and Siberian Soldier-patient............. 335
87.  Mrs. Annette Sumner Rose.......................... 344
88.  Miss Genevieve Cooke.............................. 345 
 
OUTLINES  OF  NURSING HISTORY
                   CHAPTER  I

          NURSING IN ANCIENT  TIMES

  Nursing is one of the  oldest arts.  There always has
been helplessness of one sort or another and to a greater
or less degree; wounds have demanded attention; babies
and old people have needed care, and disease in some
form—due to wilful or ignorant disregard of natural laws
—has always been present in the world.  The great, uni-
versal mother-instinct has met these emergencies by what
we call "nursing."
  Nursing Among Animals.—Animals present conditions
of helplessness similar to those of men, and have their
periods of disability.  They  meet their emergencies  by
using their instincts—faculties which when met with  in
the human race are called "common sense."
  Many of the nursing procedures of the lower animals,
because they are the  result of  pure  instinct, are thor-
oughly scientific.  A wounded animal  cleanses its hurt
by licking, its rough tongue extracting from the wound
all foreign substances.   It often puts  a wound into run-
ning water, thereby keeping it cleansed  and allaying any
inflammation which may  have occurred.  Instances have
been noted where wild birds put a broken leg into a sort
                                           11 
12    OUTLINES  OF  NURSING   HISTORY
of splint.1  Fatio captured a bird that had on its breast
a large dressing made of down taken from its own body
and fixed to the wound with coagulated blood.
  Even our domestic animals, whose habits have become
more or less  perverted, abstain  from food as a corrective
of certain digestive  disturbances, or eat  freely of plants
which are emetics.   Many instances have been observed
in which animals not  only nursed themselves, but aided
others to recover.
  Care of the Sick Among Savages.—The lowest savages
have a certain amount  of nursing  knowledge and skill.
Much of  this knowledge is  instinct, similar to  that  of
animals.  All men doubtless possess these instincts until
they lose them by indulgence in the  abnormal habits that
are the result of so-called civilization.
  Nearly all savage tribes practice massage in some form,
with good results.  Sweat baths, fomentations, and other
hydrotherapeutic measures  are  known and  used among
them.  Bleeding and cupping for pain, opening abscesses
for drainage, amputation for crushing injuries—with con-
trol of hemorrhage by cauterization  with  hot stones—are
practised  among uncivilized  peoples.   Trephining  was
done  among prehistoric races.   Wild  tribes have  been
known to perform ovariotomy.   Baas says in his "History
of Medicine," "The first curative services were surgical
in character, and attained a degree  of perfection before
internal  medicine  had  hardly  begun.  Ophthalmology
and midwifery came early.   The ancient Hindoos oper-
ated for harelip,  cataract, hernia, removal of abdominal

  1 "A snipe with a broken leg was found  to have forced the frag-
ments into a parallel position and secured them by means of a strong
band of feathers and  moss intermingled.  Flat-leaved grass was
bound about the leg spirally and fixed with a sort  of glue."—M.
Magarin. 
NURSING  IN  ANCIENT  TIMES      13
tumors, and did Caesarean section upon the dead."   All
these practices had  their origin in  dire necessity,  served
by instinct.1
   Nursing and Medicine.—In this  primitive and instinc-
tive care of the sick we  find no distinction made between
nursing and medicine or  surgery.  Only in very  recent
times has there been a sharp line drawn between these two
forms of service,  and even today there  is some confusion
as to which procedures belong to the doctor and the nurse.
   Among savage  tribes that had medicine men there was
sometimes  developed  a lower  class,  often women, who
applied the  treatment that  had been prescribed, dressed
wounds,  and,  in  general,  did work which  would  be  in-
cluded under  the term  "nursing."
    Medicine and  Theology.—Many forms of disease ap-
pear extremely mysterious.  They are plainly caused by
some external force or influence.  In consequence, most
races in their  early development came to the conclusion,
a  natural one, that sickness was caused by  evil spirits.
The medicine  man then tried to make the patient's body
unpleasant for the spirit, in the hope that it would move
   1 A traveler gives  an account of  a cesarean section which  he
saw performed among one of the wild tribes in the interior of Africa:
"The patient  was rendered half-unconscious with banana wine.
At one stroke both abdominal wall and uterus were incised,  the
child being slightly wounded by the stroke.  The opening was en-
larged, hemorrhage checked by  heated irons, and the child removed.
An assistant pressed upon the abdomen while the  placenta was
removed  through the vagina.   They  then checked  the bleeding
from the abdominal  wall.  No sutures were used in closing, but
the incision was  pulled together by means of polished iron  needles
wound about with bark threads in a figure-of-eight fashion.  The
dressing was a paste made of various roots.  The woman was kept
turned  on her abdomen for drainage. Her temperature went  to
102° F., her pulse to 110.  On the  eleventh day the wound was
healed and she appeared to be in her usual health." 
14    OUTLINES  OF  NURSING  HISTORY
out.  Pommeling, beating,  starving,  etc., were used for
this purpose; also dreadful noises, sudden fright, and evil-
smelling or vile-tasting drugs.  Remedies to be taken by
mouth were often mixed with such materials as cow dung
and human urine.
  Under such circumstances the medicine man became a
species of priest, or the priest was appealed to for help in
sickness, so that very soon medicine and religion became
inextricably woven together, and were thought of  as one
science.  For many  centuries  the  priest was the  only
physician.
  These historic  facts and the intimate and universal
connection between religion and the medical sciences help
us  to  understand many  occurrences among  the  older
peoples.  We find a similar state of affairs in many places
at the present time.  In our ignorance of the causes of
disease or death  many of us  instinctively  appeal  to  a
Higher Power for help to combat them.
  Sickness and Sin.—From the days  of old Assyria  until
now many  persons have believed that sickness  was sent
from  above as  punishment for  sin.  The various inter-
pretations of the word "sin" have led to strange  modes of
treatment for disease.  If we define sin as transgression of
law, we moderns find ourselves  agreeing to this very doc-
trine, since  we  believe that most sickness is  the  result,
direct or indirect,  of breaking the laws of nature.  Some
of the most advanced thinkers  of our day are proclaim-
ing that sickness is both a public and a private  disgrace,
and are advocating  civic and personal  righteousness,  in
their broadest sense, as the great means of  prevention.
  The supposed causes of disease have always profoundly
influenced its care and treatment.  Nursing has followed,
more or less closely, both the theology and the science of
its day, and has been radically influenced by them. 
NURSING   IN  ANCIENT  TIMES       15
   Dearth  of Nursing  History.—As we search through
 ancient  history  we  find  almost no  mention made  of
 nursing.   This is  doubtless  due to the  fact  that  men
 do not make records of ordinary events, but only of un-
 usual or striking ones.  People nursed their sick as a mat-
 ter of course, and not until cities became large  and prob-
 lems acute, so that public and conspicuous provision had
 to be made for them, did the matter of care in illness appear
 of sufficient moment to be mentioned.  The early history
 of nursing is,  therefore, lost in obscurity, and the  only
 records we have are those of hospital nursing after it be-
 came a fact.
   The First Hospitals.—Since religion and medicine were
 united so early, it  followed naturally that the first hospi-
 tals were  connected  with temples or places of worship.
 Some of the institutions which have been called hospitals
 were merely houses for  the sick who had come to  pray or
 offer sacrifice  to a god; the  patient  was cared  for by
 friends who came with him.
   Egypt and Babylon.—In ancient Egypt the sick went to
 the temples of the gods Osiris, Isis, and Serapis.  Isis was
 supposed to be especially interested in them and to bring
 help while one slept.1
   In both  Egypt and Babylon it was the custom to lay
 the sick in the streets, and there was a  law requiring  that
 the passers-by should give them what advice they could
 out of their  own experience.   Some of the  prescriptions
 obtained in this way were written down and preserved  in
 the temples.
  The ancient Persians had houses for the sick poor,  who
 were waited upon by slave  boys and girls.
  1 Burdett,  in "Hospitals and Asylums," says that the Egyptian
physicians were all  specialists, confining their practice to one part
of the body. 
16    OUTLINES  OF  NURSING  HISTORY
  India.—In the old Hindoo villages there were hospitals
for the care of sick travelers, and medical specialists were
appointed to them.  In Ceylon, in the fifth century before
Christ,  one of the kings  established what was doubtless
a true hospital.   King Asoka, about  the year 225 b. c,
built eighteen hospitals.   These public hospitals were also
schools  of  medicine.   The  attendants in them were re-
quired to be competent to cook, to give baths, to prepare
medicine, to handle bed  patients, to  get patients in and
out of bed, to give massage, and to perform a list of duties
not unlike those of the modern trained nurse.  This  must
have necessitated some sort of instruction.
  The Vedas, the  sacred books  of  India, treat of medi-
cine, of major and  minor  surgery, bandaging, poisons and
their antidotes, and drugs;  they also discuss nervous dis-
eases, insanity,  children's  diseases, and  genito-urinary
diseases.  They contain much instruction in hygiene, and
set forth the theory that disease is preventable.  They
teach that the chamber of a lying-in woman shall be very
clean  and well ventilated and that midwives shall  have
their nails  cut short.  They advise daily bathing,  daily
attention to the bowels, daily cleansing of the teeth with a
special sort of stick, etc.  They also say that physicians
shall have their hair and nails cut short,  wear white cloth-
ing, take a daily bath; that they  shall not speak of  what
they have  learned in  confidence  from the patient;  they
recommend that sweet-smelling  drugs be burned in the
operating-room to prevent devils (!)  from getting into the
wound.   In  all  their  regulations there  are hints of the
germ theory of disease.1

  1 The best era of Hindoo medicine was  250 to 500 b. c. Later it
was taught that to touch blood or morbid matter made one unclean
and the work deteriorated, until care for the  sick became almost
non-existent. 
NURSING  IN  ANCIENT  TIMES      17
  The Ancient Jews.—Moses has been called the greatest
physician of all time.   It is certain that he was a masterly
sanitarian, and  the practical  application of  his code will
be appreciated when one realizes that  he was in charge of
a camp of more than a million people.
  All the principles of modern sanitation are anticipated
in the Jewish law, and its methods  are in accord with
modern bacteriology.  There are provisions in it for the
inspection of food (Leviticus  7, 11,  and 17  and Deuter-
onomy 12 and  13),  for  the disposal of  excreta (Deuter-
onomy 23), notification of the authorities in cases of com-
municable disease (Leviticus 13 and 14), quarantine, disin-
fection (Leviticus 15 and  Numbers 19), etc.  The  rules
about menstruation and childbirth seem strange to us
(Leviticus 12 and 15), but they assured  to women the
proper rest and  privacy.
  Greece.—As far back as 1134 b.  c. there was at Epi-
daurus, in Greece,  a temple  to Asklepios, the  god of
healing.   It was a very beautiful place,  resembling  some
of our modern sanitoria.1  It was a house for  those who
came to pray to the god, and was a hospital only in the
sense that the sick  were cared for  in it.  The patients
brought their own  bedding; there were  bath attendants
and  slaves who  waited  upon the sick.
  The Greeks did not feel it worth while to care for any
cases of illness but those considered curable.  They took
the philosophic view that wo do in the  case of wounded or
sick  animals,  that it was kinder to let them die as soon as
possible.  Persons hopelessly ill were often left to die in
the streets.
  Obstetrics was done entirely by midwives, except that
in difficult cases they  sent for the  priest.   Maternity
cases and the dying were regarded as unclean,  and  were
          1 Its ruins have been found and identified.
       2 
18    OUTLINES   OF  NURSING  HISTORY
put outside the city walls, to get on as best they might.
This practice continued until about 140 a. d.
  The care of sick slaves was one of the duties of the mis-
tress of the mansion.  Wounded soldiers were nursed on
the battlefied at  public expense.   In the time of  Xeno-
phon, 400 b. c, there was an organized medical corps in the
army.   All this work was  utilitarian rather than humani-
tarian, however, since slaves were property and therefore
valuable, and soldiers were the mainstay of the nation.
  Hippocrates, the  Greek, who lived  about 400 b.  c, is
called the  Father of Medicine; he  set  forth  principles
which have governed the  practice  of medicine up to the
present  time.  He  taught that disease was not due to
demons, but to the breaking of natural laws.   He urged
careful observation  of the  sick and taught the  meaning
of posture, expression,  breathing,  and other symptoms.
His works give  full  directions about hot applications,
poultices, etc.; teach that fever cases should have fluid diet,
and advise cold sponging for temperature.   He urged the
necessity for clean,  smooth bed linen; advised the use of
mouth-washes, light and regular  nourishment  for heart
cases, and much fluid for kidney cases; suggested that the
insane be kept occupied,  that they be  provided  with
music, etc.  Most of these  things we  regard as modern
nursing  methods or discoveries.
  Rome.—The Roman  knew a good  deal about sanita-
tion.  Julius Caesar was the first statesman to  recognize
teachers of hygiene, and he had a regular medical service
in his army.
  The old Roman hospitals were,  in accordance with the
Greek idea, only for slaves and soldiers; the nursing was
done by women and old men of good  character.
  In Roman  ruins  found  in Switzerland there  were dis-
covered many  nursing utensils—enema  bulbs, tubing, 
NURSING  IN  ANCIENT  TIMES      19
rectal tips,  ointment jars, etc.  In Pompeii, which was
destroyed in the year 79, there have been found many fine
surgical  instruments very similar  to  our own—scalpels,
forceps, artery clamps,  drills, elevators, obstetric forceps,
and vaginal specula of  modern pattern.1
  Care  of the Insane.—Nearly all nations have thought
that insanity was due to the  presence of evil spirits in the
bodies of those afflicted.  The same fantastic and brutal
methods were used to get rid of them that were employed
Fig. 1.—Surgical instruments found in ancient Pompeii.
by the medicine men of savage times.  Such persons were
kept prisoners  for the safety of the public, and if they
became violent were chained or beaten.   A few authorities
say that the insane were humanely treated in Egypt and
Greece, but in most countries  and for many  centuries
they were used worse than animals.  Hippocrates  seems
to have been the only one who taught that insanity was
a disease of the brain.
  1 Among the ruins of Troy, recently  dug up, were found artery
clamps and dressing forceps which date  back to 600 b. c. 
20    OUTLINES  OF  NURSING  HISTORY
  America.—Prescott  tells  us,  in  his  "Conquest  of
Mexico," that the Aztecs "had hospitals established in all
their principal cities for the cure of the sick and the per-
manent refuge of disabled soldiers,  and surgeons  were
placed over them."

          SUMMARY OF IMPORTANT POINTS
  Nursing is one of the oldest arts.
  When ill, animals use their instincts to care for them-
selves in an effective fashion.
  The lowest savages always have had medical,  surgical,
and nursing traditions, some of them thoroughly scientific.
  Medical work and nursing were originally not  separate
sciences, but were looked upon as one and were done by
the same person.
  Illness was regarded as the work of evil spirits or due to
moral  errors.  Treatment  for the sick was  long in the
hands of the  clergy.
  There is little nursing history available for many cen-
turies, because nursing was taken as  a matter of course,
not worthy of description.
  The first  hospitals  were  connected with  temples of
worship.
  In ancient  Egypt and Babylon there was public inter-
est in the care and  cure of the sick.
  The ancient Hindoos had a well-developed system of
medicine, but their  practice deteriorated in later  times.
  Moses was  an excellent sanitarian.  His laws accord
with modern theories and methods.
  The Greeks and Romans gave care in sickness chiefly to
slaves  and soldiers.  Maternity care  was inadequate.
  Insanity was attributed by all nations to  "possession
by devils," and was treated accordingly.
  The ancient Aztecs  had well-organized hospitals. 
CHAPTER II
        EARLY AND MEDIEVAL  NURSING

  Early Christian  Hospitals.—Very early in its history
the Christian Church founded institutions  where the
sick and helpless of all kinds were cared for.  These were
commonly built next to the churches and were supervised
by the clergy.  The workers in them were called deacon-
esses,  and were sometimes unmarried women, but more
often widows.
  The first  large  Christian hospital  was probably the
Basileus at Caesarea, founded in the year  370.  Macrina,
a deaconess, was evidently its  superintendent, or at least
superintendent  of  nurses.  A little  later  Chrysostom
built  two large  hospitals in Constantinople.  Olympia,
a wealthy woman who became a deaconess, nursed in both
of them.
  About the year  300 Fabiola, a Roman  lady, erected a
house for the care of the  sick. At the Council of Nice,
held about  this time, hospitals were mentioned  as an
established work  and were  spoken  of with  enthusiasm.
Paula, a noble  Roman  lady,  founded  at Jerusalem a
hospital and a religious  community for women.
  An  Ancient Nurse.—Paula was a typical nurse of this
period.  She was an educated  woman, and one historian
goes so far as to pronounce her "the first  trained nurse."
She was doubtless one of the first persons who systematic-
ally trained  nurses.  An  old English translation gives a
quaintly vivid account of her work:  "She was marvel-
lously debonair, and piteous to them that  were sick, and
comforted them and served them right humbly; and gave
                                            21 
22    OUTLINES  OF  NURSING  HISTORY
them largely of such food as they asked.  She was oft by
them that were sick, and she laid the pillows aright and in
point; and she rubbed their feet and boiled water to  wash
them."
  Early  Visiting Nursing.—The  Deaconess Order  (see
Chapter  III) may be regarded  as the first Visiting Nurse
Association, since deaconesses in apostolic times cared for
the sick  poor in their homes as well as in hospitals.  In
the year 400 there were forty deaconesses serving as parish
nurses in Constantinople.  Phebe, mentioned by St.  Paul,
is  regarded  as  the first  district nurse.   From  her  time
visiting nursing  has  been  done  in one form or another in
all civilized countries.
  Central Europe.—In the early  days  of  France and
Germany, when  the people lived an outdoor  life,  there
was little illness of the ordinary sort.  The frequent  wars,
however, made  surgical nursing necessary, but this was
usually impromptu,  being done by the people who  lived
near where a battle  took  place.  Soldiers were taught to
dress their own  wounds, and were frequently left to look
after  themselves  when  injured.  The  wounded  were
sometimes collected  and placed in tents, but these were
not hospitals in any true sense of the word.
  About 587  Radegunde, of  Thuringia (a  province in
south Germany), daughter of a king and wife  of a  king,
took poor patients into her palace and herself helped to
nurse them.  There  appear to have been no physicians in
Thuringia, so that Radegunde prescribed for  as well as
tended the sick.  Many  women of noble birth  followed
her example.1   Eventually she founded a religious settle-
ment, with nursing as one of its chief activities.
  1 One authority states that in early German times all physicians
were women.  They were doubtless educated nurses,  who made
no distinction between different services in caring for the sick. 
EARLY  AND  MEDIEVAL  NURSING    23
  As these countries became more thickly populated, and
towns became cities, the crowding together of great num-
bers of people for protection against enemies resulted in
bad  sanitation and disease.  There were frequent epi-
demics of contagious disease, referred to as plague or pes-
tilence, and considered a visitation of God.
  These epidemics and other diseases caused by unsanitary
surroundings made the  care  of  the sick  a  considerable
problem,  which could no longer be met  by emergency
methods,  but demanded a settled and permanent  plan.
Kings, princes, and prominent men  and women began to
establish hospitals.
  The Religious  Nursing Orders.—Philanthropy of  all
kinds was considered a religious exercise, and nursing be-
came distinctly so.  Religious orders, in which men and
women gave themselves wholly and  for life to the care of
the sick and helpless, began to spring up, built hospitals,
and became responsible for  them;  through gifts  from
rulers and nobles  they accumulated  property and became
prominent in the life of the cities and towns.
  Nursing sisterhoods in great numbers were  founded
from about 500 a. d. on.  The members were at first not
bound by any vows and wore no distinctive dress.1  Later
the  clergy  obtained  control  over them,  directed  their
work, and imposed vows.
  The Sisters of St. Elizabeth, the Sisters of St. Catherine,
the Ursulines of Austria, the  Lazarists, the  Grey Sisters,
the Black Sisters, the Sisters of Our Blessed Lady, and
other orders were  established  in these early days.
  The Beguines  of  Belgium, founded in  the  seventh
century and continuing until the present, are a typical
  1 We have preserved accounts and pictures of abbesses (heads of
the  orders) and nuns dressed for state occasions in elaborate and
expensive clothing. 
24    OUTLINES  OF  NURS'ING  HISTORY
order.  The members do not take strict vows and may leave
the order at any  time.  They have always done both
hospital and private nursing.  Their large colony (Beguin-
age) at Ghent, consisting of small, separate houses, is a
most immaculate and interesting little village.
  Nursing Brotherhoods.—Fully one-half the nursing of
medieval times was done by men, since it was thought im-
proper for a woman to nurse a man who was not a close
relative. There grew  up many religious orders of  men
that included nursing among their  other duties.  Some
of these are the Brothers of St. Anthony, Brothers of the
Holy Spirit, the Begards, the Alexians,  and the Knights
of St. John.   John Howard, of England, who about 1780
made an extensive investigation of hospitals, found some
of the  best work  being  done in  hospitals belonging to
brotherhoods.
  Related Orders.—There  were a  number of orders  that
included both men and women, such as  the Brothers and
Sisters of Mercy and the Brothers  and Sisters of Charity.
They worked together in hospitals, the  Sisters caring for
women patients, the Brothers for men; they also went out
to private duty.
  The members of all these orders were from the various
ranks of society, but the nobles were executives and  held
the posts of honor, while the lower-class members did the
rough  manual labor   Three to six months' training in
nursing was usually given.
  Volunteer  Hospital Nursing.—Religion at that  period
emphasized the value of good works in securing salvation,
and it naturally followed that benevolently inclined per-
sons turned to hospitals as fields for their souls' redemp-
tion.   Volunteer visiting nursing  in hospitals became a
custom,  and many prominent persons  made  this  spec-
tacular service their favorite  charity.   The wife of the 
EARLY   AND   MEDIEVAL   NURSING    25
Emperor Theodosius the Great was accustomed to go to
the church hospitals,  where she washed and dressed the
sick, made beds, prepared  food, fed the  patients,  etc.
Such unskilled  care was perhaps more satisfying to the
consciences of those who gave it than comforting to the
patients.
  Similar service, irregular and unsystematic, is common
today in some Austrian and Italian hospitals.
  Hospitals for Pilgrims.—From the time of the apostles
many persons made  pilgrimages to Jerusalem and other
holy places.  Both men and women made these journeys
and  the  practice  became  fashionable.   In those  days
traveling  was slow and  often  dangerous,  and hospitals
were needed along the chief highways to care for pilgrims
who became ill or those who were the victims of bandits.
Many  hospitals were thus established.
  Hospitals for Crusaders.—The Crusades, beginning in
1096 and lasting for nearly two hundred years, also made
hospitals  necessary  along every great  travel route in
Europe.   Men, women, and children by thousands under-
took the long journey to Palestine in a vain  attempt to
rescue  the Holy Sepulchre from the  "infidel" Moslem.
  Many of the great  European hospitals  had their origin
in the  work  of caring for sick  or exhausted  Crusaders,
and  thousands  of  monks  and nuns did noble service in
them.   Special orders sprang up to undertake this work,
called by the general name of Hospitallers.  The Knights
Templars (an order which still survives in an altered form),
the Knights of  St.  Lazarus (whose cross is the  emblem of
the modern German  Nurses' Association), the Teutonic
Knights Hospitallers, and the Knights  of St.  John of
Jerusalem  were some of the best-known orders.  Many
of them continued their  work in one form  or another
after the  Crusades were over. 
26    OUTLINES  OF  NURSING  HISTORY
  The Knights  of  St. John was a  typical order.  They
built their first  hospital in  Jerusalem, but removed it to
Rhodes and  later to Malta.  It was richly endowed by
kings and nobles.   The  knights were men of rank, some
of whom fought  in the wars, and some of whom, with little
or no training,  prepared only by experience, undertook
the work  of physicians in the  hospitals.   The "half-
knights," or  serving brothers, were  of a lower class, and
doubtless did the actual nursing of the sick.
  The English branch of this order,  founded in 1100, still
maintains hospitals and does nursing.   St. John's House
in London was, even before Miss Nightingale's  time,  a
famous nursing  center.  St. John's  Ambulance  Associa-
tion and the  National Association for the Aid of the Sick
and  Wounded During  War are  branches of this order.
Other divisions of the order exist in Germany, with both
men and women members.  The order had an active part
in the  establishment of the  International  Red Cross
Society.
  An old description of the Hospital  of St. John, in Malta,
gives  a striking picture.  The building was  magnificent
in its architecture, though  the comfort of patients was
little considered  in its construction.   The huge wards were
high,  vaulted rooms with  very small  windows.  Their
stone walls were hung with woolen curtains in winter, but
must  have been cold in winter despite them.   Patients
were housed and cared for according to their social stand-
ing, and the slaves—who constituted a large portion of
the number—were  assigned to what was practically  the
cellar.

  "The Infirmarian [doubtless corresponding to the superintendent]
is a professed knight, to whose zeal the care of the sick is intrusted.
He must be present at the  morning visitation  of the doctors,
and must often visit the beds at night, .  . . has authority to ap- 
EARLY  AND  MEDIEVAL  NURSING     27
point and  dismiss the  warders or servants  and to punish  them
should they fail in their care of the sick.
   "Two professed knights must look after the distribution of medi-
cines and of food, making notes of the daily expenses.
   "There are fourteen servants, called warders, whose duty it is to
attend to the sick day and night.
   "To assist the cooks and warders in the care  of dirty vessels and
other mean offices there are forty-four Christians and Turks selected
from the prisons of slaves.
   "There are three  principal  physicians  who  visit  the  Infirmary
twice a day, see  that their orders are carried  out,  writing on  the
tablets attached to each bed  the food and medicine required.  To
assist them are physicians who have a room in the  Infirmary and
who see the patients several times a day.
   "There are three surgeons and six young men who sleep in  the
Infirmary  and assist  them."
   Their Schedule of Methods.—"The beds of the sick are changed
as requisite for cleanliness, and are remade every evening by  the
warders.
   "The beds with curtains number 370,  which are  changed in  the
summer for white linen curtains.   There  are 375 beds without cur-
tains.
   "Beds used by persons with  consumption  are burnt, with all
the sheets and other things belonging.
   "The sheets are changed according to the needs of the  sick, even
though it be several  times a day.
   "It contributes greatly to the dignity of the Infirmary and to the
cleanliness  of the sick, their being served with utensils of  silver.
The slaves are supplied with pewter utensils.
   "There is a house  for Incurable Women, under a woman Gov-
ernor.   There are four paid maid-servants who wait on the people,
make their beds,  and do everything necessary.
   "An experienced, elderly woman is retained for cases of scurvy."

   John Howard's  Criticism.—When John Howard visited
this hospital in 17891 he gave a rather poor account of its
   1 John Howard  began an investigation of  prisons and hospitals
about 1770.  He made seven tours on the continent, traveling 60,000
miles, and did much to make known the conditions existing in  these
institutions. 
28     OUTLINES  OF  NURSING  HISTORY
care of patients.  He says: "The wards are all  so dirty
and offensive as to create the necessity of perfuming them.
I observed that the  physician, in going  his rounds, was
obliged to keep his handkerchief to his face.

  "There were about 520 patients. They were served by the most
dirty, ragged, unfeeling, and inhuman persons I ever saw.  I once
found  eight or nine of them highly entertained with  a  delirious,
dying patient.
  "The governor told me that they had only thirty-two servants,
and that many were debtors or criminals.
  "At the same time I observed that nearly forty attendants were
kept to take care of about fifty horses in the Grand Master's stables.
  "In the hospital for women there were 230 patients.  A more offen-
sive and dirty woman's hospital I never visited."

  Degeneration  of  Religious Nursing.—From this and
other descriptions  it  appears that  in the early  days of
the nursing orders,  while their founders  were still  alive,
the proper spirit of service was maintained and the nurs-
ing was good.  After the founders died more and more use
was made of servants, until the real care of patients came
into the hands  of persons who were too  ignorant of any
of the amenities of life and too wretched  and overworked
to give  any  adequate care or to maintain even decent
cleanliness.
  Arab Hospitals.—The great Arab dynasties, embracing
all of northern Africa and  Spain, had hospitals which all
historians agree were  superior  to  those in  Christian
countries. Baas ascribes their excellence to the fact that
they were controlled  by physicians  rather than by monks
or warriors.
  The great hospital at  Cairo, Egypt, founded in  1283,
had chief physicians who held clinics for medical students.
It had its wards classified, employed both  men and women
nurses, had streams of running water in some of the wards, 
       EARLY  AND  MEDIEVAL   NURSING    29

 fever  wards cooled  by fountains,  and  other  comforts.
 Damascus and Alexandria  had well-equipped hospitals
 under expert physicians.  Bagdad employed sixty salaried
 physicians on  its  hospital staffs,  probably the earliest
 instance of the paid staff.   Cordova, in Spain, had  forty
 government hospitals.
   The oldest hospitals still  in  existence are  the  Hotel
 Dieu of Lyons (France), founded by  Clovis in 542, and
 the  Hotel Dieu of Paris,  founded  by Bishop  Landry in
 650.   They were  almshouses,  orphanages, refuges for
 travelers, etc.,  as well as being hospitals.
   The nurses  in  these hospitals were  religious women
 who devoted their lives to charity,  but were not at first
 nuns,  in that they took no vows and did not wear a dis-
 tinctive dress.   Those  in  the Hotel Dieu at  Lyons are
 referred to as  "bedroom  servants,  penitents,  repentant
 maidens," etc., and were  often recruited from among
 women who had led a vicious life and  wished to reform.
   Conditions in  the Great Church Hospitals.—In the
 Hotel  Dieu at Lyons  one  nurse cared  for from  ten to
 twenty patients, and at night there  was but one nurse to
 one  hundred patients.   It was  here  that five patients
 occupied one bed.
   The first floor of the Hotel Dieu at Paris was originally
 a candle factory and later a public slaughter-house.   It is
 said that the ward windows were nine feet above the floor
 and  were seldom opened.1  There was no separation of
 medical and surgical cases, nor  of  contagious and  non-
 contagious.
  The beds were of wood,  painted black, and had heavy
 serge curtains and canopies.  Two and four patients occu-
pied one bed, in some cases being placed two with their
heads at one end and two at the other.  We are told of a
  1 "A Century of Nursing," published in 1872, author unknown. 
30    OUTLINES  OF  NURSING  HISTORY
crowded period when eight patients were assigned to one
bed, four occupying it in six-hour turns, the other four
lying upon  the  floor meantime.1   The day nurses went
off duty at ten in the  evening, and there was practically
no night  nursing.  If a  patient  died  in the night, his
corpse remained where it was, usually in bed with a living
patient  or upon the floor.   Such conditions could hardly
fail to brutalize the nurses, and the work  must have been
very hopeless of results.
  The Hotel Dieu of Paris was staffed by  the Augustinian
Sisters,  the oldest purely nursing order.  They served this
institution for twelve  hundred years.  The sisters were
entirely subordinate to the clergy, who constantly inter-
fered with the details of their work.  The priests counter-
manded the doctors' orders at their discretion, had ideas
of their own in regard to treatment, insisted that patients
fast for the good of their souls, limited the sisters' work in
accordance with their  own ideas  of propriety, and some-
times sent them to prayers to the neglect of their  patients.
The sisters were never permitted  to help with gynecologic
examinations, to give vaginal douches, to care for venereal
cases, to  give enemata to men, to witness childbirth  or
care for obstetric  cases, nor even to diaper boy babies.
It followed  that all these things  had to  be done by ig-
norant  and uninstructed  servants.  The doctors always
protested vigorously, but  in vain.  Many of these condi-
tions have existed almost to the  present  day.
  The Sisters' Devotion.—A  just tribute has been  paid
to the work of these sisters: "There is something thrilling
and pathetic in the thought of twelve unbroken centuries
of nursing by the Augustinian Sisters in this one  hospital,
and  of  their successive generations,  toiling in complete
self-abnegation and renunciation even  through their old
      1 Dr. Christian Goler, in his work on "Deaconesses." 
EARLY  AND  MEDIEVAL  NURSING    31
age.   From the thirteenth century their lot seems to have
been made needlessly bare and hard.  Not only was their
work cruelly heavy, but they were denied that light of
knowledge which  brightens  the severest toil. .  . . For
them a professional  instruction  did not exist.  Only a
routine handed  down from  one to another approached
anything  that could  be called teaching.  What wonder
that they were left behind and that a changed civilization
found them unable to adapt themselves to it?" 1
  Civil Hospitals.—There were few large hospitals of any
sort  before 1100.  After that time trade increased,  cities
grew,  and, though the church  hospitals made  ampler
provision,  their accommodations were  insufficient,  and
the municipalities were compelled to undertake the  care
of the  sick.  City  hospitals were  built which  shortly
rivalled the  church hospitals in the size and  beauty of
their buildings.
  These municipal hospitals were usually in charge  of a
man who was not a physician, and who knew  nothing of
nursing.  There was  no superintendent of nurses and the
results can be imagined.  The religious motive was lack-
ing in the lay persons who undertook  nursing in these
city  hospitals,  the disagreeable  features  of  the  work
assumed  prominence, and  nursing  came to be  classed
with menial work.   A certain amount of teaching in the
traditional procedures of the care of the sick was inevitable,
but it must have been little more than one nurse instruct-
ing another.
  In  few  hospitals  was there  any provision for people of
means, and most of the patients were serfs or slaves,  who
were not used to rights and did not expect consideration.
  The work of the doctors was fantastic, weird, and often
brutal.   In surgical work hot irons were used  to  control
        1 "History of Nursing," by Nutting  and Dock. 
32     OUTLINES  OF  NURSING   HISTORY
hemorrhage, or the part was dipped into boiling oil.  Hot
oil was commonly used as a dressing for wounds.1   Anes-
thetics  did not exist, and operations were done  with the
patients held  upon  the  table by  strong men.  For the
convenience  of the doctors  several patients were in the
operating-room at one time, where they saw  and  heard
what happened to their  companions.
  For medical  cases  care rather than cure was  the rule.
Illness was thought to be sent of God for punishment or
                                                f, DRftlMfl&e TUOE'
Dilator u3ed <h          OfreRiEs        incision knife         (
 1CM0V1P1C flR(?OWHf"D5
 Fig. 2.—Surgical instruments used by Ambroise Pare, the famous
                     surgeon, 1510-1590.


 discipline, and was to be endured as best it might.  Chronic
 cases were very terrible because of the inadequate  care.
 Bed-sores were  common  and  horrible.  Any infection in

   1 Infected wounds were the invariable rule.  "There came such a
 stench  from wounds that the bystanders could scarce  endure it.
 Nor was this from lack of care, for the wounds of princes stank as ill
 as those of the  common people.  If any chanced to be left without
 dressing for one day, next day the wound would be full of worms
 [supposed to be bred spontaneously]."—Paget's "Life of Ambroise
 PareV'
 
EARLY  AND   MEDIEVAL  NURSING    33
a hospital spread like wildfire, and in the end every hos-
pital  became  a veritable  pest-house.  The horror  of
hospitals, which has existed  up to our own  day, doubt-
less had  its  origin in the middle ages.
  Private Nursing.—Persons who had comfortable homes
did not think of going to  a  hospital.   They were  cared
for in illness  by members of their own families or by
their  servants, maids or valets, or those accustomed  to
look after children.   Often the children's nurses remained
with the family and became sick nurses for their charges
in their mature years.
  Care of the Insane.—There were insane wards in some
hospitals; also separate asylums.  Cure of insanity was
thought to be impossible, and asylums were provided for
the protection and comfort of the community rather than
for the welfare of the patients.   The asylums were prac-
tically prisons.  Our own system,  especially  the practice
of having the insane committed to  an asylum at the word
of a judge or court rather than of a doctor, is a survival of
medieval methods.
  Insane persons, even those of refinement, were treated
much  as animals, were  often half-starved, and  were
rarely kept in any but a filthy condition.   Iron manacles
and chains  were used for  restraint.  There  was a time
When  it was seriously taught that fright and tortures were
useful in driving out madness.
  The first person to take real care of insane  persons was
Mile,  de Gras of the order of St. Vincent de Paul.   Her
work, conducted with kindness and humanity, was a reve-
lation to all who saw it. The Roman Catholic sisterhoods
always took better care of the  insane  than  did anyone
else.
  The Sisters of Charity.—Soon  after the year  1600
Vincent de Paul, a man deeply religious and eminently
       3 
34    OUTLINES  OF  NURSING  HISTORY
sensible, established a lay  organization  that  might  be
considered the forerunner of the modern Charity Organiza-
tion.   Its  members were  mostly women, and  its work
was a systematic endeavor along all lines of benevolence.1
  Mile, de Gras and Mme.  de Gossault were two of the
most  capable  women  who assisted Vincent  de  Paul.
Under his  supervision they  trained young women for  all
sorts of charitable  work, including nursing.
  In 1633 the work was organized as a definite order, with
a central home in Paris,  and was called the  Sisters of
Charity.   In 1639  they were asked to  undertake  the
nursing of several  hospitals, and Mile, de Gras trained
them for this work.
  St. Vincent allowed the  sisters to take  vows,  but only
for a year at a time, so that one might  drop out of  the
order  without  criticism.  He  wished  them to  retain
their secular dress.
  Within twenty years' time  the order  had nearly one
hundred mother-houses, and  the sisters  were  in  great
demand  for  both hospital  and  private nursing.  Later,
during the Reign of Terror, the government of France
recognized them when  all  other religious orders were
suppressed.
  Their fame reached its height early in the nineteenth
century.   The  order was established in America in 1808
at Emmetsburg, Md.,  by Mrs. Eliza Seton.
  Medieval Nursing Appliances.—There  was very little
special apparatus, either in homes or in hospitals, for  use
in the care of the sick.  Articles used by well persons were
adapted as best they could be to the purposes of illness.

  1 St. Vincent tried to suppress beggars, with whom all Europe was
overrun.  He established  municipal lodging houses, town work-
shops and trade schools, farm colonies, etc.  He was always greatly
interested in the care of the sick. 
EARLY  ENGLISH  HOSPITALS       35
 Enema bulbs and tubes, catheters, and  dressing basins
 were about all that was available.
   Beds were of straw, and it was customary to remove the
 patient when they were made.   Well-to-do families had
 two or three beds for the sick person, so that he might be
 changed from one  to another.   Draw-sheets were  of
 leather,  as rubber  goods were unknown.  Stone  jugs
 were used for  bed-warmers.   Invalid rings were in use for
 the many cases of bed-sore, but were of leather and stuffed
 with hair, moss, or feathers.  After a time oiled cloth was
 invented and  was used for draw-sheets.
   Bed curtains, usually of woolen or  some material not
 washable,  were  in common  use  as a  protection against
 flies and for privacy.   Bed screens were invented in 1777,
 but  were clumsy and not much  used.  Wards were at
 first heated by means of fireplaces and later by stoves,
 but  the rooms were so large and high that either was
 decidedly inadequate.

      EARLY  ENGLISH HOSPITALS AND NURSING

   The first hospital  in England was doubtless that at
 York, built by Athelstane  about 936.   It  was also a
 poor-house and had a department for lepers.   It boasted
 eight nursing sisters.
   Lafranc, Bishop of Canterbury, built a hospital in that
 city about 1700.
   St. Giles' Hospital was built in 1101 by Queen Matilda.
 She also built St. Katherine's Hospital in 1148.  Women
 of noble birth did nursing in these hospitals and  district
 work in the homes of the poor.
   St. Bartholomew's Hospital,  whose  organization has
 been  continuous to the present  time,  was built in  1123
by Rahere, formerly the king's jester, but then an Augus- 
36    OUTLINES  OF  NURSING  HISTORY
tinian monk.  It was the first building in England really
worthy of the name hospital, but it was at first a poor-
house and  orphanage as  well.   It was nursed  by eight
monks and four nuns.
  In almost every town there were hospitals in connection
with the  church, where the sick were cared for by monks
and nuns.
  In England and on the Continent there were hundreds
of so-called leper hospitals.  Under the term "leprosy"
were doubtless included lupus and other forms of tuber-
culosis and syphilis.
  Early English Nursing.—There were almost no doctors
in those  times, and none at  all  outside the important
cities.  The  monks  and  nuns,  self-taught, became  the
prescribers for the  community,  while  noblewomen,  who
had  great  retinues of servants  and dependents to  look
after, also  developed skill in  the art  of healing.  Edu-
cated persons, both men and women, were taught a little
"physic" and surgery as part of their schooling.
  It is doubtless a survival of these old-time ways that
causes so many of the laity at the present time to feel that
a nurse should know what is "good for" certain ailments.
The artificial division between doctors'  and nurses' work
has rarely been recognized by the people at large.
  Rise of Municipal Hospitals.—After the Reformation
(1517) monasteries were  everywhere suppressed, and the
Church hospitals were  taken over by the  cities.  The
nursing went into the hands of  the servant class, whose
best work was very poor.   A good deal of what we regard
as nursing  was done by the doctors, and wherever there
was  a medical school the students did hospital nursing.1
The personal services of bathing,  attending  to  excreta,
etc., were considered servants' work, pure and simple.
          1A similar condition exists today in Spain. 
EARLY  ENGLISH  HOSPITALS        37
  An old record specifies the nurse's duties:

  "She must stupe as often and in such a manner as the doctors shall
direct, and shall attend to the workings of all vomits.
  "She is to make all the beds on one side of the ward, and to scour
and make clean the beds and floors of the whole ward, the passages,
stairs, etc.
  "She must keep clean scoured the cans for beer, and the dishes
fouled at dinner.
  "She must attend the butler at the ringing of the beer bell and
of the bread bell,  . . .  and  at the ringing  of the cook's bell must
receive from her the exact amount of provisions appointed for each
patient.
  "She may take  to help her such patients as the sister [head nurse]
shall see fit."

  These  rules  show plainly that  the so-called "nurse"
was little more than a ward maid.  There could not have
been much real nursing under such a regime.
  The  dark  period of  nursing, so-called,  began about
1675,  and  continued until  recent times.  There  was  "a
complete and  lasting stagnation,  and it was  forgotten
that a refined woman could be a nurse, except perhaps in
her own family.   Nursing  in  any real sense of the term
practically ceased to  exist.  Solely  among the religious
orders did nursing remain an interest and some  remnants
of technic survive."1
  Nurses were  so ill-fed, overworked, and ill-treated that
no  one would undertake the work who could get anything
else to do.  The average nurse was  lacking  both in skill
and morals.  Some of the hospital rules set forth  in 1789
suggest  the state of affairs:

  "No dirt, rags,  or bones shall be thrown from the windows.
  "Nurses are to punctually shift the bed and  body linen of  the
patients,  viz., their sheets once in  a fortnight, their shirts once in
         1 "History of  Nursing," by Nutting and Dock. 
38     OUTLINES  OF   NURSING  HISTORY
four  days, their drawers and  stockings once a week or oftener  if
found necessary.
  "All nurses who disobey orders, get drunk, neglect their patients,
quarrel or fight with other nurses, or quarrel with men, shall be im-
mediately discharged."
Fig. 3.—"Mrs. Gamp propoges a toast."   (From Dickens' Martin
                         Chuzzlewit.)
  Scarcity of Protest.—It was in  protest against these
conditions that  Dickens portrayed the character of Sairy 
SUMMARY  OF  IMPORTANT  POINTS   39
Gamp,  with her selfish,  easy-going indifference to the
patient's comfort.  While not all the nurses of the day
were like her, she was typical of a large class.
  One wonders why people put up with such service.   One
finds the answer in certain conditions of our own time which
are equally irrational and inexplicable.   Our own  calm
acceptance of  political graft in public institutions, of the
social evil, of  imprisonment without labor, and of other
practices which  are as  stupid as they are wrong,  show
how slightly removed we ourselves are  from the Dark
Ages.
  If we read history with a candid mind and  open our
eyes to things about us, we shall be roused to join that
small but  glorious  army  of  those  who  have laid  aside
personal considerations  and have worked for the world's
betterment, bringing about  greater physical   comfort,
moral cleanliness, and spiritual emancipation.

          SUMMARY OF  IMPORTANT POINTS

  The early Christian nurses  were  the deaconesses, who
combined nursing with  other good  works.  Beginning in
apostolic times,  there were many large hospitals nursed
by deaconesses.
  Phebe and other deaconesses did district nursing among
the poor.
  Paula, a noble Roman lady, was one of the first who gave
training in nursing.
  In the early days of  France and  Germany there were
many educated women who developed great skill in both
medicine and nursing.
  Volunteer hospital nursing  began in early times, the
piety of the volunteer  being  considered  more  than the
comfort of the patient. 
40    OUTLINES  OF  NURSING  HISTORY
  From about the year 700 on  the deaconesses were re-
placed by nursing sisterhoods  and brotherhoods,  com-
posed  of  persons who lived isolated  from  the  world.
Nearly all philanthropic work was done by the religious
orders, and they furnished  almost the only  outlet  for
humanitarian impulses.
  The Hotels Dieu of Lyons and Paris, and other hospitals
founded as far back as the sixth  and seventh centuries,
still exist.
  Religious pilgrimages,  and  especially the  Crusades,
created a necessity for many large hospitals.  Some of
these hospitals were richly endowed and had magnificent
buildings.  Nobles held office in them, but much of the
nursing was done by low-class servants.
  Some of the nursing orders of the time of the Crusades
remain in one form or  another at the present time.
  The Arabs had fine,  well-managed hospitals in northern
Africa, western Asia, and Spain.
  As cities grew, the hospitals belonging to the religious
orders were insufficient and the municipalities took up the
work of  caring for the sick  poor.   Nursing in the civil
hospitals was done by the servant  class and was poor in
quality.
  The interference of  the clergy  caused nursing  in the
religious orders to deteriorate.
  Medical and surgical practice was rude and often brutal,
equipment was crude  and scanty,  and hospitals became
places  of horror.   A dread of hospitals  developed which
has survived almost to the present.
  The insane  were treated with  great inhumanity be-
cause of ignorance of better methods.
  The Hotel Dieu of Paris was nursed for twelve hun-
dred years by  the Augustinian nuns.   The sisters were
kind, but their work was unskilled. 
SUMMARY  OF  IMPORTANT  POINTS   41
  St.  Vincent de Paul founded in 1633 the order of  the
Sisters of Charity and improved the work of nursing.
  Early English hospitals were good, but deteriorated as
they became secularized.
  The dark period  of nursing extended from about 1675
up to the middle of the nineteenth century.  As a protest
against the existing conditions Dickens depicted the char-
acter  of Sairy Gamp. 
CHAPTER  III
THE DEACONESS MOVEMENT AND ITS CONTEM-
                     PORARIES

  In  apostolic  times there were,  as we  have learned,
deaconesses who looked after the sick  and poor.  They
were, in effect, a branch of the clergy, since they took part
in the services of the church.  They  flourished for three
hundred years.
  Decline of  the Apostolic  Deaconesses.—In the fourth
century the  order began  to decline.  Monastic orders
became popular, and the  custom  was  established that
led women who were interested in  good  works to cut
themselves off  from  the  world  by  vows.  Deaconess
nurses were, therefore, no longer heard of, and during the
Middle Ages  monks and nuns were the only people who
professionally nursed the sick.
  Attempts to Revive  the  Order.—At the time of the
Reformation  Luther  thought  seriously of  reviving the
office  of  deaconess, but felt that it  was  impracticable.
Other churchmen found the  same need of giving to women
who had the  time and inclination a  chance to put their
philanthropic instincts to use in the world.   Soon after
1520 small deaconess bodies were heard of;  late in that
century  there was a well-known  Protestant  lay  body
called the Maidens of Mercy, whose work was among the
sick and  poor.
   During the great wars of the eighteenth  century many
women's societies were organized, primarily for the care
of  the wounded; after the  wars their work included the
care of disabled  soldiers, widows, and orphans.
       42 
THE  DEACONESS   MOVEMENT       43
  Count Adelbert, von  Stein, Pastor  Kloenne,  Amelia
Sveiveking, and others attempted to establish Protestant
sisterhoods, but most of them failed sooner or later.
  In England.—Some of  the more advanced doctors  of
England felt the need of help from women of a better class
than most of the  nurses were.  About 1825 Dr. Robert
Gooch  tried to  induce either  the Methodists  or the
Quakers to "establish an order of women, selected for their
good sense, industry, kindliness and piety.  Let them be
placed as pupil nurses in  the hospitals of  Edinburgh and
London.  Let  them be examined  frequently as to what
they have learned.  Let books be  framed for them, brief
and untechnical.   Let the women thus educated be placed
two together in a cottage in some country district, and
villagers would soon have reason  to bless the hour that
they came."
  Here we find the germ idea of the training-school con-
nected  with a  hospital, of nursing text-books, of nurses'
examinations, and of district and rural nursing.
  Other prominent persons tried to set going similar plans.
Elizabeth Fry, who had  given such conspicuous service
in prison reform, was interested.  Her sister and daughter,
urged by Dr. Gooch and by Robert Southey the poet, suc-
ceeded, in 1840, in establishing an  organization called the
"Protestant Sisters  of  Charity," which name was later
changed to  "Protestant Nursing Sisters."  The training
which they had at Guy's Hospital, London, was what we
should call hospital visiting; they lived outside and went
to the hospital for only a few hours a day to work under
the doctors and untrained  ward nurses.   They seem  to
have had no classes nor theoretic work.   They were pre-
pared to be attendants in private homes.  The order is
still in existence.
  In  1845 Miss  Sellon formed  the order of Protestant 
44    OUTLINES  OF   NURSING  HISTORY

Sisters of Mercy.   They  did  some nursing among  the
poor.
  The first purely nursing order of the English Church was
founded  in  1848 at St. John's House,  London, under
Bishop  Bloomfield.  The nurses  were  required  to  be
members of the church, and were supervised by a clergy-
man, but had, in addition, a lady superintendent.   They
were sent to hospitals for training,  but lived at St. John's
House.   They  had  religious  instruction  and frequent
prayer services, but nursed  only a few hours a day.  In
1856  the order  was reorganized,  and the probationers
spent an entire  year in the hospital.   Six nurses from
St.  John's House went to the  Crimea with Florence
Nightingale.
  All these orders may be  considered  as the immediate
forerunners of the modern training-school  for nurses.
  The Founding of Modern Deaconess Work.—Theodor
Fliedner, the young pastor of  a  small parish at Kaisers-
werth on the Rhine, in  1822  went on a trip to England to
beg money for his church work.  He was  much impressed
with the philanthropy  which he saw in the countries he
visited; with  the prison work,  hospitals,  etc.   "When he
came back from this trip  Fleidner  brought  with him a
larger knowledge of the art of caring for the helpless than
any  other person  living  possessed."1   He  had  found
deaconesses at work in Holland, and took much to heart
the idea that this  order  should be revived.   He  knew
that the work could not be  undertaken without the help
of a woman.
  Soon after Fliedner married Frederike Munster, a re-
markable woman.   In her early years she had founded
an institution for the  care of children  and had  shown
initiative and organizing ability.
     1 Dr. Alfred Worcester, in "Nurses for Our Neighbors." 
THE  DEACONESS  MOVEMENT       45
  The First Modern Deaconess Hospital.—Fliedner well
knew how poor the nursing was in even the best hospitals
of the time.  Frederike was as interested as he in the plan
Fig. 4.—Gertrude Reichardt.  The first deaconess nurse trained at
   Kaiserswerth.  (From "Bilder aus dem Diakonissen-Leben.")

of reviving the deaconess order and of training its members
in nursing.   They fitted up a building for a hospital and
deaconess home.
   On October 16, 1836, the  first patient, a servant  girl, 
46    OUTLINES  OF   NURSING  HISTORY
was admitted to the hospital.  The first nurse deaconess
was Gertrude Reichardt, a woman of forty-eight, daughter
of a doctor, who had helped her father with  his private
practice  and in the  war.  Six  other women  came that
first year to be deaconesses.
  Fig. 5.—Friederike Fliedner  (nee Munster).   Superintendent
of  the Kaiserswerth Mother-house 1836-1842.  (From  "Jahrbuch
fur Christliche Unterhaltung," 1894.)

  The Kaiserswerth Training.—Nursing was the deacon-
esses' chief work, but they  also cared for prisoners and
orphans.  They had a good deal of Bible study,  and took
their turn in kitchen, laundry, and garden.
  Frau Fliedner was practically the superintendent, and
Fliedner himself always gave her  the credit of the sue- 
THE  DEACONESS  MOVEMENT       47
cess of the work.   In her journal she wrote out notes on
nurses'  training,  which  have  become the  standard  of
Kaiserswerth work to this day.  Her journal  is, in effect,
the first  work  on  nurses'  training  ever written  by a
woman.
  Fig. 6.—Caroline Fliedner  (nee Bertheau).   Superintendent of
the  Kaiserswerth Mother-house 1843-1892.  (From "Jahrbuch fiir
Christliche Unterhaltung," 1894.)

  The little institution was so excellent that it soon  be-
came well known, and many visitors came to it to study
methods.  Elizabeth Fry  was there in 1840. 
48    OUTLINES  OF  NURSING  HISTORY
  After six years of overwork, in 1842, Frederike died.
A little later Fliedner met Caroline Bertheau, who  was in
charge of the  nursing in the General Hospital at Ham-
burg, and married  her.  She  took charge of his  estab-
lishment, and remained at the head of the work for nearly
forty years, up to about 1884.l
  Growth of the W or k— Ten years after the founding of the
mother-house at Kaiserswerth there were over one hundred
deaconesses in it, and the work had been begun at several
other stations.  When Fliedner died, in 1864, at the end
of twenty-eight years  of  work,  there were thirty-two
deaconess houses, and sixteen hundred deaconesses were
at work in four hundred fields.
  In 1846 Fliedner went to London with four  deaconesses,
and  started them at work in the German Hospital.
  In 1850 Pastor Passavant of Pittsburgh, U. S., asked
for deaconesses  to start the work in America.  Fliedner
selected a number and  he himself went out  with them.
  Florence Nightingale at Kaiserswerth.—In 1850 Florence
Nightingale visited  Kaiserswerth for two weeks,  and in
1851 she came for four months' training.  She was very
happy there,  though she found somewhat  to  criticise.
She  knew that it was the best nurse's training that was to
be had, but it was far from her ideals.
  Plan of the Deaconess Order.—According to  the orig-
inal  plan, in  Germany still adhered  to, deaconesses take
no vows, receive no salary, and are taken care of for life.
In America these customs have been modified.
  The work is chiefly among the poor.   Deaconesses may
work in almshouses, have charge of  orphanages, teach
children,  work among prisoners  or  unfortunate women,
or do private nursing.  They have helped in many epi-
demics and in many wars.
         1 She had eight children.  Frederike had seven. 
THE  DEACONESS  MOVEMENT       49
  The order  is distinctly  a religious one  and under the
control of the clergy.   This power of the pastors has some-
times  interfered  with  the work  of  nursing, and some
branches have  seemed inclined to sacrifice efficiency to
religious zeal, and to  interfere with the nurse's personal
relations or  her  mental development.  Sister  Gabriele,
a  very  spirited German  deaconess, left  the  order be-
cause  of its  restrictions, and  stirred up a great deal of
comment.
  The "Free  Sisters" of Germany began  in  the latter
part of  the  nineteenth  century to protest  against these
methods of  repression and subordination.  They finally
organized and  have done much  for the  deaconesses of
Germany.   (See Chapter XV.)  Fliedner himself appears
to have been always  sensible and practical and to have
used his authority wisely.1
  What  We Owe to  Kaiserswerth.—Modern  training-
schools for nurses have inherited much from the deaconess
organizations and especially from  Frau Fliedner's regime.
"The  probationary  system, letters from  clergyman  and

  1 Some of Fliedner's Rules for Self-examination of the deaconesses
were:
  Do I take care  that the ward is aired and arranged at the proper
time?
  Have I listened attentively to the direction of the physician, and
observed punctually his orders as to medicine, diet, etc., [only verbal
orders were in use,] using no remedies not prescribed or sanctioned
by him?
  Am I careful to inform him of the patient's state, and of the par-
ticular  effects of medicine administered?
  Do I see that the patients' clothes, diet, etc., are sufficient and of
the right kind, and have 1 attended to their bodily wants kindly and
faithfully?
  Have I been prudent  and  careful in using the provisions and
appliances of the  hospital?
  Have I been obliging, cheerful, patient, and watchful?
       4 
Fig. 7.—Kaiserswerth twenty-five years ago. 
CONTEMPORARY   NURSES'  TRAINING  51
doctor as to character  and health,  allowance of pocket
money, grading  of  nurses from probationer  to  head
nurse,  superintendent at  the  head,  class work  and lec-
tures, the principles of discipline, etiquette, and ethics."1
  The deaconess hospitals took the  view,  at that time
rather unusual, that a nurse must follow out the doctor's
orders exactly, and that he and not  she was responsible
for  the  outcome.  They did  not  admit  "lady proba-
tioners," as did the  English hospitals,  but insisted that
all nurses be on the same social level. They required that
nurses sent out to private duty be treated as members of
the family, not as servants; and they saw to it that they
were allowed proper time for  rest.

    NURSES' TRAINING CONTEMPORARY WITH THE
               DEACONESS MOVEMENT

  Germany.—Schools  for  training  nurses  were  estab-
lished from  about 1830 on, but we  have little  record of
their work, and it seems to have been largely swept away
by  the deaconess work.  These  schools were  organized
and controlled by doctors, who also gave the nurses  in
them   their  teaching.   Diffenbach,  Gedike, and  Kluge
founded  schools in Berlin; Ruhstadt, one  in Gottingen.
These  men  wrote books  for  the  instruction of nurses;
Gedike a particularly good one.
  We honor these men both for their humanitarian inter-
est  in the welfare  of the patient and  for their realization
of what nurses needed.  Their work  constitutes a part  of
the foundation upon which is built the trained nursing  of
today.  That  the  value  of  their work is not now more
apparent is due not to any flaw in its quality, but to the
fact that  no work for nurses  could  have any great  and
        1 "History of Nursing," by Nutting and Dock. 
52    OUTLINES  OF   NURSING  HISTORY
lasting success  until it was  undertaken by nurses them-
selves.  Help from others is doubtless necessary  at  the
beginning of any enterprise, but not until those engaged
in it can stand on their own  feet does it make much head-
way.
  Russia  furnishes some  interesting  examples of nurse
training, chiefly in midwifery.  Up to about 1750 most
of the maternity work was  done by  German midwives.
In 1754 the Russian government established  a school for
midwives, where they were taught both the delivery and
after-care of patients; but it had no practical instruction,
merely lectures, and even those were given through an in-
terpreter, the professors being  German.
  A little later  the Empress Catherine  founded several
small hospitals  for women and children,  where midwives
did the nursing  and had some teaching; these hospitals
had a low death-rate, which proves that their work was
good.
  Soon  after 1800  Russia began to train women for  ob-
stetric work in  country districts,  the studies being not
only medical, but arithmetic, geography,  and  the Russian
and German languages.
  Switzerland.—Due  credit  has not  been given to the
school of La Source at Lausanne.  It was founded in 1859
by the Count and Countess  Gasparin for Protestant lay-
women.  The  nurses were  given  six  months' "private
instruction by a director"  and  nursed  under supervision
in the homes of the poor, the  plan being similar  to that
followed by the Waltham School in America (q. v.).  For
many years the school gave no hospital training, but since
1891 it has had a small hospital with a woman directress.
The training is individual and is unusual in character; the
pupils are selected  with  great care.  It  is said that
"better  nurses  have  never  been  sent forth from  any 
SUMMARY  OF  IMPORTANT  POINTS   53
school, and they have won distinction not only in private
service, but as heads of wards and operating-rooms  and
as matrons of large hospitals" (Worcester).

          SUMMARY OF  IMPORTANT POINTS

  After the fourth century the apostolic order of deacon-
esses began to decline,  and was replaced by those made
up of monks and nuns.
  With the  Reformation  many  persons, both lay  and
clergy, tried  to revive the order,  but without great suc-
cess.
  In  England several  Protestant  nursing  orders  were
founded that did nursing—the Protestant Sisters of Mercy
and  of Charity and the   Sisterhood of St. John.  The
latter is still at work.
  Theodor Fliedner founded at Kaiserswerth, Germany,
in 1836 the modern order of deaconesses.  His first wife,
Frederike,  may be considered as the pioneer worker in
nurses' training.   His second wife, Caroline, also carried
on the work  with  great ability.
  The deaconess movement grew rapidly and before Flied-
ner's death had spread to many countries of the world.  It
was distinctly a missionary movement, but revolutionized
hospital nursing.
  Florence Nightingale  took four  months' training at
Kaiserswerth and  drew from it much inspiration for her
work.
  The deaconess  nurses were, like the Roman Catholic
Sisters, very  religious, but were taught to follow the doc-
tor's orders in preference  to those of  the  clergy.   Any
lack of progress in deaconess  nursing is usually attributed
to increased control by the clergy.
  Training-schools for nurses  were established in Germany 
54    OUTLINES  OF   NURSING  HISTORY
by doctors as early as 1830, and are part of the foundation
of modern training-schools.
  In Russia  the  government undertook the training of
midwives about 1750, and has always given careful courses
in this branch.
  The school of  La  Source at Lausanne,  Switzerland,
founded in  1859,  is similar  to  the Waltham School in
America, and is very excellent. 
CHAPTER IV
 FLORENCE NIGHTINGALE AND HER WORK  IN
                    THE  CRIMEA

   The  general dissatisfaction with  the  nursing of that
 day, the abortive attempts of many good people to give
 training to nurses, and the success of the Deaconess Order
 all paved the way for the coming of a woman whose ability
 should be equal to the task before her.  Florence Nightin-
 gale can hardly be considered a product of her time, since
 she was far ahead of and beyond it, but she found the time
 ripe for her genius  as the  founder of modern  trained
 nursing.
   Her Early Years.—Her parents were well-to-do English
 people,  cultured, remarkable for  their  sincerity,  high
 ideals, and deep mentality.  Florence, the youngest of two
 daughters, was born in May, 1820, in Florence, Italy, and
 was named for that city.  When she was  five her parents
 returned to England.
   While she was still a little girl she  showed her kindness
 of heart and her wish to be helpful  by nursing sick ani-
 mals.  When she was in her teens  she visited among the
 sick poor of her neighborhood and did what she could for
 them.   Among her relatives she was ready and competent
 in illness.
  Her Wish to Be a Nurse.—Soon after  she was twenty
she asked her parents to permit her to go into  a hospital
and learn  to be a nurse, so that she might care for the
poor people of her own neighborhood. They knew some-
                                            55 
56    OUTLINES  OF  NURSING   HISTORY

thing of the dreadful conditions then existing in hospitals
—that the majority of nurses were of a low, rough class
and could not bring their minds to the thought of their
daughter doing such a thing.  She  would not go without
their consent, and the situation grieved her greatly.  She
believed that an earnest life must express itself in work for
humanity, and that "the service of man is the service of
God."  She longed for the chance to be helpful in a large
way.
  Her Family's Continued Opposition.—By the time she
was twenty-four she  had definitely  decided that she ought
to undertake the work of nursing.  Her family still did not
sympathize with her thought of service to the world, but
tried  to make her see that her place was at  home in the
ordinary rounds of woman's life.  For years they tried,
by travel and social life, to distract her from her purpose.
She had long trips on  the  Continent,  studied  music in
Italy, played, and sang.  She met many prominent persons
and  many brilliant  ones.   She was introduced in  Paris
society by the famous Madame Recamier.  For years she
tried  to interest herself in these things and to bring herself
to the viewpoint of her parents; but she never succeeded in
getting away from what she felt was a call  from Heaven.
  Her Personality.—She was a student of deep  and diffi-
cult  subjects.   It is  reported that Sir Henry de la Beche
said  of her, "A  capital young  lady that, if she hadn't
floored me with her Latin and Greek."  While not actually
beautiful, she was attractive.1   Julia  Ward Howe said
of her,  "She was elegant rather than  beautiful, tall and
graceful of figure, her face mobile and  expressive."  Mr.
Osborne describes her as follows:  "She is just what you
would expect  of  any well-bred  woman of her age.  Her
manner and face are prepossessing.   Her face is not easily
        1 There are twenty portraits of her in existence. 
FLORENCE  NIGHTINGALE  IN  CRIMEA   57
forgotten, pleasing in its  smile, with an eye betokening
great self-possession, and giving a  quiet  look of deter-
mination.  Her general demeanor is rather reserved; still
Fig. 8.—Florence Nightingale  in  her  early years (about  1858).
              (From a photograph by Goodman.)

I think she has a lively sense of humor.   She speaks on
matters of business with a grave earnestness one would not
expect from her appearance.   She has a mind disciplined
to restrain under action every  feeling  which would  inter- 
58    OUTLINES  OF  NURSING  HISTORY
fere.  She  has trained herself to command, and learned
the value of conciliation and self-restraint.  I fancy she
is a strict disciplinarian."
  Her Plan.—In her trips on the Continent she had vis-
ited and studied  hospitals  in France, Germany,  Belgium,
and Italy.   She had also seen those of Great Britain.
  She had in mind to establish a sort of Protestant Sister-
hood, not unlike  the Deaconess Order, in which  educated
women  should devote their lives to the  relief of sickness.
She had heard of Kaiserswerth  and Fliedner's work, and
longed  to  go there for  training.   While  at  home  she
studied  medical  and sanitary matters   and  political
economy.  Her family still tried to divert her from these
ideas.
  Training  at Kaiserswerth.—In  1850, when  she  was
thirty  years old, she was able to stop at Kaiserswerth
for  a two  weeks' visit;  the opportunity gave her great
joy.   The next year she  was allowed to go there for four
months' training.  She  realized then for the first  time
her wish for practical instruction in nursing, though the
training which she  got  was  inferior  to that  which she
later developed in her own training classes.  While not
satisfied with it, she felt that it was the best to be had and
was very happy  there.1
  When she left Kaiserswerth she spent some time in the
hospitals of Paris, doing actual work with the Sisters of
Charity, seeing the work of brilliant French surgeons, and
learning much of value.
  Her Start in Her Career.—The following year,  when she
was thirty-two, she  persuaded her  family to let her take
her life into  her own  hands.   They  despaired  of her
  1 Fliedner told her frankly  that he feared  she would not like
the work; told her that the nurses scrubbed floors, etc.  She replied
"Just try me," and  did her share of the scrubbing. 
FLORENCE  NIGHTINGALE  IN   CRIMEA   59
marrying and felt  that further opposition to her wishes
was useless.  Her father made her an independent allow-
ance of about $2500 a year.  Afterward her people were
very proud of her, and her mother  acknowledged, "You
would have accomplished  nothing had you not resisted
me."
  It was this year that she wrote in her diary, "I had three
paths  among which to choose.  I  might  have  been a
literary woman, or  a married woman, or a hospital sister."
In a sense she became the  first, since all her life she wrote
much and well.   She might have chosen the second path,
as she had many admirers and some serious love-affairs.1
She felt, however,  that God had called her for a special
work, which could  not be done if she married.
  Her First Executive  Position.—In  August, 1853, she
took charge of the Establishment for Gentlewomen  During
Illness, in Cavendish Square, London.  She was eminently
successful in the position,  both doctors and others being
impressed  with  her ability.  With  great tact she man-
aged a situation at which  she was most impatient.   Her
Board was intolerant and  could not  see that the comfort
and welfare  of  patients was more important than petty
rulings;  but her  diplomatic  methods  achieved  results
without giving offence.2

  1 A young cousin fell in  love with her, but was refused.  A very
fine man, for whom she really cared, tried for some years to per-
suade  her to become  his wife.  It was evidently hard for her to
refuse, but she felt that she  had other work to do.  When she
started for the Crimea he wrote her, "I hear that you are going to
the East.  I am happy that it is so, . . . and hope you will find
satisfaction in the work.  You can undertake that, when you could
not undertake me.  God bless you, dear friend, wherever  you go."
  2 She wrote to her family with a keen sense of humor: "My Com-
mittee refused to  let  me take in Catholic patients, whereupon I
wished them 'Good morning.'  Now it is settled that we are to take 
60    OUTLINES  OF  NURSING   HISTORY
  Not long after, King's College Hospital approached her
and asked that she become their superintendent of nurses.
She was preparing to accept this offer and had begun to
plan work there when the call to the Crimea came.
  The Call to the Crimea.—Russia was at war with the
combined forces of England, France, and Turkey.  In the
fall of 1854 it became apparent that the medical system of
the British  Army was  utterly inefficient.   Division of
responsibility, official red tape, and lack of nurses made
the condition of the wounded  after a battle a national
disgrace.  The facts  became known and  public appeals
were made for help and supplies.
  Miss Nightingale read the appeals and they came to her
as a call from God.  This was  what she had been waiting
for so many years, a field worthy of her powers.   She
wrote to Sir Sidney Herbert, Secretary of War, whom she
knew personally, and offered her services.  She began at
once to arrange a plan for financing the sending of nurses
and supplies, using her own money and getting pledges
from friends.
  Meantime the Secretary  of War had settled upon Miss
Nightingale as  the  one who  should undertake the or-
ganization of a band of nurses to go to the Crimea and
care for the wounded.  He wrote her: "I  know of but
all denominations and allow them to be visited by their respective
priests, providing that I will meet the obnoxious animal at the door,
escort him upstairs, and bring him down again in a noose. To this
I have agreed.  Amen.  From Committees, Charity, and Schism,
from the Church of England and all other deadly sins, from philan-
thropy and all deceits of the devil, .  . . good Lord, deliver us.
  "I do all my business by intrigue, which I resolved I never would.
I wrote out a series of regulations, and presented them to the Com-
mittee, not telling them from whom they came.  They passed them.
I showed them to the medical men; they had them up in two meet-
ings and approved them, thinking they were their own." 
FLORENCE  NIGHTINGALE  IN  CRIMEA  61
 one person in England capable of carrying out such a thing,
 yourself.   Upon your decision will depend the success or
 failure  of the  plan.  Your own  personal qualities, your
 knowledge, your power of administration, your rank and
 position in  society give advantages which no other person
 possesses."   With rare insight he added,  "If  the  work
 succeeds, an enormous amount of good will be done now;
 and a  prejudice  will have been  broken through  which
 will multiply the good to all time."
   His letter passed Miss Nightingale's  in the mail, and
 both had their answer.
   Miss Nightingale Starts for the War.—Five days later
 Miss Nightingale had received her official recognition and
 instructions from the government.  Two days after, on
 October 21, 1854, she  set out for the Dardanelles with
 thirty-eight nurses.
   Her nurses were Roman Catholic and Anglican sisters,
 lay nurses from  St. John's House, and others.  Some of
 them were  not a success and returned  after a brief ser-
 vice.  She herself regarded only about  half of them as
 efficient,  More  nurses went  out later,  until the whole
 number was about one  hundred and twenty-five.
   Establishment of  the Nurses at Scutari.—The nurses
 arrived  in two  weeks'  time  at Scutari, just across the
 strait from  Constantinople.   Here, in one of the most
 beautiful situations in the world, were four large hospitals.
 The Barrack Hospital was given to Miss Nightingale and
 her  nurses.  It  was supposed to accommodate   1700
 patients, but at that time there were  between 3000 and
 4000.  There were four miles of beds, set 18  inches apart.
 Miss Nightingale was given charge of  1500 patients.
  The nurses' quarters were very small, dirty, and swarm-
ing with rats and vermin.  Five and six nurses roomed to-
gether, using the same room for their meals. 
62    OUTLINES  OF  NURSING   HISTORY
Hospital  Conditions—The wards, badly crowded, had
no proper ventilation, and were dirty and unsanitary be-
yond  description.  The  toilet  accommodations  and the 
FLORENCE   NIGHTINGALE  IN  CRIMEA  63
plumbing were as bad as could be.  The beds were mostly
of straw, and  many were  laid directly on the floor.  The
few sheets to be had were of canvas, and so rough that the
men begged  not  to  have them used.  Practically  no
laundry was being  done;1 there was no hospital clothing,
and  the  patients were  still in their  uniforms, stiff with
blood and  covered with filth.   There was no soap, nor
towels, nor basins, and very few utensils of any sort.
Every  place swarmed with vermin.2
  There  were no  knives nor forks, and  the men ate
with their fingers.  The food was  badly or half-cooked,
and  the  very   ill patients had   practically  nothing
which  they could  eat.   It took four hours to serve a
meal.
  There  was a great deal  of cholera and contagious fever.
Fully as many of the soldiers died of disease as of wounds.
The death-rate was 1$  -per cent,  of the cases treated,  an
appalling state of affairs.
  Cause  of the  Difficulties.—Miss  Nightingale had been
officially  assured that there were plenty of  supplies  on
hand.  She found that some of them  had been sent to the
wrong  ports or  were buried under munitions and could
not be got.  There were  eight distinct departments con-
cerned with military affairs,  little co-operation, and  an
amount of  official red tape that made it nearly impossible
to secure supplies which were in store.
  Only part  of  the  army officers  and  surgeons  were
friendly  to the idea of  introducing women nurses.  The
nursing had been done by untrained orderlies  and soldier-
servants  whom the doctors considered as good as  need be.

  1 An official report showed that six shirts had been washed during
the month.
  2 One of Miss Nightingale's first requisitions was for 200 scrubbing
brushes. 
64    OUTLINES  OF  NURSING  HISTORY

They felt that the women were  interfering and trouble-
some.
  Miss  Nightingale's Reforms.—"What was needed was
bold  initiative.  This Miss  Nightingale supplied.   She
boldly assumed responsibility, and did  herself the things
which she could find no one else to do.  She  applied an
expert's touch and a woman's insight.   She is popularly
thought of as a gentle nurse.  Those  who knew all the
facts  spoke of her  as a commanding genius."1
  When she could not get official help quickly, she used
her own funds.  She fitted up a laundry and employed
soldiers' wives to  do the washing.  She opened five diet
kitchens in different parts of the building, so that the
sickest  patients might  have proper nourishment.   She
reported the  condition of the buildings to the  authorities
at home, and repairs were quickly made.2
  She directed her nurses to work only with doctors who
wished their  services, and to  do  nothing for the patients
of other surgeons.   She knew that they must win  their
way  by patience  and  good work.  She insisted  upon
strict discipline among her nurses.
  Her nurses were far from being well trained, and made
her realize every day the  need of proper instruction for
them.  She writes of some of them, "They are excellent,
gentle women, more fit for heaven than for a hospital.
They flit about like angels without hands, and soothe souls
while they leave bodies dirty and neglected."
  She kept the less efficient nurses under her own eye,
putting  the better ones in places  of responsibility else-
where.  She speaks in keenest appreciation of those whom

  1 "Life of Florence Nightingale," by Sir Edward Cook.
  2 A  committee had been appointed to investigate the buildings.
Miss Nightingale had them repaired before the committee's report
was even in. 
FLORENCE  NIGHTINGALE  IN  CRIMEA  65
she regarded capable:  "Mrs. Roberts is worth her weight
in gold, .  .  . she is one of the most important persons in
our expedition.   Mrs. Shaw Stewart, .  . .  without her
our work would  have come to grief.  Mrs. Drake  is a
treasure.  Rev.  Mother Moore, ...  far above me in
fitness for the General Superintendency."
   Sir Edward Cook's "Life of Florence Nightingale," and
the "History of  Nursing,"  by Misses Nutting and Dock,
give excellent descriptions  in detail of her  work in the
Crimea.  Both books are fascinating reading.
   The Good Results.—In two  months Miss Nightingale
had transformed the hospital.   In six months  she  had
reduced the death-rate to  2 per cent, and had won over
most  of the surgeons.  Lord Raglan, the Commander-in-
chief, gave her his cordial support and spoke of her as an
auxiliary general.
   The Soldiers'  Love for Her.—With all her fearlessness
in the use  of authority and all her  attacks upon  bad
administration, she was  still the womanly,  gentle  nurse.
Two famous quotations describe this aspect of her work.
   One of the soldiers wrote home: "What a comfort it was
to see her pass!  She would speak to one and nod  and
smile to many more.   She could not do it to all, you know,
for we lay  there  by hundreds, but  we could kiss her
shadow as it fell and lay our heads on the  pillow again
content.   Before she came there  was such cursing  and
swearing, but after that it  was as holy as a church."
   MacDonald, war correspondent  of the London Times,
said:  "When all  the medical officers  have retired for the
night and silence and darkness  have settled down upon
those miles of prostrate sick, she may be observed with a
little  lamp in her hand making  her solitary  rounds.   As
her slender form  glides through the corridor, every poor
fellow's face softens with gratitude at the sight of her'"
       5 
66    OUTLINES  OF  NURSING  HISTORY
  Fig. 10.—The Lady of the Lamp.  Derby memorial to Florence
Nightingale.  Erected in  the Grounds  of the Royal Infirmary,
Derby, England.
  The  Lady of the Lamp.—Longfellow's poem,  "Santa
Filomena," made her famous as "The Lady of the Lamp." 
FLORENCE   NIGHTINGALE   IN   CRIMEA   67
      SANTA  FILOMENA

Whene'er a noble deed is wrought,
Whene'er is spoken a noble thought,
  Our hearts, in glad surprise,
  To higher levels rise.

Honor to those  whose words and deeds
Thus help us in our daily needs,
  And by their  overflow
  Raise us from what is low.

Thus thought I as by night I read
Of the great army of the dead,
  The trenches  cold and damp,
  The starved and frozen camp.

The wounded from the battle plain,
In dreary hospitals of pain,
  The cheerless corridors,
  The cold and stony floors.

Lo, in that house of misery,
A lady with a lamp I see
  Pass through the glimmering gloom,
  And flit from room to room.

And slow, as in a dream of bliss,
The speechless  sufferer turns to  kiss
  Her shadow as it falls
  Upon the darkening walls.

On England's annals, through the long
Hereafter of her speech and song,
  That light its rays shall cast
  From portals of the past.

A lady with a lamp shall stand,
In the great history of the land,
  A noble type  of good,
  Heroic womanhood. 
68    OUTLINES  OF   NURSING  HISTORY

  Her mother, to the end of her life, was fond of hearing
this poem, and at its close always said, "It is all true."
  Estimate of Her Character.—Sir Edward Cooke says:
"The popular impression of Miss Nightingale is that of a
girl of high degree who, moved by a wave of pity, forsook
the pleasures of  fashionable  life for  the  horrors of the
Crimean War; . . .  who retired after it into private life,
varying her seclusion only by good deeds to hospitals and
by sentimental pieties.
  "This  legend  is  remote  from  the truth.  The real
Florence Nightingale was greater.   Her life was built on
larger lines, her work had more importance.
  "Her earlier years show a girl of high  natural ability
feeling her way to an ideal.   She had already served her
apprenticeship when the call to the Crimea came.  It
was not a call to sacrifice, but to the  fulfilment of her
dearest wish  for a life of active usefulness.
  "A certain man who knew intimately some of the great-
est intellects of  the time said  of  Miss  Nightingale that
hers was the clearest brain he had ever known in man or
woman.
  "Her character was stronger, more spacious, and, I feel,
more lovable than that of the Lady of the  Lamp."
  Her Illness.—In the summer of  1855   the work was
lighter, and she  was able to make a tour of inspection of
the hospitals of Balaklava. She went over them carefully,
planning changes and improvements.   One evening she
complained of being tired, and  it was found that she had
contracted Crimean fever.
  She  was desperately ill, and  came very close to death.
The soldiers  wept when  they heard of her  illness, and all
England waited the outcome in anxious suspense.   In a
few weeks she was better, and,  refusing to take more rest,
went back to Scutari. 
SUMMARY  OF  IMPORTANT  POINTS   69
  Close of the War.—Early in 1856 peace was concluded,
and the nurses' work became lighter.  The hospitals were
closed one by one, and the nurses went back to England.
Miss Nightingale left  last of all, returning in July, 1856.

          SUMMARY  OF  IMPORTANT POINTS

  Florence Nightingale  may be considered the  founder
of modern nursing.   She was born in 1820, in Florence,
Italy.
  She was unusually well educated, well bred, well-to-do,
had an  excellent social position, and  was attractive.
  She was deeply religious and had a passion for helpful-
ness.
  Her family opposed her idea of a life of work for others.
  She had a choice of three careers—literature, marriage,
and nursing.  She chose  the latter.
  She studied hospitals  and observed nursing in several
countries.
  She was finally permitted to take the deaconess training
at Kaiserswerth, which was a great satisfaction to her.
  She  became superintendent of a  private hospital in
London in 1853, and was shortly afterward offered the
position of  superintendent of  nurses  at King's College
Hospital.   She  was   considering this  when the  call to
the Crimea came.
  The  failure  of the  government medical service in the
Crimean War became  a call for a person of unusual ability
and character to handle the situation.   Sir Sidney Her-
bert, Secretary of War, chose Miss Nightingale almost at
the same moment that she decided to offer herself for the
work.
  She went to the Crimea in October, 1854, with thirty-
eight nurses, Catholic and Protestant. 
70    OUTLINES   OF  NURSING  HISTORY
  She  found thousands  of  sick  and  wounded soldiers
suffering from lack of nursing and supplies, with dirt and
chaos rampant.
  With remarkable initiative and insight  she  succeeded,
in a short time, in reducing the hospital  work to order,
getting supplies, establishing sanitation, and reducing the
death-rate from 42 to 2 per cent.
  The high authorities upheld her, but the lower officials
made things hard for her.
  The soldiers adored  her.   Her night  rounds in the
hospital gave origin to  the poem  "The  Lady  of the
Lamp."
  In 1855 she had Crimean fever and barely escaped with
her life.  She returned to England in July, 1856. 
CHAPTER V
   FLORENCE NIGHTINGALE'S  LATER  WORK

  The Popular Heroine.—Despite her retiring disposition
and her efforts to escape publicity, Miss Nightingale be-
came a popular heroine.   All sorts of honors were  done
her.   While she was still in the East Queen Victoria had
sent her a  wonderful brooch set with  diamonds;1 the
Sultan of Turkey had presented  her with a  diamond
bracelet and a sum of money for the nurses and hospitals.
Before her return to England  public meetings were held
in her honor, but she would not allow them afterward.
  The Meaning of Her Work in the Crimea.—Her work
in the East had been far more than the mere setting right
of great hospitals and the organizing means to secure com-
fort  for thousands  of wounded  soldiers; it had broken
through the prejudices of ages, and had  put all woman-
kind on a higher plane of  life and work.  She not  only
opened up a new profession for women, but also gave the
world a new conception of woman's place  in the world.
The effect was both  immediate and far-reaching.
  The Nightingale Fund.—While she was still at work in
the Crimea a  movement  sprang  up in England to honor
her in some  permanent  manner.   Sir Sidney  Herbert,
who knew her so well, suggested a fund which should  be
used to provide training  for nurses,  and for their living
and protection.  To  him must  be given the credit  of
devising means for founding the training of nurses  with
proper prestige and efficiency.
  Many  prominent  persons contributed largely to the
"Nightingale Fund," and it soon amounted to £40,000
 1 She wore it  there to please the soldiers, but never in England.
                                            71 
72    OUTLINES  OF  NURSING  HISTORY

($200,000),  one-tenth  of  it being  given by  the British
Army.
  Miss  Nightingale  deeply  appreciated  what was done,
as it accorded with her dearest wishes.   She accepted the
task of  administering the fund, but reminded the people
of England  that her work in the East was not  done and
that it might be a long time before she could begin this
great work at home.
  The Nightingale School of Nursing.—The long strain of
work and responsibility had  undermined her  health  so
that she never again  worked  with any physical vigor.1
Upon her return from the East she took no rest, but went
at once to work upon what seemed to her the  two most
vital  matters—army reform  and  the   establishment  of
trained  nursing.
  St. Thomas' Hospital was selected as  the place for the
experiment  of training nurses  in a new and systematic
way upon a non-religious  basis.
  As was nearly always the case in other pioneer efforts
along this line, most of the doctors on the hospital  staff
opposed it.   Of one hundred physicians whose  opinion was
asked, only  four favored  it.  They  felt  that  the nursing
at St. Thomas' was very good as it was and saw no need of
change.  They themselves  had given  the nurses  what
little training they had received, and said, "Nurses are  in
much the same position  as housemaids, and need  little
teaching beyond poultice-making and the enforcement  of
cleanliness   and  attention  to  patients'  wants."   One
doctor said publicly, "A nurse is a confidential servant; but

  1 Had she taken a long rest at this time her future  health  might
have been saved. "The history  of her case points to dilatation of
the heart and neurasthenia.  The former yields to drugs and rest;
the latter, an  atonic condition of the nervous system, to complete
rest."—Cook,  "Life of Florence Nightingale." 
FLORENCE   NIGHTINGALE'S  WORK    73
still only a servant.  She should be middle-aged when she
begins nursing; and if somewhat tamed by marriage and
the troubles of a family, so much the better."
  Only a few took the opposite view and understood what
the movement meant.  One  physician wrote, "A trained
and educated nurse would soon become most popular and
trusted.   She would  co-operate with the  physician in a
most  efficient  manner, her  presence  would  inspire the
patient with confidence, and she would be the means of
restoring  peace  and order  to a distracted household."
  It had  been hoped that Miss Nightingale  would take
personal charge of the  school, but her health would not
permit it.  She was not even  able to go to the opening
exercises.   Mrs.  Wardroper,  a  woman  of strong per-
sonality and previous  executive experience,  was chosen
for the position, but for years Miss Nightingale acted as
chief adviser on every detail of the work.
  In June, 1860,  fifteen selected probationers were ad-
mitted for training at St. Thomas'.  They worked  along-
side the old-style  nurses, whom they only gradually  re-
placed. The course of training was only one year, though
nurses were required  to remain in the  hospital for three
years.1  It was  long before the time of training was  in-
creased.
  The Nightingale nurses were never  designed for private
duty,  but for  executive positions in hospitals.   They be-
came  the  pioneer  heads of training-schools over all the
world.   Scotland,  Canada,  United States,  Australia, and
even Germany obtained heads for many of their  early
training-schools from  among the Nightingale nurses.  Up
to 1890, during its first thirty years, the school trained
1005 nurses.
  1 For the first year they were called probationers; for the second,
"nurse"; for the third and after, Sister (head nurse). 
74     OUTLINES   OF  NURSING  HISTORY
  Miss Nightingale herself  selected  most of the  candi-
dates for training.   She was especially keen at character-
reading, and almost unerring in her judgment of people.
Those who saw the early Nightingale nurses were  struck
with  "the  bright,  kindly,  and  pleasant  spirit  which
Fig. 11.—St. Thomas' Hospital, London.
seemed to pervade them."  She always called the nurses
her "daughters."1

  1 Some of Miss Nightingale's comments upon candidates for ad-
mission indicate the keenness of her intuition:
  "Miss A., flippant, tituppy,  pretension-y,  ambitious, clever, not
much feeling, talky, underbred,  no religion, may be persevering from
wish to excel; takes the thing up as an adventure.
  "Miss B. seems a  woman of good feeling and bad sense, much
under the control of anyone who will try to persuade her.
  "Miss C,  a most,  capable little woman,  no education, but one
can't find it in one's heart to regret it; she seems as good as can be.
  "Miss D., more cleverness than  judgment, more activity than
order, more hard sense than feeling.
   "Miss E., as poor a two-fisted  thing as I ever saw."__Cook. 
FLORENCE  NIGHTINGALE'S  WORK    75
  With Miss Nightingale as instigator of all details and
methods, the work proved a success.   The doctors were
one by one convinced of the superiority of the new method
and gradually came to voice their approval.  They found
their own work lighter and their field broadened, because
they were able to do  things which they had not before at-
tempted on account  of  incompetent help.  The fame of
the school spread quickly through  all countries.
  Work for the Army.—Miss Nightingale's chief work,
aside from the establishment  of the school for  nursing,
was for the health and  betterment of the British Army.
She had  seen  their  sufferings in  the Crimea,  and  she
found  that  in  time  of  peace  the army death-rate was
twice that of civilians.  She often  called the soldiers her
"children" and said, "No one  can  feel for the army as I
do.  Nine thousand of my children are lying, from causes
which  might have been prevented, in forgotten graves.
But I  can  never forget."    She  was anxious that the
lessons taught by the recent war should not be  lost, but
that  permanent  and radical  reforms  should  be made.
She had  the ear  of the government,  and pushed  her
advantage.
  She took up the matter of army  reforms in a large way,
and after many months of  painstaking  work put before
the Queen and her  ministers  a remarkable document—
 "Notes Affecting the Health, Efficiency, and Hospital Ad-
ministration of the  British  Army."  It has  been called
"one of the most valuable contributions ever  made to
hospital administration  in the time of war."1
  It  is  a significant fact that the methods  which she
recommended were  those which were later adopted  by
the Japanese with such marked success.   In their Russian
and later campaigns they had the lowest death-rate and
         1 Dr. Henry Hurd of Johns Hopkins Hospital. 
76    OUTLINES  OF  NURSING   HISTORY
the highest standard of health that any  army had  ever
attained.1
  Miss Nightingale always considered this  her most im-
portant work, calling what she did in the Crimea "mere
child's play"  in  comparison.
  Her Seclusion.—From about 1860 she rarely went out,
and for many years did most  of her  work from her  bed;
but she worked with a vigor and efficiency that few well
persons do.  She lived in London with only her servants
and her secretary, who was always a man.   She saw many
people, but only on business.   She is known to have re-
fused to see queens and princesses  when they came for
social calls, though she always  admitted anyone who came
in the interests of the army or of nursing.
  Her Work for India.—After her work for the army was
well under way,  she  took up the enormous  subject  of
sanitation in India, and for forty years devoted much time
to it.  The work was planned and carried out through a
Royal Commission, but her connection with it never ap-
peared, though it was she who made the plans and saw
that they  were carried out.
  She worked out a health program for all the millions of

  1 "The  soldier, when leaving  home,  was made  to understand
that should he become disabled by any preventable disease  he
would be looked upon by physicians and by the public as a discredit
to himself, his family, and his country. He went to war to  obey
orders.
  "He was given a package of antiseptic dressings, told to guard it
carefully, and instructed how to use it when wounded.
  "He was  told to take a bath and to put on clean underclothing
before going into battle.
  "He was told to keep a supply of boiled water or tea in his can-
teen, and to drink no water when on the march except from wells or
springs previously labeled as safe by the sanitary officer."—"Medi-
cine in Japan," by Dr. John Berry. 
FLORENCE  NIGHTINGALE'S   WORK   77
India's population, and much of it has been put into force,
with far-reaching results.  Probably no woman, and few
men, have, in the world's history, planned such a masterly
undertaking.
  Her Political Influence.—She was personally acquainted
not only with the Queen and most of the cabinet, but knew
every Prime Minister of her time, the royalty of other
nations, and such men  as John  Stuart Mill,  Benjamin
Jowett, Gladstone, Spurgeon, etc.   These men came to her
for advice and deferred  to her judgment; and  she never
failed to measure up to their confidence in her.1
  Her Work for Hospitals and Nursing.—Besides her con-
trolling interest in the Nightingale School, she gradually
came to be adviser-in-general to the whole United King-
dom upon everything pertaining to hospitals and nursing.
  She was called upon to criticise plans for new hospitals,
to advise  in every detail of construction, equipment, man-
agement,  and  question of  policy.  She  helped  in  the
starting of many schools of nursing, and wrote thousands
(literally) of letters upon  nursing subjects.
  Every  new phase of  nursing was brought to her for
criticism and approval.  William  Rathbone consulted her
before he began the workhouse  and district nursing in
Liverpool (see Chapter VI);  those who organized some of
the early  training-schools in  America came to see her be-
fore starting them;  when the matter of state registration
for nurses came up  in England she was the leader of the
opposition and the  chief cause of its defeat (see Chapter

  1 She was an advocate of equal suffrage.  She said:  "I am con-
vinced that political power is the greatest that it is possible to wield
for human happiness,  and I can neither approve of women who
decline the  responsibility of it, nor of men who would shut them out
from it.  Until women do wield it, in an open, direct manner, I am
convinced that the evils can never be satisfactorily  dealt with." 
78    OUTLINES  OF  NURSING   HISTORY
XIV).  In short, throughout her whole long life, there was
hardly a move made of any importance to the nursing
world in which she did not have a part.
  Her Writings on Hospitals and Nursing.—Her "Notes
on Hospitals," published in 1858, is considered  the  most
valuable  work of the sort that has ever been produced,
and  it revolutionized hospital  construction.  Before her
time hospitals had beautiful and imposing buildings, but
they were  sadly lacking in all things pertaining  to the
intimate  care  of patients.  Her practical mind and  deep
sympathy made her hammer away at details, necessary if
uninteresting,  until she convinced at least a part of her
generation  that the comfort and welfare of the patient is
really the chief consideration, and that sanitation is  more
important to a hospital than architecture.
  Her "Notes on Nursing," published in 1859, always has
had  an enormous  sale, and is still,  after fifty  years, a
standard  work—"an  immortal  classic."   It  was  one
of the  first text-books on  nursing, and is one of the best
books  ever written on domestic sanitation.  Every nurse
should become familiar with it.   A few quotations from it
will  serve to illustrate its sound sense:
  "The sufferings  generally considered  to  be inevitable
and incident to the disease are very often not the symptoms
of disease at all, but of the want of fresh air, of light, or of
warmth,  or of cleanliness, or of quiet,  or of punctuality
and  care in the administration of diet.
  "Volumes are written upon the effect  of the mind  upon
the body. ... I wish that  a little more was thought of
the  effect  of  the  body upon the mind.  Believe  me,
almost any sick person who behaves decently well ex-
ercises more self-control every  moment of  his day  than
you  will ever know till you are sick yourself.
  "Merely looking at the sick is not observing.  To look 
FLORENCE   NIGHTINGALE'S  WORK    79
is not always to see.   It needs  a  high degree of training
to look so that looking shall tell the nurse aright. . .  .
A  conscientious nurse is  not  necessarily  an observing
nurse, and life or death may lie with the good observer.
  "The matron should be one  whose desire is that the
probationers shall learn—a  rarer thing than  is  usually
supposed. . . . The nurses must  really  be  the matron's
children.  A training-school without a  mother  is worse
than children without parents.  ... In  disciplinary mat-
ters none but a woman can understand a woman."
  Her published  writings  number  over one  hundred,
nearly all on hospital, nursing,  or sanitary topics.
  Her Statement  of  the  Principles of  Training.—While
Miss Nightingale was but human, it seems likely that she
was nearly infallible in matters  pertaining to the training
of nurses.   Her rare union  of head  and heart qualities,
her ability to keep sight of minutest details without losing
her grasp of the fundamentals, and  her wide  knowledge
and  long experience  fitted  her  to  speak  with almost
supreme authority.  We shall be wise if we remember some
of her warnings.
  She  characterizes the essentials of a  nurses' training-
school as two:
  First, That nurses should be technically trained in hos-
pitals organized for the purpose.
  Second, That they  should live in homes fit  to  form
their moral lives and  discipline.
  A careful consideration of these  two simply stated prin-
ciples may help some  of the training-schools of today to
put their finger upon the source of their troubles.
  In the paper which she  contributed  to  the  Nursing
Section of the  Congress on  Hospitals, Dispensaries, and
Nursing, held at the World's Fair, Chicago, in 1893, she
made two very striking statements: 
80    OUTLINES  OF  NURSING  HISTORY

  "Nursing should not be a profession.  It should be a
calling.
  "The art is that of nursing the sick.  Please mark, not
nursing sickness. . .  . This is the  reason  why nursing
proper can only be taught by the patient's bedside and
in the sick room or ward.  Lectures and books are but
valuable accessories."
  It is said of her: "Her chief contribution to the inher-
itance of the race has been that, besides demonstrating in
action the full perfection of the allied arts of nursing and
sanitation,  she has left in her writings a philosophy of
nursing, together with an intellectual  demonstration of
the scientific and natural basis of hygiene and its practical
application, and has laid down once and for all their essen-
tial underlying principles with a clarity, a logic, an origin-
ality, and a depth of  reflection that mark the genius and
place her work among the classics."1
  Her Later Years.—Sir Edward  Cook, who had access
to intimate family records which no one else had, says of
the latter part of her life:  "For a few years after she was
seventy-five she was able to enjoy life; then her powers
gradually failed. .  . . She had outgrown the weakness of
heart and nerves of her middle life, and though she still
kept  her room,  she  now  [1900] made  an impression of
vigorous and robust old age.  She had worked actively up
to this  time. . . . For the last fifteen years of her life
she seldom left her room.   Her eyesight failed, her  power
of writing  went.  In  1902 she was  persuaded to have a
companion, who was  really her private  secretary.
  "Two Royal decorations  for her  services in the army
and elsewhere  were  bestowed upon her in  1883.   The
crowning honors of her life, when in 1907 King Edward
conferred upon her the Order of Merit, and in 1908 granted
        1 "History of Nursing," by Nutting and  Dock. 
FLORENCE  NIGHTINGALE'S  WORK    81
her the Freedom of the City of London, came to her when
memory and apprehension were failing."
  Death  and Burial.—She died in August,  1910,  aged
ninety years and three months.   Her family was asked to
allow her  to be  buried in Westminster Abbey, but  they
Fig. 12.—Florence Nightingale late in life.  (From a photograph by
                 Miss Bosanquet, 1906.)

knew her wishes and refused.  She was laid in the family
plot in Hampshire, and the only mark upon the grave is a
small cross with her name and the dates.
  Public monuments to her have been set up in Florence,
Italy, in Derby, and Milbank.  In  1915  there was  one
unveiled in London.
       6 
82    OUTLINES  OF   NURSING  HISTORY
  The Fundamentals of Her Character.—Let us think of
Florence Nightingale, then, not merely as a self-sacrificing
heroine, but as a woman possessed of the twofold gift of
a mind masterly  and virile  enough to  formulate and
carry out the world's great enterprises, and  of a mother-
heart which took  into its  tenderness the whole British
Army and  the whole  sisterhood of nurses, besides  every
human being who  was sick and suffering.
  Her sympathies were  broad and  deep, her feelings in-
tense, and they  always immediately  translated  them-
selves into  action.   She  could  not conceive of one feeling
sorry for a  person or a condition and doing nothing about
it.  For a whole lifetime she sacrificed her personal happi-
ness and devoted herself to the slow, difficult, and painful
processes of the reformer in the realest, truest, and best
sense of that term.

         SUMMARY OF IMPORTANT POINTS

  Upon Miss Nightingale's return from  the Crimea she
found herself a popular heroine.
  The Nightingale Fund was  established to provide for
the training of nurses.
  St. Thomas' Hospital,  London,  was  selected as the
home of the Nightingale School, which was established in
1860.
  Mrs.  Wardroper was head of the school,  but  Miss
Nightingale was really  in  control and  remained so for
most of her life, though  her health did not permit her to
do active work.
  Her work for the betterment of health conditions in the
British Army  was one of  her  most  important  pieces of
work, and occupied several years.
  Her work  in the planning of proper  sanitation for 
SUMMARY  OF  IMPORTANT   POINTS   83
India, which was done through a period of forty years,
was probably her greatest work, but is least known.
  She wielded a marked  political influence.
  She  became adviser-in-general on  all  hospital  and
nursing  topics  for the whole United Kingdom and  for
other countries.
  She wrote much.  Her  "Notes on Hospitals" is regarded
a classic.  Her "Notes on Nursing" is, after fifty years, a
standard work.
  The principles which she laid down for the training of
nurses are still considered correct.  They have never been
improved upon.
  She opposed state registration for nurses.
  She worked actively up to about 1900, and after that
failed in mind and body.  She  died in 1910 at the age of
ninety.
  Her greatness was due to her remarkable combination
of qualities.  She had intense and loving sympathy with
suffering, but her emotion was always displayed in action
of the most vigorous sort, planned by a mind with a master
grasp. 
CHAPTER  VI
THE ESTABLISHMENT  OF TRAINED NURSING IN
                 GREAT BRITAIN

  One must not set the work of Florence Nightingale as
a hard-and-fast line between the old nursing and the new,
nor between untrained and  trained nurses.   We have
seen that since early times  there were a few persons,
keener in their insight than the rest, who had realized the
place  of nursing in society and had known that women
must be  trained if it was  to  be done rightly.   Florence
Nightingale  was the greatest of  these men and  women of
vision.  She was doubtless the one who saw most clearly
and constructively, who had  the ability and the oppor-
tunity to put her thinking into immediate practice, and
to watch its outcome.
  There have  been  many  different  sorts of attempts at
training nurses  and improving in one way  or another the
quality of their work.  They are all a part of the per-
sistent effort of woman to take  her place in the work of
the world, a part of the great upward struggle of humanity.
  Progress  of  the training idea naturally made  more
rapid   progress  with  some nations  than  with others.
England and her colonies led the way, while America fol-
lowed very closely.  Germany began sooner, but has gone
more slowly and in her own way. The rest of  the world
has copied the methods of the schools in these  countries,
fitting  their  plans to individual  circumstances.
  England's  Advance.—The  progress  of  nursing in
England is typical of  that in most other countries.  It has
       84 
ENGLISH  NURSING  CHRONOLOGY     85
taken place on a larger scale than elsewhere, and  the re-
sults achieved have affected the history of nursing as have
events in no other country, unless it be the United  States.
  At  the time of the Crimean War,  doubtless,  better
nursing was being done on the Continent than in England,
because the religious zeal of the Roman Catholic sisters
and of the Deaconesses furnished so great  an incentive.
The  Deaconess movement set the  pace and laid down
many of the principles upon which  the English training-
schools were built.

           ENGLISH  NURSING CHRONOLOGY
  From 1840  to  1852 there were a number  of beginnings
of training for nurses in England.   Some of the associa-
tions  then formed still  exist.   The Nursing Sisterhood
of All Saints  is a notable example,  as well  as St.  John's
House,  to which reference has already been  made.  A
chronologic account  of the development of  trained nurs-
ing in England will serve to show how many persons had
the same germ idea and in how many ways and places it
was being developed.1
                         1851
  All Saints'  Sisterhood  was  founded in  London.  It
undertook the nursing of St.  Elizabeth's Home for Incur-
able Women and Children.

                         1852
  Dr.  West  began  training nurses at the Children's
Hospital in Great Ormond Street, London.
  Queen Charlotte's Hospital gave training  in obstetrics.
  1 Much of the material used here was taken from "A Chronology
of Nursing," in Sir Henry Burdette's "Hospitals  and Asylums."
A few quotations are also made from Nutting and Dock's  "His-
tory of Nursing." 
86    OUTLINES  OF  NURSING  HISTORY
                         1854
  Florence Nightingale went to the Crimea.
  Dr.  Neale  organized the nursing  Sisterhood of  St.
Margaret's, an order resembling the Deaconesses.
  Dr. Browne, of Crichton, began to teach attendants in
insane hospitals.
                         1855
  Mrs. Wardroper, an untrained woman, aged forty-two,
with no knowledge of hospitals, was put in charge of  the
nursing at St. Thomas', one of the older, good hospitals
of London.   By her efficiency and fine spirit she made  the
nursing so good that the hospital was  later chosen as  the
best ground for the great Nightingale  Training-school.

                         1856
  Florence Nightingale returned to England.

                         1857
  St.  John's  House undertook the  nursing  at King's
College Hospital, and gave  superior service.1

                         1858
  Mrs. Coster was appointed superintendent of nurses at
St.  Pancras' Infirmary.  She worked  under the  medical
officers for six months, then began to teach  her nurses
according to her own ideas.

                         1859
  William Rathbone, of Liverpool, a private  citizen who
was alive to the needs of his time, put a  nurse at district
  1 In 1874 the Sisterhood  clashed with the management about the
control of the nurses, but the Sisters remained until 1885,  when the
hospital began its own training-school. 
ENGLISH  NURSING  CHRONOLOGY    87
work among  the poor.   This nurse's  success  was  so
marked that he decided to employ others, but could not
find capable ones.  He consulted  Miss Nightingale, who
suggested that the training of nurses be started at the
Royal Infirmary of Liverpool.  Mr. Rathbone was on its
Board,  and succeeded  in  convincing  the authorities of
the  need of training  for  district work.  In  1861  Miss
Merry weather, from St. Thomas', was put in charge of the
work, and from it finally  grew a  great  district  nursing
association, thoroughly organized, with both nurses and
lay workers.  All her life Miss Nightingale kept  in  close
touch with this work.   It may be considered the beginning
of modern organized district nursing.
   Miss  Nightingale published her "Notes on Nursing."

                         1862
   Miss  Nightingale founded  a training-school for  mid-
wives at  King's  College Hospital, with a six months'
course.   It was discontinued after a few years on  account
of an obstinate epidemic of puerperal fever.

                         1865
   William Rathbone extended his  interest in nursing and
became the founder of the reform in nursing at the Work-
house Infirmary of Liverpool.   Through Miss Nightingale
he secured as head of the reform Miss Agnes Jones, a high-
bred, cultured woman, fired with religious zeal, who had
been trained first  at  Kaiserswerth and afterward at St.
Thomas'.  With twelve other Nightingale nurses, eighteen
probationers, and fifty-four old pauper nurses she began
the  regeneration of the care  of  1200 sick.   The  task
was  accomplished,  but Miss Jones was sacrificed, for
she died of typhus after three years of overwork.  From 
88    OUTLINES  OF  NURSING  HISTORY
this  success grew the whole  work  of  nursing in alms-
houses.
  Training-schools were started at Leicester, Manchester,
and Derby.
                         1866
  In Dublin, Ireland, there was founded the  Institution
for  Training Nurses through  the efforts of Archbishop
Trench and  his wife.  Most of the hospitals in Ireland at
this time were nursed by the Sisters of Mercy.
  Glasgow Royal Infirmary started a training-school.

                         1868
  The East  London Society was organized for doing dis-
trict nursing among the poor.  It was patterned after
William Rathbone's work in Liverpool.
  Miss Nightingale selected five of her nurses, with Lucy
Osburn  at their head, to go  to Australia and establish
trained  nursing.  Miss  Osburn became  Lady Superin-
tendent of the Sydney Hospital, while the rest did pioneer
work in other  places.   They were later reinforced by five
more from the Nightingale School.
  Middlesex Hospital started  a training-school.

                         1869
  The Mildmay Deaconess Association formed a nursing
branch.
  The city of  Birmingham appointed a district nurse.

                         1870
  Guy's  Hospital,  London,  reformed its nursing, but
gave little training.
  The Edinburgh Royal Infirmary  (founded 1736) started
a training-school under  the Nightingale system.   The
course was one year.  (In 1894 it  was made three years.) 
ENGLISH  NURSING  CHRONOLOGY    89
  Miss Florence Lees (afterward Mrs. Dacre-Craven) was
chosen by Miss Nightingale to go to Metz for work in the
Franco-Prussian War.   Miss Lees was one  of the  first
pupils  of the  Nightingale  school; she  had done post-
graduate work at Dresden, Berlin,  and Kaiserswerth, and
had seen much of hospital life in France, Holland, Den-
mark, etc.  She was in charge of a military hospital at
Metz, and later of one at Homburg.

                       1871-73
  Nursing institutions multiplied  rapidly.

                         1874
  A year of great activity among training-schools.
  The district  nursing which  was  being  done in London
was poor, and  William Rathbone, of Liverpool, wished to
help put it on a proper basis.  He organized the National
and Metropolitan Nursing Association, and Miss Nightin-
gale induced Miss Florence Lees to become General Super-
intendent of the work.   Miss Lees insisted upon educated
and refined women for  the work,  and though even Miss
Nightingale doubted the feasibility of the plan, carried it
through  to success.  Miss Lees remained in her position
for some years, having Miss Nightingale for her constant
adviser.
                         1875
  The Western Infirmary of Glasgow started a training-
school with a three-year course.

                         1876
  The Guild of  St. Barnabas for Nurses  was  organized
chiefly through the efforts of Miss  Antrobus.   It  is a
religious  guild,  under  the patronage  of the Church  of 
90     OUTLINES  OF  NURSING   HISTORY

England.  It has lay members who endeavor to be useful
to the nurses in a social way.
       Fig. 13.—Medal of St. Barnabas' Guild for Nurses.

  Most of the  better hospitals agreed to accept no more
probationers who could  not read and write (!).

                            1877
  St.  Bartholomew's Hospital,  London, started  a  so-
called training-school,  where for  two years  the  nurses
worked under the former matron (who disapproved of the
innovation) and under the old-time  head nurses, some of
whom could not read  or write.1   Miss Machin  was  ap-

  1 One of the first class of  probationers wrote a very racy account
of the work:  "Patients were not nursed;  they were 'attended to.'
Few of the Sisters could or would teach  us.  The outpatient doctor
gave us a practical lesson once  a week in bandaging, etc.  Another
doctor  took us into the wards and taught  us bed-making, poultice-
making, bathing, etc.  We picked up what we could and the resident
staff and students taught us a great deal.  The nurses never used a
thermometer, and when  we probationers were taught to do it, there
was a great fuss."
  The doctors usually took the temperatures,  gave  hypodermics,
changed the beds of fracture cases, etc.  In most hospitals of this
period  night nurses were still  of an inferior class and totally un-
trained; for this reason the day nurses had very long hours.
  The hours of duty were from 7 a. m.  to 10 p. m., with very little
time off. The German system was used, of putting each nurse on night
duty every third night, giving her thirty hours of continuous service. 
ENGLISH  NURSING  CHRONOLOGY    91
pointed matron two years later and greatly improved the
service.
                          1879
  The  Workhouse Infirmary  Nursing Association was
formed chiefly through the efforts of Miss Louisa Twin-
ing, who had visited in workhouses for twenty years, and
Miss  Francis Power  Cobbe, a well-known  writer.  The
pauper sick  were badly neglected and  conditions were
extremely bad.  Doctors and others had made investiga-
tions, and in 1872 a woman inspector had been appointed
for the workhouses, but little had been accomplished.1
This association began a real reform.
  Many nurses went to  the war in South Africa to care
for the wounded.
                         1880
  Guy's Hospital, London, suddenly removed its old-
fashioned nurses  and began  training according  to  the
newer methods.   The staff doctors objected strongly,
and great publicity was given to the matter.   The trouble
was finally adjusted,  and under the skilled  leaderhsip of
Miss  Burt  the school became excellent.

                         1881
  Marylebone  Workhouse  Infirmary and  Westminster
Hospital opened training-schools.
  Dr.  Clark, of  the Glasgow  District Asylum, began to
train nurses in insane work.
  Miss Manson (afterward  Mrs. Bedford-Fen wick) took
charge of the nursing at St. Bartholomew's,  gradually

  1 The Poor Law regulation stated that "any able-bodied woman
or girl may be  employed in the female sick wards, and any infirm
woman whom the master may deem fit for the duties of a nurse." 
92    OUTLINES  OF  NURSING  HISTORY
weeded  out all  of  the old-time  untrained nurses,  and
established the training-school on a firm basis.

                        1882
  The London Hospital  first gave  certificates to nurses
who had finished their course.
  A number of English nurses served in the war in Egypt.

                        1883
  Queen Victoria established the Order of the Royal Red
Cross, and gave decorations  to thirty  women  for their
services   in  war, among them Miss  Nightingale  and
English  and French Sisters.
  Miss Hamilton and two other nurses began permanent
work  in Alexandria, Egypt.
  Miss  Monk reorganized the  training-school at King's
College  Hospital, and under her the  school became of
unusual excellence.   (She remained in  charge until her
death in 1915.)
  A nursing home  was opened  in Rome, Italy, with  two
English  and three American nurses.   This was one of the
beginnings of modern nursing  in that country,  though
little progress was made  until about 1900.

                        1884
  Miss Alice Fisher, a Nightingale  nurse, went to Phila-
delphia  to organize a training-school at Blockley Hos-
pital.   She did a remarkable work  there, but died after
a few years' service.
  Miss Annie Crisp went out to New Zealand to establish
trained  nursing,  but it was five years later that  the  first
school was opened. 
ENGLISH  NURSING  CHRONOLOGY     93
                         1885
  English nurses again served in the war in Egypt.
  Aberdeen (Scotland) Royal Infirmary started a training-
school with a three years' course.
  The Lady  Dufferin Fund  for Supplying  Medical  Aid
to the Women of India was founded.  The British Govern-
ment, under the direction of Miss Nightingale, had paved
the way  for this movement.   When Lady Dufferin went
out to India as  wife  of the Governor-General,  Queen
Victoria  called  her attention  to the medical needs of the
women there and  suggested that she see what could be
done  about it.  The result was a large,  permanent fund,
contributed to  and  endorsed by royalty and others of
prominence.  (See Chapter XVI.)   In its years of work
this fund has done an amount of good  which cannot be
measured.  Hundreds  of women   doctors  and  trained
nurses have  gone  out  in its  service and  all India is
dotted with its  hospitals,  dispensaries,  and  medical
colleges.   In most of its hospitals there  are training-
schools for native  nurses.

                         1886
  The first training-school in India  for native nurses  was
opened in the Cama Hospital, at Bombay, by Miss Edith
Atkinson, of England.
                         1887
  The Women's Jubilee  offering,  which celebrated  the
fiftieth year of  the reign of Queen  Victoria, devoted, by
act  of the Queen,  £70,000 ($350,000) to district nursing
among the poor.   The organization which  administers
the fund was called the Queen's Jubilee Institute.  The
Metropolitan and  National Nursing Association and the
associations already organized in Scotland and elsewhere 
94    OUTLINES  OF   NURSING   HISTORY
have affiliated with it.  It gathers up into one organiza-
tion all existing forms of district nursing.
  The Institute does much midwifery  work, and most
of its  nurses hold midwives' certificates.   It also employs
"cottage  nurses,"  women  who have been given a short
course of training, chiefly in obstetrics.  Some of the
Queen's  nurses give  lectures  on nursing  topics to the
laity under the Red Cross Society.
  The National Pension Fund for Nurses was established.
Sir Henry Burdette was the founder; the Princess of Wales
president.  The scheme provides  sick, disability, and old
age insurance  for graduate nurses.
  Lady Roberts established a fund and began sending
nurses out under it to work in the villages of India.

                         1888
  The Indian  Army Nursing  Service was organized  by
Lord Roberts.
  The Egyptian scheme of Sir Sidney Waterloo  involved
the training of nurses.  Miss Munro, of St. Thomas', and
Miss Hughes, of St. Bart's, went out under it.
  St. John's House took over the nursing of Charing Cross
Hospital  and of the Metropolitan Hospital.

                         1889
  The Matron's Aid Society, which had begun in 1884 to
train midwives, incorporated as the Midwives' Institute.

                         1890
  The Rural Nursing Association was organized  by Mrs.
Malleson.
  The National Pension Fund became Royal. 
ENGLISH  NURSING  CHRONOLOGY     95
  A Scottish branch of the Queen's Jubilee Nurses was
established under Miss Peter.
  Miss Marshall began work in Fiji.
  Sister Rose Gertrude went to Molokai, Hawaii, to care
for the lepers.
  A Welsh branch of the Queen's Jubilee nurses was
organized.
                         1892
  School nursing was established, the London School Board
applying to the Metropolitan Nursing Association for the
Fig. 14.—Miss Amy Hughes.
first  nurse.   Miss  Amy Hughes  was  chosen,  and  did
signally effective service.
  The movement spread rapidly. 
96    OUTLINES  OF  NURSING  HISTORY
                         1893
  Mrs.  Rebecca  Strong,  of  Glasgow Royal Infirmary,
first saw  the need  of a preliminary course  for  pro-
bationers and started to give one.   She gave her pupils
a three months'  course at a local college, and left them
free from  theoretic work  for the remainder  of their two
years.
  From this time on the training-school movement grew
and flourished, and all  sorts of nursing enterprises were
Fig. 15.—Mrs. Rebecca Strong.  (Courtesy of "The Trained Nurse
                 and Hospital Review.")

successfully undertaken.  The  trained nurse  was an es-
tablished fact, and her  many activities were accepted as
necessary parts of the life of the United Kingdom.
  Peculiarities  in English Training.—Some of the points
peculiar to early English  training were:
  The "lady probationer"  system, which admitted  to
work  in the wards women of the upper classes who lived
at home and who did not  wish to take a full course. 
ENGLISH  NURSING  CHRONOLOGY    97
  The theory that there must be a lower class of nurses
both in hospitals and on private duty.
  The custom, common to both Germany and England,
whereby the nurse retains a vital connection with her
school after  she has finished her  course.  In the  first
English training-schools the course was  usually one year,
though the nurse was bound by an agreement to remain
for three years and often stayed much longer.1
  After graduation  she almost invariably lived at the
home which belonged to her school, and  got her calls from
the hospital.   Nurses  could  not imagine,  and did not
want, the independent life of the American nurse.  They
felt it more satisfactory to have the guarantee of work
and of care which their own training-school gave, though
it involved the acceptance of less money for their work,
than  to be  in the  lonesome and  precarious position  of
being dependent wholly upon themselves.
  Under old-world  conditions of living there was much
to be said in favor of this older viewpoint.
  The Old  vs. the New.—There is today, in England,
a constant conflict between the older ways (in which
Germany  shares) and the newer ways of America.   The
conservatives believe  that  the nurse should remain  per-
manently connected with—which usually means controlled
by—her hospital, and be subservient to its authority, even
when its head  is a man without knowledge of nursing.
The radicals  share the  American view  of personal inde-
pendence; some of them have formed co-operative clubs,
admitting nurses from many schools, similar to those  in
the United States.
  Conditions of life are changing in Europe, though more
  1 Today, when the graduate of  the London Hospital is in from
private duty, she works in the wards, so as to keep up with the newer
methods.
7 
98    OUTLINES  OF   NURSING  HISTORY

slowly than in newer lands,  and it appears likely that
nursing customs and policies must  be  modified to meet
them.
          SUMMARY OF  IMPORTANT POINTS
  England's progress in trained nursing is typical of that
of other countries.  Many of the fundamental problems
and some of the great nursing movements were first worked
out there.
  1842-1852.  There were a number of attempts made to
train nurses.
  1854-56.  Miss Nightingale in the Crimea.
  1859.  William Rathbone established district  nursing
in Liverpool.
  1860.  The  Nightingale School for Nurses was estab-
lished at St. Thomas' Hospital, London.  The course was
one year.   Mrs.  Wardroper was in charge.   Miss Night-
ingale was chief  adviser.
  1865.  Under  William  Rathbone, Miss  Agnes  Jones
began the  nursing reform in the Liverpool Workhouse.
She did a remarkable work.
  1866-70.  Ireland  and  Scotland  organized training-
schools.
  1871-75.  Many training-schools organized throughout
Great Britain.
  1880.  The  upheaval   at  Guy's Hospital.  English
nurses went to almost  every  quarter of the globe to or-
ganize schools.
  1885.   The Lady Dufferin Fund for Supplying Medical
Aid to the Women of India was founded.  Under this fund
an enormous amount of nursing and of training nurses has
been done in India.
  1887.   The Queen's Jubilee Institute, for  district nurs-
ing, was  founded with  a Royal fund of $350,000.   The
National Pension Fund for Nurses was established. 
SUMMARY  OF  IMPORTANT  POINTS   99
  1890.  The  Scottish  branch of the  Queen's Jubilee
Nurses was established.  The Rural Nursing Association
was organized.
  1892.  School nursing was established under Miss Amy
Hughes.
  1893.  The first preliminary course was given at Glas-
gow, under Mrs. Rebecca Strong.
  England presents at the present time a conflict between
the old method of the  nurse's  remaining permanently in
the control of her school and in its protection, and the new
method of complete independence. 
CHAPTER VII
         EARLY  NURSING IN  AMERICA

  Nursing Among the  Pilgrims.—Before setting out for
America  the Pilgrim Fathers, while in Holland, had a
deaconess nurse for their sick.  There is some reason to
believe that she came  with  them to Plymouth in 1620.
The early Colonial records speak of certain persons, both
men and women, who  were chosen on  account  of their
skill and  fitness to care for the sick.

            EARLY CANADIAN  HOSPITALS
  The  first  hospitals  in  America  (excluding those in
Mexico)  were in  Canada.  Their  work  was distinctly
religious, and was begun and continued with a missionary
zeal which gave it a superior quality.
  Quebec.—About 1625-30 a group of Jesuit priests who
went to  Quebec  found more or  less illness  among  the
Indians whom they were trying to evangelize, and made
appeals to France for help.   A band of Ursuline Sisters
went out in 1639 with the idea of teaching the Indians,
but as soon  as  they landed so many sick people were
brought  to  them—some stricken  with  small-pox—that
they were presently engrossed in nursing.  They built a
hospital,  the ruins of which  may still be seen at Sillery.
They also cared for the sick in their homes, and taught the
savage women to nurse, finding them good pupils.  The
Indians grew to  love these devoted women, and their
hospital was always crowded with the poor and helpless.
In 1658 they built in Quebec itself a larger hospital and
       100 
EARLY   CANADIAN  HOSPITALS      101
called it the Hotel Dieu.   It stood on the spot where the
present building of that name is, and has always been a
part of the life of the community.
Fig. 16.—Mile. Jeanne Mance.  Founder of Hotel Dieu, Montreal.

  Montreal.—The first hospital at Montreal, also named
the Hotel Dieu, was built in 1644.   It was founded by
Mile.  Jeanne Mance, a  woman of beauty, culture, and 
102   OUTLINES  OF  NURSING  HISTORY
ability, who had  come with a group of colonists in 1642.
She was the only woman in the colony with the exception
of the wife of one of the men, and had been sent on her
mission by Mme. de Bullion, who furnished the  funds.1
  Though Mile. Mance was not a nurse, and there was but
one physician in the country (Dr. Etienne Bouchard), she
opened a hospital in her own house, and for sixteen years
cared for the sick of  Montreal,  She had, in  time, as
assistants a few women  who came from France with
Fig. 17.—Hotel Dieu of Montreal in 1821.
additional colonists, but she  herself was the  one com-
petent nurse.
  In 1659 she went to France  and brought back with her
three Sisters of the Hospitalieres of St. Joseph—Judith de
Bresoles, Catherine Mace, and  Marie  Maillet.   She herself
did not regard the hospital as truly  founded until  the
arrival of these women.  The government gave land for
hospital purposes and a building was erected.  This hos-
pital has given continuous service ever since,  under  the
        1 The fact was not known until after her death. 
UNITED  STATES
103
same Sisterhood.  Mile. Mance's portrait hangs in the hall
of the present building.
  Parkman, the historian, pays high tribute to the work
of these women: "It is difficult to conceive a self-abnega-
tion  more  complete  than that of the hospital nuns of
Montreal and Quebec.  In the almost  total absence of
physicians the burden of the care of the sick and wounded
fell upon them.  Nearly every ship  from France brought
some infection.  The  nuns died,  but never complained.
Removed from the arena of political strife, too busy with
practical benevolence  to become a prey to illusions, they
were models of that benign and tender charity in which
the Roman Church is so rich."
  Some time later the Sisters  of Charity came to Canada
and began an extensive nursing and  hospital work.

                   UNITED  STATES

  The  First Hospitals.—The  earliest  hospital  on  record
was established by the West  India  Company in  1658 in
the town of New Amsterdam  (now New York  City).  It
was designed for sick  soldiers and for the negroes of the
Company, and was very small.  This later combined with
the city poorhouse, which also cared for the sick, and the
two are considered the ancestors of  the modern Bellevue
Hospital, which thus  claims to be the oldest hospital in
America.
  One  authority states that  the first  hospital in  the
United States was the Charity, of New Orleans, La., which
was founded about 1720 by Jean Louis, a sailor, and put
in charge of the Sisters of Charity, in whose hands it has
always remained.  It  was destroyed in 1779 and rebuilt
in 1780 by  a Spanish noble.   It became the city hospital
in 1811. 
104   OUTLINES  OF  NURSING  HISTORY
  Blockley, of Philadelphia, which began as an almshouse
in 1730, designates itself "the  oldest hospital in con-
tinuous service."  The Pennsylvania Hospital,  chartered
in 1751, and devoted solely to the care of the sick, thinks
itself  "the  first hospital"  in the strict sense  of the word.
Another authority states, "the oldest hospital in New York
City is the New York Hospital, founded in 1770."
  Of  these, the  Pennsylvania was  doubtless  the  best.
Bellevue and Blockley,  probably  on account of their con-
nection with almshouses and with politics, were until our
own generation very dreadful places.
  Bellevue in 1736 had only a small ward for the sick.  It
was situated where  New York's City Hall  now stands.
In 1794 the present site—then out in the country—was
secured and the name of Bellevue first given.1  It was for
some  time  used only as a  "pest house."   In 1816 the city
poorhouse  and the  penitentiary were transferred to that
location, and insane persons were also housed there.  The
sick were cared for by prisoners or paupers, political graft
flourished,  epidemics were frequent and terrible, and for
many years it was  "nothing but horrors."
  In  1837  an investigation  was made,  conditions  were
found to be unspeakable,  and the pest house, prison, and
later  the insane wards  were removed  to Blackwell's
Island.  The poorhouse continued until 1848  under the
same roof with the hospital,  no  better attention was given
the sick, the dirt and neglect were shocking, and the death-
rate was 25 per  cent.   Upon  the creation  of  a medical
board in 1847 matters improved slightly, but the service
of the sick remained most deplorable.
  Blockley,of Philadelphia, was also a combination of poor-
house, insane quarters, and hospital.  (During the Revo-
lution the inmates were turned  out by the British troops.)
    1 From the name of the estate purchased for the purpose. 
UNITED  STATES
105
All the work of the place, including nursing, was supposed
to be done by the inmates; the insane were cared for en-
tirely by men, a male  "keeper" sleeping in the women's
wards, bathing, dressing them, etc., while the rabble of
the town were allowed to come to look at them at almost
any time.
  An investigation made in 1793 brought to light these
terrible conditions, but they  were not improved.   In
1832 the matter came up again, and Bishop  Kendrick of
Emmetsburg was persuaded to send a group  of Sisters of
Charity to  reform  the  place.   Their work so effectively
transformed the hospital that  they were  besought  to
remain, but the bishop  did not feel that it was their work.
After they left the  place fell back again into its old condi-
tion.   "Old Blockley"  and "Old Bellevue" have become
synonyms for all that is bad in the  nursing of the sick.
  Hospital Nursing in Early Days.—"A Century of Nurs-
ing"1 gives  some account of the hospitals in  early days.
It tells us that in most of the city  hospitals the nursing
was  done by inmates.  Most of these  were  over fifty
years old, many seventy and  eighty.  The doctors sent
feeble old people to be nurses in the wards because they
could get better food there.2  For paid nurses, wages were
so low that only people who  could get  no  other work
undertook  it.  Women  nurses received  $2.50 a month;
men, S3.3   Naturally, they exacted  fees from the patients
  1 Published in 1876,  author unknown.
  2 "There was a ward of ten old Women, all helpless and bedridden;
to nurse them, a decrepit old woman, withered  and feeble, and for
her assistant a girl with one blind eye and  the other badly defective.
Another ward had  eight paralyzed old  women, the nurse being
equally old and her assistant a girl who had lost the use of one
hand."—Mrs. Jameson.
  3 As a relic of the old times, New York City, up to 1908, employed
persons in its hospitals who received but $5 a month. 
106   OUTLINES  OF  NURSING  HISTORY
whenever they  could.  There was  practically no  night
nursing,  the exception being a woman in childbirth or a
dying  person, when  a "night watcher" would be pro-
vided.
  Dr.  Meigs, in "The Old Nursing and the New,"  offers
an explanation of  these conditions:  "Formerly little was
known by the world in general of what took place in a
hospital.  The patients were largely  cut  off  from  com-
munication with the  outside [either because of restricted
visiting days or  because they were friendless], officers and
employees of hospitals were jealous of intrusion.  Visiting
was  not encouraged  and  visitors were few.  Managers
made tours of inspection, but saw little of the real internal
workings.  Visiting physicians and  surgeons  knew  little
of what the resident staff  did.  There was no real inspec-
tion  of the work  of  the nurses,  and if a physician had
cause  for  complaint,  the  superintendent  was too  busy
with other matters,  was not used to disciplining nurses,
and  so did nothing."
  Prejudice against  hospitals arose  here, as it had  done
in Europe,  because  of the  neglect  and ill-treatment of
patients  and because the  death-rate from infections was
so high.   A writer as late as  1877  said, in speaking of
maternity hospitals,  "Experience has taught us that any
kind of a home is a safer place for a woman to be delivered
in than any hospital; but there are  cases with no homes
who  must be provided for."1  The change in the attitude
of the public toward hospitals indicates how radical has
been the change in hospital conditions.
  Hospitals in the Revolutionary  War.—At the beginning
of the war the matter of the care of sick and wounded
soldiers was  taken up, and fairly good hospitals  were
eventually established in many places.   After the battle
 1 Dr. T. W. Wise, in the "Review of  the History of Medicine." 
THE   RELIGIOUS  NURSING  ORDERS   107
of Bunker Hill several private houses in Cambridge were
made into  a hospital  and Dr. John Warren placed in
charge;  other hospitals  were established near  Boston.
The  nurses were mostly  men.

         THE RELIGIOUS NURSING  ORDERS
  Almost the only good  hospital  nursing was done by
religious  orders.  Their  members  received a  species of
training, had at least a fair education, and were earnest in
purpose.  For these  reasons their nursing surpassed any
other in quality.
  Sisters of Charity.—The American branch of this order
was founded at Emmetsburg,  Md., in 1809, by Mrs. Eliza
Bayley Seton.  Nursing was only one branch of its work,
but it became an important one.  Their work in Blockley
has been mentioned.  In 1832,  during a great cholera
epidemic,  they  nursed  under  the  city  authorities  in
New  York,  Philadelphia,  and Baltimore.  They  have
always had many hospitals  and asylums of  their  own.
In 1849 they became affiliated with the order of St. Vin-
cent de Paul.
  Other Roman Catholic nursing orders very  early sent
their  members to America for  missionary  work.  The
Sisters of Mercy, the Sisters of the Holy Cross, and others
started  small  communities  and  established  hospitals.
Some of them also did private nursing.
  The Protestant Sisters of Charity, established in New
York in 1845, had in 1854 an infirmary and a dispensary
which were the beginning of the present St. Luke's Hos-
pital.  This order  prepared nurses for work in the  Civil
War by  taking them  for a  few months' work.   Mrs.
Adeline Tylor, a member of this sisterhood who had been
at Kaiserswerth,  conducted  two  large hospitals  during
the Civil War. 
108   OUTLINES  OF  NURSING  HISTORY
  St. John's Sisterhood and the Sisterhood of All Saints,
both Protestant, worked in Baltimore.   It was from the
latter that Sister Helen, the first superintendent of nurses
at Bellevue, came.
  St. Margaret's Sisterhood, an English order, began work
in Boston in 1869 in the Children's Hospital.
  The  Deaconess  Order began its work in America in
1850, when Pastor  Fliedner came from Kaiserswerth with
his  band of deaconesses and  opened Pastor Passavant's
hospital  at  Pittsburgh.   From  that  time  on  many
deaconess hospitals were established in a number of cities,
and many  different  churches have trained deaconesses
in the work of nursing.

                  INSANE ASYLUMS
  Insanity  was so  nearly classed with crime that scarcely
anyone realized that it  needed  human treatment.  It
was far from being  considered  a disease, and was popularly
thought of as incurable.  The  very terms "lunatic asylum"
and "keeper," used until rather recently, were  suggestive
of the  general attitude toward mental troubles.  Up to
1820 insane persons  were  exhibited for payment for the
diversion of the public.   Iron  manacles had  been used
in asylums up to  1886, and all sorts of brutal  restraints
have been common up to our  own time.  Women attend-
ants for insane women were  hardly heard of until about
1800.  The McLean  Asylum,  of Massachusetts,  estab-
lished in 1817, was the first institution of the sort to treat
its patients kindly.
  Dorothea Lynde Dix, a  New England woman,  became
interested in the work of William Rathbone, of Liverpool,
whom  she  knew personally.  She did much for the im-
provement  of prisons and poorhouses in America, but her
chief work  was for the insane.  For twenty years, begin- 
PRIVATE  NURSING
109
ning in 1841, she made investigations, gave publicity to her
findings, and made appeals to nearly every state  legis-
lature.  She not only succeeded in improving conditions
to a marked extent, but she began to educate the public
in the matter.  Her work had a great and lasting value.

                  PRIVATE NURSING
   The care given patients in their homes was very differ-
ent  from that accorded  them  in hospitals.   Hospitals
existed,  as in England, only for the very poor,  and no
one went into a hospital who could possibly be cared for
at home.  Respectable  people felt it a disgrace to send
their relatives to a hospital, and  thought it cruel.  Hos-
pital conditions being what they were, it is easy to under-
stand the prevailing feeling.
   The custom  was for  the most  expert member of the
family to care for the person who was ill; this was apt to
be  the  mother or a grandmother.   Neighbors would
volunteer for "night watching"; this unskilled night  work
assured the giving of medicine or nourishment at the proper
time, but for any skilled  care  required  the  nurse was
called.  If the nurse member of the famity gave out,  some
good  neighbor was sure to volunteer.  Worcester says:
   "The  first specialization in  nursing was the choice of
some in  the community who  were by common consent
held to  be  specially  fitted for such neighborly  service.
It was left  to them to select and teach their successors.
   "During  the  first two centuries in New England, out-
side the larger towns,  there were almost no doctors.  The
art of medicine was practised chiefly by the housewives.
   "Another step toward specialization was taken when
working women were induced to 'go out nursing' for their
living.  Only poor widows and spinsters were thus  com-
missioned.   Such service  was only  occasional; between 
110   OUTLINES  OF   NURSING  HISTORY
times they took in sewing, helped at housecleaning, etc.
These  women became the  professed nurses.   They were
entirely different from the  wretched hospital nurses who
preceded the training-schools.   They  were trustworthy,
hard-working, and sometimes teachable.   Many of them
were better nurses than the average trained nurse  of
today.  .  . .  Much of the bedside watching was excellent
nursing.  These unscientific neighbor nurses  were highly
skilled  in the  art of comforting.  Many of the  old-
fashioned doctors were themselves good  nurses.
  "The greatest pains were taken in every family to pre-
serve and hand down every scrap of knowledge  of the
healing art.  And  so the  scanty bits  of  information
gleaned from the doctors  were treasured and passed on  as
wise sayings for future times of need."1
  These  customs  account  for  the common impatience
with the  trained nurse who refuses to prescribe, and for
the universal expectation that a nurse will know what is
"good  for"  ordinary ailments.   It  also makes us suspect
that our  modern classification  of the provinces of  doctor
and nurse may be artificial, to say the least.
  Miss Linda Richards says of the nurses of the middle
of the  nineteenth century:  "Those women, who by their
kindness  of  heart and cheerful service were called the
born nurses, were  by no means untrained.  Experience,
which is an excellent teacher, together with the instruction
of older women and of the family doctor, provided a prac-
tical and efficient training.  A love for the work  and a
desire to  alleviate suffering made most of them excellent
nurses."
  All agree that there were many good  "monthly"  (ob-
stetric) nurses in those days.
  There were a large number of men nurses, mostly those
    1 Dr.  Alfred Worcester, in  "Nurses for Our Neighbors." 
PRIVATE   NURSING
111
who had been house or body servants and who took  up
nursing as they  grew  older.   After the Civil War there
Fig. 18.—An old-time nurse.   Miss Rosa McCormick of the Boston
                  City Hospital (1864-1897).

were   a  considerable  number  of  men  nurses  who had
served in  hospitals at that time.1

  1 A  Dr. Johnson, of Philadelphia, published in 1819 "The Nurses'
Guide," which he says deals with "a subject never before attempted
by any person."  He gives some very naive instructions, which he
considered  "ample  directions" for all cases.  The  following is a
sample:  "Nurses should be  careful to  carry  out orders  on time,
should keep the room warm and well ventilated, should sprinkle the
floor with lavendar water, vinegar, or strew it with herbs, to prevent
infection."  He directs that  a bed be always made so that it is
higher at the head.   He tells how to prepare a delivery bed in quite
modern fashion, and advises getting maternity cases up on  the third
day to have their beds changed.  In fracture cases he insists upon
the physician being present when the  bed is changed. 
112   OUTLINES  OF   NURSING  HISTORY
          SUMMARY OF IMPORTANT POINTS
  The  first  American  hospitals were  in  Canada.   One
was founded at Quebec in  1639 and one at Montreal in
1644  by  Roman  Catholic   Sisters.   These  hospitals
taught women in  the art of nursing.
  The  older hospitals  of  the United  States  were  usu-
ally connected with poorhouses and were  very dreadful
places.
  Bellevue, of New York, traces its history back to 1658,
but in 1736 it had only one  small ward for the sick.-
  The  Charity Hospital of New Orleans,  founded about
1720, is one of the oldest.  Blockley, of Philadelphia, be-
gan as an almshouse in 1730 and took care of the sick and
insane.  Both it and Bellevue were as bad as the Euro-
pean hospitals of the Middle Ages.
  The Pennsylvania Hospital, of Philadelphia, founded in
1751, claims to be the  first hospital in the  strict sense of
the word.
  Most of the hospital nursing was done  by the  lowest
classes,  paupers,  prisoners, etc.  There was practically
no night nursing.   The death-rate was high, the sanitary
conditions shocking.  These facts accounted for the deep-
rooted popular prejudice against hospitals.
  Insane asylums  were brutally managed until  Dorothea
Dix  began  her  work  of  publicity and   reform.    The
McLean Asylum of Massachusetts  appears to have been
the only exception.
  Roman  Catholic  sisterhoods  had  hospitals  in  the
United  States from about  1800, and did  the best work
there  was.  Protestant sisterhoods  also did nursing.
  Deaconess hospitals  began in 1849 at Pittsburgh, with
nurses from Kaiserswerth, and have always been good.
  Private  nursing was much better than hospital work and
was done  by a very different class. 
SUMMARY  OF  IMPORTANT  POINTS  113
  Doctors were few, so intelligent mothers prescribed for
as well as nursed their families.
  Women and men who were adapted for nursing and had
experience in it naturally became the nurses of the com-
munity.  Such nursing was first done as neighborly help,
later for pay.
  These household nurses were trained,  unsystematically,
by  tradition and experience.
  Doctors did many things which  are now considered
nursing.
  Most authorities  agree that the older private  nursing
was of good quality.
       8 
CHAPTER VIII
THE  RED  CROSS  SOCIETY.   NURSING  IN  THE
                    CIVIL WAR

  The Red Cross Society is, in its original inception, an
association of  citizens, outside of and unconnected  with
any government, who undertake to render effective  help
in time of war or calamity.  In the beginning it applied
only to war, but soon came to include all calamities which
involved a considerable  number of people and which
could not readily be taken care of by local work.
  There were  for many  centuries societies for  helping
the wounded in time of war, and many of them had  done
efficient work.  The Red Cross idea was far bigger  than
anything that went before it, in that  it placed the work
on an international basis and suggested team-work be-
tween nations, a thing almost unthought of before  that
time.
  Its  Origin.—The  plan originated in the mind of Henri
Dunant, a Swiss, and it is the greatness of his conception
to which the  work owes its marvellous effectiveness.
  In 1859 he was traveling in Italy and visited the battle-
field of Solferino on the  day after the great battle.   He
helped in  caring for the wounded, and was horrified and
stirred to the depth by the needless suffering that he saw.
He wrote  a vivid description of it, began lecturing on the
subject, and tried to stimulate action along that line.
  The Plan.—In 1863 Dunant appeared before the Swiss
Society of Public Utility and set forth a plan that he had
formulated.   He proposed to organize in every  country
       114 
THE  RED  CROSS  SOCIETY        115
an association for war relief,  each to  be an independent
society, but with a strong international bond of affiliation,
and with a guaranteed neutrality.
  His plan was  heartily  supported, and later in the year
an international  congress was called to consider the matter.
Official representatives of fourteen nations were present.
The United States sent  no delegate,  as she was in the
midst of the Civil War and harassed with her own prob-
lems.   Neither she nor the Red Cross  convention realized
that the masterly work  which her Sanitary Commission
was doing was along similar lines.
  The Treaty of Geneva.—This congress met again the
next  year,  1864,  and  made  a  formal  treaty  between
nations, providing for neutrality of hospitals and organiz-
ing relief for the wounded on the battlefield.  This agree-
ment  was called the Treaty of Geneva, and it marked an
epoch in the history of the world.  It  was ratified by the
conference at Geneva,  thirty-six persons being  present,
eighteen of them official representatives of their countries.
France and Switzerland  were  the first to sign the treaty.
Organizations were  already  under way  in  twenty-five
countries.
  The plans adopted by  that convention have never been
modified, proving how sound  were their underlying  prin-
ciples.   The treaty declares that all sick and wounded men,
surgeons,  nurses, attendants, ambulances and sanitary or
surgical supplies shall be regarded as  neutral when they
are under the sign of the organization.1  The well-known
emblem of the society was adopted at the signing of the
treaty.
  Growth of the  Idea.—In some countries similar  societies
were found to be already in existence; these were affiliated
  1 In the present European War bitter criticism has resulted because
Red Cross workers  have been fired upon on battlefields. 
116   OUTLINES  OF  NURSING  HISTORY

or absorbed, keeping the original idea  of  co-operation.
Women have, from the first, been prominent in the work
of the society.
  The Red Cross has always held it  of prime importance
to have official recognition, though  no  government  does
anything directly for the organization.
  Switzerland has always been the  center of Red Cross
organization  and  a  clearing-house  of  information  con-
cerning  methods, equipment, etc.  M. Moynier, a Swiss,
is chairman of its permanent central committee.
  Methods of Work.—The  society plans that in time of
peace it shall  prepare  for war  or  disaster.  It trains
nurses for service, and lays in stores of all sorts ready to be
sent out at an hour's notice.
  Its wonderful organization has been  shown repeatedly
when governments were helpless  because of their official
red tape and could get neither men  nor supplies quickly,
while the Red Cross met the need  in  one  or two day's
time.
  In great natural  calamities, such  as  floods, earth-
quakes, etc., the Red Cross often provides funds for a gift
or loan to those who need help in rebuilding their homes
or re-establishing their business.
  In most  of  the European countries  the  society main-
tains its own hospitals and trains nurses in  them,  so that
the "Red Cross nurse" is a familiar figure.  In America
dependence is placed upon using nurses trained in the regu-
lar hospitals, who stand ready  to  render  service upon
call.
  A  Typical  European  Organization.—Germany  has
doubtless  the most  perfect  Red  Cross   organization.
The Kaiser is at the  head of the Central  Committee, which
has  branches in every important city.   Each branch has
standing orders  for its work  in  war.   The Red Cross 
THE  RED  CROSS  SOCIETY        117
hospitals care for the poor, train nurses, and give courses
of lectures with  demonstrations to lay men and women.
In war or epidemics these lay workers help in hospitals 
118   OUTLINES  OF  NURSING   HISTORY

so as to release the nurses for the field, or do work at the
front for which they are suited.  The Red Cross nurses
care for sick soldiers in time of peace.
  These  nurses are entirely  under the  control of  the
organization,  though  they are  at  liberty to leave  the
service at any time.  They receive their living,  clothing,
and a very small salary, and  when old are cared for or
pensioned.
  The Red Cross in the United States.—Our own country
was the thirty-second to enter the Red Cross. It was asked
to join in 1866, but did not  accept, and again  in  1877,
when it still neglected to act.   In 1882 Clara Barton, who
had worked all through  the Civil War and had later seen
the work of the Red Cross abroad, succeeded in  persuad-
ing her own country to undertake the work and give it
official recognition.   She established the work here, and
was for many years at its head.   Some of the disasters in
which it has helped are  as follows:
   1881,   Michigan forest fires.
   1882-83, Mississippi floods  (and many times since).
   1884,   Ohio floods (and many times since).
   1885,   Texas famine.
   1886,   Charleston earthquake.
   1888,   Florida yellow fever.
   1889,   Johnstown flood.
   1898,    Spanish-American War, and following it the
              regeneration of Cuba.
   In every calamity which has befallen,  the Red  Cross
has been almost the first to bring effective help.
   The Red  Cross Nursing Service in  America.—For a
long time the society had  no regular  nursing service in
the United States.  In the  Spanish-American War nurses
served under  the government,  though the  Red Cross,
especially its Auxiliary  No. 3, supplied  both funds and 
THE  RED  CROSS  SOCIETY        119
nurses.   After that war  the Army Nurse Corps (q. v.)
was  organized.  After  the  reorganization  of the  Red
Cross a  group of  its officials, in 1904, met a group of
nurses and discussed the matter of formally establishing a
Red Cross nursing service.   In 1909 the Red  Cross War
Relief Board appointed a central committee  of  nursing
service, on which were ten nurses.  Miss Jane A. Delano
was made chairman of  this committee, and has remained
in that position up to the  present time.
   According  to   the  present  arrangement,  the Army
Nurse Corps and the Red  Cross Nursing Corps are closely
related,  so that  in time of war there is no friction, but
cordial and  practical  co-operation.   Each  state has  a
          Fig. 20.—American Red Cross Nurse's Pin.

branch of the national corps, with a committee of nurses
who pass upon applicants  for the service.1  There  are
standard  requirements for  entrance into  the  service.
Nurses  promise to  go when called, but excuses are  ac-
cepted and a nurse may refuse her  service without losing
her standing.

  1 In the  present war a great number of  candidates have  pre-
sented themselves and  the Central Committee  has drawn the lines
closer so as to exclude all but the most desirable applicants.  They
take only women in  the prime of life (twenty-five to forty years),
and make character  an important consideration.  A recent ruling
limits membership to graduates of general hospitals having a daily
average of 50 patients. 
120   OUTLINES  OF   NURSING  HISTORY

  The United States Sanitary Commission.—The simul-
taneous springing  up of  the  Red Cross Society and  the
U. S. Sanitary Commission is one of the great coincidences
of history.  Neither knew of the other's  work  until it
was fully  organized  and  in operation; yet  the  principles
and course of action in each were nearly identical.  Both
organizations marked the beginning of the joint work of
men and women in a public way.
  The Commission  was established  early  in  the  Civil
War by men and  women who saw that the government
needed help, but was not ready to admit it.  When  the
first offered supplies and service, the Government Medical
Bureau looked upon the proposal with suspicion; but its
dire need soon forced it to accept.  The Commission col-
lected and distributed supplies of all sorts, planned camps
and attended to their sanitation, tended the wounded on
the field and in hospitals;  in short, undertook  a  large
share  of the  health work for the army.   It  has  been
called  "the largest  army charity  the world  had ever
seen."
             NURSING IN THE CIVIL WAR

  At  the  beginning of  the  Civil War the government
turned for nursing  aid to  the Roman Catholic Sisters, who
in their well-established  hospitals were doing such good
work.  The sisters were already organized,  were  used to
discipline, were obedient to authority, and  were  outside
the temptations of adventure and romance which might
attract other women.  They were clearly the best persons
for the task.
  The Sisters of Charity, the  Sisters of Mercy, the Sisters
of St. Vincent, the Holy Cross Sisters, and many others
served in the war, caring for soldiers in their own hospitals,
in army hospitals,  and on  the  battlefield itself,  even 
NURSING  IN  THE  CIVIL  WAR     121
working under fire.   The nursing in some of the largest
and best government hospitals was in their charge.   The
Satterlee Hospital at Philadelphia, under Mother Gonzaga,
and the one at Mound City, under Mother Angela,1 were
notable examples.  The  Sexton  sisters  of New York,
Mother Francis of Chicago, Mother Anthony O'Connell
of Cincinnati, and others did conspicuous service.
  Yet these hundreds of devoted sisters were not enough
to care for so many wounded.  Lay women in hundreds
were needed to supplement them, and they answered the
demand.  Within thirty days after Lincoln's call for men
in April, 1861, the Woman's Central Committee of New
York had selected—out of hundreds  of applicants—one
hundred women for army service, and  had put them into
Bellevue,  St. Luke's, and other  hospitals for a month's
preparatory training.  They recognized the insufficiency
of this so-called training, but it was much better than
none.
  A Superintendent  of  Nurses Appointed.—In  June,
1861, the  Secretary  of War  appointed  Dorothea  Dix,
famous for  her reforms in insane hospitals, as Superin-
tendent of Female Nurses for the Army, giving her entire
control.  Miss Dix was then a woman past sixty, and while
she did good work, it was  not to be compared with her
earlier activities.
  The War Nurses.—Women  from  all parts of  the
country offered their  service.  Miss Dix  gave preference
to middle-aged  and plain-featured women. Some whom
she refused  applied direct to the Secretary of  War,  and
were accepted.   Many young married women went with
their  husbands'  regiments,  and  proved  so useful  that
they were allowed  to remain.   Over two thousand lay
women served as nurses during the four years of the war.
               1 A cousin of James  G. Blaine. 
122   OUTLINES  OF   NURSING   HISTORY
   Many men, ex-patients, orderlies, men unfit for active
 service,  etc., were  nurses  all during  the war.   Public
 opinion was still inclined to the doctrine that men should
 care for men.
   In the West Mrs. Mary A. Livermore did an enormous
 amount  of unofficial work.   She organized soldiers'  aid
 societies,  collected and distributed quantities of supplies,
 and by order  of the Secretary of War selected and  de-
 tailed nurses for duty in the hospitals.
   Mrs. Adeline Tylor, of Baltimore, was in charge of a
 hospital  at Annapolis and one at Chester.
   Miss Helen  Gilson  organized a hospital kitchen at
 Richmond, Va., not unlike Miss  Nightingale's at Scutari,
 and equally valuable in its work.
   We are told how "Mother" Bickerdyke, who served for
 four  years  and was in nineteen battles,  used to go at
 night, after a great battle, and by the light of her lantern
 look over the dead bodies left on the field, to be sure that
 no one who was still living had been overlooked. Her
 pitying soul could not bear the thought that some mother's
 son might be dying  out there in the dark because he was
 too weak to make the sign of life.
   The Hospitals.—Temporary hospitals were made of any
 buildings at hand.   Other structures were hastily erected
 of boards,  or tents were pitched.  Public buildings were
 commonly used.  At one time the Capitol at Washington
 was turned into a hospital,  four  hundred wounded being
 nursed in the Senate and the House and three hundred in
 the rotunda.   Hospital steamers are said to have orig-
 inated in this war, many  being  in service along  the
 Ohio and Mississippi.
  A Typical Good  Hospital.—A nurse1 who served for
over three years tells of the work at the Satterlee Hospital,
        1 Mrs. Margaret Hamilton, of Wakefield, Mass. 
NURSING  IN  THE  CIVIL  WAR     123
just outside  of Philadelphia.   The  buildings were plain
wooden structures, hastily built, with very large wards.
They accommodated five  thousand patients, and there
were tents set up for two thousand more.  Dr. Isaac
Hayes, of Arctic fame, was in charge, with Mother Gon-
zaga at the head  of the nursing.   Many noted surgeons
served here  without pay,  some coming from Europe for
the  experience.  Dr. John S.  Billings was assistant su-
perintendent for a time.
   There were ward masters and orderlies who did as much
of the nursing as they  could, such as baths, enemata, etc.
The women  nurses dressed wounds,1 gave medicines, at-
tended to the diets of the very sick,  and did only what the
orderlies and men  helpers could not do.   There were only
about forty nurses for this enormous hospital, and about
one hundred orderlies.  Convalescent patients helped as
they were able, and willing help was the rule.   There were
usually plenty of  supplies.
   Neither doctors nor nurses regarded their work ideal,
but did "just the  best they could."  The hours of  duty
were long, as  night  nursing  was  not developed.  The
nurse above referred to, in three years' continuous service,
was away from the hospital  only  twice.  Many nurses
never used their salary ($12 a month) for themselves, but
spent it on comforts for the soldiers.
   The work was very irregular.  After a battle, when the
wounded  poured in by hundreds, everyone worked con-
tinuously, day and night, until the emergency was over.
The operating rooms could not accommodate the surgeons
at such times, and much operating had to be done in the
wards.  Amputations were common.  We are told of the
big tub into  which were  thrown the legs, arms,  hands,
  1 Nearly  all  wounds were infected  (see Chapter X), and wet
dressings, changed frequently, or poultices, were much used. 
124   OUTLINES  OF   NURSING  HISTORY

pieces of ears, etc., which had to come off in the rush of
surgery after a great battle.
  There were many medical cases, fever, dysentery, and
even small-pox (which was cared for in a separate build-
ing).  Many nurses died of diseases contracted  while on
duty.
  The Dark Side.—Despite all efforts, many soldiers had
insufficient care and many died from neglect.  After some
battles the wounded were laid in open sheds or temporary
shelters by the hundreds, without bedding, and with only
a few surgeons to look after them.  The so-called ambu-
lances were often only springless wagons which, with a
load of four men  each, bumped for hours over badly kept
roads, until some of their human freight died in agony.
  The death-rate in the Army of the Potomac was 6.5 per
cent, of the cases treated.
  As late as 1865 a hospital patient reported: "The ward
master is a person who cannot read nor write.  There are
no women here.   The nurses are  citizens  paid by the
government, and  a filthy, saucy crowd they are."
  The author of  "Hospital  Pencillings"1 tells  how she
went to  the  front  absolutely  untrained, and worked as
"lady nurse"  with doctors who resented her  presence.
The patients usually preferred women nurses, but some of
the surgeons  called them "permitted nuisances."   She
speaks of the supplies, twenty-six shirts for seventy-seven
men, laundry being done by anyone who could be found
to undertake it; one hundred and  fifty men's wounds being
washed with one sponge, with the result that fifty became
gangrenous; of a ward, called by the doctors "the gangrene
ward," which was christened "purgatory" by the patients.
  Louisa Alcott's Account.—In "Hospital Sketches" Miss
Alcott has  given  a  picture of  the work of the untrained
                   1 Elvira J. Powers. 
NURSING  IN  THE  CIVIL  WAR     125
women at the front.  She says of her work in Washing-
ton: "Round the stove was  gathered  the dreariest group
I ever saw—ragged, gaunt,  and pale, mud to the knees,
with bloody bandages untouched since put on days before.
Presently Miss Blank put into my hands basin,  sponge,
towels, and a block of brown soap, saying, 'Come, begin
to wash as fast as you can.  Tell them to take off socks,
coats, and shirts, scrub them well, put  on clean shirts, and
the attendants will  finish them off and lay them in bed.'
  Fig. 21.—Memorial statue to the nurses of the Civil War.  By
Bella L.  Pratt,  sculptor.  Statue stands in the  State  House  at
Boston.
  "My first lesson in dressing wounds.  Dr. P—, whose
aid I was, had served in the Crimea; .  .  . turning up his
cuffs, whipped out a very unpleasant looking sewing case,
cutting, sewing, patching and piecing, with the enthusiasm
of an  accomplished surgical seamstress, explaining  the
process in scientific terms to the patient meanwhile.
  "The amputations  were reserved until the next day.
Then came the doctors' evening visit,  .  . .  the adminis- 
126   OUTLINES  OF  NURSING   HISTORY
tration of medicines, washing feverish faces, smoothing
tumbled beds, wetting wounds, singing lullabies, prepara-
tion for  the night."
  Fig. 22.—Mrs. Rebecca Price, President of The Civil War Nurses,
one of the women in whose honor the splendid memorial is being
erected.   (Courtesy of "The Trained Nurse and Hospital Review.")


  Our Veteran Nurses.—Having in mind that the major-
ity of the Civil War nurses were middle-aged at the time
of their service, it is not surprising to find that but few of 
SUMMARY  OF   IMPORTANT  POINTS  127
them remain at the present time.  The official roll now
contains but two hundred names, though there are doubt-
less  others who did not receive government recognition,
but  who  did long  and faithful service.  They have an
organization, The Civil War Nurses, of  which Mrs. Re-
becca Price is president.
  A memorial building to these self-sacrificing women is
being erected in Washington,  a portion of its cost  being
borne  by the  government.  It will be used  as a per-
manent home for the American Red Cross.

          SUMMARY OF  IMPORTANT  POINTS

  The Red Cross Society is an international lay organiza-
tion, organized for the  purpose of caring for the wounded
in war and for the distressed in time of peace.
  It was founded by Henri Dunant, a Swiss, who outlined
its policy.
  Its first official act  was the signing of the Treaty of
Geneva, in 1864, which provides for the strict neutrality in
war  of all supplies and persons who bear the sign of the
society.
  The United States did not  enter the  Red Cross until
1882, when a branch was organized under the leadership
of Clara Barton.
  In Europe the Red  Cross  has its own hospitals and
trains  nurses, also  giving short courses to laymen.  In
America it depends  for its supply of nurses upon  those
from the regular hospitals.
  The service of the Red Cross has always been remarkable
for its  perfect organization, its quickness to  move, its all-
round efficiency.
  The U. S. Sanitary Commission was a lay society of the
Civil War, working along lines similar  to  those of the 
128   OUTLINES  OF  NURSING   HISTORY
Red Cross.   It did remarkable work  when the govern-
ment was not equal to the task.
  The nurses in the Civil War were Roman Catholic
Sisters, lay women who had received a short training, and
a certain number of those quite untrained.
  Dorothea Dix was  Superintendent of Female Nurses.
In the West Mary A. Livermore did much unofficial work.
  The nurses worked in huge hospitals, in field hospitals,
and on the battlefield itself.  They encountered dangers
and did hard work  with great devotion.
  About two hundred of the Civil War  nurses are  still
living.
  A memorial building to the nurses of the Civil War is
being erected in Washington which  will house the Red
Cross Society. 
CHAPTER IX
 THE  FIRST TRAINING-SCHOOLS IN AMERICA

  There are several claimants for the honor of having
first trained nurses in America.  It would be unwise to
attempt to  say whose this distinction is; but it is certain
that there were a number of persons whose insight led them
to see the need of training for nurses and  to attempt to
supply it.  Those who  succeeded in effecting permanent
organizations are merely  the  fortunate inheritors of the
work of those who paved the way, often  by  crude  and
temporary efforts, but whose  faces were toward  the goal
which their successors reached.
  Beginnings.—Doubtless the  first attempt  to train
nurses was  that made by the  Ursuline Sisters of Quebec,
who about 1640 taught the savage women to care for their
sick.
  The  family of Dr. Valentine Seaman, of New  York,
holds that he was the first  person  to found a school for
nurses.   His son says,  "In 1798 Dr. Seaman introduced
the first  regular school for trained nurses, from  which
other  schools have  since been established."   He  had
about twenty-four pupils, and gave them a course of lec-
tures in anatomy, physiology, care of children, and mid-
wifery.  In 1800  a synopsis of these lectures was published.
The report  of the New York Hospital for 1882 says:  "As
long ago as the early part of the present century Dr. Valen-
tine Seaman, connected with this  hospital as attending
surgeon up  to his death in 1817, was in the habit of giving
      9                                    129 
130   OUTLINES  OF   NURSING   HISTORY
regular instruction to the nurses by lectures and otherwise.
Thus early was foreshadowed the more elaborate system
which has recently taken shape in the modern training-
school."
  Dr. Joseph Warrington, of Philadelphia, for a long time
cherished the idea of training nurses in  midwifery,  and
Fig. 23.—Dr. Valentine Seaman, Attending Surgeon to the  New
  York Hospital, 1796-1817.  One of the first to teach nurses.

about  1839 began the work in a small way,  under the
Nurse  Society  of  Philadelphia, an organization for the
care of the poor in their homes.   His pupils  were of a
good class, were taught at the Philadelphia Dispensary in
the same  classes with medical students,  were given de-
monstrations upon a  manikin, etc.   They spent  their 
FIRST  PERMANENT  TRAINING-SCHOOLS 131
whole time with one patient, and were paid $2.50 a week
by the Society.
  In 1849 a home was established for these nurses, and
they were  called pupils.   The  training was extended,1
they took medical and surgical cases as well as obstetric,
and were granted a  "certificate  of  approbation."  Early
reports call this "the first nurse training-school founded
in America, in  active operation since  1828."  In 1867
they had a long list  of "graduate nurses."
  The New York Infirmary for Women is said to have
trained nurses early, with the idea of supplying them to
private families.
  In  1861  the  Philadelphia  Woman's   Hospital  had
offered training to nurses, but no one applied until 1863,
and the school was not active until 1872.

     THE FIRST PERMANENT TRAINING-SCHOOLS
  The New England  Hospital  for Women,  of Boston,
Mass.,  an organization  composed entirely  of  women
physicians, claims and  is acknowledged to have the oldest
training-school for nurses in America.  The work prob-
ably began soon after Dr.  Marie  Zakrzewska took  the
Chair  of Obstetrics  in 1859.  She was a  German, had
studied in Berlin, graduated in medicine at  Cleveland, 0.,
and had taken an active part in founding the New York
Infirmary for  Women.  She suggested  that the women
medical students receive  practical instruction  in  the
hospital, and that a training-school for nurses be estab-
lished.  She trained  six nurses during her first two years,
but they were not given certificates.
  This hospital was  the first to  be granted a  charter for
a training-school for  nurses, it being included  in the hos-
pital charter of 1863.  At that  time about thirty nurses
      1 One authority states that the  course was two years. 
132   OUTLINES  OF  NURSING  HISTORY
had  gone through training  in  obstetrics, but  were not
certificated and were not called graduates.
  When  the New England  Hospital moved into a  new
building  in 1872,  with  Dr. Susan Dimock in charge, the
present  training-school was begun.  Dr.  Dimock  had
Fig. 24.—Dr. Marie Zakrzewska.
finished her medical education in Switzerland, had been
to Kaiserswerth, and knew its methods.  The success of
the training-school is  due chiefly  to her,  though  Dr.
Zakrzewska taught the bedside nursing.  There was  a
course of twelve lectures given the nurses, which was also 
FIRST  PERMANENT  TRAINING-SCHOOLS  133
open to outsiders, many of whom attended.  The nurses'
course was one year.1
  One of the first five pupils who entered here was Miss
Linda Richards.  She is, with justice, called "America's
first trained nurse."   Her  life  has  comprehended  the
whole story of trained nursing in this country.   Every
Fig. 25.—Dr. Susan Dimock.
nurse should read  the fascinating  story as told in her
"Reminiscences."
  Miss  Richards had  been a  nurse in the Boston City
Hospital.2   She had been offered a position as head nurse

  1 It was lengthened  to sixteen months, and in 1877 to eighteen
months,  when it included diet kitchen, contagious,  and district
work. Not  until 1893 was a two-year course established.
  2 She had gone there with the idea of learning nursing, and had
been greatly disappointed to find that the nurse's work and position
was little more than that of a maid. 
134   OUTLINES  OF  NURSING  HISTORY

there, but had refused it upon the ground that she did not
know enough and wanted some training; they had directed
her to the New England Hospital.
  She tells of the training.  The nurses rose at 5.30 a. m.
and retired at 9 p. m.  Their rooms  were  between the
wards and they had charge of the patients both day and
night, having  often  to get  up  several  times a  night.
After six months, when the second class of nurses entered,
a night nurse was put on.    There were no  hours off and
no time off on Sunday.   An afternoon off was given every
two weeks.   The nurses wore washable dresses, but not a
uniform.  "The practical  instruction  was  given by the
young women  interns.   If we  did badly, an intern was
told to give  us further teaching.  The instruction some-
times amounted to  a  consultation  between intern and
nurse as to the best  way of doing the service in question.
Great care was taken that we should not know the medi-
cines given; they were numbered  only.1   We had  no
text-books and no examinations.  We were  simply given
a diploma when we got through."2
  When  Miss  Richards  graduated  she was  asked to
remain as head nurse;  Massachusetts General  Hospital
asked her to take charge of their newly organized training-
school; Hartford Hospital offered her a position as head

  1 This practice was common in many hospitals,  and  survived as
late as 1907.
  2 The other graduates of this first class were:  Mrs. Wolhaupter,
who was at Bellevue as head nurse, then as night superintendent,
superintendent of a maternity hospital in Brooklyn, and head of the
training-school at Massachusetts  General.   She died  some years
ago.  Miss Molesca A. Woods, who was head nurse at Bellevue and
Massachusetts General,  and night superintendent  at the  Boston
City Hospital.  Miss Caroline Stapfer, who did  private  nursing
and massage in Boston  and Los Angeles.   Miss Thayer, who did
private duty. 
FIRST  PERMANENT  TRAINING-SCHOOLS  135
nurse;  Bellevue,  New York,  wanted  her  for  its night
superintendent, and she accepted.
  The  Interest of Doctors in Nurse Training.—It was in
1869 that the medical profession of America first went on
record  as favoring nurses'  training.   That year a  com-
mittee, with Dr. S. D. Gross as chairman, was appointed
to look into  the  matter.   They reported:   "There is a
marked diminution of mortality in  hospitals  where the
nursing is done by trained  women, a decided decrease in
expenditure, and a great improvement in the moral char-
acter of  the  inmates."  They recommended:   (1) That
every  large and well-organized hospital should establish
a school to train nurses for both hospital and private work.
(2) That district schools of nursing should be formed and
placed under  county  medical societies for  their instruc-
tion.   (3) That nurses' societies should be formed and
their members given preference in their work.   This out-
line plan certainly  showed remarkable insight  into the
possibilities of the trained nurse.
  The  Bellevue, Connecticut,  and Boston  Schools.—
The next year,  1873, was a notable one,  since in that
year were established three of  the  important training-
schools of the country—Bellevue, New York, in May;
the Connecticut Training-School, New Haven,  Conn., in
October; and  the Boston Training-School,  at Massachu-
setts General Hospital, Boston,  in November.
  It is interesting to note that the New York and Boston
schools were the result of the efforts of committees of lay-
women, and  were opposed by doctors; while  the  New
Haven school  was pushed by doctors.
  Bellevue.—In 1871  a woman's visiting committee had
asked that an attempt be made to have a nurses' training-
school.  The  matter was referred to the Medical Board,
which  did  nothing  whatever about it. In  1872  Miss 
136   OUTLINES   OF  NURSING  HISTORY
Louisa Lee Schuyler organized the New York State Char-
ities Aid  Association,  and  one of  their visiting com-
mittees inspected Bellevue Hospital, finding  a  seriously
bad  state of affairs.  The nursing was  done chiefly by
women who were ex-convicts, who collected fees from the
patients for the crude and inefficient services  which they
rendered them; drunkenness and foul language were com-
mon.  There were no night nurses, but three night watch-
men made rounds among the eight hundred patients.   It
was a repetition of the worst days in the hospitals of Old
England.   Dr.  Gill Wylie, who was an intern  there, said,
"The nurses had the impossible task of attending to from
twenty to thirty patients each.   The night watchman was
expected  to  attend  to patients who required  it.   The
wards  looked well on  the surface; but sepsis  followed
slight operations or injuries, and about 50 per cent, of the
amputations  were fatal.  One out of every eleven mater-
nity cases died."
  The  report of these conditions stirred the  committee,
and they  felt that there was no hope unless the nursing
could be improved.  Most of the Medical Board disap-
proved of  their interest in the  matter.  General James
Bowen was the  only commissioner who supported them.
A clergyman  said publicly that it was not proper for ladies
to visit a hospital of this sort.
  Dr. Wylie  offered to go abroad, at his own  expense, to
see what  was  being done there.  He spent  some time
doing this, met Niss Nightingale, and got valuable advice
from her.   Meantime the  ladies, under the leadership of
Miss Schuyler,1 had succeeded  in getting  six wards set
apart for  them to use in  making  the  experiment of a
  1 The National Institute of  Sciences recognizes Miss Schuyler
as the founder of Bellevue's training-school. 
FIRST  PERMANENT  TRAINING-SCHOOLS  137
nurses' training  class.   Funds  were raised  by subscrip-
tion and a house rented for the nurses' home.
  The committee was much distressed over the problem
of finding a superintendent for the school, when Sister
Helen, trained in England,1 offered her services.  Before
this time she had worked in hospitals where politics held
sway, and knew how to deal with the situation.  She was
a strict, austere woman, with  quiet  firmness—the only
type that could succeed under  such circumstances.  She
made a place for herself and her nurses, and kept it.
  Some of the former nurses wished to enter the school,
but  effort was  made to  exclude the servant class and  to
get educated women.   This was regarded by most per-
sons as impractical.  One of the physicians said, "I do
not believe  in the success of a  training-school for nurses
at Bellevue.  The patients are of a class so difficult  to
deal with and  the service is so laborious that the con-
scientious, intelligent women you are looking for will lose
heart and hope."
  In a year's time the school had gotten a firm hold of the
work, and four more wards were given  to them.  The first
class of six2 graduated in May,  1875, having completed a
course of two years, though the first year only was re-
garded as training.
  No uniform  was worn, as the pupils did not like the
idea; finally a wealthy and  beautiful nurse put on a uni-
form;  the  others  were impressed  with her appearance,
and it became the custom.3

  1 She was a member of All Saints' Sisterhood, working in Balti-
more.
  2 Seventy-three had applied  for training,  and twenty-nine had
been  accepted; some were dismissed and some dropped out.
  3 They wore a white cap and  apron and brown linen half-sleeves.
For the first few years the winter dress was of gray wool. 
138   OUTLINES  OF   NURSING   HISTORY
  Miss  Linda Richards became night superintendent in
October, 1874.  At that time no records were kept  and
there were no written orders; it was Miss Richards' notes
for  one  of her nurses that started  the practice of keep-
ing  records and writing orders.   There was no class work
and the lectures were very irregular.   "The  training did
not compare favorably with that given at the New England
Hospital,  where  far greater nicety in caring  for patients
was required."1
  Within  a  short  time  the doctors began  to approve of
the  school.   They found  that they were  getting better
results than they ever had, and that they might attempt
things which had hitherto been impossible.
  Sister Helen left in May, 1876.  She was succeeded by
Miss Eliza Perkins, a woman who was not a nurse, but who
did  excellent service for fifteen years.
  The Connecticut Training-School.—In 1872 the New
Haven (Conn.) Hospital appointed a committee of three
doctors2 to  report upon  the practicability   of training
nurses.  Dr. Gill  Wylie's  report upon  European train-
ing-schools  aided  them in  their  investigation.   They
reported  in  April,  1873,  that  it  was not expedient
for  the  hospital itself  to  undertake  such  a work,  but
that they recommended the establishment  of a  school
as  a separate  organization,  with the  hospital  as its
field.
  The school obtained its charter before Bellevue did, but
was not opened until after Bellevue.   Dr. Francis Bacon,
after a study of the English schools, made out a scheme of
organization.  The school was founded, but there were no
pupils.  They advertised for probationers through country
     1 Linda Richards.
     2 Mr. Charles Thompson also had a hand in the work. 
FIRST  PERMANENT  TRAINING-SCHOOLS  139
newspapers, ladies' missionary societies, notices at railway
stations, and  in post-offices.1
  The school  started October 1, 1873, with three pupils.
The nurses wore no uniform.  The superintendent ate in
the basement with some of the  men patients.   The doc-
tors liked the work of the nurses and were, from the first,
enthusiastic over the school.  Very shortly the school was
allowed to take eight pupils, and at the end of its second
year the pupils were sent into private nursing.   The public
took kindly to them and there was an immediate  demand
for their services.
  In  1879 the school  compiled  and published  its  own
text-book of nursing.  This was the joint work of doctors
and nurses, and as such is notable.
  The Boston Training-School.—In 1807 the  Massachu-
setts  General Hospital had been started by  a group of
prominent doctors.  It was a private enterprise,2 though
designed for non-paying patients.  It was a  model  hos-
pital for the time, noted for its cleanliness and good nurs-
ing.  Mrs. G. L. Sturtevant, who was nurse there  in 1862,
tells us of the conditions of work:  "The nurses were  paid
$7.50 a month, head nurses $12.   There were no maids;
the nurses washed the dishes and did the cleaning.  The
night watchers left the wards at 5 a. m., making a verbal
report to the head nurse.  The day nurses went on duty at
that hour, had breakfast at  six,  and remained  on until
9.30 p. m., taking  an occasional  hour off if they could get
it.  They slept in small rooms between the wards,  two

  1 All the early training-schools found it hard to convince young
women  that it was necessary to spend even six months'  time in
learning nursing.  The Civil War had, however, done  much to call
attention to the need of training.
  2 It was probably  the first  American example of a private cor-
poration that established a hospital. 
140   OUTLINES  OF  NURSING  HISTORY

nurses in a folding  bed.  In the daytime the room was
used for doctors' consultations or for dressings and minor
operations."
  The hospital had much better nurses than any other of
which we have a record.   It was far from being the dread-
ful  place that  Bellevue  was. Its  training-school came
about from a wish to help nurses rather than to improve
the hospital.
  Miss Cabot, a sister of Dr. Samuel Cabot, of Boston,
was  one  of  a committee of the  Woman's Educational
Union to  find  out  what could be  done  toward giving
American  women a chance  to be  self-supporting.  She
talked with  Mrs. Samuel Parkman and  they concluded
that nursing  could  be  made to attract a  good class  of
women.  Mrs. Parkman was on the training-school com-
mittee of the New England Hospital, and also knew Miss
Nightingale.  Dr. Wylie  was applied to for information.
Dr. Susan Dimock helped and encouraged.
  The committee which was  formed  to present the matter
to the Massachusetts  General Hospital consisted of a
group of men and women of intellect and  social promi-
nence. The  hospital trustees and staff  did  not take
kindly to the idea of a training-school for nurses, but the
standing of the committee was such that they were com-
pelled to consider it.
  It was finally agreed that the hospital should  allow the
school to nurse two wards as an experiment.    Subscrip-
tions were  secured  for the  expenses of the school, and
pupils were advertised for.   Six  probationers  were  ac-
cepted, and  on November 1, 1873, the Boston Training-
School became a fact.
  As no trained woman was to be had for a superintendent,
they selected Mrs. Billings, who had had charge of a hos-
pital during the Civil War, and sent her to Bellevue for 
FIRST  PERMANENT  TRAINING-SCHOOLS 141
two  months'  instruction under  Sister Helen.   She re-
mained with the training-school  but three months how-
ever, and was succeeded by Mrs. Mary von Olnhauser,
who  stayed ten months.   The woman's committee  at-
Fig. 26.—Miss Linda Richards in her prime.  (From "Reminiscences
    of Linda Richards," published by Whitcomb and Barrows.)

tended the nurses' lectures, looked over the pupils' notes,
and helped with examinations.   A noteworthy fact was
the class in  preliminary  work which  was  started  in
January, 1874. 
142   OUTLINES   OF  NURSING  HISTORY
  At the end of the first year  Miss Linda Richards be-
came  superintendent of  nurses.   She found  the school
still on trial and rather discredited by the staff, who did
not regard it as a success.  She saw that the nurses  were
doing their  work much as  their untrained predecessors
had, doing dish-washing and dining-room work, washing
poultice cloths,1 taking  turns  between  times at doing
night duty and being head nurse.
  Miss Richards reorganized the work, got classes under
way, and developed the school in  a remarkable manner.
By the end  of her first year  she had convinced the  doc-
tors that the new regime was a success, and the school was
accepted by the trustees as a part of the hospital.   (It
remained  a  separate organization until  1895.)  Miss
Richards remained for two and one-half years, and when
she left to  study  training-school  work  in England  the
school was on a permanent basis.

          SUMMARY OF IMPORTANT POINTS
  It is difficult to say who was actually the first  to train
nurses  in  America,  as there are several  who  claim the
honor.
  The Ursuline Sisters of Quebec, about 1640, taught the
Indian women to care for the sick.  Dr. Valentine  Sea-
man, at the New York Hospital, beginning in 1798, taught
nurses for many years.   The Nurse Society of Philadel-
phia  gave  training  in  midwifery  about  1840.   The
Philadelphia Woman's  Hospital  offered  training  from
1861 on, but did little for some years.
  The  New England Hospital  for Women,  at  Boston,
founded in 1872 what was probably the first permanent,
   Cotton was expensive, so all soiled dressings and poultice cloths,
of which there were many, had to be washed (in the patients'  bath-
tub) and ironed by the nurses. 
SUMMARY  OF  IMPORTANT  POINTS  143
systematic school for nurses.    Dr. Susan Dimock was in
charge, and Dr. Marie Zakrzewska taught nursing.   No
text-books were used.   The course was one year.  Miss
Linda Richards was the first nurse to receive a diploma.
  In  1873 three training-schools were founded: Bellevue,
of New York; the Connecticut Training-School, of New
Haven, Conn., and the Boston Training-School at Massa-
chusetts General Hospital.
  Bellevue's  school  was  founded  by a  committeee  of
women, under Miss  Louisa Schuyler, and helped by Dr.
Gill  Wylie.  The school  began under great opposition,
but shortly made good.  The training was one year, but
nurses were required to remain two years.  Sister Helen
was the first superintendent, and  was followed by Miss
Eliza Perkins.  Miss Linda Richards was night  super-
intendent  the second year.
  The Connecticut Training-School grew directly from
the hospital itself,  being organized by the doctors.  The
school published a text-book of nursing in  1879.
  The Boston Training-School  was  designed primarily
to make  nursing  a high-class  occupation  for  women.
The  Massachusetts General Hospital was already excel-
lent and felt no need of the school.  It was not an entire
success until Miss  Linda Richards  took charge,  when it
speedily reached a high standard and was accepted by the
hospital trustees and doctors as a successful innovation. 
CHAPTER X
THE WORK OF GREAT SCIENTISTS AS RELATED
                   TO NURSING

  The Nineteenth Century's Contribution to the  Care of
the Sick.—The nineteenth century produced a group of
persons, practically contemporaries,  who in fifty  years
did more than all those before them to change and im-
prove not only the practice of medicine and surgery, and
of nursing, but the whole trend of the care of the sick.
  These men were contemporaries of Florence Nightin-
gale, and her work fitted in with theirs in  a marvellous
way.  They reshaped nursing practice; she  reshaped the
nurse.  They revised, improved, and elaborated methods;
she gave them nurses  capable of carrying  out the new
methods.  They invented a new technic; she  produced
women who could be depended  upon to carry out that
technic.
  Significant Dates.—A comparison of dates brings out
the fact  that Florence Nightingale  was born in  1820,
Pasteur in 1822, and Lister in 1827.:  Holmes and Sem-
melweiss, on opposite sides of the Atlantic,  attacked the
problem of puerperal fever in the same year (1843) that
Koch, who proved their theories, was born.   Chloroform
and ether were first  used as anesthetics just as  modern
surgery was developed to the point where it most needed
them.
  The story of this whole group of persons is so interwoven
that it cannot rightly be told except as one narrative.  At
    1 Lister and Florence Nightingale died in the same year.
       144 
THE  WORK   OF  GREAT  SCIENTISTS   145
every step of the way nursing was modified and new de-
mands were made upon the women who cared for the
sick.
  State of the Work at the Beginning of the Century.—If
the nineteenth century dawned upon a dark age in nurs-
ing, so also did it find medicine and surgery in a state of
stagnation.  There  were  few  medical schools, and the
majority of doctors were taught by means of the "appren-
tice" system, being hostler and janitor to the man whose
medical library they were allowed to  read, and picking
up such knowledge  as they  could by observation.
  Medical works described  diseases very carefully, but
doubted  the  possibility of curing them.  Anatomy and
physiology were in an undeveloped state; chemistry was
young in practical value;  bacteriology  was unknown and
unthought of.   Most doctors believed in the "spontaneous
generation" of disease, i. e.,  certain living organisms grew
of themselves from nothing.  Acute disease was invariably
treated by "lowering" measures—starving, blood-letting,
large  doses  of mercury,  antimony,  opium, etc.   The
clinical thermometer did  not come into  use  until about
1850; before that time physicians and nurses guessed at
temperature  by  feeling the patient's skin.  In  short,
medicine, surgery, and nursing were  all largely guess-
work, and exact methods in  any of them were practically
unknown.
  Lister and His  Time.—Joseph Lister, whose genius lay
in his  ability to  see "the obvious rather than the con-
ventional," was English.  His  father was the man who
perfected the microscope by  producing a lens which gave
sharp outlines to  the object  instead of the blurred figure
which all these instruments had previously shown.   Thus
the elder Lister paved the way for  the work of Pasteur,
Koch, and his own famous son.
       10 
146   OUTLINES  OF  NURSING  HISTORY

  In hospital work in London  Lister  became familiar
with all  the dreadful forms of blood-poisoning then  so
prevalent, and with hospital gangrene, the scourge of the
day.  Every wound was an infected one; nothing healed
without  extensive suppuration.1   Tetanus,  erysipelas,
pyemia, and septicemia were almost constantly epidemic
in all hospitals.   In  Paris  the very name  of  the  great
"Hotel Dieu" was a ghastly jest, since its death-rate was
25 per cent., mostly from the above causes.   Munich's
largest hospital had at one time a death-rate of 80 per cent.
England was no better.
  In those  days, Wrench tells us, "Doctors paid  rather
less attention to cleanliness than other men because  of
their familiarity with offensive matter.   Before an  opera-
tion the surgeon turned up the sleeves of his coat to save
the coat, and would often not  trouble to wash his hands,
knowing how soiled they soon  would be (!).   The area of
the operation would sometimes be washed with soap and
water, but not always, for the inevitability of corruption
made it seem useless.  The silk or thread used for stitches
or ligatures was  hung over a button  of  the surgeon's
coat, and during the  operation a convenient place for the
knife  to  rest was  between his  lips.   Instruments used in
operation were washed and put away, but those used for
dressings or lancing abscesses were kept in the vest pocket,
and often only wiped with a piece of rag as the surgeon
went from one patient to another."
  Lister,  who began his surgical work under Syme,  of
Edinburgh  (a man who kept  everything very  clean and
whose results were phenomenal), made his assistants and

  1 A prominent Philadelphia surgeon of the last generation, teach-
ing a class of medical students, sent  an orderly  to the hospital ward
for a sample—to be  obtained while he waited—of "laudable" and
"ichorous" pus, a teacupful of each! 
THE  WORK  OF  GREAT  SCIENTISTS  147
nurses wash their hands often, and used Condy's fluid or
some  other deodorant.1  Despite these  precautions,  he
had almost as many cases of blood-poisoning as surgeons
who were less clean.  He determined to find out what the
trouble was.
  Lister's Problem.—Compound fractures  gave him  the
first clue.   He noted that when a bone was broken but the
Fig. 27.—Lord Lister (1827-1912).
skin remained whole, there was recovery without disturb-
ance; but that when the skin was  broken,  suppuration,
fever, and often death resulted.  He  made a thorough
  1 Lister never used a nail-brush, but merely turned up his sleeves
and  washed his hands; yet the results which he got in his best days
have never been surpassed. 
148   OUTLINES  OF  NURSING  HISTORY
study of the nature of inflammation, arriving at the con-
clusion that something got into the wound from outside.
What this something was he did not know.  One day he
found the key to this problem in the work of Pasteur.
  Louis Pasteur was  not a doctor, but a  chemist.   In
1854, while making experiments  in  wine-production, he
arrived  at  conclusions that were the beginning of  the
Fig. 28.—Louis Pasteur (1822-1895).
science of bacteriology.  He propounded the theory of the
existence of germs, and made his conclusions public; but
despite his  prominent position, they were ridiculed.  Not
until later,  when the  French Academy of Science took the
matter up,  was his work acknowledged.
  Pasteur worked  out in his laboratories all the details
of the germ theory of disease; but it was Koch  who later
developed  exact  methods  for   studying  and  handling 
THE  WORK  OF  GREAT   SCIENTISTS  149
bacteria.  Pasteur worked out a cure for rabies which is
now the standard.  He  may be  said to  have  invented
vaccines.  Lister always gave Pasteur the credit of having
discovered the principles upon which he himself built the
science  of modern surgery.1
  Pasteur's Solution of Lister's Problem.—Pasteur once
said,  "Chance favors only the  mind that is  prepared."
Lister, as he read of Pasteur's work, saw in it as no other
man  of his time did what it meant to science and to
humanity.  He found the explanation of his own troubles
with compound fracture cases, and knew that it was bac-
teria  which produced the suppuration.  He saw at once
the practical application.
  Lister's  Methods.—Searching for  a  chemical to kill
bacteria, Lister began using carbolic acid.  He  had only
the crude sort, which did not dissolve in water.  He used
it full strength at first; it burnt the wound, but sealed it up
in an antiseptic substance, so that the wound healed under
a crust, the famous "antiseptic scab" of the past genera-
tion.   Later he used carbolic  mixed with oil, soaking his
instruments and dressings in it.2   He began to get better
results.
  The possibility of air-borne infection  worried  him, and
when one of his students suggested  a carbolic spray, he
adopted the  idea, and did his operations in a fine mist of
carbolic solution.  Later  he became convinced  that air-
  1 Pasteur became personally acquainted with the men who worked
out  the application of his theories—with Koch, Roux (the inventor
of antidiphtheric serum), and Metchnikoff.   At Pasteur's Jubilee
in 1892  Lister  spoke, praising him highly;  whereupon Pasteur,
always emotional, rushed to the platform and publicly embraced
Lister, amidst the applause of the audience.
  2 Le Fort, a French surgeon, who always advocated  scrupulous
cleanliness, had in 1868 used alcoholized water for dressings, with
excellent results. 
150   OUTLINES  OF  NURSING  HISTORY
borne infection was either non-existent or unimportant,
and dropped the practice, saying that he was ashamed to
have recommended it.  Only within  a few years has air-
borne infection ceased to be believed in by our best authori-
ties; Lister anticipated them by several decades.
  The question of ligatures also troubled him.   Ambroise
Pare had invented them as a means of doing away with
cauterization,  but they  always  suppurated.  Surgeons
were in  the habit of leaving long the ends of the silk with
which blood-vessels were tied, so that the}' hung from the
wound;  when the knot literally  rotted off, the ligature was
pulled away;  secondary hemorrhage sometimes ensued,
and the suppuration  continued.   Sir James Simpson de-
vised acupressure, in  which the arteries were temporarily
compressed  between long needles  thrust into the wound;
these were removed after a few days;  while better than
ligatures, they were not  satisfactory.
  Lister,  after long  experiment,  worked out the  whole
problem of sterile catgut, and introduced the buried liga-
ture which did not suppurate  because it was clean.  He
also  invented  chromic catgut.   Rubber drainage-tubing
was another of his discoveries.1
  For a long time Lister's methods were bitterly opposed
in Great Britain.  He visited  the United States in 1876
and spoke, but practically no attention was paid to him.
  The Problem of Puerperal  Fever.—Maternity  wards
were even worse  than surgical ones.  Only the poorest
women  went into them.  As the years went on they grew
worse, until they were  hardly more than  death-traps.
In the great Maternity at Vienna, where in 1820 the death-

  1 Queen Victoria  had  an abscess under her arm, which  Lister
opened.  He drained it with  gauze, but it did not do well.   It was
then that he first thought and tried  rubber tubing,  soaking it over
night in carbolic solution. 
THE  WORK  OF  GREAT  SCIENTISTS   151
rate had been less than 1 per cent., overcrowding and care-
lessness resulted in an increase of puerperal fever, until in
1846 about 12 per cent, of the mothers died from it.  The
Pitie of Paris lost 10 per cent, of its women from the same
cause; the General Lying-in of London,  25 per  cent.  All
large maternities had a similar record.
  Fig. 29.—Ignatz Semmelweiss, the discoverer of the cause, and
the inventor of the means for the prevention, of childbed fever, or
puerperal infection.

  Ignatz Philip Semmelweiss,  born in 1818 in Hungary,
was an assistant physician in the Vienna Maternity.   His
genius led him to observe that in wards where deliveries
were done  by midwives the death-rate was 3 per cent.,
while in those  where  students delivered  the rate  was
12 per cent.   On investigation, he found men coming from 
152   OUTLINES  OF  NURSING  HISTORY

the dissecting room or from autopsies on puerperal fever
cases and going direct to a delivery without even washing
their hands.
  He began the simple regime  of  making his students
scrub their hands with a brush and soak them in  a solu-
tion of chlorinated lime.   The  death-rate in  his wards
fell rapidly—in a month to that of the midwives, and later
to about 1 per cent.
  His  chief,  jealous of his success, bitterly  opposed his
methods,  and drove  him  from Vienna.  He  went  to
Pesth, and repeated his successes; but he was high-strung
and sensitive, and finally brooded so much over the suffer-
ing and death caused by the carelessness of physicians
that he lost his  mind.   He died in 1865,  the year  that
Lister began his  work in antiseptic surgery.
   Holmes and the Same Problem.—At the time that Sem-
melweiss  gained  his success  and  his  persecution, Dr.
Oliver Wendell Holmes, of Boston, wrote his classic essay
on  "The  Contagiousness of Puerperal  Fever."  It  is a
masterly presentation of the facts, with a forceful  setting
forth of  the arguments  in favor of his theory.  It has
great literary merit and is thoroughly scientific.1  Holmes
felt  quite as deeply upon the subject as did  Semmel-
weiss, for he said, "Better that twenty  professors  be un-
seated than that one mother's life should be taken."
  Pasteur's Solution.—About twenty years after Holmes
set forth  his theories  Pasteur in his laboratory demon-
strated  that the  Streptococcus pyogenes was  the cause
of puerperal  fever.  Yet it was years later  before the
scientific world accepted his proof.2

  1 It may be found among his "Medical Essays."
  2 At a meeting of the French Academy  of Medicine a prominent
man spoke of the mystery of epidemics of puerperal fever.  Pasteur
sprang up:  "The cause of these epidemics is  no more than this— 
THE   WORK   OF  GREAT  SCIENTISTS  153
  Fig.  30.—The  dome-amphitheater,  Massachusetts General Hos-
pital.   The first  public demonstration of ether anesthesia,  October
16, 1846.   (After the  well-known  painting in the Boston  Medical
Library, by Hobert Hinckley.)
   Anesthetics.—Up to the middle of the nineteenth  cen-
tury all  operations  had had to  be  done without anes-

the doctor and his assistants carry the microbe of the sick woman
to the well woman."  The  doctor replied condescendingly that he
feared they  should  never discover that microbe.  Pasteur rushed
dramatically to the blackboard and  drew a picture of the strepto-
coccus, crying, "There is its picture."—Foster. 
154   OUTLINES  OF  NURSING  HISTORY
thesia.  This greatly limited the field of surgery, and was
the cause of many  deaths  from shock.  We can hardly
conceive of the suffering  which  surgical  cases  under-
went.
  In  1845  Sir  James Simpson, of  England, first demon-
strated the use of chloroform as an anesthetic, and intro-
duced it into surgery.  He was attacked by both his fellow
surgeons and the clergy, who denounced him as a man who
presumed to take away the pain which Heaven sent to
mortals to try or punish them; they especially thought it
wrong to lessen the sufferings of childbirth, to which they
felt women had  been doomed by the Almighty.
  Crawford Long, of Georgia, was probably  the first man
to use ether as an anesthetic, but  the credit is  given to
W.  T. G. Morton, a Boston dentist, since he was the first
to make a  public demonstration of its use in surgery.
On  October 16,  1846,  at the  Massachusetts  Genera]
Hospital Morton gave ether to a surgical patient before a
large  company of doctors.    In  honor of the event the
hospital each year observes "Ether Day," with  exercises
held in the old operating room, where the original table is
still in place.1
  Dr.  Robert  Koch, the  German scientist,  was born in
1843.   He  began his researches  in bacteriology in 1872,
the year that trained nursing was established in America.
Probably nothing has  changed  the  work of the  nurse
more,  nor made it  more an expert and  a scientific task
than has this science which he worked out.2
  1 The operating-table is  covered with plush, and there was a
velvet  cushion into which the surgical needles were  stuck.
  2 Surgery and surgical nursing have been much influenced by the
Mayo  brothers of  Rochester, Minn.   They  have done many new
operations and greatly simplified technic.  They hold a continuous
clinic to which hundreds of surgeons go.  They were doubtless the
first men to advocate nurses for anesthetists. 
THE  WORK  OF   GREAT  SCIENTISTS   155
  Koch invented practically all the modern methods of
handling bacteria, of cultivating,  staining, and studying
them.   Before his time little could be done, because no
one knew how to isolate or handle germs; even Pasteur's
methods were crude in comparison with Koch's accuracy.
  Koch discovered the bacillus of  tuberculosis, and so set
on foot the whole  antituberculosis movement, in which
nursing has come to play so vital  a part.  He attempted
Fig. 31.—Dr. Robert  Koch (1843-1910).  (Courtesy of Captain
              Henry J. Nichols, LT. S. Army.)

to find a cure for the disease, but while he failed, he has
given us valuable and accurate tests  for discovering its
presence in incipient or obscure cases.1
  Effect Upon Nursing.—It is to these men that we owe
the whole technic of the modern operating room and the
modern maternity.  They made possible the brilliant suc-
cesses of recent surgery and medicine.  It was largely
1 Koch died in 1910. 
156   OUTLINES   OF  NURSING  HISTORY
 their work  that brought nursing  out of the darkness  of
 empiricism  and made it a science as well as an art.  On
 the other hand, the trained nurse  was the sine qua non  in
 their work, for without  skilled  help no  surgeon could
 possibly carry  out an effective technic.

          SUMMARY OF  IMPORTANT POINTS
   Florence  Nightingale, Lister, Pasteur, Koch, Semmel-
 weiss,  Holmes, Simpson, and Morton belong to  a group
 that was nearly contemporary, and  who did more than
 all their predecessors to put medicine, surgery, and nurs-
 ing on a scientific basis.
   Lister invented antiseptic  and aseptic  surgery.  He
 first used the buried ligature, chromic catgut, and rubber
 drainage-tubing.
   Pasteur was  the originator of the  germ  theory of dis-
 ease, found  the causes of contagion of all  sorts,  and de-
 veloped a cure  for rabies.
   Semmelweiss and Holmes taught the contagious nature
 of puerperal fever, and  advocated cleanliness for  its con-
 trol.
   Koch worked out the whole science of bacteriology and
of modern laboratory methods.  He discovered the tuber-
cular bacillus.
  Sir James Simpson introduced  chloroform as an anes-
thetic,  and W.  T. G. Morton introduced ether. 
CHAPTER XI
THE DEVELOPMENT  OF  TRAINED  NURSING IN
                     AMERICA

  The founding, some forty years ago, of four training-
schools, with but twenty  pupils among them, marked the
beginning of a nursing era for the United States.  Most of
the members of those first training classes are still living;
they have seen, in one generation, the creation of a great
and permanent vocation for women—the development of a
profession which is already indispensable in community
and national life.
  America was only about a dozen years behind England
in the establishment  of training-schools for nurses, and
nursing progress here has closely followed that in Great
Britain.
  The Youth of Trained Nursing.—In both England and
America the need for trained  nursing was  so great that
training-schools inevitably took root and  grew.   Then
unforseen situations arose which had to be met without
mature deliberation;  unexpected difficulties  were encoun-
tered and became the subject of experiment, while prog-
ress in allied lines  of work and  in the whole life of the
world brought new conditions that had to be met by new
tactics.  There  were no precedents;  it was necessary to
establish them.
  We shall understand our own work better if we bear in
mind  that nursing is  even yet far from being  fully de-
veloped.  Another  century may  make what we now call
progress seem like the crudest of beginnings.
                                            157 
158   OUTLINES  OF   NURSING   HISTORY
  Some Early Training-schools.—The training-school idea
spread rather slowly at first—witness the fact that in 1883,
ten years after the first school had  been organized, only
twenty-two schools were reported  to be  in  existence.1
These were as follows:
Year of founding—
  1872—New England Hospital for Women, Boston, Mass.
  1873—Bellevue Hospital, New York City.
         Connecticut Training-School, New Haven, Conn.
         Boston Training-School, Mass. Gen'l Hospital.
  1875—Charity Hospital, New Yrork City.
         Pennsylvania Hospital, Philadelphia, Pa.
  1877—The New York Hospital, N. Y. City (19 pupils).
         Hartford  Hospital, Hartford,  Conn.
         Boston City Hospital, Boston, Mass.
         Washington Training-School, Washington, D. C.2
         Buffalo General Hospital, Buffalo, N.  Y.
  1880—Rochester City Hospital, Rochester, N. Y.
         The Brooklyn Hospital, Brooklyn,  N. Y.
  1881—Illinois Training-School, Chicago, 111.  (8 pupils).
         Mount Sinai Hospital, New York City (12pupils).
  1882—Mary Fletcher Hospital,   Burlington,  Vt. (17
           pupils).
         Orange  Memorial  Hospital,  Orange,  N.  J.
           (5 pupils).
         Charity Hospital, New Orleans, La.
  1883—Long Island College Hospital, Brooklyn, N. Y.
         Cincinnati Training-School, Cincinnati, O.
         Charleston City Hospital, Charleston, S. C.
         Johns Hopkins Hospital, Baltimore, Md.
  These  hospitals reported in 1883 about 600  graduates.
  1 There were probably several others not reported.
  2 This school had no hospital of its own, but gave a preliminary
course and experience in  two or three hospitals. 
TRAINED  NURSING   IN  AMERICA   159
  Growth  of  Training-schools.—After  1890 schools for
nurses  multiplied  rapidly.   In 1896  there  were  two
hundred and  twenty  schools  reported, and the actual
number  was  doubtless  considerably  greater.   In  1898
there were over five hundred  schools reported, and ten
thousand graduates were at work, while by the year 1900
there were said to be twenty-seven thousand.
  Training-schools in the Religious Orders.—All through
the long years of  hospital abuse and bad  nursing there
was much good nursing being done by Sisters and Deacon-
esses.  These  orders, because their work was already so
admirable, were slow  to establish training-schools  of  a
more modern  sort; but  they have gradually fallen into
line.
  Roman Catholic Sisters of various orders founded hos-
pitals, keeping  pace with  the spread  and increase of
population. The Mercy Hospital, of Pittsburgh, Pa., was
founded in 1847, the Mercy, of Chicago, 111., in 1851,  and
one in San Francisco in 1855.  The Sisters of Charity have
about two hundred  hospitals.   At  the time of the Civil
War the larger and better hospitals were those belonging
to the Sisters.  A certain amount  of  training was given
in these institutions.  Much of it was doubtless crude and
empirical, but in this it did not differ materially from that
of the first lay training-schools.   As  times  changed the
sisterhoods have, slowly perhaps, realized the need  and
started  modern training-schools.
  With the rapid development of hospitals  there came a
time when  there were too few nuns  to  meet the demands,
and sisters' hospitals opened their doors to  the training of
secular  nurses, along with  or  in addition  to their own
members.  Among the first  schools were  those established
in 1889  at St.  Mary's Hospital in New York City  and at 
160    OUTLINES   OF  NURSING  HISTORY
Fig. 32.—Roman  Catholic Sister nurse, America.   Sister Beatrice
         Bartlett  who nursed in the recent European War.

the Mercy Hospital, Chicago, 111.1   In  1892 St. Vincent's
  1 This hospital is affiliated with the Northwestern University, and
the nurses receive instruction from its professors. 
TRAINED  NURSING   IN  AMERICA   161
Hospital,  New York, and the  Carney  Hospital,  Boston,
opened schools.
  The sisters and their lay graduates are active members
of all the nursing associations, and take part in nearly
Fig. 33.—American Deaconess nurse.   Miss Louise Golder,  Head
    of Mother House at Bethesda Hospital, Cincinnati, Ohio.

all nursing movements.  They have helped to put through
registration laws.1
  Protestant Sisterhoods  have  not   been prominent  in
America—St. John's, All Saints, and  St. Margaret's have
been among the best known.  The latter opened in  1881
  1 In June, 1915, the Superiors of several middle-west states formed
the Northwestern Sisters' Hospital Association,
       11 
162   OUTLINES  OF  NURSING  HISTORY
the first private hospital in Boston, and since 1869 have
nursed  in the Children's Hospital of that city.   In 1907
the hospital organized a secular training-school, which,
under the sisters' direction, has become unusually good.1
   Deaconess Nurses.—A number of the evangelical  de-
nominations have deaconess orders that maintain hospi-
tals, though they have been slow to adopt modern meth-
ods.  Pastor  Passavant, whose  first  deaconess  nurses
came to Pittsburgh direct from  Kaiserswerth, founded a
hospital in Milwaukee, Wis., and one in Jacksonville,  111.
The  Passavant  Memorial  Hospital  of  Chicago  was
founded in  1865,  and  its modern  training-school  was
opened  in 1898.  St. Luke's, of New York, opened a secular
training-school in 1888.
   Church Hospitals.—There are many hospitals organ-
ized  and supported by the  various  churches.  While
most  of them make no  religious requirements either  for
patients or nurses, they keep a high moral tone, and try to
develop character and spiritual qualities  in their schools.
   Training  for Men Nurses.—For many years  certain
hospitals took men in training  along with women, though
most  of them gave  the  men a shorter course.   Some of
them  did not call the men  "nurses," but "attendants."
   The  Mills Training-School for Men,  connected with
Bellevue Hospital,  New  York, was established in 1888
and has been successful.   It gives a two-year course, and
calls its graduates attendants.   Grace Hospital, Detroit,
for a  number of years gave a two-year course to men,
graduating  them as nurses.   Battle  Creek  Sanitarium
gives  a  four-year  course  to  men,  including the usual

   1 This  school requires its candidates to be high school graduates,
sends them to Simmons College for their preliminary course,  and
gives them experience in four hospitals.  It is one of the few schools
that charge a tuition fee. 
TRAINED  NURSING  IN  AMERICA    163
 branches besides massage and hydrotherapy.   The Boston
 City Hospital gives a two-year course to men, and grants
 a diploma as "male nurse."  St.  Vincent's Hospital and
 the Carney Hospital, both of Boston, train men nurses.1
  Nearly all hospitals for the insane  give courses to men.
  In America the present tendency is to train fewer men
 as nurses, as it  is generally believed  that the public pre-
 fers women, except perhaps in alcoholic, drug, or venereal
 cases.   In  other  countries  the male nurse is still an
 established  fact; and  in countries where nursing  is just
 beginning the male nurse for male patients appears to be
 necessary.
  Colored Nurses.—Probably the first colored woman to
 graduate  from  a training-school  for  nurses was Miss
 M. E. P. Mahoney, who finished her course  at the New
 England Hospital for Women in 1879.  The first training-
 school for colored nurses was established in 1886 at Spel-
 man  Seminary, Atlanta, Ga.   In  1891 the Provident
 Hospital  of Chicago and  Hampton  Institute  opened
 training-schools, while Tuskegee Institute started  one in
 1892.
  There are fifteen or twenty hospitals for negroes, mostly
 in the South, which give full courses of training to their
 nurses.  Lincoln Hospital,  New York City,  and  Mercy
 Hospital,  Philadelphia, are notable  northern examples.2
 In the Spanish-American War  five colored  nurses from
 Tuskegee  served in Cuba; a male negro nurse was in the
 U. S.  Army service in the Philippines.
  Colored women appear to have many of the character-
 istics of the "born" nurse, and their generations of tradi-
 tion in personal  service especially fits them for this work.
  1 There is in Boston an Association of Male Nurses.
  2 There are several hospitals owned, controlled, and staffed  entirely
by colored people. 
164   OUTLINES  OF  NURSING  HISTORY
They have made good in private nursing, even  among
white people.
Fig. 34.—Class of colored nurses.   Mercy Hospital, Philadelphia,
                     Pennsylvania.
  The National Association of Colored Nurses was formed
in 1908.

THE TRAINING  OF NURSES IN  HOSPITALS FOR  THE
                       INSANE
  Early Attempts.—Before Florence Nightingale began
her work,  Dr.  Browne, of  Crichton, England,  Samuel
Tuke, of England, and Dr.  Jacobi, of Germany, had made
attempts to train attendants for the insane, but had not
been wholly successful.  "The plan of teaching was too
limited.  The professional  element in the work of nursing
as a prospective means of  livelihood was not made suffi- 
NURSES   IN   HOSPITALS  FOR  INSANE   165
ciently important as a necessary and proper  stimulus to
undertake and adhere to a methodical course of study.  No
one offered a  comprehensive course.  All doubted  that
there was any place in the public service for  an asylum-
trained nurse."1
Fig. 35.—Dr. Edward Cowles.  Founder of the first training-school
             for nurses in a hospital for the insane.

  The  First  Asylum  Training-school.—In  1879  Dr.
Edward Cowles,2  who was  then Superintendent of the

  1 Report of McLean Asylum Training-School, 1889.
  2 Dr. Cowles has probably done as much for nurses as any man in
America.   He established the  school  at the  Boston City Hospital
under great opposition, and chose Miss Linda Richards for its head.
We do not yet appreciate the full meaning of his work in establishing
the school at McLean Asylum. 
166   OUTLINES  OF  NURSING   HISTORY
McLean Asylum  at Waverly, Mass.—one  of the most
progressive  insane  institutions  in  the world—made a
definite plan for a course of training which should include
not only asylum and insane work, but general nursing as
■ ■ ■,  '..'■':■■
.'"  }

I
  Fig. 36.—Composite picture of fifteen nurses, class of 1886, at
McLean  Asylum, Waverly,  Mass.   ("Century Magazine," No-
vember, 1887.)
well.   He already had one or two trained  nurses in the
institution.
  Hospital methods were gradually introduced and class
instruction  begun, though the  training-school was not 
NURSES  IN  HOSPITALS  FOR  INSANE  167
formally organized until  1882, when a superintendent of
nurses was appointed who was a hospital graduate with
asylum experience.   In  1884  Miss Lucia E. Woodward
was made head of the school, having before this spent
some  time with Miss Linda Richards at the Boston City
Hospital.  The first class that graduated, six in number,
took over three years to complete its course; after that
the term was two years, and by 1889 included everything
taught in general hospital schools.
  Other Schools.—In 1883 Dr. Andrews began giving a
course of lectures to his  attendants at the Buffalo State
Asylum, which in 1885 developed into a systematic course
of training.   Other early schools were in  the asylums at
Norristown, Pa., and Kankakee, 111.   The New Hampshire
State  Hospital began its school in 1889.
  In  1895  there were  thirty-eight training-schools re-
ported in asylums, with about nine hundred graduates.
  Difficulties.—The establishment of training-schools in
asylums has been an extremely difficult problem.  "One
of the prime causes of the many failures was  that no
public demand had been created for asylum-trained nurses.
Superintendents could not—and later did not when they
could—set before the prospective pupil any future beyond
that   of  moderately  paid asylum work.  The general
hospital schools met a more obvious want."1  The prob-
lem was to create a type of nurse  that the public would
want.    A mere specialist in mental cases was likely to
fail of employment.
  Bodily Versus  Mental Nursing.—The  schools which
have  solved the problem are those which have affiliated
with general hospitals, and so have been able to give their
nurses the double training of "bodily" and mental nurs-
ing.
       1 Report of McLean Asylum Training-School, 1889. 
168   OUTLINES  OF  NURSING  HISTORY
   It is the experience of asylum heads that nurses trained
in general hospitals are not fitted for the care of patients
who are ill mentally.  "In the general hospital the pupil
practices her art among patients who are expected to be
obedient to her; it seems irksome to her to sit down and be
a companion to patients who do not do as they are told.
Her general hospital training has been wholly objective,
and unless she has  certain inherent'  qualifications  she
acquires a dislike or an unfitness for the  care of mental
patients—and also for a great deal of  the work which is
done in private families."1  We shall do well to ponder the
last clause of this quotation.
  Pioneer Nurses in Asylum Training.—A  few women
known  in the  world of general nursing  have  seen  the
possibilities and the importance of training in the care of
mental  cases, and have  set themselves to rescue it from
the disrepute into which it has fallen for  so many cen-
turies.   In future years their work may be regarded com-
parable to that which took bodily nursing out of the hands
of the lowest classes and put it into the hands of one of the
highest.
  The work of  Miss Woodward above mentioned; that of
Miss Sara E. Parsons, graduate of Massachusetts General
and McLean  Hospitals,  who  organized  the  training-
schools at Butler Hospital, Providence,  R. I., at the Shep-
pard and Enoch Pratt Hospital, Towson, Md., and others;2
of Miss  Cleland, of Butler Hospital, and  of  Miss Linda
Richards, have not yet been appreciated.  Miss Richards,
after 1900, organized or reorganized the  schools at  the
Taunton  (Mass.) Asylum  for the Insane, the Worcester
(Mass.) Hospital for the Insane, and the Michigan Asylum
  1 Report of McLean Asylum Training-School, 1901.
  2 She is, since 1910, head of the training-school at Massachusetts
General Hospital, Boston. 
NURSES  IN  HOSPITALS   FOR  INSANE  169
for the Insane1 (at Kalamazoo).  Her schools included both
men and women.1
  The Field of Psychiatric Nursing.—Attention to the
care and cure of mental cases is in its infancy in America,
being far behind such  work  in  France  and  Germany.
Fig. 37.—Miss Sara E. Parsons.
Our doctors and hospitals are only beginning to interest
themselves in the subject.  The  Psychopathic Hospital
of Boston, opened in 1912, and  the Psychiatric Clinic at
  1 In 1911 she was  made Superintendent  of Nurses Emeritus of
Taunton Asylum. 
170   OUTLINES  OF  NURSING  HISTORY
Johns Hopkins, Baltimore, are helping to educate both the
public  and  the nurses.   The  National  Committee  for
Mental Hygiene has  begun  a  campaign  of  information
and publicity in regard to the prevention and curability of
mental troubles.  Out-patient departments are being es-
tablished in asylums;  and every year a  greater number
of "voluntary"  patients go into institutions for mental
cases.
  There is a large and hitherto almost unrecognized field
for nurses in psychopathic work.   Such nursing demands
far  more  than does  ordinary hospital  routine—broad
training, keen  insight, catholic sympathy,  and a real
social consciousness.   It may take  us years to come to it,
but we shall, perhaps, in time see  that mental nursing is
higher, more difficult, and more worth while  than bodily
nursing can ever be.
  Physicians are coming to recognize the value of mental
treatment in bodily disease, and there is probably a time
ahead of us  when nurses will find the value of psychology
and psychotherapy in every case of illness or surgical opera-
tion.   It is a wonderful new field which invites the nurse's
study.
                       CANADA
  The first  Canadian hospitals were, as we have seen
(Chapter VII), those founded  in  early days by Roman
Catholic sisterhoods.  Many of them are still  in existence.
  Sisters' Hospitals.—Along  with the  settlers of new
regions went the good sisters and their hospitals.  Not a
pioneer town of any importance failed to be supplied with
a church hospital, until there are  now in Canada  about
one hundred sisters' hospitals.   Since about 1900 most
of these have established training-schools for their own
members and  for lay women, and  are using modern
methods. 
CANADA
171
  Municipal Hospitals.—In the eighteenth century, after
the British became established  in Canada, municipal
hospitals began to be built.  One of the first  of  these
was at Halifax, built in 1750.   The nursing in them was
of the old type, done by uneducated, incompetent women
and men; and the hospitals were  no better than those of
the same period in England and the United States.
  The  First  Training-schools.—For  reasons  which  are
not evident  training-schools  for nurses were  hard  to
establish in Canada.  Their history recounts failure after
failure  in  the struggle against  existing  evils; of  the
causes  of these failures we  may not judge.
  The  General and  Marine Hospital  of  St. Catherine's
was the first  that succeeded in  establishing a school, and
even they  failed  once, when in 1864 they made the ex-
periment with one nurse.   The final success was due to
the efforts  of Dr. Mack (for whom the school is named),
who in 1874  sent to England for  two trained nurses and
five probationers and founded a school which has always
been worthy  of the name.  It is small, but has produced
some nurses of more than ordinary ability.  Its establish-
ment made trained nursing in Canada practically simul-
taneous with  that in the United States.
  Other Early Schools.—The Montreal General Hospital,
founded in  1821, was badly nursed in the old way, and in
1875 the Board applied to Miss Nightingale for help in
establishing a training-school.  She sent out a superin-
tendent and four nurses, but their difficulties and the op-
position  that they encountered  proved  too great, and
they finally gave it up and went back to England.  Others
tried it and  failed.   In  1890 the Board applied to  the
United States, and Miss Norah Livingstone, of the New
York Hospital, went with two assistants.   She established
an excellent  school and drew to herself  ample support. 
172   OUTLINES   OF  NURSING  HISTORY
She has a record of twenty-five years of service the char-
acter of which is recognized and appreciated.
  The Toronto General Hospital, established in 1820, has
had a similar history.  In  1877 an  attempt was made
Fig. 38.—Miss Norah Livingstone.
to establish a training-school, but it did not succeed until
1881; the school did not flourish until 1884, when it was
undertaken by Miss  Mary Agnes  Snively, a  Canadian
graduate of Bellevue, New York, who, during twenty-six
years of service, brought the school up to a good standard. 
CANADA
173
Before her  retirement  in  1910 Miss  Snively  had  done
much for her own  hospital and in national organization
work.
  These two schools have furnished heads for many others
throughout  the Dominion.
  Other early training-schools were as follows:
  1886—The Hospital for Sick Children, Toronto.
  1887—Winnepeg General Hospital, Manitoba.
         Fredericton, N. B.
  1888—St. John's, N. B.
         Kingston, Ont.
  1890—St. Boniface General, Manitoba.
         Royal Jubilee, Victoria, B. C.
  Features  of Some  Canadian Hospitals.—The Royal
Victoria Hospital, at Montreal,  one of the finest and  most
largely endowed hospitals in America, opened its training-
school at the opening of  the  hospital  in 1894,  with  Miss
Edith Draper in charge.  It has always been excellent.
  The school at the Hospital for Sick Children, in Toronto,
is well known and superior.  Miss Louise  C. Brent was
for  sixteen years  its head, and to her and to  Mr. J.  Ross
Robertson,  president of  the  Board, is due much of  its
success.   The fine nurses' home, built  by Mr.  Robertson
in 1906, was much written of, and  doubtless furnished  an
incentive  to other hospitals to give their nurses pleasant
quarters.1
  The first  hospital for  the insane  that  established a
training-school for  nurses was the Reckwood Asylum  at
Kingston,  Ontario, which  began the work   in  1888.

  1 This hospital is one of the few that advertises its  work.  The
advertising is  done exactly as it is in business houses, and is justified
by its results  both of money and public  interest.  Tons of printed
matter are issued every year, telling of the appealing work of caring
for sick children. 
174   OUTLINES   OF  NURSING  HISTORY
Women attendants for insane  men  were not tried until
1910.
  Preliminary courses for probationers,  a feature  which
usually  indicates progress, have been  established at  the
Sick Children's.  Toronto;  the Montreal General,  the
Fig. 39.—Miss Louise C. Brent.
Royal Victoria of Montreal, and the Victoria at London
Ont.
  Postgraduate courses are uncommon in  Canada, and
many nurses go to the United  States for such work.
  District Nursing.—This work is  highly developed, al-
most surpassing that of any country, unless it be England. 
CANADA
175
Fig. 40.—Mr. John Ross Robertson.
-Before and after.   (Material used for advertising by the
     Hospital for Sick Children, Toronto.)
The Victorian Order is a national  association for district
work.   It was founded in 1897 by Lady Aberdeen, along 
176   OUTLINES   OF   NURSING  HISTORY
lines similar to the Queen's Jubilee Nurses  in  England.
It has local branches  throughout the Dominion, and has
Fig. 42.—Before and after.   (Material used for advertising by the
             Hospital for Sick Children, Toronto.)
in all  over two hundred nurses  in  active service.   Its
nurses are required to take a special course in this work at 
CANADA
177
one of  four  centers—Montreal,  Toronto, Ottawa,  and
Winnepeg.  They do regulation visiting nursing in cities,
milk station work, and life insurance nursing; are employed
on Indian reservations,  lecture, and  teach  in domestic
science schools, etc.
  Other  Nursing Activities.—The Lady Minto  Cottage
Hospital Fund, begun in 1900, provides for the building of
hospitals in small communities.
           Fig. 43.—Emblem of the Victorian Order.

  Lady Grey's Country District Nursing Scheme, begun
in 1909, provides nursing in rural districts.
  Canada  has factory and store  nurses,  deaconess or
parish nurses, missionary nurses (especially among the
Indians), and three  nurses' settlements.
  School nursing was begun in 1908 in Toronto, and in
1910 Miss Lina L. Rogers, who started that work in the
United States, was called to take  charge.   Mr. J. Ross
Robertson has also helped to push school nursing.  The
work is now established in more  than a dozen cities, and
Toronto gives a course in  it to graduate nurses.
      12 
178   OUTLINES   OF   NURSING   HISTORY
  The only province of Canada that has state registration
for  nurses is Manitoba.  The Incorporation Act of the
Graduate Nurses'  Association  of Nova  Scotia  almost
gives them registration.  Some of the other provinces are
endeavoring to have registration laws passed, but  none
have yet succeeded.
  (For Canadian nurses' societies and nursing magazines,
see  Chapter NX.)

          SUMMARY OF IMPORTANT POINTS
  The founding  of the  first four training-schools for
nurses marked  an era in  the history of America.   They
created a profession that has now become indispensable.
  It is important to remember that trained nursing is still
in a formative stage.
  In 1883, after ten years,  there  were  but twenty-two
schools for nurses.   In the 90's they multiplied rapidly.
In 1911 there were 1100 schools reported, and the num-
ber was doubtless considerably greater.
  The religious  orders—Roman Catholic  sisterhoods,
Protestant sisterhoods, and deaconesses—established many
of the early hospitals and did superior  nursing.   They
were slow in modernizing their work  and  in founding
training-schools because their work was already so  good.
  Church hospitals  of all  denominations are numerous,
and  usually pay marked attention to character develop-
ment in their nurses.
  There  are a number of flourishing training-schools for
men nurses, especially in  hospitals for the  insane.  The
tendency is, however, to displace men nurses by women.
  There  are fifteen  or twenty hospitals which give full
courses to colored nurses,  some  of  them being entirely
controlled by negroes.
  The first training-school in a  hospital for the  insane 
SUMMARY  OF  IMPORTANT  POINTS   179
was  founded at McLean Hospital, Waverly,  Mass., in
1882.  Such  schools  were  gradually opened  in  other
asylums, there  being  thirty-eight in 1895.
  Mental nursing  covers a broader field than does mere
"bodily" nursing, but the fact has not yet been  generally
recognized.
  Psychiatric nursing is just beginning in America,  and
it will probably be many years before it is developed.
The  new and wonderful field of psychotherapy—mental
healing—has hardly been made known to nurses.
  Canada found many  difficulties  in establishing schools
for nurses.  In point  of time, trained nursing in Canada
has followed very closely the work in the United States.
  The Mack Training-School at St. Catherine's, founded in
1874, was the first nurse training-school in Canada.   The
Toronto General School, founded in 1884, was almost the
next.  There are now many  good  schools.
  The Victorian Order,  organized in 1897, is  the national
association for district or visiting nursing.  It is one of the
best  organizations  of the kind in the world, and its work
is of high quality.  It gives a special course in the work.
  School nursing was begun in 1908, and in  1910  was
carried on by  Miss  Lina Rogers, who began it in  the
United States.
  Manitoba is  the only  province  of  Canada that  has
state registration, though others are attempting to get it
through. 
CHAPTER XII
THE  DEVELOPMENT OF TRAINED NURSING  IN
               AMERICA  (Continued)

  Organization.—Hospitals, from the very nature of their
work, tend to grow self-centered.  The nurse in training,
just because  her  work is all-absorbing,  loses touch with
the outside world and knows little of nurses even, except
those  of her own  school; if she remains in hospital work,
her isolation is likely to continue; if she goes into private
nursing, she finds little time to  become acquainted with
other  nurses or to know their interests, and it is easy for
the isolation to continue.  So, for a long time, few nurses
thought it either possible or desirable to attempt to  co-
operate with other  nurses.
  The first attempt of American nurses to get together in
a  formal  organization was doubtless  the  Philomena
Society, started in  New York  in 1886.   It lasted only
about a year, and we have no record of its work.
  The first permanent  societies of nurses were alumnae
associations.  Some of  the earliest to be organized were:
  Bellevue, New York, organized 1889.
  Illinois Training-School, Chicago, organized 1891.
  Johns Hopkins, Baltimore, organized 1892.
  Massachusetts General, Boston, organized 1895.
  Boston City, organized 1896.
  These societies  helped the nurse  to work for her own
school and with the nurses who belonged to it, but did not
bring  her  into the broader field.  Nurses were still self-
centered.
       180 
TRAINED  NURSING  IN  AMERICA   181
  The first general meeting of the nurses of the United
States was the Nursing Section of the Congress of Hospi-
tals and Dispensaries, held at the World's Fair in Chicago
in 1893.  The suggestion for such  a  meeting probably
came from Mrs. Bedford Fenwick of England.  Dr. John
S. Billings,  of Chicago,  made  the arrangements,  and
Fig. 44.—Mrs. Isabel Hampton Robb.
Miss  Mabel Hampton,  of  Johns  Hopkins  Hospital,
Baltimore, was  the  chairman.
  This Congress showed that American nurses were ready
to co-operate.  Papers on topics of common interest
were read by Miss  Hampton,  Miss Edith Draper,  Miss
Alston,  Miss Irene Sutliffe, and other  women.   Miss 
182   OUTLINES  OF  NURSING  HISTORY
Nightingale sent a paper and Mrs. Fenwick spoke.   The
need of a national union was urged.
  That same year, as a direct result of the Congress, the
American Society of Superintendents of Training-Schools
was formed.   Its first president was Miss Alston.
  In 1896 there was formed  a general society of graduate
nurses,1  called the  Nurses' Associated Aluinnce  of the
 United States and  Canada.2   Mrs.  Isabel  Robb  (nee
Hampton)  was its first president.
  After  1900  state associations began to  be formed.
Nearly all  of these had as their  primary  object the ob-
taining of  registration laws.  There are now only a few
states  that have no organization.
  Nurses have now found  not only the pleasure of know-
ing each other, but  the value of co-operation.  They see
the power  of concerted effort, not only in gaining what
they want for themselves, but in wielding an influence
over the life of the  country. None of the organizations
may yet be regarded as mature, but they are finding them-
selves  with commendable rapidity.
  State Registration.—The medical profession long since
came to feel that  it should protect  the  public  against
quacks and imposters,  and to this end devised state regis-
tration, whereby  every would-be practitioner should be
compelled to pass an examination and to receive a license
before he could do his work.  It was inevitable that nurses
should feel the need of similar  protection.   They have,
therefore, devised a state registration along like lines.
  Both nurses and doctors have had many struggles  with
the question of registration.  They have had to convince
both the legislators and each other of the need of regis-
  1 The idea originated with Annette Sumner Rose, editor of the
"Trained Nurse" and "Hospital Review."
  2 Canada formed her own association in 1907. 
TRAINED  NURSING  IN  AMERICA    183
tration.  They have had long and hot discussions over the
details of laws and rulings.
  In England  the  fact  of nurses' registration  itself has
been the bone of contention, one  party holding that it
was  advisable,  even necessary; the  other maintaining
that it  was undesirable, even harmful.
  In the United States the value of registration has been
little questioned, and the discussion  has  been over the
form and  content of the laws.   Most of the states  now
have registration laws,  hardly  any two of them alike.
These  various laws  certainly furnish basis  for experi-
ments  which should enable us to arrive in time at some
very definite conclusions.
  (A fuller  account  of the matter  of  registration will be
found in Chapter XIV.)
  The  Broadening  of the Nurse's Field.—Even at  first
three divisions of nursing were recognized:
  Hospital nursing.
  Private duty among paying patients.
  District nursing among the poor.
  Hospital  nursing has  unfolded in marked ways.   The
number of hospitals in proportion  to  the population has
increased, special hospitals have multiplied, refinements
in hospital nursing have been demanded, and the nurse's
place in hospital life has become greater than perhaps even
Florence Nightingale dreamed.   Several different classes
of hospital nurses are now recognized,1 and  many special-
ties have  developed, such as  work with  children,  con-
tagious cases, maternity, eye and ear, nervous and insane,
chronic cases, and so on.   It is impossible for any one
nurse to be an  expert  in  all these  classes of hospital
nursing.
  Private Nursing.—Despite the great growth of hospitals,
    1 See Chapter XXI, Vocational Opportunities for Nurses. 
184   OUTLINES   OF   NURSING  HISTORY
there has been an increased demand for nurses in private
homes.   The  great  army of graduate  nurses  still  find
private  duty  their  field.   Private nurses  have  also
specialized  in  order to  keep up  with the  practice of
physicians.  There is still, however, a large place  in the
community for  the  all-round nurse, the  one who  can
make a patient comfortable bodily and mentally, who can
stand beside the physician and fight death or disease with
judgment and faithfulness,  and who can be a  source of
strength to the family.  Despite its criticism of unworthy
or careless members of the  profession, the  public knows
its need of the trained nurse in the home.
  District nursing began in  this country,  as it  did in
England, when philanthropic  societies sent nurses among
the poor, to go from one patient to another, doing what
they could to make them comfortable, and teaching  the
families to render proper care in the interval  between their
visits.
  In 1877  the Women's Branch  of the  New York City
Mission  put a nurse at work among the poor; the same
year the New  York  Society  for Ethical Culture had a
visiting nurse connected with a dispensary.   Boston  and
Philadelphia are credited with starting similar work  about
the same time.
  The idea developed slowly.  In  some cities the work
was begun with one nurse paid by an individual; in others,
she worked under a  committee or society;  in others, a
definite organization was effected for this particular pur-
pose; in a few instances  a nurses' association has under-
taken the work.   In all cases there was, of necessity, a
body of  people standing back of the project,  supplying
funds for salaries and supplies.
  Some of the earlier visiting nurses' associations were as
follows: 
TRAINED  NURSING  IN   AMERICA   185
  Albany (N. Y.) Guild for the Care of the Sick Poor grew
out of the Fruit and Flower Mission, which was established
in 1880.
  The Chicago Visiting Nurse Association was established
in 1890.
  The Kansas City  Association in 1891.
  The Buffalo (N. Y.) Association in 1892.
  The Denver,  Colo.,  Flower  Mission employed  one
nurse in 1892, though the association was not formed until
1900.
  The St. Louis Association in 1895.
  In  1890 there  were twenty-one visiting  nurse associa-
tions in the United  States, most of them employing only
one nurse.   From about 1894 the work grew more rapidly,
and since 1905 the spread of the idea has been remarkable.
The rate  of growth  has no doubt been indicative of the
trend of events, and of the  developing social  conscious-
ness of the nation.
  District nursing is now a firmly established institution.
Cities, towns, and rural communities have seen their need
and have put nurses into the field.  Most of the great
movements for  social betterment have  required nurses.
The antituberculosis  movement  has taken many;1 the
infant welfare movement  and the pure  milk  movement,
many  more; life insurance companies are  using district
nurses among their  policy-holders;2 while  the National
  1 For example, the city of Boston employs  about twenty nurses
for work among the families of tuberculous patients who are in the
city or state sanitariums.
  2 The Metropolitan  Life Insurance Co.  in  1909 conceived the
idea that the establishment of a visiting nurse service among its
policy-holders might prevent serious illnesses and thereby save some
deaths. The company  consulted Miss Lillian Wald, of New York,
and made a three months' trial of the plan.   Before  the year was
out they had established the  service  in New York, Washington, 
186   OUTLINES  OF  NURSING  HISTORY
Public Health Association has  recently outlined a tre-
mendous program for the visiting nurse.
  The National Association of Public Health Nursing, in-
cluding all sorts  of district nurse work,  was organized in
1912.
  Miss Harriet Fulmer, of Chicago, has done much toward
developing visiting nursing in the West.   Miss Edna Foley
has also done important work.  Miss Mary L. Beard, of
Boston, is now doing much to enlarge and deepen  the
sphere of  visiting and public health nursing.
  Training for District Work.—Boston, New York, Phila-
delphia,   Baltimore,   Richmond,  Ya.,  Cleveland,  and
Chicago  give training in visiting nursing  in  their asso-
ciations.   Boston's courses are typical of the best that is
being done in this line.  A two months' course is given to
pupil nurses from the hospitals,  being designed to furnish
merely an insight into the work, not a  full training;  the
regular four months'  courses gives practical  work under
supervision and fits a nurse for ordinary visiting work; the
eight months' course, begun in 1914, is quite extended, in-
cluding classes  at Simmons  College and the School  of
Social Science, taking up such subjects as sanitation and
preventive  medicine,  and giving practical experience  in
social work.
  The Teacher's  College of  Columbia  University, New
York, also gives  a course in visiting nursing.
  Nurses'  Settlements.—With  visiting nursing  estab-
lished and settlement work  coming into  general  notice,

Baltimore,  Boston,  Cleveland, St. Louis, and Chicago.  The com-
pany pays for the nurse's services,  and makes her work a part of the
benefits to  their policy-holders.  It is a purely business enterprise,
and while it has saved money to the company, it has also saved lives
to the community.  The work has been extended to over one thou-
sand cities in the United States and Canada. 
TRAINED  NURSING  IN  AMERICA    187
it  followed  naturally that  nurses themselves  should
organize similar enterprises.
  The  first nurses'  settlement was the now  well-known
one in Henry Street,  New York City.  In 1893  Miss
Lillian Wald, a graduate of the New York Hospital, with-
out any knowledge that such endeavors were being made
elsewhere, persuaded a class-mate, Miss Mary Brewster,
to go into the tenement district to live and work.  From
this  informal start there has  developed a  remarkably
well-organized settlement house, with all sorts of activities
for the betterment of life among  the poor.  Miss Wald 
188   OUTLINES  OF  NURSING   HISTORY
herself has become an authority upon many matters con-
nected with social service.1
  Miss Cabaniss and Miss Minor started a nurses' settle-
ment in Richmond,  Va., in 1900, which has helped to
organize the Visiting Nurse Association,  the  Associated
Charities, the  Tuberculosis  Association,  the Playground
Association, and to develop school nursing.
  Miss Octavine  Briggs began settlement work in San
Francisco about 1900, and in 1903 Miss Elizabeth Ashe
started a second settlement there in the district known as
Telegraph  Hill.  These  settlements  have  had among
their interests  school nursing, tuberculosis work, dispen-
saries, day nurseries, and tenement inspection.
  Miss Margaret H. Pierson established in Orange, N. J.,
in 1903 the Visiting Nurses' Settlement.    It gives a course
in visiting nursing, maintains a diet kitchen, a milk station,
a first-aid room, has a night nurse on call, and  provides
public lectures on health and nursing.
  In the class with settlement work  may be  put  the
labors of Miss Lydia Holman in the  North  Carolina
mountains.   She at first  worked  alone  as a missionary
nurse in wild  districts,  and now has a  well-developed
hospital  and nursing service.
  There  are  a number of other nurses' settlements, and
there is nearly  always in settlement work a large  place for
nurses.
  School nursing was begun in England  in  1892.   Its

  1 "She has come to be  called  into consultation with one  city
administration after another,  has sat on varied public commissions,
counselled with  a governor  about the  immigrant,  interfered  suc-
cessfully with a president and his cabinet in behalf of  a Russian
refugee, and addressed a committee of Congress.  The suggestion
of the Federal Children's Bureau was hers."—Nutting and Dock's
"History of Nursing." 
TRAINED  NURSING  IN  AMERICA    189
excellent results were quickly seen, especially in the reduc-
tion of contagious diseases.  Miss Lillian Wald was famil-
iar with the work in England, and brought its advantages
to the notice of the health office of New York City.
  New York took its first step in having its school children
inspected by doctors, but found it  largely inefficient  be-
cause there was no follow-up  work.  In 1902  the city
made the experiment  of the school  nurse with Miss Lina
L. Rogers  of Toronto.  The  result was most  satisfac-
tory.
  From that time  school nursing spread throughout  the
country.  Philadelphia, Baltimore,  Chicago,  and  other
cities took  up the  work and found  it a success.   Nearly
all of them made the mistake of beginning with  a doctor
rather than with a nurse; but experience soon proved that
a nurse working alone in the inspection of school children
gets  results two or three times as great as a doctor work-
ing alone.  The reason for this is that the  nurse follows
her findings with personal visits and practical instruction
to the mothers of  the children; whereas  a doctor merely
recommends and has  no means of seeing that his recom-
mendations are even  considered.
  Nursing  in the  Spanish-American War.—The United
States declared war with Spain  in April, 1898.  Imme-
diately  women from all over the country began to offer
their  services as nurses for the  soldiers, some  of  them
being graduates,  but many  totally untrained.  Many
organizations undertook to register  nurses and send them
into the war.
  There was no nursing service connected with the army,
and  Surgeon-General Sternberg was opposed to the for-
mation  of  one.  He obstructed the  entrance  of even
trained  nurses into the army.   The Daughters of  the
American Revolution, one of the organizations that had 
190   OUTLINES  OF  NURSING  HISTORY
offered help to the government, finally brought enough
pressure to bear so that Dr. Sternberg appointed Dr. Anita
Newcomb McGee as a "contract surgeon" and as registrar
of "contract nurses."   This meant that both she and her
nurses were hired servants of the army, not a part of it.1
From May to August about one  thousand nurses were
registered and employed,  many  of them being  non-
graduates.
  The Third Auxiliary of the Red Cross raised a  large
fund and offered many graduate nurses to the Surgeon-
General.   He accepted them reluctantly.  Roman Cath-
olic Sisters to the number of over two hundred, Anglican
Sisters, and deaconesses were also accepted and  served as
nurses, some groups not being directly under the control
of either  the Red Cross or the government.  Some of the
nursing service given was poor, but much of it was of high
quality.
  By September, 1898, there were twelve hundred nurses
on duty in the various camps in the United States—Mon-
tauk Point, N. Y., Chickamauga, Ga., and Jacksonville,
Fla., each having  about an  equal  number.  A number
were sent to Cuba and Porto  Rico.
  The conditions met  resembled all  too closely those that
Miss Nightingale had encountered in the  Crimea.   Sup-
plies were short (until the Red Cross was permitted to take
a hand),  sanitation was poor or very bad.  The Detention
Camp  at Montauk,  the hospital  where four hundred
contagious cases were lying, was for thirteen days without
a nurse.
  The first  organized  group of  graduate  nurses  to  be
officially  appointed to take charge of any camp was the
Boston Society of Red Cross Nurses, under the leadership
  1 Some of the so-called contract nurses were untrained, and some
were servants who did not do nursing at all. 
TRAINED   NURSING  IN  AMERICA   191
of Dr. Laura A. C. Hughes, a graduate of the Boston City
Hospital.   She went with nine graduate nurses to Mon-
tauk  Point in August,  1898, in response to  a call from
General Joseph Wheeler, U. S.  A., commanding officer of
this camp, who,  going  over  the  head of Dr. Sternberg,
obtained permission direct from General Alger, Secretary
of War.   Dr. Hughes and her nurses took the  nursing
service in the Detention Hospital, where several hundred
men were ill with yellow fever,  scarlet fever, measles, and
other communicable diseases.   During their first hour of
duty, while inspecting the tents, they found two unknown
dead  in the beds.  Of the twenty-five thousand soldiers
encamped  at Montauk  Point,  nineteen thousand passed
through the hospitals.   These  men had  all seen service,
and suffered  from the unsanitary conditions in  Cuba,
Porto  Rico,  and  the  transports.  The death-rate  was
18 per cent., practically all of it  from preventable diseases.
  Miss  Anna Maxwell,  Superintendent of Nurses  at the
Presbyterian Hospital, New York, was put in charge at the
training  camp  in Chickamauga,  and  did  a  remarkable
work in organizing and improving conditions.  She  was
followed by Mrs. Harriet Camp Lousbury, who also did
fine work.
  Mrs. Lucy Quintard served at  Montauk and in  Cuba.
Miss Eugenie Hibbard did superior work in Cuba.  Miss
Irene Sutliffe and other women were noteworthy super-
visors.  The women who worked in the ranks rendered
most devoted service, and a considerable number of them
lost their lives from disease contracted on duty.
  The Organization of the Spanish-American War Nurses.
—The nurses who had served under contract in the United
States Army during the Spanish-American War prior to
January 1, 1899, formed an organization in 1900.   Eligi-
bility was made to include graduate women physicians as 
192   OUTLINES  OF  NURSING  HISTORY
well as graduate nurses, in order to admit a few women
doctors, including peculiarly Dr. Anita McGee.1
  The object of this organization is "To celebrate the ad-
mission of trained nurses into the United States Army, to
commemorate the work of nurses in the United  States
hospitals during  the  Spanish-American War,  to foster
the spirit of patriotism, to promote a closer bond of friend-
ship  among those who nursed during that war, and to
provide efficient means for united action when necessary."
  The organization numbered about five hundred the first
few years, but is now reduced through  death, disability,
and various  causes.   (See  Chapter XX.)   Members of
         Fig. 46.—Spanish-American War Nurses' Pin.

this organization are now on duty in Cuba, Panama, Porto
Rico, Hawaii, and the Philippines, and in Army and Navy
Hospitals throughout the  United States.
  Army Nursing.—Until after the Spanish-American War
there were no nurses regularly in the service of the govern-
ment.  In 1899 a committee from the Nurses' Associated
Alumnae presented to Congress a bill for the establishment
of a permanent Army  Nurse Corps.   Difficulties  were
encountered in getting such  a bill  passed, but in  1901 it
was  finally put through, and a Superintendent of Army
Nurses appointed.  Mrs.  Dita  G. Kinney  (graduate of
the Massachusetts General Hospital) served  as superin-
              1 Dr. McGee is not a nurse. 
SUMMARY  OF   IMPORTANT  POINTS   193
tendent until 1910.   She was succeeded by Miss Jane C.
Delano and Miss Dora E. Thompson.
  Navy Nursing.—In  1903 Medical Director Boyd  at-
tempted  to get a bill through  Congress establishing a
Navy Nurse Corps, but failed.   Another bill, with differ-
ent provisions, was pushed  through in 1908 by the efforts
of Admiral P.  M.  Rixey.   The first Superintendent of
Nurses for the  Navy was Miss  Esther  V.  Hasson.  She
was succeeded by Miss Lenah S. Higbee.
  Household Nursing.—Ever since  the advent of the
trained nurse thoughtful persons have felt  that it should
be made possible for every sick person to have skilled care.
The graduate nurse  promptly furnished this care to the
well-to-do, and the visiting nurse  organizations  and free
hospitals have  now  pretty well  covered the case of the
poor.  For years, however, it has been recognized that
the great middle class was neglected; that people whose
incomes covered only a comfortable living for themselves
and their families could not afford  a graduate nurse; that
they often could not or would not go to  a hospital, would
not accept charity, and so were practically unprovided for
in serious illness.
  Various  schemes were suggested to relieve this condi-
tion, but none appeared to be practical.
  Household nursing, initiated  and  organized  by  Mr.
Richards T. Bradley of  Boston, is now furnishing what
appears to be a solution of the  problem, and is meeting
with the approval of nurses, doctors, and the public.  An
account of it will be found  in Chapter XVIII.

          SUMMARY OF IMPORTANT POINTS

  The first organizations of nurses were alumnae societies.
They  began  late   in  the 80's.  These  brought  into
       13 
194   OUTLINES  OF   NURSING   HISTORY
closer touch the nurses from individual schools, but  did
not affect the whole nursing body.
  The first attempt of nurses to co-operate in any large
way was at a meeting held in 1893 at the World's Fair,
Chicago.   As  a result of  this meeting the  Society  of
Superintendents of Training-Schools was formed in that
same year.
  The Nurses' Associated Alumna? was organized in 1896.
  After 1900 state associations began to be formed, most
of them having as their chief object the obtaining of regis-
tration laws.
  State registration has been pushed until it now obtains
in nearly all of the states.
  At the  beginning,  three  fields for nurses were  recog-
nized, hospital nursing, private duty, and district nursing.
Each of these has broadened its  field greatly.
  District  nursing among the poor  began early, but did
not become definitely organized until about 1880.  The
idea developed slowly until about 1895, and the greatest
growth of visiting nurse societies has been since 1905.
  Special training for district nursing is now available in
several cities, Boston probably giving the most elaborate
courses.  It is also taught at Teacher's College, New York.
  Insurance nursing presents an interesting and worth-
while field.
  There are several nurses' settlements among the poor,
the oldest and largest being the one at Henry Street, New
York City.  Miss Lillian Wald,  the founder and head of
this, has become a  figure of national reputation.
  Public school  nursing was begun in New York City in
1902.  Miss Lina L. Rogers organized the work.  She
afterward  did   the  same   service   in  Canada.  School
nursing  spread  rather rapidly and is now  an established
fact  in many cities. 
SUMMARY  OF  IMPORTANT  POINTS   195
  Nursing  in  the Spanish-American  War  was done  by
"contract  nurses"  under  the government,  by  nurses
working  under the Red Cross, and by a variety of or-
ganizations.  The work was  at first in a rather chaotic
state, but was finally successfully organized in one way
or another.
  Dr. Anita McGee was appointed as a contract surgeon
and was put in charge of the nurses.  Other appointments
were made, however, so that the control of all nurses was
never in  any one person's hands.
  Many  untrained women served,  but  the greater number
were accredited graduates.
  The three principal  hospital stations were Montauk
Point, Jacksonville, and Chickamauga.  Nurses were also
sent  to Cuba and Porto Rico.
  Conditions were often very  bad indeed, and most of the
very large numbers of deaths were due to preventable dis-
eases, not to wounds.
  The Spanish-American War nurses organized in 1900.
  The United States Government was stirred by the ex-
periences of the Spanish-American War, so that in  1901
an Army Nurse  Corps  was organized, and in 1903 the
Navy Nurse Corps.
  Household nursing is an attempt  to  provide skilled
nursing for people of moderate means.   It is a new move-
ment, but appears to be practical and effective.  It was
set on foot  by Mr. Richards T. Bradley. 
CHAPTER XIII
THE  DEVELOPMENT  OF  TRAINED  NURSING IN
               AMERICA (Concluded)

  We are still in the midst of hot discussions concerning
both the fundamental  principles of trained  nursing and
the details of its practical working out.  There are many
questions, great and small, that are still unsettled,  in
regard to which we must try  to keep  an  open mind.
Trained nursing is  just  entering its  second generation,
and with so  small an experience behind it must endeavor
to keep abreast of  the world-problems that are coming
upon  us so  fast.
  Fear of Overtraining.—As early as 1876 doctors began
to take alarm at the training  of nurses and to see in it a
danger.    In that year a Philadelphia physician wrote:
"The  error has  been committed in some schools of carry-
ing the training so high as to develop a nondescript official,
not a doctor, yet more than a nurse; unequal  to great
emergencies, yet too learned for the inevitable drudgery
of the sick room.  Thus, at St. Thomas', pupil nurses are
taught to  dress wounds, to take accounts of cases, make
and apply bandages, are required  to hear lectures on
anatomy,  physiology,  pathology, and chemistry.  One
could  hardly expect them to submit to directions."
  A similar fear was often voiced by physicians, but they
have found the fear groundless.  They  see that knowledge
of medical science does  not make a nurse  less obedient to
orders, and  that the professional nurse is not a  menace
to them, but a help.
       196 
TRAINED   NURSING  IN  AMERICA    197
  The Educational Idea.—Most of the pioneer training-
schools were concerned chiefly with teaching nurses enough
to make them efficient in the all-round care of a patient.
To this routine work was sacrificed the nurse's whole time,
always her social life,  often her health.  To get the work
of the hospital done was sometimes the uppermost thought
in the minds of those  at the head of training-schools,  and
the nurse's own progress and development was a second-
ary consideration.
  As the possibilities of trained nursing began to be seen,
it dawned upon some of the more observant that  this
close  attention to  routine work and  the preponderance
of manual labor was  defeating its own object, and  was
producing a type of nurse who was a good worker, but who
lacked breadth  of  view and a realization  of her own
powers; that this sort of training was not preparing nurses
who could take their places in the big field which  was
before them.
  So there came gradually into the nursing world the idea
that nursing could be  a true branch of education; that it
could be classed with the  professions; that a more intel-
lectual type of woman was desirable in some of its  di-
visions.
  The first school to lay stress upon the educational side
of nursing was Johns Hopkins.  It has demanded  and
attracted the intellectual type of woman, and has made
a point of giving preparation for executive  work.  The
University of Texas, about 1893, made the Superintend-
ent  of Nurses in the  John Sealy Hospital of Galveston
(where the University medical students had their work) a
professor  in the  University, thus trying  to draw  the
nurses up  to  a more intellectual  viewpoint.  In  1909
Dr.  Richard O. Beard, of the University of  Minnesota,
brought forth  a plan in  which nurses' training was made 
198   OUTLINES   OF  NURSING   HISTORY
a branch of college work.   His scheme is being tried out
at the  University of Minnesota  Hospital.
  The idea appealed to certain minds, and a great deal has
been said and done in an effort to require more schooling
before  a nurse begins her training in the hospital.   In
1911 there were ten nurse training-schools connected with
colleges requiring that their probationers be  high  school
graduates; and six universities were giving nurses' training.
  Education  Pro  and Con.—The  opponents of  placing
nursing on a high educational  plane  contend that  the
average nurse does  not need college training; that  her
work is satisfactory without it; that often the intellectual
type of woman  makes a  poor nurse  in actual practice.
The  advocates of education  contend  that  the more  a
woman knows, the better her work will be  and the more
possibilities it will have.
  The truth lies,  perhaps, between the two  extremes, and
in a recognition of the fact that not one but several types
of nurses are  needed in the life  of  the country.   There
must always be  the  large  class of nurses  who are  only
workers,  and to  whom nursing  is largely manual labor.
There likewise must be the trained teacher and leader, a
woman  with  a   large  grasp  of professional  problems.
Different types of schools must produce the different types
of nurse.1

  1 The  Correspondence School.—With the growing popularity of
certificated nurses,  it was inevitable  that there should spring up
schools which offer  a short cut to  success.  The most popular of
these substitutes for hospital training has been the correspondence
school, in which the instruction is entirely theoretic  and given by
correspondence, any practical  training and experience being gotten
as best it may be.  The courses take from six to nine  months' time,
and the results are not very satisfactory.   Nursing is so essentially
a practical matter, and the theory so small a part of it, that it could
hardly be otherwise.  Such courses are makeshifts,  which doubtless 
TRAINED  NURSING  IN  AMERICA    199
  Administrative Courses.—In 1898 it was suggested that
a course be established for nurses who wished to become
heads of hospitals or training-schools.  The whole country
recognized  the  need.  Teacher's College,  a  branch  of
Columbia  University, New  York,  was selected for  the
experiment, and agreed to carry the course.
  Mrs. Isabel Hampton Robb was put at the head of the
new scheme, and her committee consisted of Miss Linda
Richards,  Miss Maud Banfield (Superintendent of  the
Polyclinic Hospital of Philadelphia), Miss M.  E. P. Davis
(Superintendent of the University of Pennsylvania Hos-
pital), Miss Lucy Walker (Superintendent of Nurses at the
same hospital),  and Miss M. Adelaide Nutting (Superin-
tendent of Nurses at Johns Hopkins Hospital, Baltimore).
  A course of two  years was arranged, and the first two
pupils entered, Miss Anna Alline1 and Miss Alice Gorman.
  In 1909  a Chair of Nursing and Health was established
at Teacher's  College, and  Miss  Nutting was called  to
occupy it.   She has developed the school and established
a variety of courses.   Short and summer courses in  all
subjects pertaining to hospital and  training-school  ad-
ministration are given and the school has become popular.
  There was also a demand for short, practical courses in
administrative work.  Two hospitals only have felt able
to try to supply what was asked.   In 1908 the Massa-
chusetts General Hospital, of Boston, began giving a six
months' course  in practical executive work, under super-

prove of help to women who are over age  for hospital training, and
to some others.  The danger is that those who hold certificates from
them will attempt to  pass themselves off as fully trained women.
No laws have yet been devised by which they can be regulated.
  1 Miss Alline was put at the head of the Teacher's College course
in 1901.  In 1906 she became New York State Inspector of Training-
schools. 
200   OUTLINES  OF   NURSING  HISTORY
vision, taking but two pupils at one time.  Grace Hospital,
Detroit, established a similar  course, taking four pupils.
These short, practical courses  have always had far more
applicants than  could be admitted.
  Both theoretic and practical courses fill a real need in
the country.  All women who aspire to executive positions
feel the need of special training  for them.  Satisfactory
and sufficient training will doubtless be worked out in
time.
  Nurses' Text-books.—In the beginning, practically all
text-books  used  by  nurses  were  written  by  doctors.
Miss Nightingale's "Notes of Nursing" probably did much
to make nurses feel that they were capable of writing their
own text-books;  a number of English nurses were the first
to undertake the  task.
  In America the first nursing text-book was written by
Miss Clara Weeks,1 a graduate of the New York Hospital;
it was for years regarded as the best work of the sort.
  Presently, nurses began to  venture further and write
books upon subjects that  had hitherto been thought to
be in the province of physicians only.  Miss Diana  C.
Kimber, of BlackwelFs Island,  was the first nurse to write
an Anatomy and Physiology.  Miss Lavinia L. Dock was
the first nurse to write a Materia Medica; Miss Mary E.
Reid the first to  write a Bacteriology; Miss Harriet Camp
the first on Ethics.  So many nurses have followed their
lead that the list has grown to be a formidable one.
  Miss  Isabel Mclsaac, long in charge  of the Illinois
Training-School, Chicago,  was a well-known  writer of
nursing books; among her works are Primary Nursing
Technic, Hygiene, Bacteriology,  etc.  She  was head of
the Army Nurse Corps in  1912, and was Interstate Secre-
tary of the American Nurses' Association.   Miss Charlotte
                    1 Now Mrs. Shaw. 
TRAINED  NURSING   IN  AMERICA   201
Aikens has written a number of text-books for nurses and
on training-school methods; in co-operation  with other
well-known persons she wrote a very practical handbook
on hospital  management.   She has  been prominent  in
Fig. 47.—Mrs. Clara Weeks Shaw.  (Taken about the time that her
           "Text-Book of Nursing" was published.)

working for a standard curriculum for schools of nursing;
and throughout her nursing life has  been  interested in
working out plans for the better care of the sick of moder-
ate means.   Miss Amy E. Pope has written  excellent 
202   OUTLINES   OF   NURSING   HISTORY
text-books for nurses that are widely used.  Miss Emily
Stoney and  others have added valuable contributions to
nursing literature.
  Each year more nurses see the duty of putting into per-
manent form the principles and methods which they have
worked out  in their everyday tasks.   The  pupil  who
looks over the books that have been of the most help to her
finds that most of them are the work of nurses.
Fig. 48.—Miss Charlotte A. Aikens.
  Small Training-schools.—It has not been the case with
nurses' training-schools as it has been with other schools,
that the ones which had the most money and were thereby
able to acquire the best  buildings and equipment and to
secure the most noted  teachers  have gotten  the best
results.  Success in nursing remains, as Miss Nightingale
found it, very largely a matter of personal qualities.  It 
TRAINED   NURSING  IN  AMERICA   203
is the failure to recognize this fundamental truth that has
sometimes  betrayed nurses when they came before the
public, and has lost them some of their influence.
  It is this matter of personality which has brought some
of the smaller, less known schools of the country up to a
very high plane in their work.  We are all cognizant of
the fact  that  some small hospitals have exploited  their
nurses and have not given them full or adequate training;
but large hospitals have done the same thing.  All through
the country there are hospitals, of thirty to seventy beds,
whose Boards have had a vision of what they might do for
their nurses, and whose superintendents have  inspired
their pupils with the true spirit of  service as well as
giving them  an exact technical  training.  Some of the
best results have been gotten in institutions where  per-
sonal instruction and individual  contact of pupil  with
teacher furnish conditions almost ideal for the production
of a high type of nurse.
  Co-operation and Affiliation.—Until  after the beginning
of  the twentieth  century training-schools  were  much
isolated,  each being practically a world in itself and in-
clined to remain so.    There was  little postgraduate  work
available to the nurse who found her  original  training
deficient  or who  wished to specialize.   Affiliations be-
tween schools were hard to arrange, since those that had
attractive special departments preferred to keep them for
their own pupils, and viewed the  training and methods of
other schools with suspicion.
  The nursing  organizations which  brought so many
schools into contact, and the spirit of  co-operation which
was  so markedly pervading the whole  world, reached out
and brought the hospitals into line.   Now affiliations be-
tween schools  have  become   common,  postgraduate
courses are available in almost any subject, and training- 
204   OUTLINES  OF   NURSING   HISTORY
schools  are every  year more  friendly,  more  tolerant of
each other's methods,  and more ready to be helpful to
outsiders.
  For a long time a nurse who had taken a partial course
in one  hospital, but  wished to finish  at another, even
though  her reasons were good and her first training ex-
cellent,  found  the way closed, and was compelled to take
a full course, getting no credit  for previous work.   Now
reciprocity is coming  to be the rule.
  Length of  Course.—The earlier training-schools gave
but one year of training, though some required two years
of residence in the hospital.   Gradually,  more and more
instruction was added and the length of training increased.
For a long time  two years was thought  to be ample to
produce satisfactory results.   About  1894  some  of  the
larger schools, in hospitals that had many  departments,
extended the time to three years.
  This longer  time for training was made  so much of that
hospitals all  over the country adopted it unthinkingly,
chiefly  because  it  seemed  to suggest  that they had a
higher standard, while the training given remained  the
same as it had under the former regime.   As a result, a
considerable number  of hospitals  now  give a three-year
course that contains less than two years' instruction, and
which actually amounts to an  exploitation of the nurses.
It is a natural result of emphasizing quantity and mistak-
ing it for quality.  This question  of length of course is
one of the much-discussed and  still unsettled questions of
the nursing world.
  Preliminary Courses.—The impossibility of giving pro-
bationers or young nurses a proper theoretic course while
they were spending most of their time in  the  wards, and
the wrong of permitting nurses to do work for which they
had not received thorough instruction,  presently became 
TRAINED  NURSING  IN  AMERICA   205
apparent.  Preliminary courses of various sorts have been
introduced to correct this difficulty, and have been adopted
by many schools.  The Johns Hopkins training-school was
probably the first to carry out such a plan, and schools in
Boston and Rochester,  N. Y., were among those that
early adopted the methods.   In 1911 there were eighty-
five  hospitals  which reported giving preliminary courses,
and  the number was doubtless somewhat greater.   Such
courses range  from six weeks to six months in length, and
from the simplest classes to an actual residence  in  a
college.
   Hours of Work.—Until very recently nurses on private
duty accepted, as a matter of course, twenty-four hours
per day responsibility for their patients.   At the beginning
hospital nurses made no complaint at a day of fifteen to
eighteen hours.   After night nursing was established, the
day  became twelve hours,  and an hour  off was the rule.
After a time some schools gave two hours off and two half-
days per week,  making  a  six-day week  and a nine-and-
a-half-hour day.    As far back  as  1891 the eight-hour
day,  which had become common in industrial pursuits,
was  tried,1  and many hospitals have gradually adopted it.
   In 1914 the State of California passed a law permitting
nurses in hospitals to work only eight hours per day and
but forty-eight hours per week.   This law is regarded by
many  as impractical,  though  an eight-hour day with  a
fifty-six hour week is approved.   The tendency is through-
out the country to shorten the  hours of duty, especially
for night nurses, and  to  take into consideration the time
spent in  class and study.
  Sending Pupil Nurses Out for Private Duty.—The older
training-schools,  both in England and  America, found
  1 Mrs. Lystra  Gretter, of the Farrand School, Detroit, was evi-
dently the originator of the plan and the first to  put it  into practice. 
206   OUTLINES  OF  NURSING  HISTORY
their mission largely in the reform of hospitals and pre-
pared their nurses chiefly for hospital service.  Presently
there came a demand for trained nurses in private duty,
and it was noted that the vast majority of graduates were
seeking  that field  of  work.   Superintendents at  once
realized that hospital conditions were far from being like
those of a home, and  that hospital training prepared a
nurse somewhat imperfectly to meet  them.   Doubtless
the complaints of doctors and the comments of the nurses
themselves helped to start  the custom of sending out for
private cases nurses who  were  still  in training.   The
original idea was to give them experience in what they
would meet later while they were still under supervision
and had some one to whom they could go for help with
their problems.1
  Unfortunately,  because  superintendents  of  training-
schools were  busy  and doctors  were thoughtless,  such
outside work was often not properly  supervised, nurses
were sometimes overworked,  and  the results were not
always  good.  Some hospitals overdid  the  matter  and
made too much of the money income  that  resulted to
them.  As a consequence,  a prejudice arose against the
practice.  At the present time some State  Registration
Boards are  discriminating  against schools  which  send
pupil nurses  out; yet so many superintendents feel that
the practice,  if not abused,  is of great value to the nurse,
that at the present time about one-fourth of the schools of
the country continue it.

  1 Miss Linda Richards approves the practice.   She writes: "I
gained practical proofs of the excellence of this method.  The most
important of these is that  a nurse's first mistakes are made when
she has her own superintendent to  go to for counsel.  The super-
intendent, in her turn, by having complaints come directly from the
patients, learns how to best instruct the nurse to avoid them." 
TRAINED  NURSING  IN  AMERICA   207
   The Continuing Problem of Private Duty.—It was plain
 from the first, both to nurses and the public, that hospital-
 trained nurses had  to  do much readjusting in order to
 adapt  themselves to private  work.  Hospital  conditions
 and home conditions are so fundamentally different that
 the criticism was a very natural one.  It has become one
 of the  most vexed questions of the day.
   Dr.  Alfred Worcester, of Waltham, Mass., set out upon
 a world-wide search for the answer to the question of how
 to train nurses for private duty.   He has written a most
 interesting account of his experiences,1 and  has  embodied
 his practical  solution of the  problem in the  Waltham
 Training-School.  This school, though much criticised, is
 acknowledged  to have produced  graduates who  rank
 among the best in the country.  Dr. Worcester gives his
 own account of its underlying principles and their develop-
 ment :
  The Waltham Idea.—"The  Waltham Training-School
 for Nurses was established  in 1885 with the purpose of
 supplying the local need of nursing service.  It was be-
 lieved  then that, in meeting this need, doctors could give
 bedside training to nurses.   At first the  physicians in
 charge of the venture and their lady assistants attempted
 to teach only a modicum of nursing knowledge; but by the
 second year Miss Mary Hackett, a graduate of  the Long
 Island  College Hospital Training-School, came  as super-
 intendent and  brought  the  school into direct line  of in-
 heritance  of  the nursing  profession's  best traditions.
 At the same time a small hospital  was started, which in
 1888 became  the Waltham Hospital.2
  "In  1891 Miss Charlotte  Macleod  became superin-
  1 "Nurses for Our Neighbors."
  2 The Waltham Hospital has 120 beds; the Waltham Baby Hospi-
tal, 16. 
208   OUTLINES  OF  NURSING  HISTORY
tendent of the school, and did distinguished service there,
until in 1898 she was called to be Chief Lady Superintend-
ent of the Victorian Order of Nurses in Canada.1  During
her term of service this was the only school in the country
  Fig.  49.—Miss Charlotte Macleod, of  the  Victorian  Order of
Canada, the Waltham Training-School of  Massachusetts, and the
Household Nursing Movement.

that taught visiting nursing, and it was her work in it gave
her the call to the Canadian service.   She was succeeded

  1 Miss Macleod has twice come back for six months' charge dur-
ing the matron's leave of absence for study of other hospitals. 
TRAINED  NURSING   IN  AMERICA   209
by Miss Beatrice De Veber,  who still remains in charge.1
From 1905 to 1907 the hospital was so fortunate as to have
for its matron Miss A. L. Pringle, formerly matron of the
Edinburgh Royal Infirmary and afterward Superintendent
of the  Nightingale  School for Nurses  at St.  Thomas'
Hospital, London.
  "The course is four years in length.   There is a prepara-
tory course of six months, followed by a year of hospital
training, after which the pupils do private nursing under
supervision, district  nursing, and nursing in one or more
hospitals.  Two-thirds  of those  who  enter finish the
course.
  "The  absolute independence of the  Waltham School
from the hospitals employing its pupil nurses has enabled
it to pursue its original educational purpose, and to retain
whatever methods have proved of value.  Thus, in sup-
plying the  need first encountered of service in the homes
of the sick, before there were in this country graduate
nurses even for those who could afford them, it was found
not only that the pupils as  resident and visiting nurses
were of great use, but also that in such service, under the
constant supervision of their teachers,  they  had  espe-
cially good opportunity for  learning the art of nursing.
Therefore,  in  spite  of  the  many objections  raised, the
school has  insisted that private family  nursing can best
be taught—not in hospital wards—but  in the patients'
homes,  and accordingly a considerable part of  the  Wal-
tham training continues to be so  given.
  "The first eighteen months of the course meets with the
approval of nurses in general; but there  is  a good deal of
disapproval visited upon the school for not continuing the
hospital training  and leaving visiting  and home nursing
  1 Two assistants, Miss Buttinger and Miss Reynolds, have had an
almost equal term of service.
       14 
210   OUTLINES  OF  NURSING  HISTORY
until the final year.  The Waltham School does not con-
form to the general custom because it has found:  (1) That
junior nurses, after a year in the wards, are not so fit for
head-nurseships and for other responsible hospital service,
and for teaching succeeding classes, as they are after an
intervening year of home nursing.  (2) That the teachers
of visiting and  home nursing1 find it far  easier to  teach
pupil nurses  at  this stage of their  development this very
different kind of work than it is to teach those who have
had their full hospital training.  (3) That by this  inter-
change of services  the  health and enthusiasm of the
pupil is maintained and enhanced.
  "The chief distinction of the school is that, as an inde-
pendent educational institution, it  is wholly in charge  of
a faculty  of  nurse teachers.2  Half the  faculty are  in
charge  of  the  hospital  training,  while the  other half
attend to the preparatory course and to the pupil nurses'
outside work in family and visiting  nursing.  This ensures
perfect co-operation between the school and the hospital,
and a proper balancing of the different departments in the
nurses' training.
  "Another  distinctive  feature,  viz.:   the  far  larger
amount of didactic instruction than is elsewhere given to
pupil nurses, is a result of the unique origin of the Waltham
school.  The  early physician  teachers gave generous
courses of lectures  and  recitations, in the belief that
nurses should be taught beforehand what will be expected
of them the  same as medical  students are.   Although
since 1894 the scientific foundation instruction has been
given in the  preparatory course and in the junior  year,
the same effort  has been continued to be beforehand in
the teaching.   Each pupil nurse has over two  hundred
       1 Two assistants give their whole  time to this work.
       2 The faculty numbers twelve. 
SUMMARY  OF  IMPORTANT  POINTS   211
and fifty hours of such instruction, and must pass fifteen
written examinations.
  "Also in the preparatory term, before the pupils even
see sickness and suffering, they are drilled in all the arts of
housekeeping—in buying,  cooking and serving food, in
asepsis, in  massage, and, what  is of most importance, in
caring for the helpless who are not sick—babies, normal
lying-in women, and aged folks, who need only to be prop-
erly fed and to be kept clean and comfortable."
  The earnings of the pupil nurses and the tuition fees
received1 are spent entirely for the school.   There is also
an endowment.
  There are nearly four hundred graduates of the school.

          SUMMARY  OF IMPORTANT POINTS
  Trained  nursing is in its second  generation only, and
there are still many unsettled questions which concern it.
  At  first,  and for some time,  doctors feared  that nurses
would be too highly  trained to be useful; most of them
have  come to take an opposite view.
  Early  training-schools  emphasized  practical  work.
Later  there arose a group of  women who felt that the
intellectual side of nursing was being neglected.   A num-
ber of schools offered courses which attracted women of
higher education, and  several  colleges are now  giving
courses in  nurse training.
  The opponents of the educational idea in nursing claim
that the intellectual type of woman is not  necessarily the
best nurse  in actual practice.  The advocates of educa-
tion say that the more education one has, the better the
results.  It is possible that both  sides are right  and both
types  of nurse are needed.
  1 Waltham is one of the few American schools that require the
payment of a tuition fee. 
212   OUTLINES  OF  NURSING   HISTORY
  The correspondence schools of nursing are discredited
by the profession because they give only theoretic work.
  A great need was felt for good courses in administrative
work.  Teacher's College, New York City, began such a
course about  1899.   In 1909  a Chair  of Nursing and
Health was established, and Miss Nutting called to occupy
it.  The school has become popular.
  The Massachusetts General Hospital  and the Grace
Hospital, Detroit, began in 1908 to give short courses in
practical executive work, taking only a few pupils.
  The first  nursing text-books were  written by  doctors,
but now the majority are by nurses.
  The larger schools  of nursing are found not to possess
the advantages that other  large schools do, since nursing
is often more a matter of personality than of equipment.
While small training-schools sometimes give inadequate
training, many of them class with the  largest and best
schools of the country.
  Affiliations between schools and reciprocity have  been
of slow growth, and are just becoming established customs.
  The question of length of course has been  a much-
discussed matter.  Advocates  of the three-year course
take  the position that a school which  cannot,  through
affiliation or otherwise, give an  adequate course of this
length,  ought not to exist.  The other view urges that
the length of a course does not necessarily imply quality,
and that the standard is a false one.
  Many schools  are  adopting the plan  of giving a pre-
liminary course in theoretic work, and the method appears
to be universally approved.
  In  early days  nurses' working hours were very  long.
The present tendency is to adopt the eight-hour system
or, at least, to materially shorten the  working day.
  The custom of sending pupil nurses out on private duty 
SUMMARY  OF  IMPORTANT  POINTS   213
arose from a feeling that the failure of the trained nurse
to adapt herself to  home conditions grew out of the fact
that they were so entirely different from hospital condi-
tions.   The custom,  while good  in its  inception, was
frequently abused, and so  came to be discredited  among
many nurses.
  The  Waltham (Mass.) Training-School is the embodi-
ment of the idea that nurses can best "learn by doing,"
and that  preparation for  private  duty  should  involve
working under the actual  conditions  which  it presents.
The school gives a  four-year  course,  about half the
time being spent in the hospital  and the other half  in
private and district work.   It has been much criticised
on account of its unique methods,  but its graduates are
acknowledged to be excellent. 
CHAPTER XIV
      STATE  REGISTRATION  FOR  NURSES

  The idea of state or national registration for nurses is
similar to that of registration for physicians.  It aims to
classify  nurses:  (1) For their own protection, so that the
better grades may not be confused with the poorer; (2)
for the protection of the public, so that they may be able
to distinguish between the qualities to be expected in a
fully and properly trained nurse, and those in an untrained,
partially trained, or imperfectly trained  nurse.
  Some of the longest and bitterest disagreements among
nurses have been over questions relating to registration.
The  first  discussions were  over the fact of registration,
whether or  not  the  thing itself was  desirable; the later
contests  have been about  details of requirements  for
registration, personnel of examining  boards, etc.
  Doctors and  hospital superintendents have  taken a
hand in the registration discussion.   Some have advocated
it; others have opposed it.   Some have insisted that physi-
cians should sit  on nurse examining boards; others were
willing for nurses to manage their own affairs.  Meantime
physicians' own registration  is  in  a chaotic and unsatis-
factory state.
  Registration Pro and  Con.—Those  who advocate state
registration  for  nurses claim that it is  the  best way—
perhaps  the only way—of  protecting  nurses  and  the
public against inferior members of the profession.   They
cite the laws governing doctors' practice.   They hold that
only nurses who  come up to certain standards should have
full privileges and full compensation.
      214 
STATE   REGISTRATION  FOR  NURSES  215
  The opponents of registration urge that nursing is a
matter of personality more than of training, and that no
examination can reveal or  register personal qualities.
They contend that amount of education, length of train-
ing, etc., are false standards by  which to judge a nurse's
work.
  Florence  Nightingale  was always actively opposed to
registration for nurses.  In 1890 she wrote: "The tendency
is now to make a formula of nursing, a sort of literary ex-
pression.  Now,  no living thing can less lend  itself to a
formula  than  nursing.  It cannot be  tested  by public
examinations, though it may be tested by current super-
vision."  Her  biographer  says:  "She  held  that,  con-
sciously  or  unconsciously,  the Registrationists had  lost
the essential truth about nursing. .  . . Her objection was
not to taking  precautions against imposters, but to the
misleading nature of the precautions; not to  the tests, but
to their inadequacy."1  She insisted that neither number
of beds in a hospital, nor length of time spent in a school,
nor ability  to  write the answers  to  a set  of  questions,
furnish any guarantee that a nurse is capable of caring
for a sick person.
  Registration  in  England.—England  has  hotly  dis-
cussed the question of registration for a quarter of a cen-
tury,  and is still far from a settlement.  The matter has
been tangled up  with the subject of organization and of
nurses' right to manage their own affairs.  It is difficult to
give a fair account  of the long struggle.  Miss Dock, in
the "History of Nursing," vol. iii, sets forth the side of the
Registrationists.  Sir Edward Cook, in his "Life of Florence
Nightingale," gives  the opposite side.2

  1 "Life of Florence Nightingale," by Cook.
  2 "The matter of establishing a College of Nursing has been brought
up again before the British Parliament (January,  1916),  and the 
216   OUTLINES  OF  NURSING  HISTORY
  The First Registration Law.—Cape  Town, in South
Africa, was the first state in which a nurses' registration
law was passed.   It went into force in 1891.   Its passage
was due to the combined efforts of doctors and nurses, and
both  are  represented  upon  the  examining board.   (In
New  Zealand, also,  doctors  and nurses have  worked to-
gether in  securing and administering registration laws.)
  Registration in the United States.—Before 1900 a  good
many nurses had felt, and some  of them had said,  that
there should be laws which would classify nurses so as to
protect both them and the public.   Americans are apt to
feel that legislation is a panacea for any ill,  and it was
inevitable  that  nurses should try their  hands at  law-
making.
  In  1899  Isabel  Hampton Robb  publicly advocated
nurse registration laws; Miss Sophia Palmer, of Rochester,
N. Y., and Miss Sylveen Nye, of Buffalo, N. Y., each began
independently to work for something of the kind.   Miss
Eva Allerton, of Rochester, also took up the  idea vigor-
ously.
  The matter was brought before the New York Federa-
tion of Women's Clubs, and that body passed a resolution
endorsing the formation of a board  of examiners  chosen
by a  state society  of  nurses, and  recommending the in-
clusion  of nursing education in  the list of  professions
supervised by the  State  Board of Regents.  Thus  New
York not only began  the idea of state registration,  but,
from  the first, connected it up with education.
  In  1901 New York  formed her State Nurses' Associa-
whole  subject of registration and nurses' organizations seems  likely
to be fought over again.  The discussion is more complicated than
ever before, owing to the  fact that there are now many volunteer
untrained or partially trained  nurses who are serving in the war
that demand recognition.  The problem is a tremendous one and
feeling in regard to it runs high." 
STATE  REGISTRATION  FOR  NURSES   217
tion, with the primary object of gaining a legal status for
the nurse.  Some of the best-known women of  the  pro-
fession were in the movement, and the whole idea was
novel and striking  enough  to attract attention  from
nurses all over the country.
  There  was a sharp  fight over what the composition of
the examining board should be,  whether all  nurses, all
doctors,  or some of each.  Other hotly contested points
were as to whether the Regents or the Nurses'  Associa-
tion should nominate the members of the Board, and as
to what control physicians should have over these nomina-
tions.  It was finally settled that the nurses should make
nominations from among their own number, and that the
Regents  should  select  five  of those  thus nominated.
There is  nothing to prevent doctors from being put on the
Board, but it leaves the matter in the nurses' hands.
  Early  Registration States.—The first registration  law
for nurses passed in America was by the state of North
Carolina.  A nurses' association  was  formed  in  1902,
and the  registration bill was  put through the following
year.  The  bill  was  not  considered satisfactory,  since
requirements were not strict, and there were two doctors
on the Board.  It has since been radically amended.
  New Jersey passed the second law, also in 1903, and a
little later in the year  New York succeeded in getting
hers passed.  Virginia followed in the same  year.
  Registration Data.—The table on page 218 gives the
dates of the passage of registration laws in the various
states, and some of the chief facts concerning these laws.
Fourteen states have  compulsory registration.  Alabama,
Arizona,  Nevada, New Mexico, South Dakota, and Utah
have no  registration laws.1
  1 Where two dates are given, the first is that given by L. L. Dock;
the second, by L. C. Boyd, 
218   OUTLINES  OF  NURSING  HISTORY
				
State.	Year that law passed.	Educational requirement.	Training required.	Composition of Board.
	1913 1905, 1913 1905 1903, 1905 1909 1907 1913 1907, 1909 1911 1907, 1913 1905, 1906 1907 1913 1914 1912 1915 1903 1910 1909 1907 1914 1913 1909 1907 1903, 1912 1903 1903 1915 1915 1909 1911 1909 1912 1910 1911 1909, 1911 1911 1903, 1904 1909 1907 1911 1909	Eighth grade. Equivalent of high school. One year of high school. Eighth grade. Eighth grade. Eighth grade. Eighth grade. Equivalent of high school. High school. Eighth grade. Eighth grade. Eighth grade. Eighth grade. Eighth grade. Eighth grade. Equivalent of high school. Eighth grade. One year of high school. One year of high school. Eighth grade. Eighth grade. Equivalent of high school. Eighth grade. One year of high school. High school. Eighth grade.	2 years. 3 years. 2 years. 2 years. 3 years. 2 years. 2 years. 3 years. 3 years. 3 years 3 years. 3 years. 2 years. 2 years. 2 years. 2 years. 3 years. 2 years. 3 years. 2 years. 2 years. 2 'or 3 years. 2 years. 2 years. 2 years. 3 years. 2 or 3 years. l 2 years. 2 years. 2 years. 3 years. 2 years. 2 years. 3 years. 2 years. 2 years. 2 years. 2 years. 3 years. 2 years.	
				
				
Connecticut.......				5 nurses. 3 nurses, 2 physicians. 5 nurses.
Dist. of Columbia . Florida.........				
				
				2 nurses, 1 physician.
				
				
				2 nurses, 2 physicians. 4 nurses, 1 physician.
				
				
				5 physicians. 4 nurses, 1 physician.
				
				
Massachusetts.....				3 nurses, 2 physicians. 3 nurses, 1 physician. 4 nurses, 1 physician. 4 nurses, 1 physician. 5 nurses. 3 nurses. 5 nurses, 1 regent, and the Board of Medi-cal Examiners. 5 nurses. 5 nurses. 3 nurses, 2 physicians. 5 nurses. 3 nurses and Secretary of State Medical Board. 5 nurses. 3 nurses. 2 nurses, 3 physicians. 5 nurses. State Board of Medi-cal Examiners. 5 nurses. 5 nurses. 2 physicians. 5 nurses. 5 nurses. Board of Medical Ex-aminers. 5 nurses. 5 nurses.
Minnesota........ Mississippi........ Montana......... Nebraska......... New Hampshire... New Jersey....... New York........ North Carolina.... North Dakota..... Ohio............				
Oklahoma......... Oregon........... Pennsylvania...... Rhode Island...... South Carolina.. . . Tennessee......... Texas............ Vermont.......... Washington....... West Virginia..... Wyoming.........				
1 The law says, "A graduate of a school in good standing." 
STATE   REGISTRATION  FOR   NURSES  219
  New York's Difficulties.—As New York was the leader
in securing laws on nursing, so she has been  the first to
attempt modifications of existing legislation.   This state
has been  the battleground of many  unique  ideas con-
cerning the legal  control of nursing, and  will doubtless
continue to be.  The composition of the Board has been
up for change, the length of the course  to be required, the
curriculum to be exacted, the matter of a State Inspector
of training-schools, and even the extreme case  of the right
of individuals of varying training, or no training, to apply
to themselves the  term "nurse."
  Compulsory  Registration.—In  most of   the   states
(including New York) registration is not compulsory, i. e.,
nurses may take the examinations and register or not, as
they choose.  This renders the law to that  degree ineffec-
tive, since it proves nothing about the nurses who are not
registered.  Some of the most prominent  nurses  of  the
country are not registered, and the moral is  not far to
seek.   If  registration is to affect nurses seriously, it must
be made to include all graduates.
  In addition, if nursing legislation  is to affect the public
to any extent, it must be made to cover all classes of nurses,
trained and untrained.   This appears to be the thing for
which we must ultimately  strive, though in the present
state  of things we are  hardly ready for it.1   One of the
great  difficulties in the way is the lack of agreement as to
how many classes  of nurses there are or should be.   Some
contend that there are three  classes—the fully trained,
the partially or imperfectly trained, and the  untrained.

  1 In the  spring of  1915 Massachusetts attempted to pass a bill
providing for the registration of all nurses, trained and untrained.
The bill provided for but  two classes in all, and was "killed" in
committee. 
220   OUTLINES  OF  NURSING  HISTORY
Others  admit  but  two  classes—the fully  trained  and
those with less or no training.
  Registration an Experiment.—The  whole subject of
nursing legislation is so new and so plainly in the experi-
mental stage that it is hardly wise to voice strong opinions
in regard to it.   Many details must be worked out and
tried, much development gained in our training-schools,
and a large amount of constructive work done before we
can hope to pass or enforce laws which will be either just
or satisfactory to either nurses or the public.
  Meantime the various states have in operation laws of
all shades and  grades of  laxness  or severity.   Another
ten years given to trying out these laws in  actual prac-
tice will doubtless modify  rather  radically our  ideas of
what may and may not  be accomplished by legislation.
  It appears, at the present time, that the states which
have  inspectors  of training-schools  are  making better
progress than others, indicating that personal work is more
effective than laws.

          SUMMARY OF  IMPORTANT POINTS
  State registration of nurses is designed to  protect  (a)
the nurses and (b) the public.
  Some of the severest conflicts in the nursing world have
been about the matter of registration.
  Advocates of registration claim that it is the best means
of protecting both  the  public and  the  nurses  against
imposters.
  Opponents of registration contend that the standards
set  by  examinations and  registration  requirements are
false ones.
  Miss  Nightingale always actively opposed registration.
  In England the matter has been hotly discussed for over
twenty-five years, and no decision has been gained. 
SUMMARY  OF  IMPORTANT  POINTS   221
  Cape Town, South Africa, was the first state to pass a
nurses' registration law.  Theirs was put through in 1891.
  Registration discussion began in the United States about
1900.
  New York was the first state to attempt to pass a regis-
tration law, but North Carolina was the first  to  get one
through.  New Jersey, Virginia, and New York all passed
laws before that year (1903) was over.
  Forty-two  states now have registration  laws.   They
are exceedingly various  in  their methods and require-
ments, and furnish  an opportunity  to try out the whole
matter and to arrive, in time, at some definite conclusions.
  New  York has always been  a leader in unique and
radical forms of nursing  legislation.
  It is possible that compulsory registration for all who
nurse  the sick may eventually be desirable, but  we are
apparently not  yet  ready for it.
  The whole subject is in the experimental stage. 
CHAPTER XV
NURSES  AND TRAINING-SCHOOLS  IN  EUROPE

                      GERMANY

  All hospitals in Germany are under government super-
vision.  Nurses belong chiefly to three classes—Roman
Catholic  Sisters,  Deaconesses, and Red  Cross  Nurses.
There are also  a few state  schools of  nursing; and there
are nurses who work independently, as in  America.
  Roman  Catholic  Sisters.—A large  proportion  of  the
people of Germany are Roman Catholics, and we find fully
one-half of the nursing being done by these  sisters.   Some
of the largest and best hospitals in Germany are nursed by
them, and a good  deal of the private nursing is in their
hands.  Their training is not highly developed, but they
manage to keep  up  with  the  progress of the  medical
sciences.   They are able to keep religion  enough in  the
background so that it will not interfere with  the work of the
physicians.
  Deaconesses.—Next in numbers are the deaconesses,
who are usually Lutheran.   There is  considerable varia-
tion in the different orders of deaconesses; some are very
strict, having an understanding with their members which
amounts  almost  to a  vow, that  they  shall  not own
property,  nor marry, and that they must give strict obe-
dience,  their connection with the order  being  for  life.
Other orders are much more free, but still control the nurse,
giving her board, lodging, clothing, and a salary of only
       222 
GERMANY                 223
 
224   OUTLINES  OF  NURSING   HISTORY
$75 to $125 per year.   Many of the hospitals are nursed
by deaconess orders  that do  district nursing and some
private duty.  The heads  of  these orders are  always
sisters, but they are controlled by the clergy.
Fig. 51.—German Deaconess nurse.  Sister Sophie, Superintendent
       of Bethany Deaconess Home, Hamburg, Germany.

  Red Cross Nurses.—The Red Cross Society, as has been
noted  (Chapter VIII), controls  its nurses much  as the
religious orders do, though it is less strict.   The  society 
GERMANY
225
trains nurses in its own schools, and retains them in its
service, or sends them out for district  work or private
duty.  The training given is of fair quality.
  The government has  no corps of nurses, but in time of
peace sick soldiers are cared for by Red Cross nurses, the
society—not the government—bearing the expense.
  In time of war Roman Catholic  Sisterhoods, Deaconess
Orders, and the Red Cross Society all send nurses at their
own expense to aid the government.
  State Training-schools.—There  are some large and ex-
cellent training-schools  controlled by the government.
The Nursing Association of the Hamburg State Hospitals
trains its nurses  in the large state hospitals, notably the
Eppendorf (3000 beds).   It requires them to remain  two
years after they finish training, but assumes that they will
be permanent.   All its  nurses must be Lutherans.
  Victoria House, of Berlin, was established in 1881 by the
Empress Frederich.   It has  always  been  non-sectarian
and gives much  personal freedom.  The training is  one
year, but  the  nurses are required to remain for three
years.
  Contrast  with  America.—Such perfect organization
seems to an American like overorganization.  It involves
a permanent connection of the nurse with her school, per-
manent protection for her, assurance of  work,  of income
(small indeed), of care in sickness and old age; but it also
means that the school controls her, that she is not her own
mistress.
  It follows that  the German nurse, even when of a supe-
rior class, is quite different from the  American type.   It
has been said of them:  "We are astonished at the silence
of these women.  Superintendents  of  nurses in  vast
establishments—women  of immense ability—have   no
associated life.  They do not unite,  write papers,  nor
      15 
226   OUTLINES  OF  NURSING  HISTORY
speak  in public.  All text-books,  lectures  to  nurses,
theories  of  nursing, and nurses'  rules  for conduct are
written by men."1
  The Free  Sisters.—There were a few  who  protested
against the settled order of things and who wanted more
freedom.  By the  beginning of  the  twentieth century
quite a number  of graduate nurses were working inde-
pendently, though leading a rather forlorn existence, and
finding it hard to make a living.  They had become known
as the "Free" or  "Wild" sisters.   Some  of them, notably
Agnes Karll, Elizabeth Storp, Helene  Meyer, and  Marie
Cauer, wrote articles  and  circulated  pamphlets  stating
their case.
  In 1902 the National Council of Women took up the
whole subject of nursing and nurses, and sent a memorial
to the government, asking for certain official changes in
the status of the nurse.  They requested that the state
define a three years' course for nurses; examine and regis-
ter those who had taken this course, and give them a
certificate and a badge;  that only hospitals  which took
proper care  of their nurses should receive recognition.2
  Part of these demands have been obtained, but the pro-
gressive  group has still much work before it if any real
freedom  is to be gained.
  The German nurses are a superior class of  women, far
above those of most of the countries of Europe.

                       FRANCE
  Nursing in France has had a stormy  history, and it is
still  far from being satisfactory or progressive.
  1 Lavinia L. Dock.
  2 Many hospitals notoriously overwork their nurses, both while
in training and afterward. There have been a very  large  number
of suicides among nurses, traceable only to overwork. 
FRANCE
227
  For centuries the work was ostensibly in the hands of
Roman Catholic sisterhoods, but their rules so restricted
their work that the bulk of the nursing was actually done
by ignorant, untrained servants.  The fault lay not with
the sisters, but with those who controlled them.
  During the first half of the nineteenth century a good
many attempts were made to train the numerous servant
nurses,  but no  progress of  any consequence resulted.
The problem became acute because  the country was at-
tempting to abolish all religious  communities.  Laws
had been passed as  far back as 1790 providing for  the
laicization of  hospitals,  but they could not be enforced
because there was no one to take the place of the sisters.
  About 1850 all hospitals  in France were placed  under
one central administration, a plan  which  has worked
well in many  ways.   In 1861 a  complete reform in  the
nursing  was attempted, and though  the  matter was
earnestly studied  and faithfully experimented with, no
particular improvement resulted.   Only  the sisters  or
ignorant servants could be induced to care for the  sick.
  Bourneville's  Training  Scheme.—After the  war  of
1870 a  group  of  men  from F Assistance  Publique (the
Department of Charities), of Paris, with Dr. Bourneville
at  their  head, felt that systematic  training  should  be
offered and an attempt made to  elevate hospital attend-
ants.  (France  was at this time officially atheistic and
eager to be rid of the religious element in its  hospitals.)
Bourneville began by seeing that nurses were better paid,
better housed, and better fed.  In  1877 he went to England
and studied the training-schools there.   In 1878 he  estab-
lished three official  training-schools—at  the Salpetriere,
the Bicetre, and the Pitie.   These  hospitals had  in all
some 800 or 900 nurses, but the work was not compulsory
and only about sixty pupils attended the first classes. 
228   OUTLINES  OF  NURSING   HISTORY
  Dr. Bourneville himself  wrote a series  of  text-books
for  use  in these classes—excellent,  practical works.   He
had for lecturers some of the best men of  Paris.  In his
enthusiasm he threw the classes open  to all who wished
to come, so that orderlies and kitchen servants came, lay
women from both the upper and lower classes, as well as
the  nuns and attendants for whom the work was primarily
Fig. 52.—Dr. Anna Hamilton.
designed.   The course was eight months of lectures, given
in the evening, supplemented by  some practical teaching
in the wards.  Other cities than Paris took up the plan.
  The anticipated  results did  not come.  Most  of the
pupils could not read nor write, and were utterly  unable
to profit by the lectures  from  learned men.   Classes  in 
FRANCE
229
elementary branches were given, but men and women who
were tired by a long day  of manual labor did not make
much progress.  Dr. Bourneville, brilliant  and earnest,
worked for thirty years at the problem of nurses' training,
and in the end accomplished little.
  Dr. Anna Hamilton's Plan.—Dr. Hamilton, during her
study of medicine  on  the Continent, had been deeply
disappointed at the lack of benefit which patients received
from medical  work and nursing.   She set herself to  in-
vestigate the causes. In 1898 she visited England, and in
1900 wrote her now famous thesis, "Considerations sur les
Infirmieres Hopitaux" (Concerning Hospital Attendants).
  In this thesis she reviewed the whole nursing situation
of France in a masterly manner, and laid  down the prin-
ciples upon which successful reform must be built.   She
insisted—
  (1)  That pupils should be women of education.
  (2)  That theoretic instruction should be simplified.
  (3)  That a great deal of practical instruction should be
given by graduate head nurses.
  (4)  That the nurse's  diploma should recognize the prac-
tical work.
  (5)  That the training-school be under a  woman head, a
trained nurse, with full powers of  control.
  The fifth point she considered the vital one, as Florence
Nightingale had before her, and  regarded its neglect as
the  chief cause of the failures of Bourneville and others.
  Her thesis  stirred up much comment  and many hot
discussions followed. Her criticism of the public authori-
ties and her advocacy  of foreign  methods made her un-
popular.
  Dr. Hamilton's  First  Training-school.—In  1901 the
Protestant Hospital of Bordeaux decided to give Dr. Ham-
ilton a chance to prove her theories. The school had been 
230   OUTLINES  OF  NURSING  HISTORY
under the Red Cross Society, and the so-called training
had been chiefly lectures, while the real care of the sick
was taken by servants.   Over one hundred diplomas had
been granted, but only sixteen of those who received them
had actually worked in the wards or cared for patients.
  Dr. Hamilton maintained  that a physician could not
teach nurses properly, and made her own work in Bor-
deaux merely  preparatory to that of a  trained  nurse.
After one or two non-successes the school was put into
the hands of Miss Catherine Elston,  a nurse trained at
the London Hospital.  In three  years' time she  trans-
formed  the  place  and had in operation  a  really good
school of nursing.
  Dr. Lande,  mayor of Bordeaux, determined to try the
same system in the public hospitals of the city.  He began
it in 1904 in three wards of the hospital of St. Andre,
with a Dutch nurse in charge.  It was not a success until
Miss  Elston  took  hold  of it.   She  encountered   great
opposition, but established  the  school.    One of her
pupils  was  put  in  charge  (Mile. Gallienne),  and she
founded  another  school  at  the Tondu  Hospital.  All
these schools are doing work  which is up to the standard
of England.
  Spread of the New Nursing.—From this beginning, the
new  style training  (called the Nightingale  System) has
spread to many cities in France, Rheims,  Dijon, Pau,
Cambrai, twenty or more in  all.  Some of the hospitals
which have adopted it are large ones that had before been
in the hands of Roman Catholic sisters.
  Paris did not believe in the new system nor its principles.
A woman head, with real  authority, seemed to Frenchmen
unthinkable.   Dr.  Hamilton  spoke  before the National
Congress of Charities in 1903, but only  partially con-
vinced them. 
FRANCE
231
  Paris Tries Again.—In 1907 the Paris authorities made
another attempt at training nurses.  They set themselves
the enormous task of establishing a municipal training-
school which should  include the  whole  hospital system
of the city.1  Provision was made for a two-year course
for one hundred and  fifty  pupils.   The Directress was a
cultured woman, a midwife, but not a nurse.   The new
school retains many of the old features, and it has not as
yet done much  to  improve  the  nursing of  the  Paris
hospitals.
  There is a general feeling that, owing to the French
social prejudices, it will be for a long time impossible to
induce the educated French girl to take up nursing.  It
may be borne in mind, however, that the same feeling was
common in both our  own  country and in England when
the first training-schools were opened.
  The Red Cross Society of France gives lecture courses
to the public, and permits lay pupils to visit  hospitals
with doctors.  Many  of the women who are caring for the
wounded in the present war have received such training
and are finding it a great help.
  The Maternite of  Paris trains midwives for the whole
of France, giving a one-year course; each city pays for the
pupils which it sends.
  The American Hospital.—In 1904 there was felt  to  be
need for an American hospital, and in 1906 the organiza-
tion was effected.  The site of an old chateau  in Neuilly-
sur-Seine, a suburb of Paris, was purchased, and a build-
ing to accommodate  about forty  patients erected.   The
first patient was received in  the  spring of 1910.   The
staff is entirely American, though eminent French special-
ists are called in consultation.   The nurses are American
graduates.  An attempt was being made in 1914 to start a
   1 There are over 30,000 hospital beds, with 8000 attendants. 
232   OUTLINES  OF   NURSING  HISTORY
training-school when the war broke out.   This hospital
has  done a  remarkable work during the  present  war.
(See Chapter XIX.)
  School and District  Nursing.—The first visiting nurse
began  her  work  in Bordeaux in 1908.   She was Mile.
Amory, a graduate of the Protestant Hospital.
  Public school nursing was tried in Paris in  1908-09
with pupil  nurses, but it was not an entire success.  In
1912 Mile. Rolland established school nursing in Bordeaux.

                    SWITZERLAND

  There appears to be no nursing problem in Switzerland.
Nursing is  not organized on modern lines, but  even the
severest critics admit that it is being well done.   Reforms
take place so quietly that they are not recognized as such.
Nurses are  well paid.
  Most of the hospitals are municipal, and there are good
deaconess hospitals.  The eastern part of the country is
German, the western French, and each part copies the
nursing methods of  its neighbor.  A Red  Cross school
was  established in 1899 at  Berne,  and  gives a  two-year
course.  The Society of Swiss Women established in 1901
at Zurich a school with a three-year course.   There are a
number of sisters' hospitals with training-schools, the one
at Ingebohl also giving training to lay women.
  The  school of La Source  at Lausanne, already men-
tioned  (see Chapter III), was begun in 1859, before Miss
Nightingale began her school in England.   It has never
been large, and gives  only  a small amount of  hospital
work.   It selects  its  pupils  carefully,  and produces a
body of graduates of unusual  ability.  It gives  them no
supervision after graduation,  an unusual proceeding in
Europe. 
HOLLAND
233
                      HOLLAND
  Before the middle of  the nineteenth century the nurs-
ing of Holland, both in hospitals and in homes, was done
chiefly by Roman Catholic nuns.  With the development
of the Deaconess Order most of the work was transferred
to their hands.  There were also a good  many nurses of
the ignorant servant class.
  About 1875 a gradual change began.  The Red Cross
Society,  the White  Cross Society, and  the  Deaconess
Hospitals began to  give  training.  In 1882  the Dutch
Association  for Sick  Nursing was founded, a body much
like the  American Hospital Association,  with  both men
and  women  members.  In 1898 this  society made  an
inquiry into nursing conditions and found  them  bad.
Nurses were kept on duty for excessively  long hours, had
few holidays and little time off, were not allowed proper
time for meals, and had very insufficient teaching, whether
theoretic or  practical.  In short, the situation  was  not
unlike that of our own country during the same time.
  In 1900 an association  was  formed,  called  Nosokomos
(Nursing), admitting only nurses to membership.  It felt
that the larger association did not adequately represent
the nursing interests, and that it was time for  the nurses
themselves to try to better  nursing conditions.  They
have worked for state registration, feeling that the setting
up of fixed standards would bring the hospitals into line.
Later an Association of Directresses of Training-Schools
was formed  in an attempt to accomplish more.
  Not much progress has been  made in improving nursing
conditions, probably because the women of Holland are
still dominated by their men,  who do not appreciate the
conditions of woman's life.
  There  are many men nurses in Holland, and they have
a national organization of their own. 
234   OUTLINES  OF   NURSING  HISTORY
  District nursing has been done for many years by the
Deaconesses organizations.   In 1900 it was begun under
lay nurses,  with  hospital  training.  Amsterdam,  The
Hague,  and  Rotterdam  have  well-organized  district
nursing  associations which care for both free and paying
patients.
                      BELGIUM
  Before the  present  war  Belgium  was  making good
progress in the training of nurses, though the work was
yet in its early stages.  Most of the nursing was done
by  nuns,  assisted by servants.   The  nuns  received a
certain  amount  of  training.  A number of  training-
schools  were established by doctors, who laid emphasis
upon the theoretic work given; these schools were reason-
ably successful.
  The first  school along  more  modern lines  was one
under municipal control,  organized  in  1907  in  Brussels.
The course was three years, and the training was given in
four hospitals, in  each of which  the nursing was done
under a trained woman; an English  nurse, Miss Cavell,
was at the head of the school.  Antwerp also had a muni-
cipal training-school for nurses which was developing well.
  In  1908, with very  little discussion, state registration
for nurses was established.   The  standard required was
low at first, but was later raised; the examinations were
given by physicians  and could  be  taken by  any  one,
trained  or untrained,  who was  eighteen  years of  age.
The religious orders did much toward raising the standard
still higher, so as to emphasize the practical side of nurs-
ing, and were making slow progress.  This registration
movement is an interesting example of one which grew
naturally and  did not fight its way.
  The first school nurse in Belgium worked in the city of
Brussels in 1910. 
SWEDEN
235
                       NORWAY
  Education  is general in Norway  and organization  is
looked upon  as a matter of course.  Nurses' training,
therefore, met with no great difficulties, though its progress
has been slow.
  The Red Cross Society is the most active agency in all
sorts  of nursing.   In 1894 it began to train nurses  sys-
tematically.  A home was  established where a preliminary
course was given; the nurses then went to different hos-
pitals for medical, surgical,  obstetric,  and tuberculosis
training.  This course had been taken by several hundred
nurses.  There are many  Red  Cross hospitals, and  the
society sends  nurses  into both private  and district work,
making  a specialty of tuberculosis.
  The Deaconess Order also does a considerable amount
of good  work in hospitals  and elsewhere.
  Nursing conditions in Norway may be regarded as ideal,
and progress satisfactory.

                       SWEDEN
  During the  Middle Ages nursing in  Sweden was done
chiefly by Roman Catholic sisters, who  worked both in
hospitals and in private duty.   Later  the work fell  into
the hands of lay men and  women and was not well done.
The  Deaconess movement  influenced  Swedish nursing,
and several hundred deaconesses who have had one  and
a half year's   training  in  the work are thus  employed.
The Deaconess homes  also give a year's course in nurs-
ing to paying pupils.   At the Samaritan Deaconess Home
in Upsula an eighteen months' course in district nursing is
given.
  The Red Cross began training nurses with a four months'
course, but soon found  it  too short.  Through Frederika
Bremer, the author, Miss Nightingale gave  training at 
236   OUTLINES  OF  NURSING  HISTORY

St. Thomas' to Miss Emmy Rappe, who started an ex-
cellent school under the Red Cross and was for years at
its head.  This  school  gives two  years in the various
branches of hospital work  and follows it with eighteen
months of private duty.
  Queen Sophia was interested in nursing,  and in  1884
started  a nursing home with a  St.  Thomas'  nurse in
charge.   The  course is three  years  and the training is
given in several different hospitals.   Many of its gradu-
ates  remain with the school, on the same basis as dea-
conesses do.
  Some of the Roman  Catholic  sisters' hospitals give a
two- or three-years' course, some only eighteen months.
  Sweden finds short courses of various sorts adapted to
her needs and  is not afraid of them.   Courses of one year
are given in several places to women  who wish them.
One good insane asylum gives six  months' work to gradu-
ate nurses.
  There is a General Pension Fund for Nurses, established
in 1896; also  a Benevolent Society which provides sick
insurance for them.
  Norway and Sweden  are interesting examples of coun-
tries where nursing development has not been forced, but
has grown naturally.  Progress has been slower, but there
have never been the conflicts that there have in America,
England, Germany, and France.

                      DENMARK
  The hospitals of Denmark are  nearly all under govern-
ment supervision.  Deaconess orders  are  common  and
much of the nursing is in their hands.
  The Red Cross is active in Denmark and has trained
nurses since 1876.  They gave  only short courses at first,
but now have a  three  years'  course which includes all 
FINLAND
237
branches.   They also give a ten months' course for country
nurses.
  Modern nursing was  introduced  into the government
hospitals in 1876 by  Dr. Fenger, and it  was then that
>
Fig. 53.—Ward in Rigs Hospital, Copenhagen, Denmark.  Nurse
                       at work.
educated women first took it up.  Hospital matrons have
never had much  power,  the situation being much as  in
Holland.
                      FINLAND
  In time past Finland's nursing was done by religious
orders, whose work included both prescribing and nursing. 
238   OUTLINES  OF   NURSING   HISTORY
  Later there were government hospitals and those be-
longing to  deaconess  orders.   In  the former the nurses
were mostly middle-aged or elderly women, often with a
family  to  support,  and  were  quite untrained.  The
deaconesses were  largely women trained in  Germany,
Russia, or Sweden.
  A modern  training-school  was  founded  in 1888  at
Helsingfors, by  Dr. F. Salzmann.  The  course was  at
first only in  surgical  nursing  and but six months long;
later this was changed.  It  has had two matrons trained
in England, and Miss  Nightingale has given much help.
  At the University Hospital in Helsingfors short courses
are given in district and hospital work for rural nurses.

                       AUSTRIA
  Modern  nursing does not exist in Austria.   There are
great hospitals, with elegant buildings, and their surgeons
and physicians are among the best in  the world; but the
nursing is frankly admitted  to be poor.
  In the famous General Hospital of Vienna, with two
thousand beds, the nurses are of the servant class, are
engaged by the man  superintendent  (without a  "char-
acter"), and there is no woman over them.   They sleep
in cubicles in the wards and take their meals there.   They
are badly overworked,1 their wages are low, and they ex-
pect fees from the patients.  One observer characterizes
their condition as "inhuman."
  In  the Rudolph Stiftung at  Vienna  they  have  an
"extraordinary system," where part  of the  nurses are
Catholic sisters  under a head  sister,  while the rest are
lay nurses under the doctors.  No effort is made to teach
them, but they are said to be kind to the patients.
  1 They have a twenty-four-hour  period of duty, then a broken
day, then a night's sleep, then another twenty-four-hour period. 
AUSTRIA
239
Fig. 51.—Ward in Children's Hospital in Vienna.  (From Hofmokl,
                   "Wiener Heilanstalten.")
Fig. 55.—Austrian midwife   (From  Hofmokl, "Wiener Heilanst-
                           alten.") 
240   OUTLINES  OF  NURSING  HISTORY
  The Rudolfinerhaus, at Vienna, and the Elizabeth Hos-
pital, at Buda-Pesth, are nursed by Red Cross sisters, who
are given a species of training during three years' service.
  There is a large order of the Brothers of Mercy work-
ing in men's hospitals.   They also do  district work, the
only known instance where this has been undertaken by
men.
  Austria has twenty-six schools of midwifery connected
with the  large universities,  where midwives are taught
and have hospital experience.  The city which sends them
pays their expenses.
                        ITALY
  Italy  has many old and very beautiful  hospitals, the
buildings dating from the Middle Ages.  They are under
the control of the  Roman Catholic  orders,  and  both
monks and nuns serve  in  them.  The  criticism is made
that the nursing is controlled by the priests rather than by
the doctors.  Much of  the care of patients falls to paid
servants,  whose work  is very poor; they are  paid only
about fifteen cents a day, and exact fees from patients at
every opportunity.  Many of the important nursing pro-
cedures  are done by doctors or  medical students.   Even
in private nursing a student may  be sent along with a
nun, he being on call for special work, she watching the
patient.
  There  are several so-called courses  of  training  being
given by doctors to lay  men and women, the time  spent
being two  to six  months.  The  instruction is both  theo-
retic and practical, but  the students are too unlettered to
profit by it, and the results are very poor indeed.
  In 1894 was made the first attempt, so far as is known,1
  1 Thompson states that  "in 1883 three Bellevue graduates and
two Enghsh nurses went to Rome and introduced modern methods
into a hospital for English and  American travelers." 
ITALY
241
to train Italian girls  as  nurses in a modern way.   Miss
Amy Turton, an English nurse, began a school in Rome,
and persisted with the most difficult sort of pioneer work.
In 1896 she induced Miss  Grace Baxter, an American nurse,
to undertake a similar work in Naples.
  In 1901 Signora Celli,  a German-trained nurse, wife of
a doctor, made a thorough investigation of hospital con-
ditions in Italy, and by  the publicity given to her report
stirred up  a good deal of interest  for  their betterment.
The  queen herself took  up  the  matter, and has given
much help to  the struggling training-schools.  In  1908
Signora Celli made a  second report, which further stimu-
lated progress.
  It is  very difficult  to induce  Italian girls to take  a
nurse's training, as they  are strictly chaperoned, and it is
almost unheard of for an educated young woman to go
away from home.  Also, they marry very young, usually
before they are sixteen, and few who do not become nuns
remain unmarried.  This makes the number available for
training  very small.   For these  reasons Miss Turton
advocates the retention of nuns as nurses in hospitals, but
urges that they be trained.
  Signora Celli opened a second training-school in Rome
about 1904.  Miss Dorothy Snell took  charge of the one
founded by Miss Turton; in  1913  this school graduated
sixteen nurses from a full course.
  In 1906 the Pope became interested and started a train-
ing-school for nuns under his own auspices.  In 1912  a
school  was started at Milan  in  the Medico-Chirurgical
Hospital which used  modern  methods.
  The work is still in  a pioneer stage, and must go slowly
until social conditions are modified somewhat.   Mean-
time these little schools are shining lights on the path of
progress.
      16 
242   OUTLINES   OF   NURSING  HISTORY
                        SPAIN
  Nursing in Spain is in much the same state that it is
in Italy, if anything, worse.  Hospitals are under religious
control, the nuns are head nurses,  the patients  being
cared for by ignorant  men and women, while doctors and
medical students attend  to  all important procedures.
  In  1896 Dr.  Rubio, a  famous and influential surgeon,
organized a nurses'   training-school  in  Madrid.  His
pupils were absolutely illiterate,  but the good  doctor
hopefully undertook to give them  a complete course  in
two years.   Their working  hours  were from  5 A.  m.  to
10 p.  m., their duties arduous, their rules very strict, their
uniform hideous, and the  whole  scheme amounted  to
restrictions as great as those of convent life.
  In 1910 Dr.  Gutierrez was in charge of this school, and
engaged Miss Marie Zomak, a nurse trained in Germany,
to take the head of the school, with  the  understanding
that reforms were to be made.  She  first went to Bor-
deaux, France,  and  studied the methods of Dr. Hamilton
and Miss Elston.  Her results have been most encourag-
ing.
  With this one exception,  nursing in Spain  remains  of
the worst  medieval  type,  and any  change seems  far
away.
                       RUSSIA
  All hospitals  in  Russia  are under  a central medical
board, the head of which is a medical man appointed by
the Czar.  There are very large general hospitals and many
small special hospitals.1  The nurses come almost entirely
from the lower classes; they are both male and female, and
married couples are often employed; widows are especially
well thought of for the work.  The calling is semireligious.
  1 Petrograd is said to have the finest woman's hospital in the world. 
RUSSIA
243
  In 1854 the Grand Duchess Helena founded the nursing
order of the Sisters of Mercy, which admitted all creeds,
had no vows, and wore a lay dress.   They did good work
in the Crimea.
  In 1878 a school for female "dressers" was established,
giving a two-year course.   Their work was the preparing
and giving of medicines, the preparing and doing of surgical
Fig. 56.—Ward in woman's hospital in Russia.
dressings, and some other skilled work.   They stood in a
higher class than did the nurses.
  The Russian Red Cross gives training to many nurses,
the teaching  being  largely  practical   and classes  few.
These  schools are always attached to  hospitals.
  Midwives have always been of  importance in Russia;
for a long time they were all German.   In the early part
of the nineteenth century short courses in midwifery were
given, with both lectures and practical  work.   In modern 
244   OUTLINES  OF   NURSING   HISTORY
times midwives  take two-year   courses  at  the  great
universities  and lying-in hospitals.  Shorter courses are
provided  for  country midwives.   They are  examined,
licensed, and paid  by the government for  district work
among the poor.
  In Petrograd one-third of the births take place in the
City Maternities, of which there are sixteen, scattered so
as to be readily accessible.   They are in charge of mid-
wives; middle-class patients as well as the poor go to them.

                       GREECE
  Greece  appears throughout her  history to have  been
either too warlike  or too artistic to be humanitarian.
Both medicine and  nursing have been neglected subjects.
The sick were taken care of by their own families as best
they might be.   The absence of large  cities  made  the
problem of the sick  poor less acute. The few nurses there
were belonged to the servant class,  and nursing has always
been regarded as menial work.
  Until 1884 Athens, the capital, had but one hospital—
the Municipal.   Another was dedicated that year, having
been built out of the gifts of citizens; it was small, having
but three hundred patients the first year.
  The Royal family, who have been the  most progressive
people in Greece,  have for some  time interested them-
selves in nursing.  As far back as 1875 the Queen requested
a doctor to  write a  text-be ok for nurses.  She decided to
send Greek  girls abroad for training in this work.
  Miss Kleonike Klonare was the first to come to America.
She graduated from the Massachusetts General Hospital
in 1899, being the first Greek woman  to  complete such a
course.   After some postgraduate  work,  she was for two
years assistant  superintendent at  the  New  England
Baptist  Hospital, then returned to Greece.  She nursed in 
GREECE
245
the Royal family1 and was asked by the Princess Sophia to
take charge of the Children's Hospital of Athens upon its
completion.  She  organized a training-school for nurses
which gives a good two-year course.
  In recent years  Sophia, now Queen, has undertaken to
send a number  of Greek girls  to America for  training.
Fig. 57.—Miss Kleonike Klonare.  The first Greek woman to take a
                   full course in nursing.

Two graduates  of  the Athens Children's  Hospital  were
sent to Boston  for a  two-year course and some  special
work.  On their way back they visited hospitals through-
out Europe  as  a further  preparation  for their  future
executive work.2  At  the present time  there  are seven
   1 Miss Klonare nursed the King during his illness in 1915.
   2 One of them, Miss Aneste, has recently nursed the King. 
246   OUTLINES  OF  NURSING  HISTORY
Greek  women under Royal patronage taking  nurses'
courses in the United States, four in Boston, the others
in New York  and Philadelphia.1
  The present Queen is doing everything in her power to
interest the women of her country in nursing and to make
them feel that it is  skilled labor, suited to the educated
woman.
          SUMMARY OF  IMPORTANT POINTS
  In Germany  hospitals  and nurses' training are largely
in the hands of Roman Catholic sisters and of deaconesses;
the Red Cross Society also does a considerable  amount,
and there are state training-schools.   It is the custom for
nurses  to  retain  a  permanent connection  with  their
schools and to be controlled by them all their lives.   The
"Free" sisters are those nurses who resent this custom and
who are working independently; they are doing much to
better  the conditions of the nurse's life in Germany.
  Nursing history in France  is that of a succession of at-
tempts to train uneducated men  and women.   It has been
persistently and brilliantly worked at, but without success.
Most of the nursing is now done by Catholic  sisters, whose
duties  are much restricted and whose training is scanty, or
by persons inferior both mentally and socially.  Dr. Anna
Hamilton has succeeded  in introducing the "Nightingale
System" into a considerable number of hospitals, and the
movement is making its  way slowly.
  Nursing in  Switzerland is not yet thoroughly  modern-
ized, but the  work is almost everywhere well done, and
still further  improvement is  being gradually and quietly
made.
  1 Two graduates of the Baptist Hospital, Miss Kalafati, and Miss
Paterou, are doing private nursing in Greece under Royal patronage.
Miss Dervishoglan, who graduated some years ago from the Massa-
chusetts General, is in charge of a hospital in Constantinople. 
SUMMARY  OF  IMPORTANT  POINTS   247
  Holland's nurses are largely deaconesses, and there are a
good many of the lower class.  Hospital nursing is done
under very hard conditions.  The hospital  and  nursing
associations have worked for some time to secure reforms,
but progress is slow.   District nursing is well organized in
several cities.
  Before the present war Belgium was making fair prog-
ress in  modernizing  her  nursing.  The Catholic sister-
hoods were especially active in promoting better methods
and in pushing registration.
  In Norway nurses' training  is given by the Red Cross
Society and by  Deaconess orders.  Conditions are ideal
and progress is steady, though slow.
  In Sweden nursing is largely in the hands of the deacon-
esses, though some Roman Catholic orders  are at work.
Queen Sophia was  much  interested  in nursing.  Short
nursing courses are popular.
  The nursing in Denmark is chiefly in the  hands of the
Red Cross and  the deaconesses.  Modern  methods  are
being gradually introduced.
  The hospitals  of Finland are either under deaconesses
or  the government.  English  nurses  have  introduced
modern methods of  training.
  Austria's nursing is that of  the Middle Ages.   Nurses
are uneducated and their working conditions intolerable.
Much nursing is done by religious sisterhoods and brother-
hoods.  Midwifery training is excellent.
  Italy's nursing is much like that of Austria, except as a
few small  schools  of modern  type have been  started.
There are two schools in Rome and one in Naples which
are doing pioneer work, and matters are extremely hope-
ful for a new era in nursing.  Social customs make progress
slow.
  Nursing in Spain is hopelessly  medieval.  There is one 
248   OUTLINES  OF   NURSING   HISTORY
successful school of modern type at Madrid, which is, so
far as is known, the only attempt of the sort.
  Russia's nurses are chiefly of the lower class, but some
fairly successful  attempts have been  made  to give them
a species of training.   The work is earnest, but not pro-
gressive.  Midwifery  training is, however,  good.
  Nursing in Greece was an utterly neglected subject until
recent times.  The Royal family have taken the matter
up and have sent  a  number of nurses  to America for
training.  Hospitals and training-schools are being started
in Athens. 
CHAPTER  XVI
   NURSES AND TRAINING-SCHOOLS IN ASIA

   All effective medical work and nursing which is done in
Asia is the result of missionary endeavor.  Whatever skill
the ancients may have had in the care of the sick was long
before our day lost in a mass of superstition.  Of nursing,
for centuries there was none worthy of the name.
   Anatomy is an unknown subject, since religion forbids
the dissection of  the  human  body.   India guesses that
there are nine hundred bones in the body, and has never
thought of counting them.  China endows the body with
five tubes leading from the mouth to the stomach, one for
each kind of food. ... All agree  that nervous diseases
and delirium are  the work of  evil spirits, and  abuse the
sufferer in order to dislodge the spirit.   In obstetrics the
practices seem calculated to sacrifice life or entail lifelong
suffering.1   In therapeutics all agree that the more weird,
powerful, and nauseous the dose, the more effective it is.2
   The first skilled nursing in Asia was doubtless done by
women doctors, who, with little or no training in the work,
had to care for the sick as best they could with their own
hands.   Native  helpers were  made use of in illness and

   1 A board is placed across the abdomen and pressure exerted by a
person sitting at either end. If there is an abnormal presentation,
the child may be pulled at until actually dismembered.
  2 "A patient reported that she had eaten more than two hundred
spiders and a large number of snakes' eggs without receiving any
benefit."  (China.)
                                             249 
250   OUTLINES  OF  NURSING  HISTORY
crude training was given them; but very soon the need of
trained nurses was felt and the call went out for them. 
JAPAN
251
  With the advent of the trained nurse into the mission
field came the possibility  of properly training native men
and women to care for their own sick.   Tradition and
prejudice have obstructed progress, but the foundation of
the work has been laid, and we now find in almost every
country  the beginnings of expert nursing for the people.

                         JAPAN
  Nursing in Japan is recent in origin, but has developed
rapidly and well.  The old nursing in homes is described
as follows:  "The ties binding members of a family are
strong; the consequence is that they are not content that
one person  should care  for the sick  member, but  the
whole  family at once vie  with each other in giving relief.
The result is that they all become exhausted by sleepless
nights and anxious watching, and give up in despair."1
  The first hospital in Japan was built by the government
in 1857, and was put into the charge of a Dutch physician.2
  Dr.  John  C. Berry, of Massacusetts, was in  1872 made
Medical  Director of  the International Hospital at Kobe.
In 1883 he proposed  the establishment of a nurses' school
for Japanese women.  The need of such  work was  ad-
mitted, but  it was opposed on the ground that the status
of the  Japanese woman was such  as to render such a step
premature and hazardous.
  The First Training-school.—Prejudice was  overcome
enough to admit of a trial, and in 1885 Miss Linda Richards
came from America and opened at Kioto the first training-
school  for nurses in Japan.   There were five pupils, two

  1 Dr.  John C. Berry.
  2 The first American physician who was allowed to practice was
Dr. James C. Hepburn, of the University of Pennsylvania, who began
work in 1859. 
252   OUTLINES  OF  NURSING  HISTORY
of them educated in mission schools and three of them
married women.
  The pupils nursed in the wards of the hospital, worked in
the dispensary, and did district work under supervision in
the homes of the people.  The district work was regarded 
JAPAN
253
as an important means of breaking down prejudice  and
opening the way for nursing  by actual demonstration.1
The nurses wore American  uniforms, but  in  the care of
patients the Japanese customs were followed.2   Patients'
families came  to the hospital with them,  so that they
should not be lonely, and  sometimes helped  with the
care.
  Both hospital and training-school grew.3   In two years
there were twenty nurses in training.  The school became
a model for all future work.  The graduates  were en-
gaged, even before  they had  finished  training, for posi-
tions in other  hospitals.
  Miss Richards remained  until 1890, when the  school
passed into Japanese hands.   She may be regarded as
having laid the foundation of trained nursing in Japan.
  Training-schools were  started by the Japanese  them-
selves in  other hospitals, with modern methods  and a
a progressive spirit.   In 1909 there were over one hundred
schools.   The Japanese women are steady, self-sacrificing,
and make excellent  nurses.    They have developed  self-
reliance and organizing ability.
  Red Cross Schools.—Japan's Red Cross Society  joined
the international organization in 1887, and in 1890 began
to open training-schools in the hospitals under its control.
There are a number of these schools; they give a three-year
course, which  includes work in naval and military  hos-
pitals.
  1 The nurses were allowed to keep the money which they earned
on outside cases.
  2 The beds consist of cotton-filled comfortables, placed on mats
on  the floor. For warmth,  a charcoal brazier is placed inside  a
species of bed cradle and covered with  comfortables.   Meals are
served on a tray only a few inches from the floor.
  3 Miss Richards supplied a demand for home nursing instruction
to mothers and grandmothers. 
254  OUTLINES  OF  NURSING  HISTORY
 
CHINA
255
  In the wars with China and Russia  many Japanese
nurses, all hospital-trained women,1 worked at the front;
in the Russian War there were 2700 who thus served their
country, and  who received official recognition.
  A considerable number of Japanese women have taken
nurses'  training abroad, and many  go to England and
America for postgraduate work.2
  There is a national association of nurses.

                        CHINA
  Skilled nursing  in  China is of very recent date.  Its
early history is even  now being made.  The country has
always been far behind in medical matters, doubtless be-
cause of the firmly rooted belief that disease is caused by
evil spirits.   Many of the native doctors are men who
failed in other  occupations;  no  license  nor diploma is
required for  one  to   practice  medicine,  and that in a
country where learning is revered.  Nursing among  the
people is practically non-existent; the care of the sick is
looked upon as work fit only  for coolies.   Also the people
fear to  handle the sick  because  they think that  the evil
spirit which  caused  the  illness may  enter  their  own
bodies.   They will not touch  a dead body, and to touch a
sick person is nearly as bad.  Sometimes the sick are put
outside the  door to die, so that the devils will leave  the
family.
  Early Hospital Conditions.—The first hospital in China
was established  at Canton  in 1835 by Dr. Peter  Parker,
a man  of distinguished ability.   Other  missionary hos-

  1  Japan is the only country except  the United States in  which all
Red Cross nurses are fully trained women.
  2  The Superintendent of Nurses at St. Luke's Hospital, Tokyo, is
Araki San, an American-trained woman. 
256   OUTLINES  OF  NURSING   HISTORY
pitals have followed, and  there are now many excellent
ones.1
  A part of the care of the patients was taken by their
relatives.   "There were no nurses, as we know the word.
There were men and women who learned  to help  in the
dispensaries,  sterilize  dressings,  give  medicines, and
do  treatments  to  a limited degree.  They were  called
'dressers' and  are  still found  all over China in the mis-
sion hospitals.  They had little or no book-training; some
were married women with children and worked only part
time. They did noble work, so far as their knowledge and
capacity went; but the overworked  doctors could  not
train them further, neither  were they the right material
to make trained  nurses.  Only with  the  advent of the
foreign  trained nurse  has  there  been any possibility of
a better grade of helper."   (Quoted from "A Missionary
Nurse.")
  Beginnings.—So  far as it is possible  to discover, the
first graduate nurse to begin  work in China  was Mrs.
Thompson, wife of Arch-deacon Thompson of  Shanghai,
who went from America in 1883, and was for twelve years
in active work at the West Gate Hospital of  Shanghai.
Another early missionary nurse was Miss Ethel Halley,
from Australia, who began  work in  Shanghai in 1891.
She  has trained native nurses since  about 1906.
  As far back as 1895 Dr. Saville, of the London Mission
at Peking,  had a  class in nursing  and dispensing.  The
missionary hospitals trained doctors, who  worked  in the
wards and did much of what we should call nursing.
  Dr. Eleanor  Chestnut, who was a graduate nurse, be-
fore her death in  1903 (she was killed in one of the anti-
  1 St. Luke's Hospital, at Shanghai, began work in 1866; Wuchang
Hospital began in 1878; the Porter Hospital, at Pang Chuang, in
1882. 
CHINA
257
foreign riots) had a school for women physicians, one for
nurses, and one for masseuses at Lien Chow.
  Some of the hospitals which have established training-
schools for native nurses are as follows:
  St. Luke's Hospital, Shanghai.
  The Union Training-School  (three missions) in Peking,
1905.
  The Wesleyan Mission, Wuchang, 1905.
  The David Gregg Hospital, Canton, 1907.
  Soochow Hospital, 1907.
  Elizabeth Bunn Memorial Hospital, Wuchang, 1907.
  Nanking Union Nurse Schools, Nanking, 1908.
  Magaw Memorial Hospital, Foochow, 1911.
  Porter and Willimas Hospitals, Tehchow, 1915.
  Yale Hospital,  Changsha.
  There are several others, and  the  number is increas-
ing.   The Central China  Mission has schools in several
places.
  Because of the  peculiar ideas of the Chinese, it is neces-
sary to have separate hospitals for men and women, and to
employ men nurses for men patients.   Many Chinese men
are taking up the training and make good nurses.
  Private nursing  hardly  exists  in  China,  as  all the
graduates are needed for hospital positions faster than
they can be supplied.
  The  China Nurses' Association.—In  1907  Dr. P. B.
Cousland, translator for medical  work in China, said to
Miss Cora E. Simpson, of Foochow, that he felt it  time
that the foreign nurses working in China should get to-
gether  and  organize.  He offered a page in  the China
Medical Journal as  a  medium  of  communication.  A
circular letter was sent to every hospital  in China, asking
for information as to work already done in the training of
nurses,  urging  that more be undertaken,  suggesting  a
       17 
258   OUTLINES  OF  NURSING   HISTORY
standard course of study, the translation of text-books for
nurses, and the formation of a nurses' association.
  In  1009,  chiefly through Miss  Simpson's efforts, the
China Nurses'  Association  was formed.   A  few  group
meetings  were held that  year,  and  in February,  1910,
the association met with the  Medical  Association at
Hankow,  and began its work.   The  Terminology  Com-
mittee of the Medical Association agreed upon a standard
  Fig. 61.—The China Nurses Association, 1914.  Mrs. Thompson,
the first trained nurse to work in China, is near the center, also Miss
Elsie Chung (now Mrs. Lyon), the first Chinese woman to take a
nurse's training.  Miss Simpson, the founder of the association, is at
the extreme left.

word for "nurse" in Chinese, which was later adopted  by
the nurses.
  Registration.—It  was in  1910  that the Board of the
Central China  Medical Association began  to give public
examinations to nurses and to present certificates to those
who passed them.   Public examinations are time honored
and respected in China, and the practice has done much to
put nursing on a dignified  plane.
  In 1913 the Nurses' Association prepared  a standard 
CHINA
259
curriculum for training-schools, and planned for examina-
tions and registration certificates both for schools and for
individuals.
          Fig. 62.—Three registered nurses of China.

  There are now about one hundred members of the asso-
ciation, and it is an influential organization.   Mrs. Elsie
Lyon (nee Chung), the only Chinese nurse trained abroad,1
          1 Several others are now studying abroad. 
260   OUTLINES  OF  NURSING   HISTORY
 a graduate of Guy's Hospital, London, is Yice-President
. of the association and a member of the national examining
 board.
   The  Pioneers.—"Names that  should be remembered
 are those of Dr. Philip  Cousland, of Shanghai, the nurses'
 best friend; Dr. Lucy Gaynor, who started one of the first
 schools in Nanking, and who died of typhus contracted
 by caring for patients; Dr.  Mary Fulton, who helped with
 the  early  schools  at  Canton, and who has done  much
 work in translating; Mrs. Caroline M. Hart, of Miku, the
 association's first president; Miss Mary Ogden, the second
 president; Miss  Maud  T.  Henderson, Miss Alice Clark,
 Miss Gage, and Miss Hope Bell,  who did much to  make
 the association what it is."1
   Text-Books—Before  her death Dr. Chestnut began the
 translation of Hampton's  "Nursing"; Miss Ruth Boggs
 finished it.  Mrs.  Lyon  has recently translated the
 "Oxford Handbook of Nursing" into  Chinese, and Presi-
 dent  Yuan Shi  Kai, whom she  nursed, has given the
 money to  publish  it.  Dr.  Cousland  has  prepared  an
 Anglo-Chinese dictionary for nurses.  Other translations
 are:    "Abdominal Surgery,"  by  Fullerton; "Till the
 Doctor Comes," by  Hope;  "The Roller Bandage,"  by
 Hopkins; "Materia Medica," by Dock; an "Anatomy and
 Physiology," a "Probationers' Manual,"  a "Bacteriology,"
 a book on "First Aid," on "Obstetrics," one on  "Sanita-
 tion," etc.
   The  Outlook.—In a  paper read at the China Nurses'
 Association in 1914 Miss Simpson said:  "We are here to
 build  up a great  profession.   We  must have educated
 women for it. . .  . The Chinese live in great  families,
 and the nurse will always find plenty of cheap, unskilled
 labor ready to help with work which they can do, leaving
           1 Quoted from  a letter of Miss Simpson's. 
CHINA
261
her free for the more scientific part.   In hospitals,  ward
maids  save the nurses' strength and give them time for
study.   Dependence upon such service by no means unfits
the nurse for her place after graduation.   If we demand
all work and no study, we cannot get educated women,
and if we  do,  they are not  strong  enough  to  do both.1
Fig. 63.—A Chinese training-school in 1915.
If we do not train our nurses in books, we shall soon find
the profession looked down upon by the educated Chinese,
the very ones who might quickest help the nurses to help
China.   If you cannot  get  the educated women up to
  1 Chinese women of good  class have for centuries led an indoor
life, and because of foot-binding, etc., got little exercise. They are,
therefore,  lacking physically, and cannot do the hard manual work
which nurses do in other countries. 
262   OUTLINES  OF   NURSING  HISTORY
the standard they ought to attain, do not call them nurses.
If you do, it will harm the name when you want the better
women to take up the work.
  "We foreigners are here for a  few years at the longest.
China will one  day control  her own  institutions.   The
nurses must be taught  as  soon  as possible to rely upon
themselves.   They  must eventually be the teachers  of
the women of China."
  Fig. 64.—Miss Cora Simpson of Foochow, China, and her 1913
graduating class.  (The nurses are Grace Go, Alice Cieng, Sarah
See, and Mary Ding.)
  Government Training of  Nurses — The Chinese Gov-
ernment has already undertaken the work of training
nurses.   It has appointed Dr. Yamei Kin, who graduated
in the United States, as Director of Nursing and Medical
Work for Women.  A school of nursing has been opened
in Tientsin,  with forty  pupils;  its  superintendent  is
Mrs. Lyon. 
KOREA
263
  The Rockefeller Commission, newly  formed,  which is
undertaking to help  extensively with  medical  work  in
China, is much impressed with the importance and need
of nurses' work in China.  It has  undertaken to support
a nurse for translation work.  It is also establishing schol-
arships for the study  of  nursing in America for Chinese
women who are able  to meet their requirements in the
English language.

                        KOREA
  A number of American women  have done missionary
nursing in  Korea  with  great  devotion and  success.
The first  foreign nurse who worked there was  Miss Ellers;
she went in 1886.  (In 1884 the  King  of Korea had built
the Royal Korean Hospital,  the  first in the country, with
Dr. N. H. Allen  in charge.)  In 1895-96  Miss  Anna P.
Jacobson, of Portland, Me., worked in Korea, dying after
a short service.   In 1897 Miss  Esther Shields, of Phila-
delphia, began work, and in 1906 opened the first  training-
school for native nurses.   The school  is at the Severance
Hospital  in Seoul.
  The first two native nurses were graduated in 1908 from
this school.  They were  Mrs.  Martha Kim and  Mrs.
Grace Yee.  A report of this school says, "A number  of
applications for training come in, but  many are  excluded
by our rules; they must be Christians,  not too young, etc.
Only married women are taken.  Class work is carried on
by  two Korean  doctors, two  Korean  nurses,  and the
American superintendent.   There  are  calls  for Korean
nurses to  do district  work,  hourly nursing, and to give
massage in foreign homes; also  to assist Korean doctors
with obstetric cases in Korean homes."
  American text-books,  translated  into Korean,  are used
in this school. 
264   OUTLINES  OF  NURSING  HISTORY
                        INDIA
  Nursing in India is as truly the work of Florence Night-
ingale as is nursing in England, though less directly trace-
able to her.   For thirty years or more Miss Nightingale
devoted a large part of her time to the health problems of
India, and  formulated  plans which  were gradually put
into force by the government.  All later work has been
built more or less upon her foundation.1
  The need  of nurses and of women doctors for India
was a most bitter one.  No man physician was permitted
to examine or treat a woman; the most that he might do
was to feel her pulse from the other side of  a  curtain.
Obstetric  practice was in the hands  of densely ignorant
midwives, and was most brutal.   The early age (eight to
twelve)  at which most of the girls married further  com-
plicated matters, so that difficult labors were common,
and the results in unskilled hands very terrible.  Similar
conditions still exist.  There are numerous native nurses,
ignorant and  immoral, who are practically doctors for a
large class.
  Beginnings.—As in other mission  fields, women mis-
sionary  doctors probably  did the first skilled nursing.
After them English nurses went into the mission hospitals,
and finally American nurses followed them.   Low-caste
native helpers were employed  in hospitals and dispen-
saries, but they lacked the education to make competent
nurses.  The missionary doctors recognized the need for
training native women in nursing, and  began early to
attempt it.
  Early Training-schools.—Probably  the earliest attempt
to train native nurses was by the Sisters  of St. John the
Baptist, who established, about  1860, the Canning Home
  1 Most of the hospitals are supported  or partly subsidized by the
government. 
INDIA
265
for  Nurses  in memory of  the Countess Canning,  and
taught  the  nurses at  the  European  General  Hospital.
The Zenana1 Bible Medical Mission had English trained
nurses from  1882 on, and kept in mind the training of
native women.   In 1888  Miss Gregory opened  a native
school for nurses  at Lucknow.   The  mission now  has
several  hospitals giving full courses.
Fig. 65.—Training-School, Nellore  Hospital, Nellore, India.  (Dr.
          Gerow, R. N., Dr. Benjamin, and nurses.)
   The  Sisters of All Saints  began  in  the 80's to train
native  nurses, and after 1907 gave full  courses.  The
North India  School of  Medicine  began  similar work in
1894,2 and after 1900, under Miss Winifred Thorpe, gave
a  three-year  course.  The  Albert Edward Hospital  at

  1 The zenana is the women's quarter of the house.  Indian women
of good class are kept in strict seclusion.
  2 Isabella Bird Bishop, the noted traveler, gave the first  hospital
to Kashmir. 
266   OUTLINES  OF   NURSING  HISTORY
Kolhapur began  training in  1890,  and from 1905  did
superior  work.   In  1896  the  Canadian  Presbyterian
Mission  in  Central  India began  giving training under
Miss Harriet Thomson; the American Evangelical Luth-
eran Mission in South  India in 1899.
  Many  other missions have  done excellent  work  in
training native nurses,  and have been able, little by little,
to break  down caste lines and  make women see that nurs-
ing  was  not menial.   Foreign doctors  and nurses have
relieved an appallingly enormous mass of suffering which
native religions left untouched; their influence has natur-
ally  been in  proportion.  The  Hindus, who resent  the
introduction of foreign ways, and especially of foreign
religions, now  admit  that the  greatest  hold has been
gained by medical work among women.
  The Countess  of Dufferin's Fund.—By far the most
extensive work in caring for the sick has been done by the
National Association for  Supplying Medical  Aid to the
Women of  India, ordinarily  known as the Countess of
Dufferin's  Fund.  This work is nation-wide, and  is a
unique and  remarkable piece of  work, absolutely without
parallel in  history.  The movement was the  result  of a
suggestion  made by  Queen  Yictoria  to  Lady  Dufferin
when she went out to India as wife of the Yiceroy.
  The plan involves  three lines of work:   (a)  Medical
tuition—training  the women of India as doctors, hospital
assistants, nurses, and midwives.  (b)  Medical relief, the
establishing of hospitals and dispensaries, especially in the
smaller towns, providing in  particular for women and
children,  (c) Supplying trained nurses and midwives to
hospitals and private families.
  The association was organized in 1885 (see Chapter YI),
and from the first had official recognition from  the govern-
ment.  The original fund was very large, being  contrib- 
INDIA
267
uted to by prominent persons in England and by native
princes in India.1   A large amount was set aside as endow-
ment.  The work is organized under a central committee
and  has  independent branches in every  province.   It
affiliates  with all medical missionary work, and under cer-
tain  conditions grants aid  to  it.  It  keeps free of sec-
tarian  entanglements, yet helps every society that  gives
medical  aid to women.
  Its earliest school for nurses was established in 1886  at
the Cama Hospital in Bombay, a government hospital for
women and children.  Miss Edith Atkinson, an English
nurse,  had charge of the school for nineteen years, until
her  death.  She  graduated over  two  hundred nurses,
the length of training being gradually  increased from one
year to three.
  There  are many native  Indian nurses, both from the
Countess of Dufferin's Fund schools and  from mission
hospitals, who have been put in charge of  hospitals and
are doing excellent work.
  The Lady Roberts' Fund  has also supplied many nurses
to India.   In one district they reduced the typhoid death-
rate  from 52 to 17 per cent.
  Organization.—The Association  of Nursing  Superin-
tendents  of India  was  formed  in 1907.  The  Trained
Nurses'  Association of India was formed  in 1911, and
includes  many native nurses.
  "The Nursing Journal of India" was established in 1910.
  State registration for nurses is favored by many of the
women  in  charge  of  training-schools.  In  1910 the

  1 Even in early days some native princes gave largely to hospitals.
The Grant's College Hospital at  Bombay was given by Sir Jamsetja
Jejeebhoy, a Parsee, and in 1869 his wife and children built a hos-
pital  for incurables.  Another Parsee gave an  ophthalmic hospital
about the  same time. 
268   OUTLINES  OF   NURSING  HISTORY
Bombay Nursing Association  formed  a central board
whose work should be to standardize training, to give ex-
aminations to graduates, and to grant certificates.

                       CEYLON
  Dr. John  Scudder was probably the first  medical  mis-
sionary  to  go to Ceylon.  He  began his work in  1819.
Burdett reports  that in  1893 there were nurses of both
sexes being  trained and  paid by the government.   The
men took their work under doctors; the women under a
lady superintendent.  Dr. Mary A. Scott, herself a nurse,
established the first  modern training-school  for nurses in
Ceylon.
  In 1900 there were said to be good hospitals for natives
all through Ceylon, mostly with English women as super-
intendents, and with many Dutch women as head nurses.
Two very  good  hospitals  are the Lady  Havelock at
Colombo, with an entire staff  of women; and the Civil
General at Colombo (350  beds), with French Sisters in
charge and most of the nursing  done by native helpers.
  Before 1900 there was  organized  an  Association of
Trained Nurses in Ceylon.  There were  only ten mem-
bers, all doing private duty.

                       PERSIA
  In the older times Persia had government hospitals in
all its chief cities, with paid  attendants to care for the sick.
These hospitals were for non-contagious diseases only; and
despite the frequent  epidemics of communicable diseases,
no hospital ever provided for them.
  At the present time there are but three  native  hos-
pitals, and the good medical work is done by missionaries.
Dr. A. Grant and his wife (a nurse) were the first medical 
TURKEY
269
missionaries in Persia; they went out in 1835.   The West-
minster Hospital  at  Uroomiah was  built by Dr. J. P.
Cochran in 1883.  The American Hospital  of that  city
was largely the gift of one man; it gives a species of training
to both men and women nurses.1
   Miss H. D. McKim, graduate of the Toronto General
Hospital,  went  to Persia  as missionary nurse in 1903.
Miss Janet McVeigh, of the Colonial  Nursing Association
of England, and Miss Elizabeth H. Stewart, of the Medico-
Chirurgical  Hospital  of  Philadelphia,  are  doing mis-
sionary nursing  in Teheran.
   Of the native hospitals, the Royal Hospital at Teheran
takes only men patients; students of the medical college
get experience here.  At Meshed there  is a government
hospital that  takes both men and women, and employs
nurses of  both sexes.

                        TURKEY
   Constantinople  has a considerable number  of  native
hospitals,  with paid attendants.   The Children's Hospital
was built by the Sultan in memory of a favorite daughter;
it is nursed  by German deaconesses with  native ward
attendants; when Dr. Nicholas Senn of Chicago visited
it, he pronounced it excellent.
   There are ten  hospitals for foreigners in Constantinople.
The British is in  charge of English  trained nurses; the
Cerman,  under  deaconesses;  the  French,   Austrian,
Italian, Greek,  and  Russian hospitals  are nursed  by
Sisters of Charity.
  Asia Minor and Syria.—There are a number of mis-
sionary hospitals that  have started  training-schools for

  1 This work  is now thoroughly disorganized on account of the
recent extensive massacres. 
270   OUTLINES   OF  NURSING  HISTORY
native nurses, and are making slow but excellent progress.
The Protestant  College at Beirut was among the first;
their school was begun in 1906, and is in charge of Miss
Jane  E. Van Zandt, of the New  York Post-Graduate
Hospital.   Miss North has  a school  at  Caesarea.   The
Smith  Hospital  at  Aintab established a school in 1909
under  Miss Alice Bewer, of the Philadelphia Hospital.
Miss Bewer and Miss Wortabet have  translated nursing
text-books into Syrian or written them in that language.
  The Kaiserswerth deaconesses have hospitals at Beirut
and at Jerusalem.
  Miss Emma D. Cushman,  of Paterson, N. J., went in
18991 to Konia  (the  Iconium of the  New Testament).
She taught nursing  to native girls for some years, and in
1908  organized  a training-school.  The course is  from
two to four years, according to the  ability of the pupil.
She writes of her work:
  "Konia is almost entirely  Mohammedan, having only
a small percentage of Greeks and Armenians.  The nurses
are Greek  or Armenian, never Moslem.
  "Nursing and nurses are very recent accomplishments
in Turkey.  Ten years ago only widows and men did such
work, but now we have no difficulty in getting plenty of
graduates from  mission  schools.  The hospital here is
quite  on the American plan.  The nurses wear uniforms
of the regulation stripe, and a cap which is a protection to
them, as it sets them apart as persons engaged in a holy
work.
  "For text-books  I have  been using Aikens' 'Primary
Studies'  and 'Clinical Studies,' translating them lesson
by  lesson,  and  adding  explanations as required.   The
Turkish language is poor and lacking in scientific terms,
but the Greek nurses recognize those that come from their
     1 She had been in executive work in the United States. 
TURKEY
271
language.1  The pupils from mission schools know a little
English.
  "One of my graduates is head nurse here, and one is our
operating nurse.   One  is doing  fine  work  about three
hundred  miles east  of  us,  trying to  redeem a  horrible
native hospital."

Fig. 66.—Visiting nursing in Jerusalem. (Block loaned by Hadassah,
       the Women's Zionist Society of New York City.)
  District  nursing in  Jerusalem  has been  started  by
 Hadassah, a woman's Zionist organization.   Mr. and Mrs.
Nathan Straus,  of  New York, started the fund for this
work.  In January, 1913, Miss Rose Kaplan, of Mt. Sinai
Hospital, New York, and Miss Rachel Landy, of  Cleve-
land, began the work in a settlement house.  They have
1 French is the business language. 
272   OUTLINES  OF  NURSING  HISTORY
the co-operation  of  two doctors.  They are also doing
school nursing under Dr. Ticho, of the Zion Eye Clinic.
  In  a year's time they so won  the children that they
would come to them of their own accord if their eyes were
at all troublesome.  They report an incredible amount of
eye trouble, chiefly trachoma, and say that if contagious
eye troubles and contagious impetigo were excluded from
the schools, there would be almost no school left.  In the
past year these  nurses have undergone great hardships,
but have stuck to their post.
  In the summer of 1914  two more nurses were to enter
this work, but the war brought such  uncertain conditions
that the society cancelled its contract with  them.


          SUMMARY  OF IMPORTANT  POINTS
  Skilled nursing  in Asia is entirely the result of mis-
sionary endeavor.  Probably the first nursing which was
at all good was done by women doctors.  With the foreign
trained nurse came the possibility of  training  native men
and women for this work.
  In Japan in former times the whole family took care
of a sick member in devoted but unskilful fashion.
  The first modern training-school for nurses was estab-
lished in 1885 under the direction  of Dr. John C. Berry,
by  Miss Linda  Richards  of America.  Miss  Richards
remained five years and made the school a model for all
future work.
  Many modern training-schools, started and carried on
by the Japanese themselves, have been  organized; in 1909
there were  over one hundred of them.
  There are a number of Red Cross training-schools which
give a full course.   In the war with  Russia 2700 trained
nurses served  the  Japanese Government. 
SUMMARY  OF  IMPORTANT  POINTS   273
  Japan and the United States are the only two countries
whose Red Cross Society demands that its nurses be fully
trained.
  Nursing in China is of recent date and training-schools
are only beginning.  The Chinese are afraid to touch a sick
person.
  The older missionary hospitals had "dressers" who were
instructed in a few procedures, but no nurses.  Trained
nursing probably began about 1895, but little was done
until about  1905.
  There are now a goodly number of training-schools for
native  men and women connected with missionary  hos-
pitals, a full course being given to educated pupils.  Men
nurses  are necessary, as a Chinese woman may not nurse
a man.
  The  China  Nurses'  Association  was formed  in 1909.
Its Vice-President  is  Mrs. Lyon (nee Chung), the only
Chinese woman who has yet finished her training abroad.
There are one hundred members, a part being Chinese.
The association has planned  a standard curriculum, and
conducts examinations for registration.
  A goodly number of American text-books for nurses
have been translated into Chinese.
  The  Chinese Government has undertaken the work of
training nurses.  It has a school of forty at Tientsin.
  The  Rockefeller Commission is planning very material
help in nursing work in China.
  Modern nursing  began  in  Korea  with Miss Ellers  in
1886.  A training-school was established at Seoul in 1906,
and is doing an excellent work for native nurses.
  Nursing in India is indirectly the result of the work of
Florence  Nightingale.  Native  nursing  is  practically
non-existent.
  Native nurses were  first trained by  the Sisters of St.
       18 
274   OUTLINES  OF  NURSING  HISTORY
John the Baptist  and  by  the Zenana  Bible  Medical
Mission.  Several training-schools for native nurses were
begun in the 80's, but modern courses were not given until
about 1900.  Most of these courses are in mission hospi-
tals.
  The Countess  of Dufferin's  Fund has trained women
doctors and nurses since 1885, and has done an enormous
amount of excellent work.  Native nurses are in charge
of hospitals and are making progress.
  There are two nursing associations in India and a nurs-
ing journal.
  In Ceylon Dr. Mary A. Scott opened the first training-
school for native nurses.   There are now many good ones,
mostly in government hospitals.
  There are but three native hospitals in Persia.  There
are missionary nurses at work, but no training of any im-
portance has been attempted.
  The hospitals of Constantinople are nearly all nursed by
foreign trained nurses, deaconesses, and Sisters of  Charity.
  There are throughout Asia Minor and Syria a number
of training-schools for native nurses in connection with
mission hospitals.  None  of the pupils are Moslems.
  Two Zionist nurses are doing district work in Jerusalem. 
CHAPTER XVII
           NURSING  IN  MANY  LANDS

  In the older English colonies, such  as  South Africa,
Australia, and  New Zealand, nursing is almost abreast
with Europe  and America.   In Latin America and  the
pioneer countries it  is only just beginning.

                       AFRICA
  In South  Africa there are  many graduate nurses work-
ing, some of them American, but mostly English.  There
are excellent  hospitals and good training-schools; nearly
all the schools are in charge of English graduates.  Cape
Colony was the first country  in the world to  establish state
registration for nurses; it was begun in 1891, at the request
of about sixty nurses.  The registration Board is composed
entirely of physicians.  Registration laws were passed in
Natal in 1899, and in the  Transvaal in 1906.  There is a
South African  nurses' association  and a  good  nursing
journal.  (See Chapter XX.)
  In Egypt, at Alexandria, Port Said, and Cairo, there are
hospitals nursed by English  graduates.   At Cairo there
is  a government  training-school  for nurses,  in which
natives have  been trained since about 1900; but there is
said to be little demand for  native nurses.   A number of
American nurses are at work here.
  In Algiers, Miss Elston, of Bordeaux, France (see page
230), took charge of a  hospital in 1913 and is developing it.
  On the West  Coast there are a number of English hos-
pitals, with graduate nurses  in charge.
  In 1901 Miss Agnes P. Mahoney, who had been Super-
intendent of  Nurses at the  Metropolitan Hospital, New
                                             275 
276    OUTLINES   OF  NURSING  HISTORY
York,  went to  Liberia  as missionary  nurse,  and  did
pioneer work for a considerable number of years.
   In Central Africa  there are  a number of  mission hos-
pitals,  with English or American graduates in  charge.
   On the East Coast there is at Mombosa  a government
hospital with a staff of English nurses.   At Tanga there
is  a German  deaconess hospital.   At  Zanzibar  there
are  a number of hospitals, the  English one,  under  the
Universities  Mission,   doing   considerable  in  training
native  nurses; the men are found more satisfactory pupils
than the women.
   The  training of the native African as a nurse is still in
the experimental stage, since there is not even civilization
to build upon.
                        LABRADOR

   One  of the best-known medical missions in the world is
that of "Grenfell of Labrador."1  Dr. Wilfred T. Grenfell

   1 Dr. Grenfell, born in England in 1865, was a graduate of Queen's
College,  Oxford, and a pupil  of Sir Frederick Treves at the London
Hospital.  His work has been that of a medical missionary, healing
the sick, doing skilled surgery, and preaching the gospel.  He went
out with his first hospital ship in 1892, and spent three months along
the coast of Labrador, treating hundreds of sick.   He has not only
established hospitals, but has opened schools, a Seamen's Institute,
an orphanage, several co-operative stores, and has established new
industries for both men and women.  His boundless energy  and
enthusiasm, his great ability, and  his practical good sense have
drawn to him skilled doctors,  nurses, teachers, and other helpers.
   He selected  Labrador as  his field because he felt  it  to  be an
especially difficult one.   "Had he been a weakling or a coward, he
would long ago have died or  been driven out by the dangers of his
life along that perilous coast.   He has out-sailed the Labrador skip-
pers, out-dared them, done under their eyes deeds of courage which
they would shiver  to contemplate,  never in a  fool-hardy  spirit,
always with the object of kindly service.  He is a  man unafraid."
—James Johnston. 
LABRADOR                 277
began work about 1893 among the deep-sea fishermen of
Newfoundland  and Labrador,  establishing a hospital at
Battle  Harbor  for summer  work.   The first nurse who
helped him in  this hospital was  Miss Paton, of Halifax,
Fig. 67.—Dr. Grenfell and his  staff at St. Anthony's Hospital,
                    Labrador, 1914.
N. S.,  who remained through the winter, doing visiting
nursing by long sledge trips.   Miss Cecelia Williams, Miss
Ada Cawardine, and Miss Maud Bussell, all of England,
worked in the Battle Harbor Hospital during  its  first
years. 
278   OUTLINES  OF  NURSING  HISTORY
  There  are now hospitals at St. Anthony and  Pilley's
Island (Newfoundland), Harrington, Battle Harbor, and
Indian Harbor (Labrador), each with doctors and graduate
nurses.   There are  nursing stations at Forteau and  St.
Paul's River, Labrador, that serve an extensive territory.
There are about seventeen nurses at work, five of  them
Canadian graduates.
  One of the first American nurses to enter this work was
Miss  Kennedy,  of  Johns Hopkins Hospital,  who  went
about 1906 and remained for four years; in the summer of
1908 she went the whole length of the Labrador coast with
Dr. Grenfell.  The Mission speaks of her as "a nurse of
the finest type,  with marvelous powers of endurance."
Miss Sarah A.  Cannon, of St. Luke's Hospital, New York,
has done a variety of service, and is now engaged in winter
visiting nursing in about seventy  stations.   Miss Florence
E. Bailey, of England, went out in 1907 and has worked in
a number of the hospitals; she is  now alone at Forteau.
  Nurses and doctors spend their summer vacations,  often
at their own expense, working under Dr. Grenfell. Harvard
and Johns Hopkins medical  schools  send doctors every
year; the Presbyterian, Roosevelt,  and St. Luke's  Hos-
pitals of New York,  the Massachusetts General of Boston,
and others are accustomed to send nurses for this inter-
esting but difficult work.  The Victorian Order of Canada
also helps.  Dr. Grenfell and his  staff are expert surgeons,
and all the work is  of high quality, though some of it is
done  under most primitive conditions.

                       ALASKA
  Nursing in Alaska is done chiefly in mission hospitals.
Bishop Rowe1 has been the chief founder of the work, which
began only with the "Klondike rush," upon the finding of
           1 Of the Protestant Episcopal Church. 
TUBERCULOSIS  WORK  AMONG  INDIANS 279
gold.  The work has  been of  a migratory  character,
changing as the population changed.  If  in a suddenly
developed town of some Alaskan "find," where a thousand
miners,  prospectors,  and others  appear over night,  the
demand arises for hospital work, some way is managed to
plant a hospital and a nurse along with a chapel.  When
that demand for medical help declines,  the work is dis-
continued and carried to some other place.
  The  first nurse to go to Alaska was Miss Elizabeth
Deane, who went out in 1897  and took charge of Grace
Hospital at Circle City, in  the far north.  Miss  Eliza J.
Woods and Miss Annie C. Farthing followed her  here; in
1906 the hospital was discontinued.  Miss Annie Dickey
and Deaconess Carter have worked at Skagway; Deacon-
ess Deane worked at Valdez and Ketchikan; Miss Farth-
ing at Fairbanks.  Miss I. M. Emberly has done  work at
Fairbanks and  at Skagway.  Miss Agnes  Huntoon took
charge of the Ketchikan Hospital in 1911.  Miss Agnes
Bolster has been missionary nurse among the natives since
1907, her salary being paid by  St. Barnabas' Guild for
Nurses.
  The  native girls help in the care of the sick, but  no
organized attempt has yet been made to train them.1

     TUBERCULOSIS  WORK AMONG THE INDIANS
  About 1909 the United States  Government had its at-
tention  turned  to  the alarming  prevalence of tubercu-
losis among  the Indians.  It  appropriated  funds  for
sanitaria and home  instruction,  and has increased  the
amount each year.
  Four sanitarium schools for tuberculous Indian  children
have been established: at Toledo, Iowa, Laguna, N.  M.,
  1 Thanks are due for this information to Rev. E. B. Rice, of the
Church Missions House,  New York. 
280   OUTLINES  OF  NURSING   HISTORY
Phoenix, Ariz., and Fort Lapwai, Idaho.  Indians from six
to twenty-one years  of age  who have incipient  tubercu-
losis live and are educated in these institutions, work and
study being regulated by the physicians and nurses.   The
nursing is in charge of graduates from recognized  training-
schools.   The sanitarium at Fort  Lapwai accommodates
two  hundred children;  its chief nurse is  Deaconess Mary
Elizabeth, a woman of unusual ability.
  Fig. 68.—Patients and Deaconess nurse superintendent at United
States Government Sanitarium School for Tuberculous Indian Chil-
dren, 1915, Fort Lapwai, Idaho.
  The work in these sanitarium  schools has been emi-
nently successful, as  nearly all the  cases  treated have
had  the  disease  arrested, and have  gone back to their
homes to spread the gospel of fresh  air,  good food, and
proper  sanitation.   Pupils  are  received   from  about
thirty-five tribes.1
  1 This information was  obtained through the courtesy of  the
United States Indian Department. 
CUBA
281
                        CUBA
  Nursing in Cuba was formerly done almost entirely by
Spanish Sisters of  Charity.  The Church hampered their
work, and  in  hospitals most of the  actual nursing was
done by servants from the lower classes; their work was so
badly done that even  their very name, enfermero, was a
term of reproach.
  At the close of  the  Spanish-American War,  when the
United States occupied the island, the Church withdrew
the Sisters  and sent them back to Spain.   This  left the
hospitals and  their nursing  in the hands  of  United
States military officials, a situation unique  in the world's
history.
  There was but one course to follow—to  put American
trained nurses in charge of the hospitals and to take up
the matter of training for native nurses.  There were the
difficulties of previous  poor work and of native customs
and prejudices.  There was the one great advantage of a
clear field for work.  There followed a  remarkable piece
of nursing  organization and development.
  Major L. J. Greble, head of the Department of Charities
and Sanitation, called Mrs. Lucy  Quintard  and  Miss
Sarah Henry, women  who had been superintendents of
large schools in the United States, to be special inspectors
of hospitals and to assist in the establishment of training-
schools for native nurses.
  The native Cubans are far from being good material for
nurses.  They  lack  education and  force  of  character;
they are emotional  and affectionate, but  are  more like
children in  their attitude  toward life than like  mature
persons.  The task of selecting and training them has been
one of extreme difficulty, but it is being done with a goodly
measure of success. 
282   OUTLINES  OF  NURSING  HISTORY
  The first American-controlled  school1 was opened in
August, 1899, at Havana, with seven pupils, under Miss
Mary  A.  O'Donnell, of Bellevue  Hospital, New York.2
The second was the one established in March,  1900, at
the Civil  Hospital of Cienfuegos,  under Miss  Jeanette
Byers, of  the  Woman's Hospital  of  Philadelphia.   In
rapid  succession came schools under Miss Eugenie Hib-
bard, Miss Gertrude  Moore,  Miss Mitchell, and  Miss
Sampson.
  In  1901 Major  J.  R. Kean  (who  had taken Major
Greble's place) appointed a board to draw up a system of
regulations for training-schools for nurses in Cuba.  The
board  consisted  of  three   prominent   Cuban   doctors,
Mrs.  Quintard, and Miss Hibbard.  The two  American
nurses did practically  all the work, since the doctors de-
ferred  to their knowledge and experience.  Miss Hibbard
is chiefly  responsible for the plan  of organization.   It is
regarded as one of the most creditable pieces of work ever
done by American nurses.3
  The training-schools  flourished,  and  by 1909  Cuban
graduates  were placed at the head of new  schools.  A
corps  of  visiting sanitary   nurses  was  organized,  with
American nurses in charge.
  The National  Nurses' Association of  the Republic of
Cuba  was organized in 1909, and has  several hundred
members.

  1 Early in 1899 a Cuban  doctor had started a  nurses' training-
school in Havana, but it was in existence only five months.
  2 Miss O'Donnell translated Hampton's "Nursing" into Spanish.
  3 It was ruled that a training-school must have at least twenty
pupils;  that the course was  to be three  years; and that the hours
of day  duty were to be only eight.  State registration was made
compulsory. 
MEXICO
283
  In 1908 Miss Hibbard was made Inspector-general  of
Nurses for Cuba.1
                     PORTO  RICO
  The most noteworthy  work done  in  the training  of
nurses is that which was begun about 1902 at the Munici-
pal Hospital of San Juan, by Miss Amy E. Pope, of the
Presbyterian Hospital, New York.  During two years  of
work  Miss Pope put the school on a firm basis.  She left
it  in  charge of Senorita Pilar Cabrera, a Porto Rican
woman  trained in the United States,  who  has continued
it successfully,  training lay nurses and Sisters of Charity
in  modern   methods.  Miss  Cabrera  translated  into
Spanish  Maxwell-Pope's "Practical Nursing."
  The Presbyterian Mission  Hospital also has  a good
modern training-school.

                       MEXICO
  Mexico has  the distinction  of possessing  the oldest
hospital  in  America.   It  is  the  Hospital  of Jesus the
Nazarene (originally called the Hospital of the Immacu-
late Conception), built in Mexico  City about  1520 by
Cortez, the  Spanish conqueror of the country.   Its super-
intendents are  now appointed by descendants of Cortez;
it is nursed  by Roman Catholic Sisters.2
  Formerly most  of the nursing in Mexico was done by
Sisters of Charity and their work was regarded as good.
In 1857 reform laws were passed and the sisterhoods were

  1 In 1903 Miss  Hibbard was sent by the Isthmian Canal Commis-
sion to be Chief Nurse at the Ancon Hospital, Panama, a position
that involved  organization.  She returned to Cuba about 1906 and
is still there.
  2 Two other very old hospitals are those of St. Lazarus, founded
about  1530, and the Royal Hospital, founded about 1540. 
284   OUTLINES  OF  NURSING   HISTORY
suppressed.  Nursing  largely fell into  the hands of un-
trained and ignorant  persons.
   In  1885 one of  a  party of tourists from New England
who were stopping in Mexico City contracted  small-pox
and died.  The inadequate  care available for him started
a  movement for an  American hospital.  This institution
was shortly established,  and has for years done excellent
work; it is nursed by American graduates.  There  is a
considerable  number of American nurses doing  private
duty  in the city of Mexico  and elsewhere, chiefly among
the American population.
   The Mexican General Hospital,  a government  institu-
tion,  finished about  1905, is one of the  finest hospitals in
America.   It has 1040 beds,  and consists of thirty modern,
well-equipped  buildings, erected  at  a  cost  of  about
$1,500,000.   At its opening a training-school for Mexican
nurses was organized  under  Miss  McLeod, a  Canadian
graduate.
   There are a number  of railway hospitals in Mexico,
built  and maintained  by the  American companies that
own the roads.  They are nursed by men.1

                   SOUTH  AMERICA
   The whole of South America is far behind in its nursing.
There are  some foreign  graduates  working,  but modern
training-schools do not exist, so far as can be ascertained.
Good medical and surgical work is done; many hospitals
are in existence  (though they are few in proportion to the
population), some  of them being very old.  The hospital
nursing is done in medieval fashion, the  head nurses being
Roman Catholic Sisters, and much of  the personal care
being rendered by low-grade servants.
  XA11 work has been  so disorganized by the recent  revolutions
that it is impossible to say what present nursing  conditions are. 
AUSTRALIA                 285
  In most of the countries there are national hospital
boards.
  Argentina has a number of large native hospitals, with
Roman Catholic  Sisters in charge  of them.   Buenos
Ay res has a British hospital, with English nurses.
  Brazil has many  municipal  hospitals,  with Sisters in
charge; some of these are attempting to give training to
their nurses, but  are  making  little  headway,  probably
because the pupils are of an uneducated class.  There are
a number of military hospitals, nursed by men under the
direction of doctors.  There are a few private hospitals,
staffed by foreign trained nurses.  The Strangers' Hospi-
tal, in  Rio de Janiero, founded  about 1900, has English
graduate nurses.
  In Chile "the hospitals  are  semi-religious and semi-
political.  All are in charge of the Sisters of Charity, and
orderlies and nurses care for the  patient under their direc-
tion.   One resident physician  often  has  two  or three
hundred patients under his care.   There is no classification
of cases.  No records of any sort are  kept.  Erysipelas is
endemic in many  of them."1
  Colombia, Peru, Bolivia,  and  Uruguay  have national
boards  that  look  after  health  matters and control the
hospitals.   The  nursing is  done by  Sisters  and servant
attendants.
                      AUSTRALIA
  Australia is a comparatively new country, having been
settled by the English, who have pushed back or  assimi-
lated the natives.  Nursing is modern and has made good
progress,  keeping  very  close to that in  America and
England.
  The  first hospital was the Sydney Infirmary, opened in
1811.   Its nursing was  done by servants, while the doc-
                1 Dr. Louis Asta-Buruaga. 
286   OUTLINES   OF  NURSING  HISTORY
tors attended to the more important procedures.   In 1868
Miss Lucy Osburn and four other Nightingale nurses came
from England.  Miss Osburn established a modern  train-
ing-school in the Sydney Hospital, and  the  others did
pioneer training work in other cities.
  With the coming of five more Nightingale nurses  a few
years later modern  training for  nurses  began to be an
established fact.  The difficulties  were considerable; pro-
bationers were  hard to get, doctors thought  the move-
ment a dangerous one, and opposed it.  The early  train-
ing extended through but one year; nurses were  badly
housed and fed, much housework was required of them,
and their hours were long.  Only  gradually did these con-
ditions improve.
  Four of the  best known training-schools are those in
the Alfred Hospital at Melbourne and the Prince Alfred
at Sydney, both  opened in  1871; the  Brisbane Hospital
School,  opened in  1885;  and the  one at the Adelaide
Hospital, opened  in  1886.  These schools have been de-
veloped under some  very  fine  women,  and now give full
and good three-year courses.
  District nursing in rural districts, called "bush" nursing,
was begun in 1911 under a fund started  by the Countess of
Dudley.  The Lady Talbot Milk Institute employs two
nurses in  infant  welfare work.    There  are insurance
nurses and one  or two nurse sanitary inspectors.
  School nursing  has been started  in  Hobart.  There is
medical inspection of school children in many  places and
school nursing will  doubtless follow  shortly.   Hourly
nursing has succeeded to an  extent among the  middle
classes.
  The national nurses' associations (see Chapter  XX)
were founded in 1899 and 1901, and  have a large member-
ship.   An interesting feature of these organizations is that 
NEW  ZEALAND
287
for a number of years their officers were doctors.  Later,
without any friction, the nurses came to hold office.   It
is  the  general opinion  that  physicians and nurses work
together more harmoniously here  than in  almost any
other country.
   State registration was put  into effect in 1912.
   Australia has two nursing magazines (see Chapter XX).

                    NEW ZEALAND
   The progress of nursing in New Zealand  has  followed
rather closely that of Australia, and the advance  has been
commendable.
   The first hospital was built about 1850,  at Auckland,
but was small and  inadequately nursed.  In 1885 it had
grown to one hundred beds,  when Miss Alice Crisp came
out from  England  to be its  matron.  She  established a
training-school in  1889,  which  now  has about  eighty
nurses.
   The Wellington Hospital established the earliest train-
ing-school, beginning in 1883. It has furnished nurses for
many  important positions.   Christchurch Hospital, built
in 1862,1 organized  a school in 1887.   Dunedin Hospital,
connected  with the medical  school, opened  its training-
school  in 1888.2
  There are now about fifty hospitals in New  Zealand, and
the majority of them have training-schools for nurses.
  Four hospitals, all  called  St. Helen's,  train nurses  in
midwifery, giving a course of a  year.3  Each nurse is re-
quired to deliver and care for twenty cases.   The gradu-
ates are regarded as very competent.

  1 Its old-fashioned nursing was  regarded as good.
  2 The course was at first but one year, but was soon lengthened to
three years.
  3 Postgraduate work is also given. 
288   OUTLINES   OF  NURSING  HISTORY
  There  have always  been many  men nurses in New
Zealand because of the scarcity of women; only a few of
them have taken training.
  A few  native (Maori) girls have graduated in nursing,
and have done successful work.
  District  nurses  are  working in  several cities, under
philanthropic  societies.  Several  nurses are doing baby
hygiene  work.  Rural nursing,  called  "back  block"
nursing, is being gradually organized.
  A National Nurses' Association  was formed in  1909.
State registration was  begun in 1902, being put forward
by  the government, not by the nurses.
  About  1882 the government established the office  of
Inspector of Hospitals.  In  1895  he was given a trained
nurse assistant, the first woman in that office being Mrs.
Grace  Neill,  the  present  one  Miss  Hester  Maclean.
Their work has done much to improve training methods.
  New Zealand has a nursing magazine (see Chapter XX).

                  THE PHILIPPINES
  Before the American  occupation of the Philippines at the
close of the Spanish-American War  nursing was almost
non-existent.   Health  conditions  were about  as  bad as
could be and  the death-rate was very high.    Hardly a
family of the lower class escaped  tuberculosis,  hookworm
was very  prevalent, small-pox, cholera, malaria, beriberi,
and other communicable diseases  were rampant.  The
infant mortality was enormous.
  The Bureau of Health, established by the United States
Government, with  responsibility  for the medical and
sanitary  inspection of  the  whole group of islands, has
done and is doing a remarkable  work.  It  aids  private
hospitals and  charitable societies in doing health work.
It controls and operates the  Philippine  General Hospital; 
THE  PHILIPPINES
289
the San Lazaro (for communicable diseases and insanity);
the Bilidid Prison  Hospital;1 the Baguio  Hospital (for
government employees) ;2 and the Culion Leper Hospital,
in the island  of Cebu.   Doubtless  the first and  most
efficient instructors  in health have been the officers of the
United  States  Army and the American public  school-
teachers.
  The first nurses who came to these  islands were those of
the army and the Red Cross.   Their work was temporary,
and only among Americans.
  Miss Anna E. McEvoy went to Manila in 1898, and
was made Chief Nurse of the Military Hospital on Cor-
regidor Island,  a position which  she held for some time
with great distinction.  Later she became superintendent
of the famous San Lazaro Hospital, and did a remarkable
work.  She died in 1911 as a result of her long and arduous
labors in the islands.   She was  buried  in the National
Cemetery at Arlington, D. C.
  A government training-school  for native  nurses was
talked of as far back as 1903,  but  the work was not begun
until  1907,  when it  was started as a branch of the Philip-
pine Normal School.  The school gave one year's study,
then  sent its pupils to three hospitals—St.  Paul's, the
University, and the Philippine General.  Each  of  these
hospitals now has its own school.
  Mrs. Eleanor U. Snodgrass was the first superintendent
of this school,  which graduated  its first class in  1911.
Both  men and  women are admitted as pupils, and it is
required that^they be at least sixteen years old and have
a common  school education.   This seemingly low stand-
ard is necessary among a people who are just  entering
upon civilized life.
      1 These three hospitals are in Manila.
      2 This hospital also cares for the Igorots, a wild tribe.
      19 
290   OUTLINES  OF  NURSING  HISTORY
  The training of  the native Filipino, who comes  from
and must go back to a very primitive mode of life,  is no
light  task.  The beginnings are excellent, however, and
the progress is rapid.  There are nurse training-schools at
several missionary  hospitals,  the University  (with ten
pupils), St. Paul's (with twenty-five), the Mary Johnson,
and others.   The  government is  planning  several  new
hospitals  in  outlying districts and  will extend  nurses'
training work to them also.
  Miss Mabel McCalmont  did good  work in reorganizing
the nursing service while she was Superintendent of the
Philippine General Hospital, and was  largely responsible
for the planning of the buildings of the new institution.
She was also  Supervising  Nurse  of  the United  States
Bureau of Health.
  The health  program  of  the  government,  cleaning up
unsanitary conditions, checking tuberculosis by means of
education and sanitarium care, opening milk stations, and
instructing mothers  in the care of  their children, has
required the help of American nurses, and they are doing
commendable  work.
  An interesting work is that  of  the French Sisters of
Mercy at the Culion Leper  Colony.   There are  2200
persons in the colony,  and it has a hospital of sixty beds.1

                        HAWAII
  Nursing in Hawaii was originally very crude, and has
been  little developed, except as foreign graduates  have
taken up the work there. Nurses' training for the native
women is  just  beginning to be talked of.

  1 The popular  idea of the danger of contagion from living among
lepers is erroneous.  It is much less easily communicated than  many
other diseases. 
HAWAII
291
  The first  hospital established  in  the  islands was  the
Queen's, at Honolulu, named in honor of Queen Emma,
who took an active interest in it.   In 1879 Mr. J. F. Eck-
hardt, an American, took charge of  the hospital, and for
many years, with the help of an untrained man, took
care of  the  men  patients; a Hawaiian woman, also  un-
trained, cared for the women.  Even this unskilled nurs-
Fig. 69.—American District Nurses at Paloma Settlement, Honolulu,
                        Hawaii.
ing was vastly superior to what the natives had in their
own homes.   In  1892 the  hospital  began  to  employ
American-trained nurses, of whom Miss Margaret Carroll,
of the  New York Post-graduate  Hospital, was the first.
A fund has recently been given to provide for the training
of native nurses.
  At the  Children's Hospital, Honolulu, established  in 
292   OUTLINES  OF   NURSING  HISTORY
1909, an effort is being made to give a short course to
native girls.
  The Japanese Hospital, Honolulu, is nursed by graduate
nurses from Japan.   It receives Chinese, Filipinos, and
other nationalities.
  The Paloma Settlement at Honolulu, founded in 1896,
employs seven district nurses  and has  the work well
organized.   They have a milk station, a tuberculosis camp,
etc., and are heartily supported by the churches and civic
authorities.
  There are a number of hospitals in various parts of the
islands,   most  of  them nursed  by American graduates.
The military hospital at Fort Shafter has a number of
Red  Cross nurses.  There  are many small plantation
hospitals.
  A goodly number of graduate nurses are doing  private
duty here  among the wealthier  classes.  There  is  an  un-
filled demand for  "practical" nurses or attendants, who
can be had at a lower price than the graduate.

                        SAMOA
  Two  American Navy nurses are in charge  of a hospital
here.  They have  four native  nurses in training under
them, this (1915) being the first year of their work.

           SUMMARY  OF IMPORTANT POINTS
  In South Africa nursing is well developed  and progres-
sive.  Cape Colony was the first country in  the world to
pass a registration  law for nurses.   In Egypt and on the
East Coast of Africa attempts  are  being made to train
native nurses.   On the West Coast and in Central Africa
there are graduate  nurses working in mission hospitals.
  In Labrador Dr.  Wilfred Grenfell  has established a re- 
SUMMARY  OF  IMPORTANT  POINTS   293
markable medical mission, which has attracted as workers
some  very fine doctors and  nurses.  The  work is done
under primitive conditions, but  is excellent in quality.
The first nurses who went out to it were English, but now
many American nurses are entering.  Nursing in Labra-
dor,  in  lieu of a summer vacation, has become almost
popular.
  In Alaska the only nursing done is in missionary hos-
pitals, which have  moved from place  to place with the
migrations of the  population.   Nurses trained  in the
United  States are at work here.
  The  United  States Government has four  sanitarium
schools for tuberculous Indian  children, with trained nurses
in charge.
  In Cuba, before the Spanish-American War, the nursing
was done  by Spanish Sisters  of Charity.   After the war
they were withdrawn by the Church and the work was left
in the  hands  of United States  officials.   They put
American nurses of experience in charge, and a remarkable
piece of organizing was  done under Miss Hibbard and
Mrs. Quintard.  There are now a number of good schools
for  nurses in charge of   Cuban  graduates.  There is a
flourishing nurses' association.
  In  Porto Rico  trained  nursing was established  about
1902 by Miss Amy Pope. It is  now in charge of  Porto
Rican graduates.   There is also some missionary nursing.
  Most of the  nursing in Mexico is in the hands of the
Sisters of  Charity.  There are several very old hospitals.
The Mexican General Hospital is a modern institution of
a thousand beds, with a  Canadian nurse in  charge of a
training-school  for native  women.  There  is  a  small
American  hospital in Mexico City, and a number of rail-
way  hospitals in charge  of American doctors, with men
nurses. 
294   OUTLINES  OF  NURSING  HISTORY
  South America is almost medieval in its nursing.  There
are a  good many native  hospitals, nursed  by Roman
Catholic Sisters, and in some of them attempts have been
made to give a small amount of training to the servants
who help in the care of the sick.   There are a number of
foreign trained nurses  at work, some in private hospitals
and some in private duty among foreigners.
  Nursing in Australia is modern and  progressive.   The
first training-school was established in 1871 by a Nightin-
gale nurse.  There are now many good schools.   District
and  school nursing  are  established, rural nursing, milk
station work, etc.  There is a national association in which
doctors work along with nurses.  State registration  was
begun  in 1912.
  New Zealand has  closely followed  Australia,  and is
making  good progress.   The  first  training-school  was
established in 1889, and there are now  a number of good
ones.  Some  native girls have  taken training.  The  four
St.  Helen's  hospitals, for  training  in obstetrics,  are
unique.  District and rural nursing is being done.   There
is a  national nurses' association.  State registration has
been in force since 1902.  There is a  government inspector
of hospitals, whose assistant is a trained nurse.
   In  the  Philippines, before  the American  occupation,
there was  practically  no nursing, and  health conditions
were extremely  bad.   Conditions are  primitive and ig-
norance  is dense.   The United States  Bureau of Health
has done a remarkable work in improving health mat-
ters.  It has  established training-schools for nurses, both
men and  women.  Mission  hospitals  are  also  giving
nurses' training.   The work is very difficult, but impor-
tant.   The largest leper colony in the world is at Culion,
and is  nursed by French Sisters.
  In  Hawaii there is little native nursing.  The  first 
SUMMARY  OF  IMPORTANT  POINTS   295
hospital, established about 1860, was  crude,  but much
appreciated by the natives.  American graduate nurses
are doing  hospital,  district,  and  private nursing  here.
Japanese graduate nurses are also at work.  There is talk
of training native nurses.   There is a  demand for  prac-
tical nurses.
  In Samoa two  American graduates are attempting to
train native nurses. 
CHAPTER XVIII
GREAT  MOVEMENTS  IN  WHICH NURSES  ARE
                    CONCERNED

  The nineteenth century was intensely  individualistic.
The twentieth has been called "the century of social con-
sciousness."  It marks the organization of many forms of
social work which even in the nineteenth century were
classed with dreams and Utopias.  We cannot say that
the twentieth century began these social activities, since
the germ ideas were in the mind  of men centuries back;
but it has been the period of their unfolding.
  The Nurse's Part.—Nurses are taking their larger place
in the life of the world.  The isolated hospital existence of
the past is gradually giving  way to co-operation.  The
individualistic life of the nurse of the past is broadening
out into the social nursing activities of the present.  The
former demand was for but two or three types of  nurse;
the present demand is for twenty types, to fill places in the
world's growing life.
  In three great movements the nurse of today plays an
important part:  Public Health, Hospital  Social Service,
and Household Nursing.  In the second,  she is still an
experiment; in the first and last, she is already recognized
as an essential factor.

              PUBLIC  HEALTH NURSING
  This work, which  has now become a whole,  began as
many parts.  The germ idea dates  back to apostolic times,
when visiting  nursing  began.  The  visiting or district
      296 
PUBLIC   HEALTH  NURSING       297
nurse has been and  always will  be connected with  all
great movements for race betterment.
  The  antituberculosis  movement  began  in 1899  in
Berlin.  Its avowed purpose was  nothing less than edu-
cating the whole civilized world in  the main facts concern-
ing the prevention and cure of  tuberculosis.  The world
was ripe for it, and the idea spread rapidly.  In less than
three years  there were seventy-five  antituberculosis  as-
sociations; they  now  number thousands.
  Great meetings,  exhibits, and printed  matter all had
an important place in this  work;  but it  was soon found
that much individual instruction was needed, much home
demonstration, and much adaptation of principles to cases.
Doctors did what they could,  but they presently per-
ceived that  the nurse was their best helper.  They found
the visiting  nurse ready to hand, and,  with a little special
instruction,  sent her into the work.
  Several states  now have sanitaria for the  care of their
tuberculous poor.  In some, counties have gone into the
work; Michigan is this year starting a movement to put a
tuberculosis nurse in  every county.   In Massachusetts a
law  recently passed requires every town  of ten thousand
inhabitants  to  have  a  tuberculosis  dispensary.   These
fast-multiplying enterprises call  for hundreds of nurses to
specialize  in this branch; and  the  supply is wholly  in-
adequate.
  The infant welfare movement, made up  of branches such
as the  Association for the Study and Prevention of Infant
Mortality  (organized in  1909)  and  the   National Child
Helping Association, designed to  check the appalling death-
rate of children in their early years and to insure them a
reasonable degree of health, demands, above all things,
nurses.  It  needs nurses with  both general and special
training, nurses  able to guide the mother with prenatal 
298   OUTLINES  OF  NURSING  HISTORY
care and  advice, to help  with or oversee  the  actual de-
livery, and to give practical aid and counsel in the early
months of  the  child's life.   The Pure Milk  movement
alone, an essential part of the larger program, has hundreds
of nurses  in its  service.
   Every visiting nurses' association gives a large share of
its attention to babies, recognizing this work to be funda-
mental.   Hospitals  and  homes  for  babies,  in  town,
country, and by the seaside, floating hospitals,1 and milk
stations are important factors; but it is in the end the work
of the individual nurse in the home that reachest farthest
and goes deepest.
   School  nursing,  starting with  medical  inspection and
ending with intimate work in the homes, concerning itself
with the  health of the growing child, has  almost uncon-
sciously grown into the life of the country.  Practically
everyone  feels its  social and  economic value,  and it is
being rapidly extended  in cities, towns,  and  rural dis-
tricts.   Hundreds of nurses are needed for the work.
   The National Organization for Public Health  Nursing
was  formed in  June, 1912.  In  the  beginning, a  com-
mittee of the  American  Nurses' Association and the
National  League of  Nursing  Education  discussed the
formation of a national visiting  nurses' association.  In
collecting  opinions from all parts of the  country, they
found the time  ripe for  organizing a bigger and broader
organization, one which  should include all nurses who are
working for the public health.
   Miss  Lillian  Wald  was elected president,  and  Miss
Ella  Phillips Crandall, of  Teacher's College, was chosen
for executive secretary.  "The  Visiting Nurse Quarterly,"
started in 1909  by the  Cleveland (Ohio)  Visiting  Nurse
  1 Such as the Boston Floating Hospital and the hospital steamers
of St. John's Guild of New York. 
PUBLIC  HEALTH  NURSING       299
Association, was taken over and made the official organ of
the society.
  The organization  has in hand the enormous task of
selecting, teaching, setting at work, and encouraging the
nurse who devotes herself to the improvement of  com-
munity health.  The secretary  makes personal visits to
different cities, gives addresses,  furnishes advice on local
problems, helps with questions  of policy, standards, etc.
An effort is made to have all nurses engaged in the  work
undergo special training for it.
  The Scope of Public  Health Nursing.—State and City
Health Boards are being reorganized upon a new basis.
It is coming to be felt that much of their former work—
attention to water-supply, milk-supply, handling and care
of food, garbage disposal, etc.—has been developed to the
point where it may be handed over  to the police depart-
ment; that, standards  having been established and ac-
cepted,  it is chiefly  enforcement that is needed in  these
lines.
  This policy  leaves Boards of  Health free to turn  their
attention to the prevention of disease.   The proposal is
made to educate the whole community in health matters,
to get rid of the superstition  and mystery  that has sur-
rounded disease.  Recognition is had of the fact that the
matter becomes at once a series of individual problems,
since community health in any  real sense is but personal
hygiene in  its  broad sense.
  The National Public  Health Association openly pro-
claims its dependence upon the  nurses of the  country for
the carrying out of its program.  The work which it has
in mind is an extended and glorified visiting nursing, with
teaching as its  important feature.  It is planned that every
family in the land shall  have instruction in the laws and
practice of  health.  Only  nurses can undertake such a 
300   OUTLINES  OF  NURSING  HISTORY
task.   Dr. Selkar S.  Gunn,  secretary  of  the National
Association, says, "Visiting nursing is no longer largely
bedside care, but largely teaching."
  A few organizations are  undertaking to train the nurse
for work in this wide field (see Chapter XII).   It must be
done  by special agencies,  since hospital training-schools
have, as a rule,  neither time  nor facilities  for it.   The
Public Health nurse must be familiar not only with tuber-
culosis and other  contagious diseases,  and with all  that
pertains  to infant welfare and obstetrics, but also  with
midwifery, with occupational diseases,  and with the social
agencies of the community.   She must have the necessary
humanitarian impulses, and must be educated to the social
viewpoint.  It is  difficult, but possible, to produce such a
high type of nurse for this important work.   Certain it is
that hosts of nurses must undertake it, if we are to meet'
the pressing problems  of the day.


              HOSPITAL SOCIAL  SERVICE
  "Social service" is  a term that covers the whole  field
of philanthropy.   It includes all activities whereby  men
serve their  fellow-men  without  pay.   Hospital  social
service limits the  work to whatever may be  done toward
establishing the patient's bodily health, and involves ques-
tions not only physical, but moral and spiritual as well.
  Facts Underlying the Work.—In the  past the great fault
of hospital service and of  trained nursing has been  that
they considered the patient merely from his physical  side,
and as an isolated unit.  Nothing could be  further from
the truth of life, and  we  are  beginning now  to see the
stupidity of attempting to  cure a patient without taking
into consideration his environment,  his  past, and his
future.  No person is a "one dimension" proposition; no 
HOSPITAL  SOCIAL   SERVICE       301
illness is the result of any one factor; no disease can be
cured by any one agency.
  The real causes of disease often lie far back in the past,
involving  heredity, childhood  surroundings, youthful
pleasures,  labor conditions,  living conditions, or home
exigencies,  and being the result  of a tangle of causes, of
which the one that seems the least may be the greatest.
Recovery from illness may involve mental rest, change in
another person's attitude, reorganization of family life, a
new occupation, all sorts of modifications, small or great,
in which many more than the patient himself must take a
share if the desired result is to be had.
  The folly and ineffectiveness of  our former  method, or
lack of method, in dealing with certain forms and cases of
illness may be illustrated by the mere statement of a few
concrete instances:
  A mother, delivered by a  midwife or  by a dispensary
doctor, assisted by a visiting  nurse, in a week or less goes
back to the care of her family because there is  no one else
to do the work and because neither she nor her husband
knows that she should not.  She becomes a half-invalid in
consequence, and in time undergoes one  or more surgical
operations  for the  setting right of the trouble.  Economy
in any real sense of the  word would have  prevented the
disaster.
  A painter contracts lead-poisoning in his work.  He is
treated and recovers at a hospital, but, knowing no other
trade, goes back into the same  occupation.  The doctor
may protest, but no one knows what to do about it.   The
man has repeated  attacks, and finally becomes invalided
or dies,  leaving  his family  dependent  upon  the  com-
munity.  Economy would have got the man into another
job at the  start, and prevented the waste and suffering
which characterized the  outcome. 
302   OUTLINES  OF  NURSING  HISTORY
  Two children  of a  family  of  ten  contracted scabies.
They were treated at a dispensary and cured, but mean-
while had infected other members of the family, so that
for a space of two years one or more out of the  ten were
patients,  at much expense of  time and money for them-
selves and the dispensary.  One  visit of a social worker
got at  the root of the trouble and the disease  was per-
manently stopped.
  An unmarried mother was allowed to leave the hospital
with her  baby, because in her ignorance  and desperation
she had said that she knew where to get work.  The work
was not  forthcoming,  and two days  later  her body and
that of her baby were recovered from the river.
  A coachman, having received an injury by which he lost
his leg, had no home and  no  funds.   He was anxious to
enter some business for which he was physically fit, but
because no one was at hand to plan for him, he became a
public dependent.
  A thousand cases might be cited, and every nurse knows
many more.  The problems  are not those that can  be
handled by an individual working alone, nor by  a family.
They are community problems, and must be met by neigh-
borhood and community resources.   The person  who is to
render effective help with  them must be one  who knows
human nature and who knows  where to go for the  means of
aid.
  Hospital social service workers state that some of the
chief problems are:
  The tuberculous patient.
  The convalescent patient.
  The chronic case.
  The syphilitic.
  The unmarried mother.
  The mentally unbalanced. 
HOSPITAL  SOCIAL   SERVICE       303
  The suicidal.
  The feeble-minded.
  The physically handicapped.
  Those who need material relief.
  Forerunners of the Present Movement.—Hospital social
service has always been  done to some extent, but as an
organized work it  is  comparatively new.  Four of its
predecessors may be mentioned.
  Visiting nurse work has always had some  connection
with hospital service, and has doubtless pointed the way
to our modern methods,  in working for  the  whole and
permanent recovery  of the sick person.
  The Society for the After-care of the Insane was founded
in England in 1880, and the idea has been followed out to
some extent  in this country.
  The lady almoner has been employed in English hospi-
tals.  She was not  unlike the social worker, in  that she
had a mind trained to her work and stood ready to use all
community resources that might be needed in the treat-
ment of any case.
  In 1902 some of the students of Johns Hopkins Medical
School organized for friendly visiting in connection with the
Charity Organization of  Baltimore,  thus recognizing the
social side of illness.
  Founding of the Work.—It was not until 1905, however,
that hospital social service was set in order and a begin-
ning made in establishing principles and standardizing its
work.  In that year Dr.  Richard Cabot, of Boston, seek-
ing  to improve dispensary practice in the Out-patient De-
partment of the Massachusetts General Hospital, intro-
duced into the medical treatment of patients the trained
social worker.  From his  work and from his writings have
grown an enthusiasm for an orderly, definite program in
the  consideration" of illness—a program which takes in the 
304   OUTLINES  OF  NURSING  HISTORY
whole life and environment of the patient, and which un-
dertakes to meet his problems by all the resources of the
family and the community.
  The work at the Massachusetts General was begun under
Dr. Cabot by Miss Garnet I. Pelton, a nurse.   She was
Fig. 70.—Miss Ida M. Cannon.
succeeded by Miss Ida  Cannon, also  a nurse, who has
become one of the authorities of the country on the sub-
ject.  Miss  Cannon  was  chosen by  the  Russell Sage
Foundation to write a book on "Hospital Social Service,"
a volume which almost any nurse will enjoy and find profit-
able. 
HOSPITAL  SOCIAL  SERVICE       305
  In 1906  the  work  was started at Bellevue Hospital,
New York, with the  help of Miss Wald, Miss Mary A.
Wadleigh, a nurse, being chief worker.
  Several hundred hospitals throughout the country have
taken up the idea, and the number is rapidly increasing.
In almost every community there were people who felt a
need of just this sort  of work, but who could not under-
take it until a program was prepared for  them, a formula
worked out, and a definite plan of work established.  It
is this  that Dr. Cabot has furnished.
  Training for  the Work.—The hospital  social service
worker requires special  training just as  much as does a
nurse or doctor.  One must be trained to  discover "the
psychic or social conditions  which may lie at the root of
the patient's trouble," and  must know the remedy and
how to apply it.  She must be able to recognize whether
the trouble is acute and temporary, and can be met by
some simple expedient, or whether it is chronic and must
be treated by  a radical change  in family, working, or
social conditions.
  "Many of the problems that come to the medico-social
worker are  human tangles, involving  numerous  other
elements besides  poverty;  fatigue, moral  danger,  alco-
holism, and  incurable  disease  are  some  of  the  evils
that attack  mankind  irrespective  of  economic  condi-
tion.!'1
  Just as an untrained woman,  with the kindest inten-
tions, may hinder  rather than help  a  sick person in his
recovery, so  a  person unfamiliar with the psychic and
economic aspects of disease  may  do quite as  much  harm
as good in a well-meant attempt  to put an ex-patient on
his feet again.  Special  training is demanded in hospital
social service quite as much as in hospital nursing.
        1 "Hospital Social Service," by Ida M. Cannon.
       20 
306   OUTLINES  OF  NURSING  HISTORY
   Nurses as Social Workers.-—It is still an unsettled ques-
tion as to whether nurses make the best workers of this
kind,  since they  have  much to unlearn.  The nurse's
ordinary  work tends to make her insist, tacitly perhaps,
that  the  patient  be  dependent  upon  her.  The social
worker's task is the opposite—to enable,  and sometimes
to urge, the patient to stand upon  his own feet.   The
methods used in the two sorts of work are as different as
are the viewpoints.
   A few  hospitals with well-organized social service de-
partments have been able to give their nurses a short term
of service in the work; the experience has awakened in the
nurse an interest in and a consciousness of the individual
patient and his problems as  hardly anything else could
have  done.  In other  hospitals  where social workers are
employed they have many opportunities for putting the
nurses  into possession of facts concerning the patient
that will make the work of nursing him mean vastly more
than  a routine of  physical  care.   In either  case the
nurse's life and  usefulness will be broadened  and her
eyes opened to the possibilities of social work.
   Each year an increasing number of  nurses take up the
training for  this work.  The Boston  School  for  Social
Workers and the New York School of Philanthropy give
special courses in it.
  The Newness of the Work.—After ten years the leaders
in hospital social service still consider the work to be in a
formative stage, and are uncertain along what lines its
best development will be.  There are at the  present time
many types of the work being done, and many interpreta-
tions  of its meaning are  being  given to the world.  The
whole movement  is just finding itself. 
HOUSEHOLD   NURSING
307
                HOUSEHOLD NURSING
  Doubtless one of the greatest problems of the time is
that of  providing  proper nursing  for  the middle-class
patient.   The graduate  nurse and  the private hospital
have  supplied  the  need  of  the well-to-do  patient; the
visiting nurse has taken  care of the poor patient.  Be-
tween them lies the largest class of all,  for whom no ade-
quate arrangement exists.  The fact, only  recently dis-
covered, that despite the great increase in hospital capacity
(even to  the accusation  of  "over-hospitalization"), at
least 80 per cent, of all sick people are still cared for in
their own homes, adds very materially to the  weight of
the problem.
  Doctors have constantly demanded that the trained
nurse do something about this problem, and she has been
given many a scheme for its solution; but since, in nearly
all of these, the  burden fell upon the individual nurse, no
progress of any  account has been made.
  The  Household  Nursing Movement,  initiated by Mr.
Richards Bradley, of Boston, bids fair to put us far on our
way toward providing proper  care  in  sickness for the
middle-class, independent  citizen.  Mr. Bradley tells us
of its principles  and practice:1
  "The modern nurse, shortly  after she began to train,
became as a nurse the product  or, unfortunately, the by-
product of the hospital; her weak point, due partly to this
one-sided training, has been her one-dimension view of the
problems  that a family has to  meet in case of sickness.
She has, doubtless because of her training, very consist-
ently ignored the household and family side of the patient's
problem.  She has too often failed to see that the meeting
of that  phase of the  problem is a necessary part  of the
handling of the  case,  and that this often cannot be done
     1 This account was prepared especially for this volume. 
308   OUTLINES  OF  NURSING  HISTORY
in a small household by the entire separation of the func-
tions of household work and nursing.  . .  .
              Fig. 71.—Mr. Richards Bradley.

  "Should the West Point graduate propound the theory
that non-commissioned  officers  and  privates  were  no
longer necessary to the conduct of a campaign, it would 
HOUSEHOLD  NURSING          309
hardly be more extraordinary than are some of the ideas
that have prevailed  in  regard  to  the graduate  nurse.
She can be the keystone of the arch if she will realize her
relation to the other parts, but she can never be until she
does.   The theoretic  difficulties vanish,  as they always
do  in  practice, when good women  get  together in the
service of the  sick and helpless.  . .  .
  "The non-graduate nurse is the product of the human
home,  evolved by its human needs.  She is still doing 80
per cent, or more of the nursing work of the country, and
is doing a great deal of it well.   In fact, she is still filling
some of the vital needs of the home in sickness, needs that
have hardly been touched and are too often ignored by
her more highly trained  sisters.   In  spite of her gains  in
skill and efficiency with  the individual patient, and  in
spite of her splendid accomplishments in organized public
and educational nursing, the graduate nurse has not yet
found a fitting place when the stress of sickness comes  to
the average independent family.
  "Maternity nursing,  since it  is less of  an  emergency
than other illnesses, is an excellent criterion by which  to
judge of efficiency.  A recent canvass,  covering about ten
thousand people in  Dutchess County, New York, embrac-
ing three farming townships and a city ward, showed that
out of one hundred and thirteen cases of childbirth only
one case had continuous care from a graduate nurse, and
only eighteen  any service whatever from graduates, while
fifty-six  had  practical  nurses.  This  district  is neither
remote, poor, nor unenlightened, and is doubtless a typical
one.
  "These  conditions have been  made the  subject  of
especial  study by the managers of  a  foundation known
as the Thomas Thompson Trust.  One of its chief fields
of operation is in Brattleboro, Vermont, a factory town of 
310   OUTLINES  OF   NURSING  HISTORY
about eight thousand, the center of a farming  district.
The locality contains few wealthy people, but there are
few not financially independent.
  "To meet the needs of this community in sickness the
trustees of the fund helped in establishing a hospital and
the work of a visiting nurse.  They were surprised to find
that, in spite of the obvious benefits from these institu-
tions, a large part of the stress and difficulty from sickness
still continued.  They sought a remedy.
  "There followed a long course of study and experiment
by an organization known as the Mutual Aid Association,
formed to find out and meet the actual unfilled needs in the
homes of the people during sickness.  It resulted in a diag-
nosis of the trouble and in the working out of a remedy
which has since been applied in more than one  place.
The system developed appears to be meeting the situation
there and elsewhere, and to  be  opening up a wider field
of usefulness for the trained nurse.
  "In this work has been applied the underlying principle,
recently  developed in  hospital social  service,  that the
patient is not  a one-dimension proposition, to be consid-
ered and treated with reference to his disease alone, but is
a human  problem  all of whose surroundings and circum-
stances must be considered and dealt with if satisfactory
results are to be  achieved.  When sickness comes, the
disorganization of  the family machine in addition to the
care of the patient  constitutes a pressing problem, and the
meeting of this household problem is often just as impor-
tant a part of the proper treatment and care of the patient
as are medicine or  correct methods of nursing.
  "This fact has always been recognized and acted upon
by  the old-fashioned  practical nurse, and has too  often
been  ignored by the  graduate whose training has been
incidental to hospital  management.  The result is, that 
HOUSEHOLD  NURSING
311
in spite of her deficiencies, [the practical nurse has for years
held her own in the homes of the people and has done the bulk
of the nursing work of the country].1
   "The Brattleboro organization began its work by seek-
ing out all cases whose needs were not met by the hospital,
the visiting nurse, or the graduate, and by finding out and
using all forms of service that could meet the  family
exigencies incident to sickness.   It found the most diffi-
cult nursing problems often interwoven with these other
problems.
   "Under Miss Charlotte Macleod, a system was evolved
as part of which a body of household nurses or attendants
work [under the instruction and supervision of a graduate
nurse], with the backing and assistance of a central office.
The graduate  attends  personally  to  matters in  which
special skill and training is needed, while the non-graduate
is in continuous attendance,  helping to carry the family
along and performing other duties in connection with the
patient.
   "The working of this system as developed shows to par-
ticularly good advantage in  maternity work.   The pre-
natal watching of the patient by frequent visits, advice,
encouragement, and care is done by the graduate maternity
nurse under the doctor.  The patient is thus brought up to
the time of labor in the best condition, being guarded so far
as possible from overwork,  helped as to diet, and watched
so that unfavorable  symptoms may  be  discovered and
given prompt treatment.
   "During labor the patient has the care and attendance
of the graduate, being assured the best skill and experience
at her most critical time.
   "After the  delivery  the  graduate  returns  to  head-
quarters, leaving  her  assistant—the  undergraduate  or
                  1 The italics are ours. 
312   OUTLINES  OF  NURSING   HISTORY
non-graduate—to look after mother and child and to see
that the family machine is kept running smoothly, meals
got, children cared for, etc.
  "The case is carried on by visits from the graduate and
continuous  service by the assistant.   The  net  result  is
that more  complete and better service is given at less
expense than such cases are usually put to.
  "It will be observed  that this  is merely applying to
nursing the old principle  of co-ordination of labor, using
different kinds of workers in co-operation, a method that
has been used in other branches of human enterprise from
time immemorial.
  "This  co-operation in nursing was inevitable.  It did
not come sooner  because  the  scientifically  trained nurse
was a new thing in the world.   She had to  fight her way
into recognition and use in competition with the practical
nurse, who  until lately held the entire  field.  Under the
circumstances, both graduate and non-graduate  have had
a much keener appreciation of the other's failings than of
her strong  points.  They have even  yet  to learn that
each has need of the other if full and satisfactory service
is to be given to the sick and helpless in the homes of the
great body  of the people.
  "It has been gratifying  to find that where this relation
of co-operation has been established by broad-minded and
able  graduates  and  conscientious  and  devoted  non-
graduates, [the results have been satisfactory to both, and have
been recognized by the people as meeting their needs].1
  "This system has been applied in large places as well as
small,2 to both manufacturing and agricultural populations,

  1 The italics are  ours.
  2 Household Nursing Associations are at work in Boston, Mass.;
Detroit, Mich.; Rhinebeck, N. Y.; and Norwood, Mass., as well  as
in Brattleboro, Vt., the original field. 
HOUSEHOLD  NURSING          313
 to foreigners as well as natives.  It has been found ser-
 viceable where the primary principle has been followed of
 studying the needs of the individual home and of adapting
 the  service to the home, not trying  to adapt the home to
 the  service.  It has succeeded in giving to  people at a
 price which they  could afford to pay  the service they
 wanted, instead of offering them for a price beyond their
 means a service which  they did not want.
   "In some places it is evident that the chief need is for
 visiting graduate service, using and instructing members
 of the family.  In others, there is a much larger demand for
 the non-graduate assistant.  In cities where various forms
 of nursing service  are well  established and highly devel-
 oped, it has been found advisable to make this  combined
 graduate and  non-graduate work a  special  enterprise by
 itself.   In  smaller  places, the best form has  been found
 to be a health center where the school nurse,  the  visiting
 nurse, and the supervising nurse with her assistants can
 do team work under one able head, each  department help-
 ing the other  with both work  and information.  In  this
 way the ground can be thoroughly  covered by  localities,
 a method that may eventually be found desirable in larger
 places to  prevent duplication of visits and  waste of
 energy.
  "This work is not a charity.   Hitherto organized nurs-
 ing service  has been prevented from extending its field
 among  people at  large  by its too  intimate  association
 with charity.  This has been due to circumstances,  but
 outside the  large centers of population there is no reason
 for continuing a connection with dependence that repels
 the independent classes.
  "The  main hope for obtaining  good service in sick-
ness  for the whole  people lies in the better organization
and  training of  all the available forces, and in  dealing 
314    OUTLINES  OF  NURSING  HISTORY
with  the people  at  large on  a sound basis of business
equality."1
  Miss  Frances  Stone,  graduate  of  the  Presbyterian
Hospital  of New York,  is working with  Mr. Bradley to
spread  the Household  Nursing idea, and a number of
cities and towns  are on  the verge of adopting  it.2   Miss
Charlotte Aikens, of Detroit, has done much to promote
the movement.  Miss Anna Louise Davis, of Brattleboro,
Vermont, has  done a work in organizing a health center
that serves as  a model for future associations.

           SUMMARY OF IMPORTANT POINTS
  In  the present  "century  of  social  consciousness"
nurses in considerable numbers  are  finding their  larger
place in the life of the world.   They are intimately con-
cerned in some of the great  health movements.
  Public health nursing  is a new term which includes all
forms of  visiting nursing,  tuberculosis  nursing, infant
welfare and milk  station work, school nursing, etc.

  1 Mr. Bradley  speaks further of the need of sick insurance:  "The
expenses of sickness  are becoming recognized as one of that class of
expenses for which  some  system of  insurance  is required by all
except the very rich and the frankly independent.  Such expenses
fall at irregular intervals and at  times strike with crushing weight.
The great body  of  self-supporting people  cannot  meet them by
resorting to charity nor by depending on a  few stray bequests, nor
can they  always be met from current income any  more than can
fire, death, or accident.
  "Sick insurance has proved successful in more than one country,
and its extension in  America would not only increase the ability of
people to  obtain and pay for the services and supervision  of a
graduate nurse, but would greatly extend the field of organized nurs-
ing."
  2 The Bureau for  Organizing the Home Care of the Sick has its
office at 60 State St., Boston. 
SUMMARY  OF  IMPORTANT   POINTS  315
  The National Organization for Public Health Nursing
was formed in 1912.   Its aim is to include all nurses who
are working for community health.
  The National  Public  Health  Association,  which  in-
cludes many prominent  physicians, announces a broad
and progressive program, in which one of the most im-
portant factors is the trained nurse.  Their plans include
much teaching and less of actual bedside care of patients.
  Hospital social service is a new term which includes
social work done with a  view  to  establishing health.  It
emphasizes the fact,  long overlooked, that a patient can-
not be  successfully treated unless  environment,  family,
and working  conditions are taken into  consideration.  It
finds special problems in the tuberculous, the convalescent,
the chronic,  the syphilitic, the  unmarried  mother, the
mentally unbalanced, the  feeble  minded, the physically
handicapped, and the poverty stricken.
  Four agencies preceded  and were  prophecies of the
present movement: Visiting nurses, the Society for the
After-care of the Insane, the lady almoner, and friendly
visiting done by medical students.
  Hospital social service work, as  such, was founded in
1905 by Dr. Richard Cabot, of Boston.   It was the result
of his attempt to improve out-patient work.  He has been
the leader of the movement throughout the country.
  Miss Ida M. Cannon,  who works with Dr. Cabot, is a
nurse who has become an authority on the subject.
  Bellevue Hospital, New York, was the second to organ-
ize a  social service department.  Several hundred hospi-
tals have followed suit, and the movement is very popular.
  The work  requires special training,  and  at least two
schools of social work are giving courses in it.   Nurses,
if of the right  temperament and  the proper training,  are
adapted to this work, and  some of them are entering it. 
316   OUTLINES   OF  NURSING  HISTORY
  The  Household Nursing movement attempts  to  solve
the problem of the care of the patient of middle class, and
to provide proper nursing for the 80 per cent, of our popu-
lation that does not go to hospitals and that is cared for in
sickness by the practical nurse.
  The  movement is the outgrowth of a special study of
such problems made by the Thomas Thompson  Trust, a
foundation which began its work in Brattleboro, Vermont,
where it has made a number of years' experiment.
  This movement aims to establish health centers wherein
all labor needed in  time of sickness  may  co-ordinate its
work, and by rational  co-operation, under proper super-
vision, may give  the middle-class citizen a good  nursing
service at a comparatively low rate.
  The  scheme has been successfully tried out in small and
large towns, and has proved an entire success.
  It provides a wider field for the trained nurse, and puts
her into proper and  cordial relation with the untrained or
practical nurse.
  It is a system whereby the non-graduate and graduate
work  together  in the  homes  of the middle class,  each
giving  the service for which she is best fitted. 
CHAPTER XIX
  NURSING IN THE RECENT  EUROPEAN  WAR

  No adequate nor complete account can here be given
of nursing in the present great war.  So many organiza-
tions and individuals are caring for the sick and wounded
that it is a question whether the whole story will ever be
known.
  The Personnel.—Each government involved  in  the
struggle is providing nurses through its accustomed and
emergency channels.   The  Red Cross  Society of each
country is doing its utmost.  These agencies, especially at
first, proved insufficient for such unheard-of numbers of
wounded,1 and individuals offered help, each choosing his
own field of  work.  Some  confusion has  resulted from
these methods, but  better organization  and  more  co-
operation is bringing about a better order.  Almost  the
whole world has shown itself ready to help.  Huge funds,
running into millions, have been collected, and thousands
of women have, in every land, month after month, made
up  surgical dressings,  bandages,  hospital  clothing, etc.,
sending them through  the Red Cross or other agencies.
  Hospital Accommodations.—Every hospital, large  or
small, which  already existed near  enough to the battle
lines to be of service,  has been pressed  into service  for
wounded soldiers, and  many have  refused to take other
cases, letting sick citizens get on as best they  may.  In

  1 It is estimated that during the first year of the war about  five
million men were wounded, besides the two million who were killed
outright.   There were probably  over a  million  prisoners, some of
whom also needed nursing.
                                            317 
318   OUTLINES  OF  NURSING   HISTORY
France almost  all the hotels  and  convents (about four
thousand) have been taken for  hospitals.1   In England
palaces and public buildings of  various sorts  have been
taken for hospitals, and everywhere chateaus and country
houses have  been offered for the  use of the  wounded.
Thousands of tent and field hospitals are used  in the first
aid or immediate care of wounded  men.
   England has fitted  out several large hospital barges.
The Princess Christian and others have equipped hospital
trains, which may be used either  as stationary hospitals or
for transporting the injured.  At  the beginning of the war
Germany had ten fine hospital trains, and now  has thirty-
eight.  Russia  has  even finer  ones.
   Procedure.—The wounded are given first aid treatment
on the field by  surgeons, nurses, or orderlies, and are re-
moved by stretchers to field hospitals,  which are usually
behind some hill or other protection near the firing line.2
The seriously injured  are transferred  by ambulance  or
train to  hospitals farther away,  or to the base hospitals
which are situated well out of the zone of combat,  often
many miles away.3  These transfers, though  absolutely
   1 The American Hospital of Paris had in the summer of 1914 a
capacity of about  forty beds.   As soon as the war began the num-
ber was immediately increased to two hundred,  the city gave the
use of a large school building, and the  institution grew  still further,
as its funds would  permit.  Its work for the wounded has been done
under the name of the American Ambulance Association.  Distin-
guished American  surgeons have given services here, expert dental
surgeons, and many American nurses. The hospital  has become
famous for the superior quality of its work.
   2 Many of those who are but slightly wounded return to the firing
line direct from these hospitals.
   3 Germany, in handling the wounded, uses a system of colored
tags whereby the  slightly and seriously wounded may  be distin-
guished at a glance, and upon which the  examining surgeon may make
notes. 
NURSING  IN  RECENT  EUROPEAN   WAR 319
necessary, result in a certain amount of neglect en route,
the trains of wounded being frequently side-tracked to let
those of fresh troops go through.  The treatment being 
320   OUTLINES  OF  NURSING  HISTORY
given in two or more hospitals prevents doctors and nurses
from knowing the program tnat their predecessors have 
NURSING  IN  RECENT  EUROPEAN  WAR  321
carried out.  These things are, however, inevitable in the
handling of such enormous numbers of wounded.
  Untrained Nursing.—A good deal of chaos existed, and
many unfortunate occurrences took place during the first
months of the war from the fact that a flood of untrained
women from every rank  in  life, adventuresses and reli-
gieuses, servants and countesses, were allowed to render
important nursing service  in the hastily improvised hos-
pitals.  A nurse writes of it:  "Imagine a huge salle with
Fig. 74.—Training-school at the Protestant Hospital of Bordeaux.
very little light and air, unswept, beds dirty, patients look-
ing neglected, and about two hundred ladies, untrained,
doing dressings  of the most serious kind.   There were a
few religious sisters who were  very good, but with five
hundred patients they could do little.  At  my first visit it
reminded me of opera bouffe.  Ladies dressed in the height
of fashion,  some with slit skirts, silk stockings, high heels,
diamonds and pearls on necks, wrists, and fingers, wearing
gowns and Red  Cross  caps!  Poor  w7ounded soldiers!
       21 
322   OUTLINES  OF  NURSING  HISTORY
They very soon showed their preference for the trained
nurses." 
NURSING  IN  RECENT  EUROPEAN   WAR 323
  Many of these untrained women have done noble work
when there was no one else  at  hand, and have helped
materially in the organized hospitals when they were will-
ing to do the simpler services to  which they were suited;
but in some cases, where they have insisted upon taking
the duties  of a trained  woman,  their help  has  been of
questionable value.
Fig. 76.—Japanese Red Cross Nurses.  From left to right, Sister
   Kasai, Sister Kiyooka, and Sister Yamamoto.  (Chandler.)

  The Trained Nurses.—Every country concerned in the
war  has a goodly  number of  its trained  women in the
service,  and  many  have  gone from  neutral  countries.
Germany has women serving from the regular hospitals,
the  nurses'  associations,  and  the  Red  Cross  schools.
"Nurse  helpers who have had only theoretic training are 
324   OUTLINES  OF   NURSING  HISTORY
kept strictly to housekeeping or waiting on the sisters.
No voluntary nurses, whether trained or not, are allowed
at the front."   England has hundreds of trained women at
work.1  Canada has sent several groups to England or to
the Continent (about three hundred during the first year).
Australia  and New Zealand  have sent  full quotas, Miss
Maclean, Assistant Inspector of Hospitals, going out with
fifty.   Japan has sent two contingents to France, among
them being nurses who served in the wars with Russia and
China.
  The American Red Cross.—During a  little more than a
year,  up to October  1,  1915,  the  American Red  Cross
spent a fund amounting to $1,560,000, sending shiploads of
supplies and many nurses into the war,  distributing them
impartially to the various countries.  The list is as follows
(a "unit" consisting of three doctors and  twelve or thirteen
nurses):
  Sept. 8, 1914—One unit to Servia.
  Sept. 13, 1914—Two units  to Pau, France.
                 Two units  to Paignton, England.
                 Two units  to Kief, Russia.
                 One unit to Budapesth, Austria.
                 One unit to Vienna, Austria.
                 One unit to Gleiwitz,  Germany.
                 One unit to Cosel, Germany.
  Nov. 20, 1914—Two units to Servia (six nurses in each).
  Feb. 19, 1915 —One  unit  to  Yvetot,  France  (nine
                   nurses).
  Apr. 17, 1915 —Two units  to Belgium.
  On July 31, 1915 two medical directors and two nurses
were sent to Nish,  Serbia,  to establish a hospital  for
children.
  1 Enghsh  volunteer nurses are now required to take  a course in
First Aid. 
NURSING  IN  RECENT  EUROPEAN  WAR  325
  When the first groups sailed, a General Superintendent
of Red Cross Nurses was appointed, Miss Helen S. Hay,
of the Illinois  Training-School, Chicago, being selected.
Miss Mary E. Gladwin, of Ohio, was made Supervisor for
the first Servian unit, and Miss Mathild Krueger, of Wis-
consin, of a later Servian unit.  Miss Donna Burgar, of
Massachusetts, was in charge of a German unit.  Irene K.
Sumner worked in Antwerp during the bombardment.
  In addition to the units named above, seventy  nurses
have been sent out to relieve those  whose terms had ex-
pired and who wished to return.  Most of the nurses went
for six months' service, but their actual term has aver-
aged nine or ten  months.1
  It is said that "no Red Cross Society of a neutral  nation
ever before rendered  so long and  extensive service to
nations engaged in war."  The American  society  has,
since October  1,  1915, withdrawn most of its nurses.2
  Other American War Nurses.—Several medical colleges
in the United  States—Harvard, University of Chicago,
and others—have sent  large groups  of nurses along with
their  doctors.  Many  American nurses  have gone  out
under  private  funds, and a  few at their own  expense.
Great care  has been taken to see  that  all nurses were
physically fit for  hard  service.  Antityphoid vaccination
has usually been  insisted upon.  Women who speak some
European language have been given the preference.
  Nurses' Experiences.—As a rule, few women nurses have
been allowed at the battle front, but a certain number have

  1 The above information was furnished by Miss Jane C.  Delano,
Chairman of the Red Cross Nursing Service.
  2 The chief argument against the continuance of the  work was
that nations who were able to spend millions upon  keeping up the
war were able to provide care for the wounded resulting  from that
war. 
326    OUTLINES  OF  NURSING  HISTORY

worked under fire  and  have had thrilling experiences.
Sister Rosa Yecht, of Holland, and Sister Mary Magill, of
England, died of wounds received while on the firing line.1
Miss Violetta Thurstan, of England, who served in Belgium
and in Russia, has written a book entitled "Field Hospital
and Flying Column" concerning it.   In a letter  written
Fig. 77.—Miss Rosa Vecht.  (Courtesy of "The Trained Nurse and
       Hospital Review.")  ("Nursing Times," London.)

from Poland during the winter she said, "We have had to
get sheepskins, it is so very cold here.   Our ears must be
covered or they would be frost-bitten; the Russian Sisters
wear a black serge square, folded like army caps, but cover-
ing the ears and pinning under the chin. ... I have been
  1 Seventeen Russian Red Cross nurses have been killed on the
battlefield or died of wounds received there. 
NURSING  IN  RECENT  EUROPEAN  WAR  327
unlucky, first wounded in the leg with shrapnel, now in
bed  with pleurisy.  We  were out all night with  some
wounded and it was very cold, so I suppose I got chilled.
My party had to  leave me here, and I am being looked
after by an old woman of eighty-four, who is stone deaf."1
Fig. 78.—Miss Mary Magill.  (Courtesy of "The Trained Nurse
          and Hospital Review.")   ("Daily Mirror.")

  Servia doubtless presented the most appalling condition
of affairs.   Early in 1915 typhus became epidemic  and
spread  with such  frightful  rapidity that  before other
countries  could come  to its aid  a considerable portion
of the country was "one vast charnel house, with doctors,
nurses, and the wounded in  the grip of  typhus, the true
war disease.  Men lie in the roads dying  from it. Women
         1 Quoted from the "Nursing Times," London. 
328   OUTLINES  OF   NURSING  HISTORY
and children die from it in the darkness and squalor of their
own homes, unseen and untended.   There is no escape for
either  rich or poor, and no  immediate  and  effective
remedy."1  A doctor's estimate places the whole number
of cases at from 300,000 to 500,000.
Fig. 79.—Miss Edith Cavell, British Army nurse executed by the
    Germans. (Copyright by Internationa] Film Service, Inc.)

  A nurse, working under the Red Cross in Servia, writes:
"One hospital  with 1400 cases, with two nurses and two
doctors. . .  . The Greek hospital, with four doctors for
four hundred  patients and not a  single trained  nurse.
Now I am on  day duty and my friend is on night duty.
I have a German orderly and a Russian  who speaks bad
                1 From the "London Times." 
NURSING  IN  RECENT  EUROPEAN  WAR 329
German.  There is a Greek doctor who, luckily, speaks
French.  What  with  trying  to translate  the  doctor's
orders, the Centigrade thermometers, and their measures
for  medicines,  you  can  imagine  my  difficulties. .  .  .
The only way infection spreads is through lice,  and then
it has to be one that has bitten a typhus patient, so if one
Fig. 80.—Russian medal of St. George presented to Miss Violetta
                       Thurstan.

could be sufficiently careful there is no reason for catching
the disease; but with such a crowd of dirty patients it is
hard to prevent insects from getting to other people."1
  In Valjevo, Servia, a nurse reports: "There was not
even straw for the wounded to lie  on, as everything had
been burned and  destroyed by the invading army. .  .  .
                1  From the "London Post." 
330   OUTLINES  OF  NURSING  HISTORY
The hospitals are full of typhus cases, without attendance
or medical help, for many doctors have fallen- victims to
typhus. .  .  . The x-ray room was full of corpses, and the
dying were carried there and left. .  . . The air is tainted
with the  odor of death, corpses lying unburied  in  the
      Fig. 81.—Polish nurses in winter.  ("Daily Mirror.")

streets.  Under such conditions an epidemic was certain,
as the wretched prisoners were literally  swarming  with
vermin."1  Many  nurses  and  doctors  from  Holland
worked here.
       1 From "Nosokomos," the Dutch nursing journal. 
NURSING   IN  RECENT  EUROPEAN  WAR  331
  Mrs. Hankin  Hardy, a woman with a partial nurse's
training,  and  Dr.  Yakschitch,  a Servian  woman,  had
charge of the prison nursing at Kragujevatz.   They found
"a  condition of  unspeakable filth  and overcrowding."
There were six hundred patients at the prison, and no one
to care for them except themselves, with the help of some
of the prisoners.  "She has no nurses.  Her supplies  are
short; disinfectants, blankets, sheets, food  are wanting
Fig. 82.—Mrs. Hankin Hardy.
every day.  Yet she is holding on, taking care of all she
can, turning  away scores who  have nowhere  else to go.
Her own bedroom is a prison cell."1
  Miss  Allender, an English nurse, writes  from Nish:
"The state of the hospitals is beyond description.  Hos-
pital appointments are nil—the bedding is too terrible for
words; straw mattresses, a filthy uncovered pillow, and
one dirty blanket is the outfit for each bed.   I am the
only  trained  nurse  for nine  hundred  patients. ...  I
           i From the "Nursing Times," London. 
332   OUTLINES  OF  NURSING  HISTORY
would  give my soul for bed  linen, sheets,  shirts,  and
pajamas."1
  In less than six months' time, due chiefly to the efforts
of American doctors and the American Red Cross, these
conditions  were relieved, sanitation established,  and the
epidemic checked.
  Methods.—The nursing in this war has presented many
features unfamiliar  to the modern nurse.  The big prob-
Fig. 83.—A ward in the Kragujevatz Prison, Serbia.
lem of parasites (pediculi of all sorts, mange, and scabies)
has required the best technic to handle.  The utterly new
methods of warfare and novel  conditions under which the
war has been carried on  have  presented  situations which
had to be met by new methods.  Aerial warfare, with the
use of bombs and steel arrows; attacking the enemy with
poisonous  gases;  the preponderance of artillery fighting,
            1 From the "Nursing Times," London. 
NURSING  IN  RECENT  EUROPEAN  WAR  333
and the fact that so many soldiers are stationed in trenches,
make new varieties of wounds and disease.
  Wounds  of the head are very common, some of them
terribly disfiguring, so that much dental surgery is re-
quired.   The dirt of the trenches is driven into the wounds
at the time they occur, so that practically every wound is
an infected one.   For a long time tetanus was common,
but  antitetanic serum and  antiseptic  (as  opposed  to
Fig. 84.—In the American Hospital at Nish, Serbia.  (Newspaper
                     illustrations.)
aseptic)  methods  have improved  matters.   Amputa-
tions have been common because of the many cases of
gangrene.
  Miss Underwood, an English nurse, gives a picture of the
work in  France: "The  men  had to be  undressed,  their
clothes generally cut off; they had on two or more coats,
all caked with mud; they must be cleansed as best they
might, and many of them operated on at once. . . .  The
operations are  most  extraordinary,  no  preparation, no 
334   OUTLINES  OF   NURSING  HISTORY
dose, no anything that the surgical nurse is accustomed
to—there is no time for them.  The wounded arrive, are
operated on, put to bed, and sleep the heavy sleep of ex-
haustion; when they awake refreshed, they are all given
full diets, except the abdominal  cases. .  . .  There were
many terrible cases of tetanus, but after a while these de-
Fig. 85.—English  nurses and Hindoo soldier-patient.  (Central
                        News.)

creased. .  .  . The wounds of those who come to us from
the front beggar description.  I had to set my teeth at
first, but one gets accustomed to it.   The smell is terrible,
many of the wounds being hopelessly gangrenous by the
time they arrive.  This evil grew less as we began to get
men directly from the firing line,  but even then many of
them were  very bad  from the fact  that the  shells were 
NURSING  IN  RECENT  EUROPEAN  WAR  335
poisonous and set up the terrible "gas gangrene" within a
few hours.   In these  cases the fluid blood, serum, etc.,
bubbles in the  wound, smells badly, and is frightfully in-
fectious."1
  Value  of Trained Women.—There has  never  been a
time in the  world's history when the value  of  nurses'
training has been so evident.  We can hardly judge what
     Fig. 86.—Russian nurse and Siberian soldier-patient.

has been the relief of both doctors and patients when a
trained woman has come to them, reduced chaos to order,
done the efficient thing and done it quickly, and cheered
by her very presence and  manner a dreary and hopeless
situation.
  "Self-sacrifice" is a term not in the war nurse's vocabu-
lary; she is merely doing what she likes to do, relieving suf-
1 Quoted from "Nursing Notes." 
336   OUTLINES  OF  NURSING  HISTORY
fering.  She calls it "great luck" to be sent into the worst
places and into the  most desperate  conditions.   Many
nurses have already given up their lives in this most terrible
of all wars.  Many more will never recover from the strain
of their overwork.  But the life and the health has been
gladly given, and the nurse, no less than the man at the
battle front, has been found a good soldier. 
CHAPTER XX
     NURSING ORGANIZATIONS.  NURSING
                    MAGAZINES

  Trained nurses  are now organized in almost every
civilized country except in South America.  In the United
States, Canada, Australia, and South Africa there are also
State Associations.
  Magazines devoted to the interests of nursing have been
established in  most countries which  have nursing asso-
ciations.   In a few instances the magazines  preceded the
organization,  but in most  they were practically  simul-
taneous.
                  ORGANIZATIONS
  The  International Council of  Nurses was organized in
1900.   It includes nurses from more than twenty countries,
and more  are coming in each year.   In 1912  the list in-
cluded England, Scotland, Ireland, United States, Canada,
Germany, France,  Belgium, Switzerland, Holland, Den-
mark, Norway, Sweden, Finland, Russia, Austria, Italy,
South Africa, Australia, New Zealand, Japan, India, and
Turkey.
  The  president of the Council  is Mrs. Bedford Fenwick,
of London, and the secretary is Miss  Lavinia L.  Dock, of
New York City.
  The headquarters are 431 Oxford St., London, England.

                   UNITED STATES
  The  American  Nurses'  Association was  organized in
1896, under the name of the Nurses' Associated Alumnce 
338   OUTLINES   OF  NURSING  HISTORY
of  the  United  States   and  Canada.   The name  was
changed in  1912.  Canada  formed her own association
in 1908.
   The National League of Nursing Education was organ-
ized in  1893 under the name of the American  Society of
Superintendents  of  Training-schools.   The  name  was
changed in  1911.1
   The National Organization for  Public Health Nursing
was organized  in  1912.  It includes  visiting or  district
nurses and all engaged  in public nursing work.   Its head-
quarters are in New York City.
   The National Committee on Red Cross Nursing Service
was organized  in  1909.  Its headquarters are  with the
American Red  Cross, in Washington, D.  C.  The  same
committee also maintains a rural department, called the
Town and Country Nursing Service.
   The Army Nurse Corps  was  organized in 1901.   Its
headquarters are  at  the War Department,  Washington,
D. C.
   The Navy Nurse  Corps  was organized in 1908.  Its
headquarters are at the Navy Department,  Washington,
D. C.
   The Spanish-American War Nurses organized in 1899,
with 359 members.  The present  number is about 430.
The maximum  has been 616.
   The National Association  of Colored Nurses was organ-
ized about  1908.  The first president was  Miss M.  A.
Franklin, of Hartford,  Conn.  It  has  a membership of
about 150.
   The Guild of  St. Barnabas for Nurses was organized in
1886, as  an  outgrowth  of the English society of the  same
name, by Rev.  Father  Osborne, of Boston.  It  is a relig-
  1 Many members belong also to the American  Hospital Associa-
tion, formed in 1898, and including both men and women. 
UNITED  STATES
339
ious society with social features.   It  has about 2000
members.
   The Guild of St. Radegonde was organized in  1908 in
Boston.   It  is  similar  in purpose  and  methods to  the
Guild of St. Barnabas, but  is for Roman Catholics.   It
has four branches.
  State Associations of nurses exist in all but four states—
Arizona, New Mexico, Nevada, and South Dakota.
  New  York was the first state  to  form an association,
but Virginia and Illinois organized the same year,  1901.
North  Carolina  and  New  Jersey  organized  in  1902;
Maryland, California, Indiana, Pennsylvania,  Washing-
ton, and the District of Columbia in 1903.  The follow-
ing list  gives the  dates of organization:
Alabama................1913
Arkansas................1912
California...............1903
Colorado................1904
Connecticut..............1904
Delaware................1909
District of Columbia.....1903
Florida..................1912
Georgia.................1907
Idaho...................1911
Illinois..................1901
Indiana.................1903
Iowa....................1904
Kansas..................1912
Kentucky...............1906
Louisiana................1904
Maine...................1913
Maryland...............1903
Massachusetts...........1904
Michigan................1904
Minnesota..............1905
Mississippi...............1911
Montana................1912
Nebraska................1905
New Hampshire...........1906
New Jersey..............1902
New York...............1901
North Carolina...........1902
North Dakota............1912
Ohio....................1904
Oklahoma................1908
Oregon...................1911
Pennsylvania.............1903
Rhode Island.............1905
South Carolina...........1907
Tennessee................1905
  (Beorganized)..........1915
Texas...................1906
Utah....................1914
Vermont.................1914
Virginia.................1901
Washington..............1903
West Virginia.............1905
Wisconsin................
Wyoming................1908 
340   OUTLINES  OF  NURSING  HISTORY
                       ENGLAND
   The Matrons' Council of Great Britain and Ireland was
organized in 1894 by Miss Isla Stewart.  Its headquarters
are at 431 Oxford Street, London.
   The British Nurses' Association was organized in 1887
by Mrs. Bedford Fenwick.
   The National Council of Nurses for Great Britain and
Ireland, a union of alumnae societies, was formed in 1908.
  Queen Victoria's Jubilee  Institute, for visiting  nurse
work, was organized in 1887.
   The Central Midwives' Institute was organized in 1881.
   The Colonial  Nursing Association has  a  few hundred
members in all parts of the world.
   Canada.— The Canadian Society of Superintendents oj
Training-Schools for Nurses was organized in 1907.1
   The Canadian National Association for  Trained Nurses
was  organized in  1908.
   The Canadian Nurses' Association.
  Queen Alexandra's  Imperial Military  Nursing Service.
   Nursing  Branch  of the  Canadian  Permanent  Army
Medical Service.
   The Victorian Order of Nurses, for visiting nursing, was
organized in 1897.  Miss Charlotte Macleod did long and
excellent service as its superintendent.   Miss Mary Ard
Mackenzie, of Ottawa, is now the superintendent.
   Lady Grey's Country District Nursing Scheme, for rural
nursing, was organized in 1909.
   The Canadian Public School Nurses'  Association.
   Provincial Associations have since 1895 been organized
in almost every part of the  dominion.

  1 Many members belong also  to the Canadian Hospital Associa-
tion,  organized in 1907, a society similar to the American Hospital
Association. 
                       SWEDEN                   341

                       SCOTLAND
   The Matrons' Council of Scotland.
   The Scottish Nurses' Association.

                       IRELAND
   The Irish  Nurses' Association was formed first in 1900
 as  the  Dublin  Nurses' Club.  It became the  national
 association in 1904.
                        FRANCE
   There is a Society of Hospital Directresses in Bordeaux.

                       GERMANY
   The German Nurses' Association was organized in 1903,
 through the  efforts  of Sister Agnes Karll, aided by the
 National Council of  Women.  Its  headquarters are at
 Berlin.
                       HOLLAND
   Nosokomos, the Dutch Nurses' Association, was organ-
 ized in 1900 by the efforts of Dr. and Mrs. Aletrino.  Miss
 J. C. V. Hubrecht is president.
   The Dutch  Association of  Superintendents of Training-
 Schools for Nurses.
   The male nurses of Holland have a national association.
   There is also the Dutch Association for Sick  Nursing
 (de Nederlansche Bon voor Ziekenverpleging), often referred
 to as "the Bond."  It was formed in  1892 and is similar
 to the American Hospital Association.

                       SWEDEN
   The General Council  of Swedish Nurses was organized in
 1910, with Miss Emmy Lindhagen, of Stockholm, as presi-
dent.  Its members are nurses who  have  had eighteen
months'  training and  an additional eighteen months of
hospital or private duty. 
342   OUTLINES  OF  NURSING  HISTORY
                       NORWAY
  The National Council of Nurses was organized in 1912.
It is an association of trained nurses.

                      DENMARK
  The Danish Nurses'  Union was formed in 1899.  Mem-
bers are required to have had  three years' training, and
are given a badge.1  There were thirteen hundred members
in 1911.  Mrs. Henry  Tscherning is president.

                       FINLAND
  The Association of Nurses in Finland was organized in
1898.  It  has several hundred  members.   It has a home
for probationers, gives  a preliminary course to them, etc.2

                      AUSTRALIA
  The Australian Trained Nurses' Association was organ-
ized  in 1899, largely through the  efforts of Miss Milne, of
Tasmania.   Dr. Norton Manning was its  first president.
  The Royal Victorian Trained  Nurses' Association was
organized  in 1901, with Dr. J.  W. Springthorpe as presi-
dent.  In 1911 it elected a nurse  as president.
  These two  associations  are  witness  to the fact that
nurses and  doctors may work  together harmoniously in
public life.
  The two  associations co-operate, and have together a
membership of about  five  thousand.  They hold an ex-
amination  for membership  every six  months,  recognize
only hospitals which use their  standard curriculum, and
keep an oversight of the whole nursing field in the country.
Their work amounts to a State  Bureau of Registration,

      1 This amounts to  State Registration.
      2 This is nearly an equivalent of State Registration. 
JAPAN                    343
and is a remarkable example of what can be accomplished
without legislation.
  There  is a branch of the British Nurses' Association in
South Australia.
                    NEW ZEALAND
  The New Zealand  Trained  Nurses'  Association  was
formed by uniting four local associations, those of Well-
ington, Dunedin, Auckland, and Christchurch.  A Central
Council was elected in 1909.

                    SOUTH  AFRICA
  The South African Trained Nurses' Association has four
branches—the  Border, Eastern Province, Natal Inland,
and Rhodesian. The General Secretary is Mrs. H. C. Hes-
senaur, of  East London.
                        INDIA
  The Association of Nursing  Superintendents of  India
was organized in 1907.  It has over fifty members, mostly
English,  but some are native.
  The Trained Nurses' Association of India, organized in
1911, was  an outgrowth of the above.
  There  are several local nursing associations.  In 1910
the Bombay Presidency Nurses' Association  held its first
examination for nurses, a beginning of registration.

                        CHINA
  The Chinese  Nurses' Association was organized in 1909.
It has over one  hundred members,  both Chinese  and
foreign,  the vice-president  being  Chinese.  It  has  a
central examining  and registration board.

                        JAPAN
  There is a national association of the trained nurses of
Japan. 
344   OUTLINES  OF   NURSING  HISTORY

                         CUBA
  The  National Association of Nurses of the Republic of
Cuba was formed in  1909.  It has several hundred mem-
bers.
                     MAGAZINES

                   UNITED STATES
  The  American Journal of  Nursing was  organized  in
1900 as a stock company of nurses.  It is  the property
and official organ of the  American Nurses' Association,
Fig. 87.—Mrs. Annette  Sumner  Rose, editor of "The Trained
                       Nurse."
the official organ of the National League of Nursing Educa-
tion, and of nearly all of the state societies.  Miss Sophia
Palmer, of Rochester, N. Y., has always been its editor. 
UNITED  STATES
345
  The Trained  Nurse and Hospital Review was  estab-
lished in 1888.   It was the first nursing and hospital jour-
nal of this country  of  national  circulation, and  did a
valuable pioneer work.   In 1889 it combined with the
Journal of Practical  Nursing, of Rockford, 111., a local
Fig. 88.—Miss Genevieve Cooke.
paper, established in 1886; and later absorbed, one at a
time, The  Nightingale, The  Nurse, The  Nursing World,
and  The Nursing Record.  It was for ten years the only
nursing and hospital journal of America, except  for the
brief  existence  of  the journals  mentioned.  For  the
greater part of its existence it has been under the direction 
346   OUTLINES  OF  NURSING  HISTORY
of Annette Sumner Rose.  The editor is Miss Charlotte
Aikens, the directing editor Mrs. Annette S. Rose.
  The Pacific Coast Journal of Nursing was established
in 1904 by Miss Genevieve Cooke, who has always been
its editor.  It is published in San Francisco.
  The Visiting Nurse Quarterly was established in 1909
by the Visiting Nurse Association of Cleveland, Ohio.  It
is  the official organ of  the National Organization for
Public Health Nursing.
  The Nurse, a new magazine, is published by the same
men who conduct a correspondence school for nurses,
and is, therefore, not recognized by the profession.

                       CANADA
  The Canadian Nurse  began in  1905 as an  alumnae
quarterly of the Toronto General Hospital.   It was made
a national magazine in 1907, and  in  1910 became the
official organ of all the Canadian nursing associations.  It
is published in Toronto.

                      ENGLAND
  The British Journal of Nursing was established in 1893,
as an outgrowth of the  Nursing Record of 1888.  In 1902
it was enlarged and assumed its present name.  It is the
official organ of the British Nurses' Association and of the
Matrons'  Council.  Mrs.  Bedford Fenwick has  always
been its editor.
  Nursing Notes and Midwives' Chronicle, a  weekly, is
the official organ of the Midwives' Institute, the Associa-
tion for Promoting the Training of Midwives, the Society
of Trained Masseuses, the Colonial  Nursing Association,
and the Workhouse Nursing Association.
  The Nursing Times  is a weekly of good size  and ex-
cellent quality. 
NORWAY
347
  The  Nursing  Mirror was  originally included in  The
Hospital, the organ of the Hospitals Association of Great
Britain, but later was published separately.  It was long
the leading nursing journal of England.

                      IRELAND
  The  Irish  Trained Nurse  and Hospital Review is a
monthly.
                       FRANCE
  The  Hospital  Nurse (La Garde-Malade  Hospitaliere),
with the subtitle of Organ of the Nursing  Schools of the
Florence Nightingale System, is published by the nurses of
Bordeaux.
                      GERMANY
  Unterm Lazaruskreuz was established in Berlin in 1906.
It is the official organ of the German Nurses' Association
(the "Free"  Sisters).
  The  Nurse (Der  Krankenpfieger),  published twice a
month at Berlin, is the property and organ of the Central
German Nurses' Association.

                      HOLLAND
  Nosokomos (Nursing) was established in  Amsterdam
about 1905.
  The   Journal  of Nursing  (Tijdschrift voor Ziekenver-
pleging) is a bimonthly published by the "Bond," estab-
lished in 1890.   Its staff is chiefly doctors.

                       SWEDEN
  The  Swedish Nurses' Journal was established at Stock-
holm in 1909.
                       NORWAY
  The Nursing Journal (Sykplein) was established in 1912. 
348   OUTLINES   OF  NURSING  HISTORY
                      DENMARK
  The Journal of Nursing (Tidsskrift for Sygeplege) is a
bimonthly,  established  at Copenhagen  in  1901.   It is
the official organ of the  National Nurses' Union.

                       BELGIUM
  De Vlamsche Verpleging was published at Antwerp be-
fore the war.
                       FINLAND
  Epione, established in 1907, is the official organ of the
National Nursing Association.   Mrs. Olga Lackstrom is
the editor.   It  is published at Helsingfors.

                     AUSTRALIA
  The Australian Nurses' Journal, published at Sydney,
N.  S. W., is the official organ of the Australian Trained
Nurses' Association.
  Una, published at Melbourne, is the official organ of the
Royal Victorian Trained Nurses' Association.

                    NEW ZEALAND
  Kai Tiaki, published  quarterly at Wellington,  is  the
official organ of the National Association.  The editor is
Miss Hester Maclean.
                        INDIA
  The Nursing Journal  of India was established in  1910.
It is the official organ of the two nursing societies.   The
editor is Mrs.  Etha B. Klosz. 
CHAPTER XXI
  VOCATIONAL  OPPORTUNITIES  FOR NURSES
  Probably no other profession or occupation  presents
so wide a  field  as  does  modern nursing.   The  term
"nursing," originally embracing little but personal service
to the sick,  now includes an increasing number of public
and social activities.  It may mean executive or educa-
tional work, inspection, or organization  of the  work of
others.  The number of administrative or teaching posi-
tions  has  increased  markedly.  The demand  for nurses
with special training far exceeds the supply, and some of
the great social movements are likely  to proceed slowly
because of it.
  For the nurse who is awake there are opportunities on
every hand to lead a happy and useful life.   Women who
have  the ability to handle numbers of people find  insti-
tutional and  organizing positions  waiting.  Instructors
of all  grades are always in demand.  The woman who has
a well-developed social consciousness finds the great field of
public health nursing.  Those who have  scientific minds
find their  chance; and  those who prefer to work with
their  hands  see occasions more various than ever before.
  The following list includes the more conspicuous  fields
of service.   It is given as a reference table for the pupil or
graduate who is trying  to decide upon her special  field.
It suggests  the requirements for each line of work and
gives  the approximate salary to be expected:

               Superintendent of Hospital
  In small hospitals the position is combined with that of
head of the training-school.
                                            349 
350   OUTLINES   OF  NURSING   HISTORY
  In  moderate-sized  hospitals it  may  include  house-
keeper's  duties.
  In large hospitals it involves control of all departments
through assistants.
Requirements.
Salary.
' Mature age.
 Good education.
 Experience in executive work.
] Ability to direct others.
| Special training if possible.
I Business experience if possible.
 $600 to $2500 per year, with maintenance.
Requirements... . <
Salary.
Principal of Training-school
 'Mature age.
  High school or college education.
  Experience in executive work.
  Teaching ability.
  Special training if possible.
  Must be registered nurse.
  $600 to  $2000 per year, with maintenance.
Requirements.

Salary........
  Night Superintendent
No age requirement.
Good education.
Robust health.
Executive experience.
 10 to ?100 per month, with maintenance.
Requirements.


Salary........
  Operating-room Nurse
r Youth and health.
 Fair education.
 Recent surgical training or experience.
 Mental and physical alertness.
 Methodic habits.
^ Some teaching ability.
 $50 to $100 per month, with maintenance.
   (N. B.—Recent graduates are preferred.) 
PRIVATE  NURSE
351
Requirements.

Salary........
Head Nurse or Supervisor
f Good education.
j Good health.
] Recent hospital experience.
^Executive and teaching ability.
 $40 to $60 per month, with maintenance.
Requirements.

Salary........
Salary.
                   Anesthetist
             {Fair education.
             Calm disposition.
             Special training.
            f $75 to $125 per month, with maintenance.
           \ $2 to $10 per case, without maintenance.

Instructor in Nursing.  (Resident or Non-resident.)
            ( Mature age.
            ! High school or college education.
           ^ Special training if possible.
             Teaching ability and experience in three  or
               more hospitals.
                to $125 per month, with maintenance.
Requirements.
                  I $3 to $5 per lesson, without maintenance.

               Dietitian, Teaching  or Executive
                   ' No age requirement.
Requirements....   Fair education.
                   Special training in domestic science.
                   Teaching and executive ability.
Salary...........   $50 to $100 per month, with maintenance.

                         Private  Nurse
   Many specialize in obsterics, contagious  diseases, drug
victims and alcoholics, children, etc.
                   ' No age requirement.
                   Fair education.
                   Good health.
                   Training with paying patients.
                   Pleasing personality.
                   . Even disposition and adaptability.
galary...........   $21 to $35 per week, with board.
Requirements. 
352   OUTLINES  OF   NURSING   HISTORY
Hourly Nurse.   (Usually  Private  Duty.)
Requirements.


Salary........
 Fair education.
 Training with paying patients.
I Some capital.
L Persistence in working up practice.
f 50c. to $1 per hour for actual time of work.
I $5 to $10 for attendance at delivery.
Public Health Nursing.  District or Visiting Nursing
             No age requirement.
             Fair education.
             Training in all departments of a general hospi-
                tal.
Requirements. . . .  <
Salary.
Requirements. .


Salary.........
  Special training in tuberculosis, obstetrics, and
    infants is desirable.
  Some teaching ability.
  Personal interest in people.
  Knowledge of social agencies.
  Abihty to find those who need her.
  For position of  Supervisor,  special training is
    needed.
  $80 to  $125 per month for  Supervisor, with
    carfare.
  $50 to $85 per month for Nurse, with carfare.

       School Nurse
f No age requirement.
I  Fair education.
\  Liking for children.
|  Some teaching ability.
1^ Dispensary experience if possible.
  $60 to $100 per month, with carfare.
> Welfare work
      Factory Nurse
      Department Store Nurse
      Insurance Nurse (employed by Insurance Company)
      Infant Welfare Nurse
      Tuberculosis Nurse
      Milk Station Nurse
Requirements and salary same as for Public Health Nursing. 
DOCTOR'S  OFFICE  NURSE         353
Requirements.
       Rural Nurse
f Similar to those for Public Health Nursing, but
•j   should  add  knowledge  of  and  liking for
*■   country life.
Requirements.
Salary.
Requirements
Salary.
Hospital  Social Service  Nurse
 f Mature age.
 I High school or college education.
  (Special training.
  Experience with people and adaptability.
  Hopeful disposition.
 ( $75 to $150 per  month,  with or without main-
 l   tenance.

         Army Nurse
 f Age twenty-five to forty.
 ! Good education.
 I Good health and physique.
 [ Training in general hospital of 100 beds.
  ($50  to $75 per month,  with maintenance and
     traveling expenses.
  Chief Nurse, $S() to $100 per month.
                         Navy Nurse
Requirements and salary same as  for Army Nurse.

         Supervisor of Household Nursing Association
Requirements.


Salary........
f Mature age.
J  Good education.
I  Experience in private nursing.
[ Teaching and executive ability.
f  $75 to $150 per month, with or without main-
\   tenance.
                     Doctor's Office Nurse
  Should be young and of good appearance, and have some knowl-
edge of stenography or book-keeping.  The salary is $60 to $100 per
month, without maintenance.
        23 
354    OUTLINES  OF  NURSING  HISTORY
         Resident Nurse in Boarding-school or College
  Should be well educated,  and have some teaching ability.  The
salary is $50 to $100, with maintenance.

                     Laboratory Nurse
  Should be well educated and have special training for the work.
The salary is $40 to $150 per month, with or without maintenance.

                   Occupational Instructor
  Should have  teaching  ability,  patience, and  enthusiasm,  with
special training.  The salary is $75 to $100 per month, with or with-
out maintenance.

  Nurses are also employed in the inspection of tenement
houses, in massage, hydrotherapy, and the giving of medi-
cal gymnastics, as policewomen, etc.  Many are devoting
themselves to literary work, and a few have  gone  into
hospital planning and equipment.  New fields are coming
into view every year, so that the  list is never complete. 
INDEX
Adelbert, Count, 43
Administrative courses, 199
Africa, nursing in, 275
  South, organizations in, 343
  training-schools in, 275
After-care of the Insane, Society
  for, 303
Aikens, 201, 202, 314, 346
Alaska, nursing in, 278
Alcott, 124
Aletrino, 341
Alexians, 24
Algiers, nursing in, 275
Ahce Cieng, 262
All Saints' Sisterhood, 85
      in America, 108
Allen, 263
Allender, 331
Allerton, 216
Alline, 199
Alston,  181, 182
America, ancient, hospitals in, 20
  church hospitals in, 162
  Deaconess nurses in, 162
  early nursing in, 100
  Roman Catholic Sisters in, 159
  trained nursing in,  develop-
         ment of,  157
      early training-schools,
      youth of, 157
  training for men nurses in, 162
  training-schools in, Bellevue,
      135
    Boston, 139
    Connecticut, 138
    early, 158
    first, 129
      permanent, 131
    growth  of,  159
    in religious orders, 159
American  branch  of  religious
    nursing orders, 107
  Hospital in France, 231
    in Mexico, 284
    of Paris in present European
       war, 318
  Journal of Nursing, 344
  Nurses' Association, 337
    in present European war, 324
  Red Cross in present European
    war, 324
  Society of Superintendents of
    Training-schools, 182, 338
Ancient nurse, 21
  times, nursing in, 11
Andrews,  167
Aneste, 245
Anesthetics, 153
Anesthetist,  requirements   and
  salary, 351
Angela, Mother, 121
Animals, nursing among, 11
Anthony O'Connell, Mother, 121
Antiseptic scab, 149
Antituberculosis     movement,
  nurses'  part in, 297
Antrobus, 89
Arab hospitals, early, 28
Araki San, 255
Archbishop Trench, 88
Argentina, nursing in, 285
Army, British,  Florence  Night-
    ingale's work for, 75
  Nurse Corps, 338
    requirements and salary, 353
  nursing, 192
Ashe, 188
Asia Minor, nursing in, 269
    training-schools in,  269
  nursing in, 249
                    355 
356
INDEX
Asia, training-schools in, 249
Asklepios, 17
Association  for the  Study  and
     Prevention of Infant Mor-
     tality, 297
  of Nurses in Finland,  342
  of Nursing Superintendents of
     India, 267, 343
Asta-Buruaga,  285
Athelstane, 35
Atkinson, 93, 267
Augustinian Sisters, 30
     devotion of, 30
Australia, district nursing in, 286
  magazines in, 348
  nursing in, 2S5
  organizations in, 342
  registration in, 2X7
  school nursing in, 286
  training-schools in, 285
Australian Nurses' Journal, 348
  Trained  Nurses' Association,
     342
Austria, nursing in, 238
  training-schools in, 238
Aztecs, ancient, hospitals among,
  20
Baas, 12, 28
Babylon, ancient, nursing in, 15
Back  block  nursing  in  New
  Zealand,  288
Bacon, 138
Bailey, 278
Banfield, 199
Bartlett, 160
Barton, 118
Basileus, 21
Baxter, 241
Beard, 187, 197
Bedford-Fenwick, 91
Begards, 24
Beguinage,  24
Beguines, 23
Belgium, magazines in, 348
  nursing in, 234
  training-schools in,  234
Bell, 260
Bellevue of New York, early, 104
  Training-school, 135
Berry, 76, 251
Bertheau, 47, 48
Bewer, 270
Bickerdyke,  Mother, 122
Billings,  123, 140, 181
Bishop, 265
Black Sisters, 23
Blockley, of Philadelphia, early,
  104
Bloomfield,  Bishop, 44
Boggs, 260
Bolivia, nursing in, 2X5
Bolster, 279
Bombay   Presidency   Nurses'
  Association, 343
Boston Training-school, 139
Bouchard, 102
Bourneville's training scheme in
  France, 227
Bowen,  130
Boyd, 193, 217
Bradley, 193, 307, 308, 314
Brazil, nursing  in, 285
Bremer, 235
Brent, 173, 174
Brewster, 187
Briggs, 188
British Army, Florence Nightin-
    gale's work for,  75
  Journal of Nursing, 346
  Nurses' Association, 340
Brotherhoods, nursing, 24
Brothers and Sisters of Charity,
      24
    of Mercy, 24
  of the Holy Spirit,  24
  of St. Anthony, 24
Browne,  86, 164
Burdctt, 15, 268
Burdette, 85, 94
Burgar, 325
Burt, 91
Bush nursing in Australia, 286
Bussell, 277
Buttingcr, 209
Byers, 282

Cabaniss, 188
Cabot, 140,  303, 304, 305
Cabrera, 2X3
Caesar, Julius, 18 
IN
Camp, 200
Canada, district nursing in, 174
  hospitals in, first, 100
  magazines in, 346
  organizations in, 340
  school nursing in, 177
  sisters' hospitals in,  170
  state registration in, 178
  trained nursing in, develop-
    ment of, 170
  training-schools in, first, 171
Canadian Hospitals, early, 100
    features of,  173
  National    Association    for
    Trained Nurses, 340
  Nurse, 346
  Nurses' Association, 340
  Public School Nurses'  Associ-
    ation, 340
  Society of Superintendents of
    Training-schools for  Nurses,
    340
Cannon, 278, 304, 305
Carroll,  291
Carter, 279
Cauer, 226
Cavcll, 234, 328
Cawardine,  277
Celli, 241
Central  Midwives' Institute,  340
Cesarean section in savages,  13
Ceylon,  nursing in, 268
  training-schools in, 268
Charity Hospital at New Orleans,
  103
Chestnut, 256, 260
Chile, nursing in,  285
China, first hospital in. 255
  government training in, 262
  Nurses' Association, 257
  nursing in, 255
  organization in, 343
  pioneers in nursing in,  260
  registration in, 258
  Rockefeller  Commission   and
    nurses' work  in, 263
  text-books in, 260
  training-schools in, 255
Chinese Nurses' Association,  343
Chloroform as anesthetic, intro-
  duction of, 154
EX                       357
Christian hospitals, early, 21
Chronology of English  nursing,
  85-96
Chrysostom, 21
Chung, 258, 259
Church  hospitals,  early, condi-
       tions in, 29
    in America, 162
Civil hospitals, early, 31
  War, hospitals in, 122
    Nurses, 127
    nursing in, 120
       dark side,  124
    Satterlee Hospital in, 122
Clara Barton, 118
Clark, 91, 260
Cleland,  168
Clovis, 29
Cobbe, 91
Cochran, 269
Colombia,  nursing in, 285
Colonial Nursing Association, 340
Colored nurses, 163
    training-school for, first, 163
Compulsory  state  registration,
  219
Connecticut Training-school, 138
Contract  nurses  in   Spanish-
  American War, 190
Cook,  64, 65, 68, 72, 80, 215
Cooke, 345
Co-operation  and  affiliation  of
  training-schools,  203
Correspondence school, 198
Coster, 86
Cottage  nurses, 94
Count Adelbert,  43
  Gasparin, 52
Countess Gasparin, 52
  of Dufferin's Fund, 266
Course, length of, 204
Courses, preliminary, 204
Cousland,  257, 260
Cowles,  165
Crandall, 298
Crimea,  Florence Nightingale in,
         60
       close of war, 69
       difficulties encountered, 63
       establishment of nurses at
         Scutari, 61 
358
INDEX
Crimea, Florence Nightingale in,
        good  results  obtained
        by, 65
      hospital  conditions, 62
      illness of, 68
      meaning of work, 71
      reforms enacted by, 64
      soldiers' love, 65
Crisp, 92, 287
Crusaders, hospitals for, 25
Cuba, nursing in, 281
  organizations in, 344
  training-schools in, 281
Culion Leper Colony,  290
Cushman, 270
Dacre-Craven, 89
Danish Nurses' Union, 342
Dark period of nursing, 37
Davis, 199, 314
Deaconess hospital, first modern,
    45
  movement and its contempora-
      ries, 42
    decline of, 42
    in England, 43
    nurses'  training  contempo-
      rary with, 51
  nurses in America, 162
  Order in America, 108
  work, modern, founding of, 44
    plan of, 48
Deaconesses,  nursing  by,  in
    Germany, 222
Deane, 279
de Bresoles,  102
de Bullion, 102
Degeneration  of religious  nurs-
  ing, 28
de Gossault, 34
de Gras, 33, 34
Delano,  119, 193, 325
Denmark, magazines in, 348
  nursing in, 236
  organizations in, 342
  Red Cross Society in, 236
  training-schools in, 236
Department   store  nurse,  re-
  quirements and salary, 352
Der Krankenpfleger, 347
 Derby  memorial  to  Florence
   Nightingale, 66
 Dervishoglan, 246
 De Veber, 209
 De Vlamsche Verpleging, 348
 Dickey, 279
 Dietitian, requirements and sal-
   ary, 351
 Diffenbach, 51
 Dimock, 132, 133, 140
 District  nursing,  broadening of
       field, 184
     by Metropolitan Life Insur-
       ance Co.,  185
     in Australia, 286
     in Canada, 174
     in France, 232
     in Holland, 234
     in Jerusalem, 270
     in New Zealand,  288
     requirements and salary, 325
     training for,  186
 Dix, 108,  121
 Dock, 200, 215, 217, 226
 Dock and Nutting, 31, 37, 51, 65,
   85, 189
 Doctor's  office  nurse,  require-
   ments and salary, 353
 Draper, 173, 181
 Dunant, 114
 Dutch Association for Sick Nurs-
      ing, 233, 341
     of Superintendents  of Train-
      ing-schools for  Nurses, 341
   Nurses' Association, 341


 Early nursing, 21
 Eckhardt, 291
 Educational side  of nursing, 197,
   198
 Egypt, ancient, nursing in,  15
   nursing in, 275
   training-schools in,  275
Elizabeth, 280
Ellers, 263
Elston, 230, 275
Emberly, 279
Empress Catherine, 52
England, deaconess movement in,
    43 
INDEX
359
England, establishment of trained
    nursing, 84
  magazines in, 346
  nursing chronology, 85-96
  organizations in, 340
  registration in, 215
England's  advance  in  trained
  nursing, 84
Enghsh hospitals, early, 35
  nursing, early, 35, 36
  training, peculiarities in, 96
Epione, 348
Ether as anesthetic, introduction
    of,  154
  Day,  154
Europe, central, early nursing in,
    22
  nursing in, 222
  training-schools in, 222
European war, present, American
           Hospital of Paris in,
           318
         nurses in, 325
         Red Cross in, 324
      hospital  accommodations,
         317
      method    of   handling
         wounded, 318
      nurses' experiences in, 325
      nursing in, 317
         methods, 332
      personnel in, 317
      trained nurses in, 323
      untrained nursing  in, 321
      value of trained  women,
         335
Experimental stage of state regis-
  tration, 220
Fabiola, 21
Factory nurse, requirements and
  salary, 352
Farthing, 279
Fatio, 12
Fenger, 237
Fenwick, 181, 340, 346
Finland, magazines in, 348
  nursing in, 237
  organizations in, 342
  training-schools in, 237
First hospitals, 15
Fisher, 92
Fliedner, 44, 45, 46, 48, 5B
Fliedner's rules for self-examina-
  tion of deaconesses,  49
Florence Nightingale, 55, 144
    at Kaiserswerth, 48, 58
    death and burial, 81
    Derby memorial to, 66
    early years, 55
    estimate of character,  68
    first executive position, 59
    fund, 71
    fundamentals of  character,
      82
    her plan,  58
    in Crimea, 60
       close of war, 69
       differences   encountered,
         63
       establishment of nurses at
         Scutari, 61
       good results obtained by,
         65
       hospital conditions, 62
       illness of, 68
       meaning of work, 71
       reforms enacted by, 64
       soldiers' love, 65
    later work, 71
       years, 80
    Notes on Hospitals, 78
       on Nursing, 78
    on equal  suffrage, 77
    on registration for  nurses,
       215
    personality of, 56
    political influence, 77
    popular heroine, 71
    School of Nursing, 72
    seclusion period of life, 76
    start in career, 58
    statement of  principles of
       training, 79
    "The  Lady  of  the Lamp,"
       66
    wish to be a nurse, 55
           family's opposition to,
              56
    work for  British Army, 75
       for hospitals,  77 
360
INDEX
Florence  Nightingale, work for
         India, 76
       for nursing, 77
    writings on hospitals, 78
       on nursing, 78
France,  American Hospital in,
    231
  Bourneville's   training-school
    in, 227
  district nursing in, 226
  early nursing in, 22
  Hamilton's plan in, 229
  magazines in, 347
  nursing in, 226
  organizations in, 341
  Red Cross Society of, 231
  school  nursing in, 232
  training-schools in, 226
  visiting nursing in, 232
Francis, Mother,  121
Franklin, 338
Free Sisters of Germany, 49, 226
Fry, 43, 47
Fulton, 260

Gage, 260
Gallienne, 230
Gasparin, Count, 52
  Countess, 52
Gaynor, 260
Gedike, 51
General   Council  of  Swedish
  Nurses, 341
Geneva, Treaty of, 115
German Nurses' Association, 341
Germany, early nursing in, 22
  Free Sisters in, 226
  magazines in, 347
  nursing in, 222
  organizations in, 341
  Red Cross  Society  in, 224
  schools for training nurses in,
    51
  state training-schools in, 225
  training-schools in, 222
Gerow, 265
Gertrude, 95
Gilson, 122
Gladwin, 325
Golder, 161
Goler, 30
Gonzaga, Mother, 121, 123
Gooch, 43
Gorman, 199
Government training  in  China,
  262
Grace Go, 262
  Yee, 263
Grand Duchess Helena, 243
Grant, 268
Great Britain.  See England.
Greble, 281
Greece, ancient,  nursing  in, 17,
  244
  training-schools in, 244
Gregory, 265
Grenfell, 276
Gretter, 205
Grey Sisters, 23
Gross,  135
Guild of St. Barnabas for Nurses,
    89, 338
  of St. Radegonde, 339
Gunn, 300
Gutierrez, 242
Hackett, 207
Halley, 256
Hamilton, 92, 122, 228, 229, 230
Hamilton's  first  training-school,
    229
  plan in France, 229
Hampton, 181
Hardy, 331
Hart, 260
Hasson, 193
Hawaii, nursing in, 290
  training-schools in, 290
Hay, 325
Hayes, 123
Head  nurse,  requirements and
  salarv, 351
Helen, Sister, 108, 137,  138
Helena, Grand Duchess, 243
Henderson, 260
Henry, 281
Hepburn, 251
Herbert, Sir Sidney, 71
Hibbard, 191, 282, 283
Higbee, 193
Hindoo medicine, ancient, 16 
INDEX
361
Hippocrates, 18, 19
History, nursing, dearth of, 15
Holland, district nursing in, 234
  magazines in, 347
  nursing in, 233
  organizations in, 341
  training-schools in, 233
Holman, 188
Holmes, 144, 152
Hospital accommodations in pres-
    ent European war, 317
  American, in France, 231
    in Mexico, 284
  Charity, at New Orleans, 103
  deaconess, first modern,  45
  first,  at Montreal,  101
    at Quebec, 100
    in Canada, 100
    in China, 255
    in United States, 103
  for  Sick   Children,  Toronto,
    training-school at,  173
  Nurse Magazine of Bordeaux,
    347
  nursing,   broadening  of  field,
       183
    in early days, 105
    volunteer, 24
  of Jesus the Nazarene, 283
  of  the Immaculate   Concep-
    tion, 283
  Satterlee, in Civil War, 122
  social service, 300
       founding of work, 303
       nurse,  requirements  and
         salary, 353
       nurses as workers, 306
       training for, 305
  St.   Thomas',    Nightingale
    School  of Nursing  at, 72
  superintendent   of,   require-
    ments and salary, 349, 350
Hospitallers, 25
Hospitals among ancient Aztecs,
    20
  Arab, early, 28
  Canadian, early, 100
    features of, 173
  Christian, early, 21
  church, early, conditions in, 29
    in America, 162
Hospitals, civil, early, 31
  early, in United States, preju-
    dice against, 106
  English, early, 35
  first, 15
    in Canada, 100
    in United States, 103
  Florence  Nightingale's  work
        for, 77
      writings on, 78
  for Crusaders, 25
  for  insane,  training  of, diffi-
      culties,  167
    training of nurses in, 164
      of pioneer nurses, 168
  for negroes,  163
  for pilgrims, 25
  in Civil War, 122
  in Revolutionary War, 106
  leper, early, 36
  municipal, early, 31
    in Canada, 171
    rise of, 36
  oldest, 29
  Sisters', in Canada, 170
Hot oil as dressing for wounds, 32
Hotel Dieu at Montreal, 101
    at Quebec, 101
    of Lyons, 29
    of Paris,  29, 30
Hourly  nurse, requirements and
  salary, 352
Hours of work, 205
Household nursing, 193, 307
    Movement,  307
Howard, 24
Howard's criticism of Hospital of
  St. John, in Malta, 27
Hubrecht, 341
Hughes, 94, 95, 191
Huntoon, 279
Hurd, 75
India, ancient, nursing in,' 16
  Association  of Nursing Super-
    intendents of, 267
  Florence  Nightingale's  work
    for, 76
  magazines in, 348
  nursing in. 264 
362
INDEX
India, organizations in, 343
  Trained  Nurses'  Association
    of, 267
  training-schools in, 264
Indian Army Nursing Service, 94
Indians,    tuberculosis    work
  among, 279
Infant welfare movement, nurses'
      part in, 297
    nurse,    requirements   and
      salary, 352
Infected wounds in early surgery,
  32
Insane Asylum,  McLean, 166
  asylums, early nursing in,  108
    training of nurses in, 164
  care of, in ancient times,  19
    in early days, 33
  hospitals for, training of nurses
          in, 164
        difficulties, 167
        pioneer nurses, 168
  Society  for the  After-care of,
    303
Instructor  in nursing, require-
    ments and salary,  351
  occupational, requirements and
    salary, 354
Instruments,  surgical,  found in
  ancient Pompeii, 19
Insurance  nurse,  requirements
    and salary,  352
  sick, need of,  314
International Council of Nurses,
  337
Ireland, magazines in, 347
  organizations in, 341
Irish Nurses' Association, 341
  Trained  Nurse  and  Hospital
    Review,  347
Italy, nursing in, 240
  training-schools in, 240
Jacobson, 263
Jamsetja Jejeebhoy, 267
Japan, nursing in, 251
  organizations in, 343
  Red Cross Society in, 253
  training-schools in, 251
Jerusalem, district nursing in, 271
Jews, ancient, sanitation among,
  17
Jijdschrift  voor  Ziekenverpleg-
  ing, 347
Johnson, 111
Johnston, 276
Jones, 87
Journal of Nursing  in  Holland,
      347
    of Denmark, 348
  of Practical Nursing, 345
Julius Caesar, 18
Kai Tiaki, 348
Kaiserswerth,  Florence Nightin-
    gale at, 48, 58
  training, 46
    growth of, 48
  what we owe to, 49
Kalafati, 246
Kaplan, 271
Karll, 226, 341
Keun, 282
Kendrick, Bishop,  105
Kennedv, 278
Kim, 263
Kimber,  200
Kin, 262
King Asoka, 16
Kinney,  192
Kloenne, 43
Klonare, 244, 245
Klosz,  348
Kluge, 51
Knights  of St. John, 24, 25, 26
  of St. Lazarus, 25
  Templars, 25
Koch,  144,  145, 148, 149,  154
Korea, nursing in, 263
  training-schools  in, 263
Krueger, 325
Labrador, nursing in, 276
Laboratory  nurse, requirements
  and salary, 354
Lady almoner, 303
  Dufferin Fund, 93
  Grey's Country  District Nurs-
    ing Scheme, 177, 340 
INDEX                       363
Lady Minto  Cottage  Hospital
    Fund, 177
  of the Lamp, 66
  Roberts, 94
    Fund, 267
  Talbot Milk Institute, 286
Lafranc, Bishop, 35
La  Garde-Malade  Hospitaliere,
  347
Lande, 230
Landry, Bishop, 29
Landy, 271
La Source, School of, 52, 232
Lazarists, 23
Lees, 89
Le Fort, 149
Length  of  course  in  training-
  schools, 204
Leper hospitals, early, 36
Liberia, nursing in, 276
Lindhagen, 341
Lister, 144, 145, 148, 147, 149,
  150
Lister's methods, 149
  problem, 147
     Pasteur's solution, 149
Livermore, 122
Livingstone, 171, 172
Long, 154
Longfellow's poem, Santa  Filo-
  mena, 67
Louis, 103
Lousbury, 191
Lyon, 258, 259, 260, 262
MacDonald, 65
Mace, 102
Machin, 90
Mack, 171
Mackenzie, 340
Maclean, 288, 324, 348
Macleod, 207, 208, 311, 340
Macrina, 21
Magarin, 12
Magazines in Australia, 348
  in Belgium, 348
  in Canada, 346
  in Denmark, 348
  in England, 346
  in Finland, 348
Magazines in France, 347
  in Germany, 347
  in Holland, 347
  in India,  348
  in Ireland, 347
  in New Zealand, 348
  in Norway, 347
  in Sweden, 347
  in United States, 344
Magill, 326, 327
Mahoney, 163, 275
Maidens of Mercy, 42
Maillet, 102
Mance,  101, 102
Manning, 342
Manson, 91
Marshall, 95
Martha Kim, 263
Mary Ding, 262
Matrons' Aid Society, 94
  Council of Great Britain and
      Ireland, 340
    of Scotland, 341
Maxwell, 191
Mayo brothers, 154
McCalmont, 290
McEvoy, 289
McGee, 190, 192
Mclsaac, 200
McKim, 269
McLean Asylum,  109, 166
McLeod, 284
McVeigh, 269
Medicine and nursing, 13
  and theology, 13
Medieval nursing, 21
    appliances, 34
Meigs, 106
Men, Mills' Training-school for,
    162
  nurses, training for, in America,
    162
Merryweather, 87
Metchnikoff, 149
Metropolitan Life Insurance Co.,
  visiting nursing by, 185
Mexican General  Hospital, 284
Mexico, American hospital in, 2X4
  ancient, hospitals in, 20
  nursing in, 283
  training-schools in, 283 
364                       INDEX
Meyer, 226
Midwives' Institute, 94
Milk station nurse, requirements
  and salary, 352
Mills' Training-school for Men,
  162
Milne, 342
Minor, 188
Mitchell, 282
Monk, 92
Montreal, first hospital at, 101
  General  Hospital,  training-
    school at, 171
Moore, 282
Morton, 154
Moses, 17
Mother Angela, 121
  Anthonv O'Connell, 121
  Bickerdyke, 122
  Francis, 121
  Gonzaga, 121
Moynier, 116
Municipal hospitals, early, 31
    in Canada, 171
    rise of, 36
Munroe, 94
Munster, 44
Mutual Aid Association, 310
National Association for Aid of
      Sick and Wounded During
      War, 26
    for  Supplying  Medical Aid
      to Women of India, 266
    of Colored Nurses, 164, 338
    of Nurses of the Republic of
      Cuba,  344
  Child Helping Association, 297
  Committee on Red Cross Nurs-
    ing Service, 338
  Council of  Nurses, 342
      for Great Britain, 340
  League of Nursing Education,
    338
  Organization for Public Health
    Nursing, 298, 338
  Pension Fund for Nurses,  94
Navy Nurse Corps, 338
    requirements and salary, 353
  nursing.  193
Neale, 86
Negroes, hospitals for, 163
Neill, 288
New Amsterdam, first hospital in,
  103
New   England  Hospital   for
  Women,  131
New  Orleans,  Charity  Hospital
  at, 103
New York, difficulties with state
      registration in, 219
    Hospital, early,  104
New Zealand, district nursing in,
      288
    magazines  in, 348
    nursing in, 287
    organizations in, 343
    Trained Nurses' Association,
      343
    training-schools  in,  2S7
Night  superintendent,  require-
  ments and salary, 350
Nightingale,   Florence.     See
  Florence  Nightingale.
Nineteenth  century's  contribu-
  tion to care of  sick, 144
North, 270
Northwestern  Sisters'  Hospital
  Association, 161
Norway, magazines in, 347
  nursing in, 235
  organizations in, 342
  Red Cross Society in, 235
  training-schools in, 235
Nosokomos, 233, 341, 347
Notes   on  Hospitals,  Florence
    Nightingale's, 78
  on  Nursing,  Florence  Night-
    ingales, 78
Nurses'  Associated  Alumnae of
    United States and Canada,
    182, 338
  Association of China, 257
  settlements, 1S6
  training  contemporary   with
    Deaconess  movement, 51
Nursing and medicine, 13
  appliances, medieval, 34
  Branch of Canadian Perma-
    nent Army Medical Service,
    340 
INDEX
365
Nursing Brotherhoods, 24
  Journal of India, 267, 348
    of Norway, 347
  Magazine in Holland, 347
  Mirror, 347
  Notes  and Midwives' Chron-
    icle,  346
  orders, religious,  23
  Record, 345
  sisterhoods, 23
  Times, 346
  World, 345
Nutting,  199
Nutting and Dock,  31, 37, 51, 65,
  85,  1X9
Nye, 216
Occupational  instructor,  re-
  quirements and salary, 354
O'Donnell, 282
Ogden, 260
Oil, hot, as  dressing for  wounds,
  32
Olnhauser, 141
Olympia, 21
Operating-room nurse,  require-
  ments and salary, 350
Opportunities,   vocational,  for
  nurses, 349-354
Order of the Royal Red Cross, 92
Orders, related, 24
Organ of the Nursing  Schools of
  the Florence Nightingale Sys-
  tem, 347
Organization of American nurses,
  180
Organizations, nursing, 337
    in Australia, 342
    in Canada, 340
    in China, 343
    in Cuba, 344
    in Denmark, 342
    in England, 340
    in Finland, 342
    in France, 341
    in Germany, 341
    in Holland, 341
    in India, 343
    in Ireland,  341
    in Japan, 343
Organizations,  nursing, in New
      Zealand, 343
    in Norway, 342
    in Scotland, 341
    in South Africa, 343
    in Sweden, 341
    in United States, 337
Osborne, 338
Osburn, 8S, 286
Overtraining, fear of, 196
Pacific Coast Journal  of Nurs-
  ing, 346
Palmer, 216, 344
Pare, 150
  surgical instruments  used by,
     32
Parker, 255
Parkman, 103, 140
Parsons, 168, 169
Passavant, 48
Pasteur, 144, 145, 148, 149, 152
Pasteur's  solution  of  Lister's
      problem, 149
     of puerperal fever,  152
Paterou, 246
Paton, 277
Paula, 21
Pelton, 304
Pennsylvania Hospital, early, 104
Perkins, 138
Persia, ancient, nursing in, 15
  nursing in, 268
  training-schools in, 268
Peru, nursing in, 285
Peter, 95
Philippines,  nursing in, 288
  training-schools in, 288
Philomena Society, 180
Pierson, 188
Pilgrims, early  nursing among,
     100
  hospitals for, 25
Pioneer nurses in  asylum train-
  ing, 168
Political influence  of  Florence
  Nightingale, 77
Pompeii, ancient, surgical instru-
  ments found in,  18
Pope, 201, 283 
366
INDEX
Porto Rico, nursing in, 283
    training-schools in, 283
Powers, 124
Preliminary courses, 204
Prescott, 20
Price, 126
Principal  of training-school, re-
  quirements and salary, 350
Pringle, 209
Private duty, continuing problem
      of,  207
    sending pupil nurses out for,
      205
  nurse, requirements and salary,
    351
  nursing, broadening  of field,
      183
    early, in America, 109
    in early days, 33
Protestant Nursing Sisters, 43
  Sisterhoods in America, 161
  Sisters of Charitv in America,
        107
      in England, 43
    of Mercy, 44
Provincial Associations, 340
Psychiatric nursing, field of, 169
Public health nursing, 296
      national organization  for,
        298
      requirements and  salary,
        352
      scope of, 299
Puerperal fever, 150
Pupil nurses,  sending  out,  for
  private  dutjr, 205
Pure  milk   movement,  nurses'
  part in, 298

Quebec, first hospital at, 100
Queen Alexandra's Imperial Mili-
    tary Nursing  Service,  340
  Matilda, 35
  Sophia,  236, 245
  Victoria's Jubilee Institute, 340
Queen's Jubilee Institute, 93
Quintard,  191, 281, 282

Radegunde, 22
Rahere, 35
 Rappe, 236
 Rathbone, 77, 86, 87, 89, 108
 Reckwood Asylum at Kingston,
  Ontario, training-school at, 173
 Red Cross Society, 114
       American, in present Euro-
         pean war, 324
       growth of idea, 115
       in Denmark, 236
       in France, 231
       in Germany, 224
       in Japan, 253
       in Norway, 235
       in Russia, 243
       in Sweden, 235
       in Switzerland. 232
       in United Stales,  118
       methods of work, 116
       origin, 114
       Treaty of Geneva, 115
 Registration, first law, 216
  in Australia, 287
  in Canada, 178
  in China, 258
  in England, 215
  in United States, 216
  state, 182, 214
     compulsory, 219
     data on, 217
     early states, 217
     experimental stage, 220
     in United States, 216
     New York's difficulties, 219
 Reichardt, 45, 46
 Reid, 200
 Related orders, 24
 Religious nursing, degeneration
       of, 28
     orders,  23
       American branch, 107
  orders  in America,  training-
     schools in, 159
Resident nurse in boarding-school
  or  college,  requirements  and
  salary, 354
Revolutionary War, hospitals in,
  106
Reynolds, 209
Rice, 279
Richards, 110, 133, 138, 141,  142,
  168, 199, 206, 251, 252, 253 
INDEX
367
 Rixey, 193
 Robb, 181, 182, 199, 216
 Roberts, 94
 Robertson, 173, 175, 177
 Rockefeller  Commission,  nurses'
   work in China and, 263
 Rogers, 177, 189
 Roman Catholic Sisters in Amer-
          ica, 159
        nursing  by,  in  Germany,
          222
 Rome, ancient,  sanitation in, 18
 Rose, 182, 344, 346
 Roux, 149
 Rowe, 278
 Royal Victoria Hospital at Mon-
     treal, 173
   Victorian  Trained Nurses' As-
     sociation,  342
 Rubio, 242
 Ruhstadt, 51
 Rural  nurse,  requirements and
     salary, 353
   Nursing Association, 94
 Russia, nursing in, 242
   Red Cross Society in, 243
   training-schools in,  52,  242


 Sairy Gamp, 38
 Salzmann, 238
 Samoa, nursing in, 292
   training-schools in, 292
 Sampson, 282
 Sanitary   Commission,   United
   States,  120
 Sanitation among ancient Jews,
     17
   in ancient  Rome,  18
   in  India,  Florence  Nightin-
     gale's work on, 76
 Santa  Filomena, 67
 Sarah See, 262
 Satterlee Hospital in Civil War,
   122
Savages, care of sick among, 12
  Cesarean section in, 13
Saville, 256
School, correspondence, 198
  nurse, requirements and salary,
    352
 School, nursing, 95, 188, 298
     in Australia, 286
     in Canada, 177
     in France, 232
   of La Source, 52,  232
   of Nursing, Nightingale, 72
   Waltham, 52
 Schools for training   nurses  in
         Germany, 51
       in Russia, 52
       in Switzerland,  52
 Schuyler, 136
 Scientists,  great,  work  of,   as
   related to nursing, 144
 Scotland, organizations in, 341
 Scott, 268
 Scottish Nurses' Association, 341
 Scudder,  268
 Scutari, Florence Nightingale and
   nurses at, 61
 Seaman, 129, 130
 Sellon, 43
 Semmelweiss, 144, 151
 Senn,  269
 Seton, 34, 107
 Settlements, nurses', 186
 Sexton sisters, 121
 Shaw, 200, 201
 Shields, 263
 Sick, care of, among savages, 12
   insurance, need  of, 314
 Sickness and sin, 14
 Simpson, 150, 154, 257, 258, 260,
   262
 Sin and sickness, 14
 Sister  Beatrice Bartlett, 160
   Gabriele, 49
   Helen, 108, 137, 138
   Kasai, 323
   Kiyooka, 323
   Sophie, 224
   Yamamoto, 323
Sisterhood, All Saints', in Amer-
        ica,  108
       in England,  85
   St. John's, in America, 108
  St. Margaret's, in America, 108
Sisterhoods,  nursing, 23
  Protestant, in America, 161
  Roman  Catholic, in America.
    159 
368
INDEX
Sisters, Augustinian, 30
     devotion of, 30
  Black, 23
  Free, in Germany, 226
  Grey, 23
  Hospitals in Canada, 170
  of Charity, 33, 34
  of Our Blessed Lady, 23
  of St. Catherine, 23
  of St. Elizabeth, 23
  Roman Catholic,  nursing by,
     in  Germany,  222
Small training-schools, 202
Snell, 241
Snively, 172
Snodgrass, 289
Social service, hospital, 300
       founding of work, 303
       nurses as workers, 306
       training for, 305
Society for the After-care of the
     Insane, 303
  of  Hospital  Directresses  in
     Bordeaux, 341
Sophia, Queen, 236, 245
Sophie, Sister, 224
South  Africa, organizations in,
      343
South  African  Trained  Nurses'
     Association, 343
  America, nursing in, 284
     training-schools in, 284
Southey, 43
Spain, nursing in, 242
  training-schools in, 242
Spanish-American  war  nurses,
        338
      organization of,  191
     nursing in, 189
Springthorpe, 342
Stapfer, 134
State associations, 182
     of nurses, 339
  registration, 182, 214
    compulsory, 219
     data on, 217
    early  states, 217
    experimental stage, 220
    in Canada, 178
    in United States, 216
     New York's difficulties, 219
State  training-schools  in  Ger-
   many, 225
St. John, Knights of,  25, 26
St. John's  Ambulance  Associa-
    tion, 26
   Sisterhood in America, 108
St.  Margaret's   Sisterhood   in
   America,  108
St. Thomas' Hospital,  Nightin-
   gale School of Nursing at, 72
Stein, 43
Sternberg, 189, 190, 191
Stewart, 269, 340
Stone, 314
Stonev, 202
Storp, 226
Straus, 271
Strong, 96
Sturtevant,  139
Sumner,  325
Superintendent,  night,  require-
    ments and salary, 350
   of Hospital,  requirements and
    salary,  349,  350
Supervisor of household nursing
    association,  requirements
    and  salary, 353
   requirements and salary, 351
Surgical   instruments  found  in
   ancient Pompeii, 19
Sutliffe, 181, 191
Sveiveking,  43
Sweden, magazines in, 347
   nursing in, 235
   organizations in, 341
   Red Cross Society in, 235
   training-schools in, 235
Swedish Nurses' Journal, 347
Switzerland, nursing in, 232
   Red Cross Society in, 232
   schools for training  nurses  in,
    52
Sykplein,  347
Syme, 146
Syria, nursing in, 269
  training-schools in, 269
Teacher's  College,   Columbia
  University, 199
Teutonic Knights Hospitallers, 25 
INDEX
369
 Text-books, 200
   in China, 260
 Thayer, 135
 The Bond, 341
 Theology and medicine, 13
 Thomas Thompson Trust, 309
 Thompson,  138,  193,  240,  256,
   258
 Thomson, 266
 Thorpe, 265
 Thurstan, 326
 Ticho,  272
 Tidsskrift for Sygeplege, 348
 Toronto General Hospital, train-
   ing-school at, 172
 Town  and  Country  Nursing
   Service, 338
 Trained   Nurse  and   Hospital
     Review, 345
   Nurse's Association  of India,
     267, 343
   nursing,  establishment  of,  in
       Great Britain, 84
     in  America, development of,
         157
       early training-schools, 158
       youth of, 157
     in  Canada, development of,
       170
     progress of, 84
 Training   for   men  nurses   in
     America, 162
   of  nurses  in  hospitals for  in-
           sane, 164
         difficulties, 167
      pioneer nurses, 168
 Training-school at Hospital for
     Sick Children, Toronto, 173
   Florence  Nightingale's  essen-
     tials of,  79
   for colored nurses, first, 163
   Hamilton's first, 229
   in insane asylum, first, 165
   Mills', for Men, 162
   principal of, requirements and
    salary, 350
Training-schools,   co-operation
    and affiliation, 203
   in Africa, 275
   in America, Bellevue,  135
    Boston, 139
 Training-schools in America, Con-
       necticut, 138
     early, 158
     first, 129
       permanent, 131
     growth of,  159
     in religious orders, 159
   in Asia, 249
     Minor, 269
   in Australia, 285
   in Austria, 238
   in Belgium, 234
   in Canada, first, 171
   in Ceylon, 268
   in China, 255
   in Cuba, 281
   in Denmark, 236
   in Europe, 222
   in Finland, 237
   in France, 226
   in Germany, 51, 222
   in Greece, 244
   in Hawaii, 290
   in Holland, 233
   in India, 264
   in Italy, 240
   in Korea, 263
   in Mexico, 283
   in New Zealand, 287
   in Norway, 235
   in Persia, 268
   in Philippines, 288
   in Porto Rico, 283
   in Russia, 52, 242
   in Samoa, 292
   in South America, 284
   in Spain, 242
   in Sweden, 235
   in Switzerland, 52, 232
   in Syria, 269
   in Turkey, 269
   length of course, 204
   small, 202
   state, in Germany, 225
Treaty of Geneva,  115
Trench, Archbishop, 88
Tscherning, 342
Tuberculosis nurse, requirements
     and salary, 352
  work among Indians, 279
Tuke, 164
24 
370
INDEX
Turkey, nursing in, 260
  training-schools in, 269
Turton, 241
Twining, 91
Tylor,  107, 122
United  States,  hospitals  in,
           first, 103
        prejudice against,  106
    magazines in, 344
    organizations in, 337
    Red Cross Society in, IIS
    registration in, 216
    Sanitary Commission, 120
Unterm Lazaruskreuz,  347
Untrained   nursing   in   recent
  European war, 321
Ursulines of Austria,  23
Uruguay, nursing in,  285
Van Zandt, 270
Vecht, 326
Victoria House, of Berlin, 225
Victorian  Order of Nurses,  175,
  340
Vincent de Paul, 33, 34
Visiting  Nurse  Quarterly,  298,
      346
    work, 303
  nursing, 184
    by Metropolitan Life Insur-
      ance Co., 185
    early, 22
    in Australia, 286
    in France, 232
    in Holland, 234
    in Jerusalem, 271
    in New Zealand, 288
    requirements and salary, 352
    training for, 186
Vocational   opportunities   for
  nurses,  349-354
Volunteer hospital nursing, 24
von Olnhauser,  141
von Stein, 43
Wadlekjh, 305
Wald, 185, 187. 189, 298, 305
Walker, 199
Waltham Training-school, 52, 207
War,  European,  present,  317.
     See also European war, -pres-
     ent.
  Spanish-American,  nursing in,
     189
Wardroper, 86
  as head  of Nightingale School
     of Nursing at St.  Thomas'
     Hospital, 73
Warren, 107
Warrington, 130
Waterloo, 94
Weeks, 200
West, 85
Wheeler, 191
Wild sisters in Germany, 226
Williams, 277
Wise, 106
Wolhaupter, 134
Women's Jubilee offering, 93
Woods, 134, 279
Woodward, 167, 168
Worcester,  44, 109, 110
Work, hours of, 205
Workhouse  Infirmary   Nursing
  Association, 91
Wortabet, 270
Wounded,  method of handling,
  in present European war, 31S
Wounds, hot oil as dressing for,
    32
  infected,  in early surgery, 32
Wrench, 146
Wylie, 136, 138, 140
Xenophon, 18
Yakschitch, 331
Yee, 263
Zakrzewska,  131, 132
Zomak, 242 
 
 
Books  for  Nurses
                  PUBLISHED BY

W.  B.   SAUNDERS  COMPANY
West  Washington  Square       Philadelphia
         London: 9, Henrietta Street, Covent Garden
Sanders'  Nursing      NEw ^/edIt?™
This new edition is undoubtedly the most com-
plete and practical work on nursing ever pub-
lished.  Miss  Sander's  already  superior  work
has been amplified and the methods  simplified to
bring it down to the newest ideas in nursing.
There is  none other  so full of good,  practical
information detailed in a clean-cut, definite way.
       Modern Methods in Nursing.  By Georgiana J. Sanders,
       formerly Superintendent of Nurses at Massachusetts Gen-
       eral Hospital.  12mo of 900 pages, with 217 illustrations.
                                Cloth, $2.50 net.


Dunton's Occupation Therapy
                JUST ISSUED
Dr. Dunton gives those forms likely to be of most
service to the nurse in private practice.  You get
chapters on  puzzles, reading, physical exercises,
card games,  string,  paper, wood,  plastic and
metal work, weaving, picture puzzles,  basketry,
chair  caning,  bookbinding, gardening, nature
study,  drawing, painting, pyrography, needle-
work, photography, and music.
       Occupation Therapy for Nurses.  By  William Rush
       Dunton, Jr., M. D., Assistant Physician at Sheppard
       and Enoch Pratt Hospitals, Towson, Md.  i2tno of  240
       pages, illustrated.  Cloth, $1.50 net. 
Stoney's  Nursing
    JUST ISSUED
NEW (5th) EDITION
Of this work the American Joiirnal of Nursing says: "It is the

fullest and most complete and may well be recommended as

being of great general usefulness. The best chapter is the one

on observation of symptoms which is very thorough."   There

are directions how to improvise everything.

             Practical Points in Nursing. By Emily M. A. Stoney.  Revised
             by Lucy Cornelia Catlin, R. N., Youngstown Hospital, Ohio.
             12mo, 511 pages, illustrated.               Cloth, SI.75 net.



Stoney's  Materia  Medica      new <3d)  edition

Stoney's Materia Medica was written by  a head nurse  who

knows just what the nurse  needs.   American Medicine  says

it contains "all the  information in regards to drugs that a

nurse should possess."
             Materia Medica for Nurses. By Emily M. A. Stoney, formerly Super-
             intendent  of the Training School for Nurses in the Carney Hospital,
             South  Boston, Mass, nmo volume of 300 pages.  Cloth, $1.50 net
     JUST ISSUED
NEW (4th) EDITION
Stoney's Surgical Technic

The first part deals with bacteriology, including antitoxins; the
second with  all the latest developments  in  surgical technic.
The National Hospital Record says:  "Pregnant with just the
information nurses constantly need."
             Bacteriology and  Surgical Technic for Nurses.  By Emily M. A.
            Stoney.  12mo volume of 342 pages, illustrated.  Cloth, $1.75 net.



Goodnow's  First-Year  Nursing   2d edition

Miss Goodnow's work deals entirely with the practical side  of
first-year  nursing  work.   It is the  application of text-book
knowledge. It tells the nurse how to do those things she is called
upon to do in her first year in the training school—the actual
ward work.
             First-Year Nursing. By Minnie Goodnow, R. N.t formerly Super-
             intendent of the  Women's Hospital, Denver.    12100of 354 pages,
             illustrated.                           Cloth, $1.50 net. 
Aikens'  Hospital  Management
This is just the work for hospital superintendents, training-
school principals, physicians, and all who are actively inter-
ested in  hospital  administration.   The  Medical Record says:
"Tells in concise  form  exactly  what  a  hospital  should  do
and how  it should be run, from the scrubwoman up to  its
financing."
             Hospital Management.   Arranged and edited by  Charlotte A.
             Aikens, formerly Director of Sibley Memorial Hospital,  Washing-
             ton, D. C.  i2mo of 488 pages, illustrated.       Cloth, $3.00 net

Aikens'  Primary  Studies        new (3d)  edition
Trained Nurse and Hospital Review says: "It is safe to say
that  any pupil who has  mastered even the major portion of
this work would be one of the best prepared first  year pupils
who ever  stood for examination."
             Primary Studies for Nurses.  By Charlotte A. Aikens, formerly
             Director of Sibley Memorial Hospital, Washington, D. C. i2mo,of
             471 pages, illustrated.                    Cloth, $1.75 net.

Aikens'  Training-School  Methods   and

the  Head  Nurse
This work not only tells how to  teach, but also what should
be taught the nurse and how much.  The Medical Record says:
" This book is original, breezy and healthy."
             Hospital Training-School Methods and the Head Nurse.   By Char-
             lotte A. Aikens, formerly Director of Sibley Memorial Hospital,
             Washington, D. C.  i2mo of 367 pages.         Cloth, $1.50 net

Aikens'   Clinical   Studies      NEW (3d)  EDITION
This work for second and third year students is written on the
same  lines as the author's successful work for primary stu-
dents.   Dietetic and Hygienic Gazette says there " is a large
amount of practical information in this book."
             Clinical Studies for Nurses.   By Charlotte A. Aikens, formerly
             Director of Sibley Memorial Hospital, Washington, D. C.  121110 of
             56g pages, illustrated                     Cloth, $2.00 net 
 Bolduan & Grund's Bacteriology  2^™
The authors have laid particular emphasis on the immediate
application of bacteriology to  the  art of nursing.   It is an
applied bacteriology in  the truest sense.    A study of all the
ordinary modes of transmission of infection are included.
              Applied Bacteriology for Nurses.  By Charles F. Bolduan, M.D.,
              Director Bureau of Public Health Education, and Marie Grund,
              M.D., Bacteriologist, Research Laboratory, Department of Health,
              City of New York. 12mo of 188 pages, illustrated. Cloth, $1.50 net.

Fiske's  The  Body                      anew idea
Trained Nurse and Hospital Review says  "it is concise, well-
written and well illustrated, and should  meet with  favor in
schools for nurses and with the graduate nurse."
              Structure and Functions of the Body.  By Annette Fiske, A. M.,
              Graduate of the Waltham Training School for  Nurses,  Massa-
              chusetts. i2mo of 221 pages, illustrated.        Cloth, $1.25 net


Beck's Reference  Handbook  new (3d) edition
This book contains  all the information that a nurse requires
to carry out  any  directions  given by the physician.   Tht
Montreal Medical Journal says it is "cleverly systematized ano
shows close observation of the  sickroom and hospital regime.!i
             A Reference Handbook  for Nurses. By Amanda  K. Beck.  Grad-
             iuate of the Illinois Training School fcr Nurses,  Chicago, III.
             32010 volume of ^44 pages.  Bound in flexible leather, $1.25 net


Roberts'  Bacteriology &  Pathology
This new  work is practical in the strictest sense.   Written
specially for nurses, it confines  itself to information  that the
nurse should know.  All unessential matter is excluded.  The
style is concise and to the point, yet clear and plain. The text
is illustrated throughout.
             Bacteriology and Pathology for Nurses.  By Jay G. Roberts, Ph. G.,
             M. D., Oskaloosa, Iowa.  i2mo of 206 pages, illustrated.  $1.25 net. 
DeLee's  Obstetrics  for  Nurses     8%£$
Dr.  DeL,ee's book really considers two subjects—obstetrics
for  nurses and actual obstetric nursing.   Trained Nurse and
Hospital  Review says  the  "book abounds with practical
suggestions, and they  are given  with such clearness that
they cannot fail to leave their impress."
             Obstetrics for  Nurses.  By Joseph  B. DeLee, M. D., Professor of
             Obstetrics at the  Northwestern University Medical School, Chicago.
             i2mo volume of 508 pages, fully illustrated.      Cloth, $2.50 net.


 Davis' Obstetric  & Gynecologic Nursing
                       NEW (4th) EDITION
 The Trained Nurse and Hospital Review says:  " This is one
 of the most practical and useful books ever presented to the
 nursing  profession."  The text is illustrated.
             Obstetric and Gynecologic Nursing.  By Edward P. Davis, M. D.,
              Professor of Obstetrics in the Jefferson Medical College, Philadel-
             phia. 12010 volume of 48a pages, illustrated.   Buckram, $1.75 net

 Macfarlane's  Gynecology for   Nurses
                       NEW (2d) EDITION
Dr. A. M. Seabrook, Woman's Hospital of Philadelphia, says:
"It is a most admirable little book, covering in a concise but
attractive way the subject from the nurse's standpoint."
             A  Reference Handbook of Gynecology for Nurses. By Catharine
             MacfaRLAne, M. D., Gynecologist to the Woman's Hospital of Phila-
             delphia.  32mo of 156 pages, with 70 illustrations. Flexible leather.
             Si.25 net.

Asher's Chemistry  and Toxicology
'Dr. Asher's one aim was  to emphasize throughout his book
{he application  of chemical and toxicologic knowledge in the
 study and practice of nursing.  He has admirably  succeeded.
             i2mo of igo pages. By Philip Asher, Ph. G., M. D.,Dean and Pro-
             fessor of Chemistry, New Orleans  College of  Pharmacy. Cloth,
             $1.25 net.
                              5 
Aikens' Home  Nurse's  Handbook
The point about this work is this:  It tells you, and shows you
just how to do those little things entirely omitted from other
nursing  books, or  at best only  incidentally  treated.    The
chapters on  "Home Treatments" and  " Every-Day  Care of
the Baby," stand out as particularly practical.
             Home Nurse's Handbook.  By Charlotte A. Aikens, formerly Di-
             rector of the Sibley Memorial Hospital, Washington, D. C.  i2mo of
             276 pages, illustrated.                      Cloth. $1.50 net

Eye, Ear, Nose, and  Throat Nursing
This book is  written from beginning to end for the  nurse.  You
get antiseptics, sterilization, nurse's duties, etc.  You get an-
atomy and physiology, common  remedies, how to invert the
lids,  administer  drops,  solutions,  salves,  anesthetics, the
various diseases and their management.    New (2d) Edition.
             Nursing in Diseases of  the Eye, Ear, Nose  and Throat.  By  the
             Committee on Nurses of the  Manhattan Eye, Ear and Throat Hospital.
             i2tno of 291 pages, illustrated.                Cloth, $1.50 net

Paul's Materia Medica           NEW (2d)  edition
In this work  you get definitions—what  an alkaloid is, an in-
fusion, a mixture,  an ointment,  a solution, a  tincture, etc.
Then a classification of drugs  according to their physiologic
action, when to administer drugs, how  to  administer them,
and how much to give.
             A Text-Book of Materia Medica for Nurses. By George P. Paul.M.D.,
             Samaritan Hospital, Troy, N. Y. 121110 of 282 pages.  Cloth, $1.50 net

Paul's Fever Nursing              NEW(3d)  Ed,t.on
In the first part you get chapters  on fever in general, hygiene,
diet, methods for reducing the fever, complications.   In the
second part each infection is taken up in  detail.  In the third
part you  get antitoxins  and vaccines, bacteria, warnings of
the full dose of drugs, poison antidotes, enemata, etc.
             Nursing in the Acute Infectious Fevers.  By George P. Paul, M. D.
             i2moof 275 pages, illustrated.                Cloth, $1.00 net 
McCombs'  Diseases of  Children  for  Nurses
                 NEW (3d) EDITION—JUST ISSUED
Dr. McCombs' experience  in lecturing to nurses has enabled
him to emphasize/^?/ those points that nurses  most need to know.
National  Hospital  Record  says:  "We  have needed a  good
book  on  children's diseases and this volume admirably fills
the want."   The  nurse's  side  has  been  written  by  head
nurses, very valuable being the work of Miss Jennie Manly.
             Diseases of Children for Nurses.  By Robert S. McCombs, M. D.,
             Instructor of Nurses at the Children's Hospital of Philadelphia. i2mo
             of 509 pages, illustrated.                    Cloth, $2.00 net

Wilson's  Obstetric  Nursing  NEW m edition
In  Dr. Wilson's work the entire subject is covered from the
beginning of pregnancy,   its course, signs, labor, its actual
accomplishment,  the  puerperium and care of the infant.
American Journal of Obstetrics says:  " Every page empasizes
the nurse's relation to the case."
             A Reference  Handbook of Obstetric Nursing. By W. Reynolds
             Wilson, M.D., Visiting Physician to the Philadelphia Lying-in Char-
             ity.  32010 of 355 pages, illustrated.      Flexible leather, $1.25 net

American  Pocket  Dictionary  NEw (9«h) edition
The  Trained Nurse and Hospital  Review says:   "We  have
had many occasions to refer to this dictionary, and  in  every
instance we have found the desired information."
             American Pocket' Medical Dictionary.  Edited by W. A, Newman
             Dorland, A. M.,  M. D., Loyola University, Chicago.   Flexible
             leather, gold edges, $1.00 net; with  patent thumb index, $1.25 net

Lewis' Anatomy   and   Physiology   EDT,?,oS
Nurses Joarnal of Pacific Coast says "it  is not in any  sense
rudimentary, but comprehensive in its  treatment of the sub-
jects."  The low price makes this  book particularly attractive.
             Anatomy and Physiology for Nurses. By LeRoy Lewis, M.D., Lec-
             turer on Anatomy  and Physiology for Nurses, Lewis Hospital, Bay
             City, Mich.  i2mo  of 326 pages, 150 illustrations.   Cloth, $1.75 net 
Bohm & Painter's  Massage
The methods described are those employed in Hoffa's Clinic
—methods that give results.  Every step is illustrated, showing
you the  exact  direction of the strokings.   The pictures are
large.  You get the technic used in Professor Hoffa's Clinic.
             Octavo  of 91 pages, with 97 illustrations.  By Max Bohm, M. D.,
             Berlin, Germany.  Edited by Charles F. Painter, M. D., Professor
             or Orthopedic Surgery, Tufts College Medical School, Boston.
                                                Cloth, $1.75 net
SECOND
EDITION
Grafstrom's  Mechano-therapy
Dr. Grafstrom gives you here the Swedish system of mechan-
otherapy.  You are given the  effects of certain movements,
gymnastic  postures,  medical  gymnastics, general  massage
treatment, massage for the various conditions.   The illustra-
tions are full-page line drawings.
             Mechanotherapy (Massage and Medical Gymnastics).  By Axel V.
             Grafstrom, B. So, M. D., Attending Physician Gustavus Adolphus
             Orphanage, Jamestown, New York. i6mo of 200 pages.
                                                Cloth, $1.25 net

Friedenwald and  Ruhrah's  Dietetics  for

lNUrSeS                                  NEW (3d) EDITION
This work has been prepared to meet the needs of the  nurse,
both in training school and after graduation.  American four-
nal of Nursing says it "is exactly the book for which  nurses
and others have long and vainly sought."
             Dietetics for Nurses.  By Julius  Friedenwald, M. D.t Professor of
             Diseases of the Stomach, and John Ruhrah,  M.D., Professor of
             Diseases of Children, College of Physicians and Surgeons, Baltimore.
             i2mo volume of 431 pages.                   Cloth, $1.50 net

Friedenwald & Ruhrah on Diet      E™
This work is a  fuller treatment of the subject of  diet,  pre-
sented along the same lines as the smaller work.   Everything
concerning diets,  their preparation  and use,  coloric values,
rectal feeding, etc., is here given in the light of the most re-
cent researches.
             Diet in Health and Disease. By Julius Friedenwald, M.D., and
             John Ruhrah, M.D.  Octavo volume of 857 pages. Cloth, $4.00 net 
Pyle's Personal  Hygiene       NEw «<» ed.t.on
Dr. Pyle's work  discusses the care of the teeth, skin, com-
plexion and hair, bathing, clothing, mouth breathing, catch-
ing cold;  singing, care of the eyes,  school hygiene,  body
posture,  ventilation,  heating, water supply,  house-cleaning,
home gymnastics, first-aid measures, etc.
             A Manual of Personal Hygiene. Edited by Walter L. Pyle, M. D.,
             Wills Eye Hospital, Philadelphia, umo, 543 pages of illus. $1.50 net

Galbraith's  Personal   Hygiene and  Physical
Training  for Women                     illustrated
Dr. Galbraith's book tells you how to train the physical pow-
ers to their highest degree of  efficiency by means of fresh air,
tonic baths, proper food and clothing, gymnastic and  outdoor
exercise.  There are  chapters  on  the  skin, hair, development
of the form, carriage, dancing, walking,  running, swimming,
rowing, and other outdoor sports.
             Personal Hygiene and Physical Training for Women.  By Anna M.
             Galbraith, M.D., Fellow New York Academy of  Medicine,  umo of
             371 pages, illustrated.

Galbraith's  Four  Epochs of  Woman's  Life
This book covers each epoch fully, in a clean, instructive way,
taking up puberty, menstruation, marriage,  sexual  instinct,
sterility, pregnancy, confinement, nursing, the menopause.
             The  Four Epochs of Woman's Life. By Anna M. Galbraith, M. D.
             With an Introductory Note by John H.  Musser, M. D., University of
             Pennsylvania. i2mo of 241 pages.            Cloth, $1.50 net

Griffith's  Care of the  Baby    NEw (6.h) edition
Here is a book that tells  in simple, straightforward language
exactly how to care for the baby in health and disease; how
to keep it well and strong;   and  should it fall sick, how to
carry out the  physician's instructions and nurse it  back  to
health again.
             The Care of the Baby.   By J. P. Crozer Griffith, M.D., Univers-
             ity of Pennsylvania. 12010 of 458 pages, illustrated. Cloth, $1.50 net 
Aikens' Ethics  for Nurses           just ready
This book emphasizes the  importance of  ethical training.  It
is a most excellent  text-book, particularly  well  adapted for
classroom  work.   The illustrations and practical problems
used in the book are drawn from life.
              Studies  in Ethics for Nurses.  By Charlotte A. Aikens, formerly
              Superintendent of Columbia Hospital, Pittsburg,  nmo of 318 pages.
                                                Cloth, $1.75 net.

Goodnow's  History of  Nursing  ready soon
Miss Goodnow's work gives the main facts of nursing history
from the beginning to the present  time.  It is suited for class-
room work or postgraduate reading.   Sufficient details  and
personalities have been added to give color and interest,  and
to present a picture of the  times described.
              History of Nursing. By Minnie Goodnow, R.N., formerly Super-
              intendent of the Women's  Hospital, Denver.  i2mo of 300 pages,
              illustrated.

Berry's Orthopedics for  Nurses      ready
The  object of Dr.  Berry's book is to supply the nurse with a
work that discusses clearly and simply the diagnosis, prog-
nosis and treatment of the  more common and important ortho-
pedic deformities.   Many illustrations are included.   The
work is very practical.
              Orthopedic Surgery for Nurses.  By John McWilliams Berry,
              M.D., Clinical Professor of Orthopedics and Rontgenology, Albany
              Medical College, iamo of 100 pages, illustrated.  Cloth, $1.00 net.

Whiting's  Bandaging
This new work takes up each bandage in  detail, telling you—
and  showing  you by original illustrations—just how  each
bandage  should be applied, each  turn made.  Dr. Whiting's
teaching experience has enabled him to devise means for over-
coming common errors in applying bandages.
              Bandaging.  By A. D. Whiting, M.D., Instructor in Surgery at the
              University of Pennsylvania. i2mo of 151 pages, with 117 Illustra-
              tions.  Cloth, $1.25 net.
10 
Smith's Operating-Room            just issued
The object is to show you how to assist the surgeon according
to the  newest operative technic.  You  get the result of active
experience systematized, and in concise form.  You get a thor-
ough digest of every essential; detailed lists  of  instruments;
glossary of medical  terms.  Every  phase  of the subject  is
covered by  ample,  practical instruction.
             The  Operating-Room.  A Primer for Nurses.  By Amy Armour
             Smith, R.N., formerly Superintendent of Nurses at the Woman's
             Hospital of the State of New York. 12mo of 295 pages, illustrated.
                                                 Cloth, $1.50 net.

Bandler's The  Expectant Mother  justout
This is an  anatomy,  physiology  and  hygiene covering  those
points and functions  concerned in child-bearing and designed
for the use of the nurse and  the mother.  Every question of
interest to the  expectant mother is treated.
             The  Expectant Mother.  By S. Wyllis Bandler,  M. D., Professor
             of Diseases of Women, New York Post-Graduate Medical School
             and  Hospital. 12mo of 300 pages, illustrated.    Cloth, $1.25 net.

Winslow's  Prevention of  Disease     iSSjuesJ
Here you get a  practical guide, giving you briefly the means
to avoid the various diseases described.  The chapters  on diet,
exercise, tea, coffee, alcohol, prevention of cancer, etc., are of
special  interest.  There are, besides, chapters on  the  preven-
tion of malaria,  colds, constipation, obesity, nervous disorders
and tuberculosis.  It is a record of twenty-five  years' active
practice.
             By Kenelm Winslow, M.D., formerly Assistant Professor of Com-
             parative Therapeutics, Harvard Medical School.  12mo of 348
             pages, illustrated.

Brady's Personal Health              justout
This is different  from other health books.  It is written  by a
physician with some fifteen years' experience in writing for the
laity.  It  covers  the entire  range  of  health questions—care of
mouth and teeth, catching cold, adenoids  and  tonsils, eye and
ear, ventilation,  skin, hair and nails, nutrition,  nervous ail-
ments, etc.
             Personal Health.   A Doclor Book for Discriminating People. By
             William Brady, M.D., Elmira, N.Y.  12mo of 400 pages.
                                                 Cloth, $1.50 net.
11 
Hoxie &  Laptad's  Medicine for  Nurses
            Medicine for Nurses and Housemothers.  By George
            Howard Hoxie, M. D., University of Kansas;  and
            Pearl, L. Laptad.    12mo of 351 pages, illustrated.
            Cloth, $1.50 net.                 New (2d) Edition.
This book gives you information that will help you to carry  out the
directions of the physician and care for the sick in emergencies.  It
teaches you how to recognize any signs and changes that may occur be-
tween visits of the physician, and, if necessary, to meet conditions until
the physician's arrival.


Boyd's  State  Registration  for  Nurses
            State Registration for Nurses. By Louie Croft Boyd,
            R. N., Graduate Colorado Training School for Nurses.
            Octovo of 149 pages.  Cloth, $1.25 net. New (2d) Edition.


Morrow's Immediate  Care of  Injured
            Immediate Care of the Injured. By Albert S. Mor-
            row, M. D., New York City Home  for Aged and In-
            firm.  Octavo of 354 pages,  with 242 illustrations.
            Cloth, $2.50 n«t.                New  (2d) Edition.


deNancrede's  Anatomy          NEW am edition
            Essentials of Anatomy.   By Charles B. G. deNan-
            crede, M. D., University of Michigan.  12mo of 400
            pages, 180 illustrations.            Cloth, $1.00 net.


Morris'  Materia  Medica        NEw km edition
            Essentials of Materia Medica, Therapeutics, and Pre-
            scription  Writing. By Henry Morris, M. D.  Re-
            vised by W. A.  Bastedo, M. D., Columbia University,
            New York.  12mo of 300 pages, illustrated.
                                          Cloth, $1.00 net.


Register's  Fever Nursing

            A Text Book on Practical Fever Nursing.   By Edwartj
            C. Register, M. D., North  Carolina Medical College.
            Octavo of 350 pages, illustrated.     Cloth, $2.50 net. 
 
aavaan ivnuiivin
a INI JIU3
> Aavaan ivnouvn
gNiDiasw jo Aavaan ivnouvn
3NiDia3w jo Aavaan ivnouvn
V -5
/^Sb l t&S<y\ $ /^ I  ^\
 
   MIDDLETOWN, »*
   JANUARY 75
I» e 'rtOftidity Bound