CIRCULARS Q£ INFORMATION OF THE V7 BUREAU OF EDUCATION. 1ST o’. 1-1879. TRAINING SCHOOLS FOR NURSES. WASHINGTON: GrOVEENMENT PRINTING OFFICE, 1879. CIRCULARS OF INFORMATION OF TIIE v7 BUREAU OF EDUCATION. No., 1-1879. TRAINING SCHOOLS FOR NURSES. WASHINGTON: GOVERNMENT PRINTING OFFICE. 1879. LETTER. Department of the Interior, Bureau of Education, Washington, D. C., December 20, 1878. Sir: Education, as you are aware, now less and less limited to the preparation of persons for the learned professions, is, happily, more and more recognized as possessed of power to fit the young for the industrial pursuits of life. Schools for this purpose are on the increase. Those who have carefully studied the life of Florence Nightingale have learned that her eminent attainments were not the fruit of accident, but that she acquired them in a training school in Germany. The experience of nurses in our late war has extended the interest in this subject in our country. Several training schools for nurses established in our cities have vindicated the wisdom of their founders. They disseminate much useful information in regard to the care of the sick, and, by helping to shorten the period of suffering, save many lives. Moreover, by render- ing women skilful, training schools for nurses secure for them employ- ment they would not otherwise be able to find, and fitly supplement schools of medicine. The subject of the extension and management of these institutions has largely entered into the correspondence of this Office. The great superiority of well trained nurses, manifested in the care of yellow fever patients in the late epidemic, has led to the hope that schools for nurses may be speedily established in many cities that are not yet supplied. In addressing the training school for nurses,in this city recently, I had occasion to summarize much of the information desired from this Office in many quarters by those who seek to promote the establishment of similar schools. In answer to such requests, and to relieve the Office from much correspondence, I submit the following for publication, and have the honor to be, sir, very respectfully, your obedient servant, JOHN EATON, Commissioner. Hon. Carl Schurz, Secretary of the Interior. Approved, and publication ordered. C. SCHURZ, Secretary. TRAINING SCHOOLS FOR NURSES. Ladies and Gentlemen (officers and friends of the Washington Training School for Nurses): I have watched with great interest the beginning and progress of your plans. The sickness and death of an infant child, which prevented the delivery of this address some months since I may say, greatly quickened my interest in its preparation. At first it seemed as if the little one’s father and mother alone could per- form the difficult task required for his nursing. In our exhaustion the best of mothers and neighbors, with all knowledge and skill possible without special instruction, came to our aid. At last we secured a lady of excellent character, good general education, specially trained in the school for nurses in Boston, and experienced in hospital and private nursing. Our relief can hardly be described. We soon saw that all that it seemed to us that we could do well she could do better, excelling us even in the skill required in the delicate handling of the little one, while carrying out with the utmost fidelity the directions which the best medical skill could give, keeping that full record of temperature, pulse, respiration, and other symptoms that enabled the physician to judge with the utmost accuracy of the effects of treatment and the progress of the disease. I speak, therefore, not solely from the standpoint of book information, or the observation of facts in the training of nurses in this country and in Europe, but from that of the liveliest personal interest. A similar experience on the part of others I am sure could hardly fail to point to a similar conclusion. To many, doubtless, the establishment of a school for nurses will seem extreme foolishness; yet one cannot well foresee all the possibilities of good in this enterprise. So little has been thought and known on this phase of education, that, in this country at least, up to the beginning of the late war, Florence Nightingale occurred to most minds as the only representative nurse, and she to most as a miracle or an accident, whereas she is neither, but a genuine Englishwoman of ability and culture, who had received a thorough training as a nurse in the school at Kaiserwerth, on the Bhine. I desire to state in the briefest manner certain facts and observations which are, to my mind, a vindication of the wisdom of your undertaking. During the last years of financial distress large numbers have appealed to you for something to do. You have sought to aid them in finding employment, but in doing this you have found a general demand for higher skill than most of the applicants possessed. Among the indus- tries meriting consideration, your attention was specially called to one 5 6 CIRCULARS OF INFORMATION FOR ]879. supplemental to the medical profession in the care of the sick, or associated with parental duties in the care of the infant; an industry often delicate, always most honorable, and affording, especially in our cities, occupation to many men and women, if persons properly qualified could be found. In the most common sense way, you propose to meet one of these demands for labor by a school in which those with proper qualifications may fit themselves to answer the call for nurses. Having carefully ma- tured your plans, you come to the public for its approval. Your school, once opened, is immediately seen to relate closely, first, to all in the community who for any reason, whether on account of infancy or old age, or bodily or mental disease, require the care of the nurse; second, to all who wish to devote themselves to these duties; third, to the medi- cal profession. ' What parent has not sighed for a more skilful nurse*? What physician has not found all his skill and toil for his patient fruitless because the nursing did not correspond with his directions? IIow many bereaved ones, as they remember their departed, mourn that the nurse did not better understand this or that direction of the physician, this or that turn of the disease! Such an enterprise as you have undertaken presents many difficulties in itself, that it will take time to remove. But your board of officers, rep- resenting the several interests out of which the enterprise springs, is well fitted to assure its continuous growth and final success. Other obsta- cles may be expected to arise from misapprehensions as to what you propose. The fact that a training school for nurses is new will be sufficient to arouse opposition in some quarters. Need I say that without and be- yond the influence of Christianity this objection might be fatal? For other religions leave no room for what is new, and do little to incul- cate those sentiments of benevolence which make it a duty and an honor to relieve every form of human distress. The sick, the orphan, the de- formed, those deprived of the power of speech or of the senses of sight and hearing, beyond their own family limits, and sometimes even within them, are considered burdens to be cast off at convenience, wastes of society, for whom no provision is to be made by the civil or social or- ganization. Moreover, no other than Christian civilization has given to woman the sphere you offer her through this school. But from the earliest dawn of Christianity woman’s {dace in the family was exalted; the church formally recognized her in the distribution of its offices; she took new rank and was given larger power in the organized relations of society. Aside from the responsibilities confided to women in the com- mon walks of life from the days of the Sanctimoniales, there have been those who, from the highest religious motives, have devoted their lives to the relief of human suffering. You will readily recall Olympia, who was described by Chrysostom “as most noble in character, and for her ex- posure in behalf of others as living in perpetual fellowship with pain.” 7 TRAINING SCHOOLS FOR NURSES. Lecky, in liis History of European Morals, says tliat “ a Eoman lady named Fabriola, in the fourth century, founded at Borne, as an act of penance, the first public hospital,” and declares that “the charity planted by that woman’s hand overspread the world, and will alleviate to the end of time the darkest anguish of humanity.” You will recall the story of Paula, a Eoman lady, descended from the Scipios and the Gracchi, who, leaving Eome in 385 accompanied by her daughter, took up her residence in Bethlehem of Judea, and assembled around her a community of women who spent their days in prayer and good works From an old translation we learn that Paula “ was marvellous debo- nair, and piteous to them that were sick, and comforted them and served them right humbly. She laid the pillows aright and in point, she rubbed their feet and boiled water to wash them.” When the Bishop of Paris, in 6G0, founded a hospital afterwards known as the Hotel-Dieu, nursing sisters attended upon the sick from motives of piety. This and other hospitals founded in the early centuries in France and the Xetherlands are still served by the same sisterhoods. Not far from this period we meet with the Gray Sisters, who enrolled in their ranks queens, princesses, wives of burghers, as well as poor widows and maid- ens ; the married women serving only occasionally, the widows and un- married devoting themselves especially to nursing the sick in the hos- pitals. Then appeared the Begumes, or hospital sisters, who, after a time, organized a community at Liege. Of these afterwards, Howard, the celebrated philanthropist, wrote: “There are twenty of them in one hospital; they rise at four, and are constantly employed about their numerous patients; they prepare as well as administer the medicines. The directress of the pharmacy has just celebrated her jubilee, or the fiftieth year of her residence in the hospital.” Time would fail us to describe the Sisters of Martha, the Sisters of Elizabeth, the Sisters of Charity, the Blind Sisters of St. Paul, or the Ursulines (whose founder began her first community in a garret with five poor children), the Sisters of Mercy, the Little Sisters of the Poor, and scores of others. Educators will recall with gratitude the fact that there naturally grew up with these organizations schools for the education of girls; and doctors of medicine who remember that their predecessors in these early cen- turies were astrologers and chemists will also gratefully remember the fact that these sisters in the hospitals wTere collecting a fund of knowl- edge respecting the treatment of disease and the uses of remedies which was turned to account in shaping a rational theory when medicine in the sixteenth century took its place among the experimental sciences. Early in the seventeenth century, Vincent De Paul, in his efforts to ameli- orate the condition of the poor and the suffering, invited women to his aid. Charitable societies were organized, not only in Paris but in the villages and small towns of France, and “ the female members relieved personally the wants of the poor, made their beds, and prepared their food and 8 CIRCULARS OF INFORMATION FOR 1879. medicines.” A French lady of wealth, Madame Le Gras, came to the aid of Vincent De Paul, and we have as one result of their united efforts the first organization of the Sisters of Qharity, among us the most numer- ous and best known of the sisterhoods. Before the seventeenth century closed, these Sisters were sent to fields of battle in groups of two or four to care for the wounded. They were invited to the hospitals of besieged towns, and to the hospitals of Warsaw when the plague broke out in Poland. They were found in the prison infirmaries where condemned felons lay cursing and writhing in their fetters; and wherever, since, war or pestilence has prevailed, there these Sisters have appeared to nurse the sick and relieve the distressed. In Canada, too, we have the record of nurses at Quebec, members of religious sisterhoods, as early as 1640, and at Montreal, where a hospital was built a few years later. In that year, when the small small-pox raged among the Indians gathered at Quebec, the labors both of the Ursulines and of the hospital nuns were prodigious. In the infected air of their miserable hospitals, where sick and dying savages covered the floor and were packed one above another in berths, amid all that is distressing and revolting, with little food and less sleep, these women passed the rough beginning of their new life. t But if these facts should suffice to convince our objector of the excel- lences and long experience claimed for these sisterhoods, another may object that your organization is not under ecclesiastical direction and restraint. But here again there is ample ground for your vindication. Not a few, long ago, felt embarrassed because there was no well defined an d generally approved method by which woman might prosecute her great work in the relief of suffering without joining some ecclesiastical order. Fortunately, there is a valuable experience in this direction. At Kaiser- werth, a small town near Diisseldorf, on the Rhine, a manufacturer be- came bankrupt in 1822, and his workmen were reduced to poverty. Their pastor, Mr. Fliedner, went to England to collect funds for their church. There he met Mrs. Fry, and as a result of this acquaintance his mind was turned toward the objects engaging her attention. lie founded first an institution for the discharged women convicts; a lunatic asylum, an orphan asylum, and an infant school followed, and, in 1836, a hospital. This he had been led to think of, partly from the want of good nurses for the sick, partly from regret (as he expressed it) to see u how much good female power was wasted,” partly from a perception that the women who had voluntarily come forward to assist him required a larger sphere for the exercise of their faculties. But the chief purpose of this hospital is to serve as a training school for nurses. Every one who offers herself (and there is no lack of applicants) is taken on trial for six months, during which time she pays for her board and wears no distinctive dress. If she persists in her vocation and is accepted, there is a further probation of from one to three years; she then assumes the hospital dress, and her board and lodging are free. Here Miss Florence Night- ingale went through a regular course of training before she took charge TRAINING SCHOOLS FOR NURSES. 9 of tlie Female Sanitarium in London. Recognizing the value of this training, Sir Sidney Herbert requested the assistance of Miss Nightin- gale in the Crimean war. After using some arguments for the task drawn from the scenes “ full of horror” to which he invited her, lie added very appropriately: “If this succeed, an enormous amount of good will be done now, and to persons deserving everything at our hands; and a prejudice will be broken through, and a precedent estab- lished, which will multiply the good to all time.” So satisfactory were the efforts of Miss Nightingale and her associate nurses in the Crimea that Mr. Stafford declared that “ success more complete had never before attended human efforts. They could scarcely realize without person- ally seeing it the heartfelt gratitude of the soldiers to these noble ladies, or the amount of misery they had relieved, or the degree of comfort— ho might say joy—they had diffused.” After Miss Nightingale’s return to England, the school for nurses was opened at St. Thomas’s Hospital, in London, and others have followed. One in Liverpool has especially attracted attention. When civil war broke out in our country, woman’s glory in this work of relief outshone all her past achievements. The representatives of the several sisterhoods were at once ready for service. Woman was the first to start that movement for relief which resulted in the organization of the United States Sanitary Commission. On the very day President Lincoln made his first call for troops, the women of Bridgeport, Conn., and Charlestown, Mass., formed societies for the relief of the sick and wounded, and a few days afterwards a society was organized at Lowell the primary object of which was to “ supply nurses for the sick and wounded.” On the 29th of April, 1861, a call for a public meeting of “ the women of New York, and especially to those engaged in preparing against the time of wounds and sickness in the Army,” signed by Mrs. General Dix, Mrs. Hamilton Fish, and ninety other prominent ladies of New York, was issued. One of the objects of the organization, to perfect which the meeting was called, was “the offer of personal service as nurses.” The meeting was duly held, and within a few days (May 18) a committee then appointed submitted its plans to the War Department. One of these was stated to be “the selection, out of several hundred candidates, of one hundred women, suited in all respects to become nurses in the general hospitals in the Army. These women the distin- guished physicians and surgeons of the various hospitals in New York have undertaken to educate and drill in a most thorough and laborious manner; and the committee ask that the War Department consent to receive, on wages, these nurses, in such numbers as the exigencies of the campaign may require.” This branch of the work was prosecuted with such zeal that early in the following October Dr. Bellows, the president, was able to report: “Up to this date the association has forwarded thirty-two nurses to Washington. Miss Dix has received them, and as many others, per- 10 CIRCULARS OF INFORMATION FOR 1879. haps, from other quarters, of similar effieiency and worth. * # * A few other nurses are in training, and more will be put in training if re- quired. # * * It seems important, therefore, that the training of at least a hundred good nurses should be -proceeded with.” Much has been written of woman’s work in the civil war, but books have failed, and always will fail, to tell fully the thrilling tales of her heroism and of the relief experienced at her hands by the American soldiery. These historical observations, recalled as replies to objections, would be seriously incomplete if I did not refer particularly to the opinions and acts of the medical profession upon this subject. As early as 1825 Dr. Gooch, an eminent English physician, advocated the founding of an order somewhat resembling the Sisters of Charity. Respecting the qualifica- tions of its members he said: “Let them be women of good, plain sense, of kindness of disposition, of indefatigable industry and deep piety. Let them receive not a technical and scientific, but a practical medical education. Let them be placed both as nurses and pupils in hospitals. Let their attention be pointed by the attending physician to the prin- cipal symptoms by which he distinguishes a disease. Let them be made as familiar with the best remedies (which are always few) as they are with barley water, gruel, and beef tea. Let them learn the rules by which these remedies are to be employed. Let them be examined frequently on these subjects in order to see that they carry these rules clearly in their minds. Let books be framed for them containing the essential rules briefly, clearly, and untechnieally written.” In our own country distinguished physicians have given their emphatic indorsement to efforts to prepare nurses for service. At the meeting of the Ladies’ Military Relief Committee, at the Cooper Institute, New York, April 29,1801, already referred to, Dr. Wood, speaking in behalf of Bellevue Hospital, said that that institution offered to aid the ladies in their good work by advice and by practically training at least fifty nurses for this purpose. Dr. Valentine Mott said that while not every woman could be a nurse, intelligent and competent women properly taught could be speedily fitted for the sick room. Dr. A. H. Stephens said that women of discreet manners and strong constitutions should be selected. At the meeting of the American Medical Association in this city in 18G8, S. D. Gross, m. d., ll. d., spoke upon the training of nurses; he said: “I am not aware that the education of nurses lias received any attention from this body; a circumstance the more surpris- ing when we consider the great importance of the subject. It seems to me to be just as necessary to have well trained, well instructed nurses as to have intelligent and skilful physicians. I have long been of the opinion that there ought to be in all the principal towns and cities of the Union institutions for the education of men and women whose duty it is to take care of the sick and to carry out the injunctions of the medi- cal attendant. There is hardly one nurse, of either sex, in twenty who TRAINING SCHOOLS FOR NURSES. 11 Inis a perfect appreciation of tlie requirements of tlie sick room, or who is capable of affording the aid and comfort so necessary to a patient when oppressed by disease or injury. It does not matter what may be the skill of the medical practitioner, how assiduous or faithful he may be in the discharge of his functions as a guardian of health and life, his efforts can be of comparatively little avail unless they are seconded by an intelligent and devoted nurse. * * * Myriads of human beings perish annually in the so called civilized world for the want of good nursing.” At the meeting the following year, Dr. Gross, as chairman, presented the report of the committee of the association upon the subject The report called attention to the lack of organized effort in this direc- tion; enlarged on the importance of good nursing; on the universal interest which should be taken in it, since it affected every class of society, as an important adjunct to the services of the physician; on the history of efforts of this kind in other countries; called attention to the great number of women in this country of whom good nurses might easily be made, and for whom it would be a natural and useful employ- ment; and concluded with several suggestions, the first being that schools for the training of nurses should be attached to hospitals, the teaching to be furnished by the medical staff and the resident physician in each place. He also suggested the formation of schools under the guardianship of the county medical societies throughout the country for instruction in this art as a means for the further supply of trained nurses, a demand1 for whom would arise as soon as it was known that they could be obtained. Here I would call your attention to the fact that the training of nurses is substantially an educational work, and may be urged purely on edu- cational grounds; that persons employed as nurses can be best fitted for this delicate and responsible duty by special training and instruc- tion; and that nursing is not necessarily the work either of physicians or of religious bodies, though done under the direction of the former and not subversive of the latter. To establish schools for training nurses is not antagonistic to either; it is rendered necessary by the times in which we live. While man has always been subject to disease and has always pos- sessed the power of sympathizing with the sufferings of his fellows and the capacity to alleviate them, the church was the first instrumentality which enjoined the performance of this duty. Nor need this fact sur- prise us. The teachings of Christ are the origin of this as of every other modern philanthropy. The education and civilization of the Greek were unduly physical and esthetic; of tlie Hebrew, too exclusively moral and religious, and so of other ancient civilizations. Christianity only is uni- versal in its aims, methods, and results. Education has always been the chief instrumentality of those who wish to improve their fellow men. Morals, philosophy, and science all contribute to its stores and depend on it for perpetuation and increase. 12 CIRCULARS OF INFORMATION FOR 1879. The church has used it for the training of its officials, and from the schools of the church all modern instruction in theology, law, and medi- cine has arisen or been suggested. The necessities of modern nations have forced states to imitate the church and to encourage aud hise edu- cation for the promotion of civic ends. Thus the same doctrine as to education has been reached by the church and the state, the one need- ing intelligence in its believers, the other in its citizens. The modern state may thus be regarded as composed of individuals imbued with or influenced by the humane spirit of Christianity, and as assuming certain necessary humane functions and encouraging voluntary humane efforts without antagonizing the work of the church or denying its teachings. As I have already said, education is the means of propagating ideas, conveying information, and solving the problems of society. There is much popular misconception as to its scope. It may and should be ap- plied to physical and manual as well as mental training; and if more generally applied in this way, the usual dislike of manual labor and the industrial troubles of our day would disappear, in a great measure, to the common profit of capital and labor. Apprenticeship is rapidly becoming a lost institution in this country, and industrial schools for training in arts and trades will no doubt take its place. In this we shall follow the example already set by other na- tions. It is on these principles and for these reasons that the founders of the Washington Training School for Nurses have acted. In the light of experience, you propose that this special industry, nursing, in the language of Miss Woolsey, shall be rescued from the hands of ignorant, unfaithful people, so far as now enrployed, and made, as it deserves to be, a supplemental and honorable profession. The re- lation of the nurse to the physician is exactly expressed in the words which Shakspere puts into the mouth of Helena when she offers the King her father’s remedy for his illness: I come to tender it, and my appliance, With all hound humbleness. — (All’s Well that Ends Well, act II, scene 1.) What are the qualifications of a nurse ? Some one in answer has enumerated obedience, presence of mind, cheerfulness, sobriety, pa- tience, forbearance, judgment, kindness of heart, a light, delicate hand, a gentle voice, a quick eye. Another has said of the nurses in our late war: “The service required a combination of rare qualities; zeal was not enough; it was necessary to add to this, knowledge; and to knowl- edge, patience; and to patience, wisdom; and to wisdom, health; and to health, great powers of endurance.” A generation ago, an American physician, emphasizing the duties of the nurse, observed: “ It may appear a refinement to talk of the educa- tion of the nurse, but there is not greater difference between noonday and night than between an educated and ignorant nurse. The former is often an aid to the physician, not only in carrying his orders into effect, TRAINING SCHOOLS FOR NURSES. 13 but in informing him of symptoms that have occurred in his absence, whereas the ignorant nurse is a source of constant anxiety and too often assumes the privilege of acting in direct contradiction to his orders, and according to her own opinions.” Several training schools for nurses have met with a fair measure of success in this country. The Lying-in Charity, in Philadelphia, for many years has provided means for preparing persons for this department of nursing, and since 1814 one hundred and ninety-five nurses have received regular and ex- plicit instruction in its lecture room. More than six thousand persons have applied for nurses, of whom about four thousand have been sup- plied. In New York, in May, 1873, and in Boston, in November of the same year, successful efforts were inaugurated for the establishment of schools for nurses. The Johns Hopkins University is considering similar plans in connection with its hospital in Baltimore. At New Haven, Conn., a school was organized with the additional purpose of preparing nurses for mission work. The importance of nursing for the poor has been recently pointed out in an admirable article by Mrs. Gladstone, which gives hints on nursing among the cottagers in Great Britain. The Boston school began with six pupils and in three years had twenty- five. In their last report they say: “One of our greatest obstacles in training valuable nurses is the want among them of robust health.” The Bellevue Training School for Nurses has published its experience more fully, and there is such similarity of plan and method in the several schools that for our purpose it will suffice to give outlines of the plans and experiences of this school. They secured for superintendent a lady who previously had charge of the nursing staff of University College Hospital in London ; the term began with a class of six. The persons admitted must be over twenty-one years of age and must present a cer- tificate from a clergyman and a physician that they are of good character and in sound health. They are received for one month on probation, during which time they are lodged and boarded at the expense of the school, but they receive no other pay for their services if they leave before the expiration of the month or are found unsuitable for further training. Those who satisfy the conditions of the probation are accepted as pupil nurses and must sign a written agreement to remain at the school one year and after that be subject to the orders of the school committee for another* year. Bor their year of tutelage they receive board, lodging, and $10 a month for personal expenses. At the expiration of the year they are promoted to such positions as they are found competent to fill, and receive a proportionate increase of salary. When the full term of two years is ended with approval, they are permitted to choose their own fields of labor, either in hospitals, private families, or among the needy. In the report of the school for 1874 the secretary says: “We were at first disappointed at the few desirable applicants who presented them- 14 CIRCULARS OF INFORMATION FOR 1879. selves to be trained. Some were entirely unfitted by incapacity, physi- cal weakness, or because, belonging to the ignorant and uneducated class, they fell below our standard of admission. But the majority were unwilling to devote two years to gaining a career, seeming to care little for really perfecting themselves in their profession. * * * This in- difference to thoroughness is the stumbling block in the way of all edu- cators, and has proved one of our most serious difficulties. * * * The scarcity of professionally trained nurses throughout the country was perceived in the effort to find women capable of acting as head nurses. Advertisements, applications to doctors, and, in fact, all available means only brought us four, one of whom we were soon forced to discharge for inefficiency. * * * The degree of success in the work and the appre- ciation of it by the hospital authorities are indicated by the fact that, whereas there was considerable hesitation in intrusting three wards to their control, they were soon requested to undertake the nursing of the entire hospital.” As the object of the school came gradually to be understood through- out the country, applications from women deliberately choosing this profession, and desiring to learn it thoroughly, were too numerous to be granted. In May, 1875, the first class of six graduated ; a second class of seven passed the examination and graduated January 31, 1876. Last spring a class of thirteen was graduated. In his address to the class Dr. William II. Draper said: u It gives me great pleasure to testify in this way to the esteem in which I hold this institution. I consider it one of the wisest and best in the city, and I regard your occupation in no respect as inferior to my own. It is curious to observe how, in this age, science takes hold of matters heretofore supposed to belong exclu- sively to the domain of sentiment. For a long time it was generally accepted that nothing more was needed in a nurse than tact and kind- ness. To-day science recognizes that woman is indeed the only mate- rial from which nurses can be formed, yet teaches that nurses are made, not born.” In the use of this strong language the doctor doubtless does not in- tend to deny that there are positions in which male nurses are neces- sary, and in that event would require their education also. The school sends out every six months a class of trained women, who either establish themselves in the work of private nursing or remain attached to the training school as nurses, being sent out with pupils of the second year to private cases. On leaving the school each receives a certificate of ability and good character, signed by the physicians of the committee and the superintendent. It is required that these certificates be renewed at fixed periods, in order to prevent the public from being imposed upon and to keep up the interest of the nurses in the school. A nurse sent out to a private case is to bring back with her a certificate as to her conduct and efficiency from the family of her patient or from TRAINING SCHOOLS FOR NURSES. 15 tlie medical attendant. On entering the school the pupils receive in- struction : First, from the head nurse of the ward to which they are assigned in general “ ward work,” and in the personal care of the pa- tients ; second, from the assistant superintendent, in physiology, man- agement of a sick room, and the duties of a nurse; third, from physicians and surgeons by the bedside of the patients; and, fourth, from lectures. The training includes: (1) The dressing of blisters, sores, and wounds; the application of fomentations, poultices, and minor dressings; (2) the application of leeches externally and internally; (3) the administration of enemas; (4) the management of trusses, &c.; (5) the best method of friction to the body and extremities; (G) the management of helpless patients; making beds, moving, changing, giving baths in bed, pre- venting and dressing bed sores, and managing positions; (7) bandaging, making bandages and rollers, lining of splints. The pupil nurses will attend and assist at operations. They are taught every kind of sick cookery and the preparation of drinks and stimulants for the sick; to understand thoroughly the art of ventilation without chilling the patient, both in private houses and in hospital wards, and all that pertains to night in distinction from day nursing; to make ac- curate observations and report to the physician of the state of the secre- tions, expectoration, pulse, skin, appetite, temperature of the body, intelligence as to delirium or stupor, breathing, sleep, condition of wounds, eruptions, formation of matter, effect of diet or of stimulants or of medicines, and to learn the management of convalescents. It is considered important to place the nurses, in all matters regarding management of the sick, absolutely under the orders of the medical men, and in all disciplinary matters absolutely under the female super- intendent. Of course if she does not exercise the authority intrusted to her with judgment and discretion, it is then the legitimate province of the governing body to interfere and remove her. But to turn a num- ber of young women into a > hospital with no female head whom they can respect and must obey will be sure to end in failure so far as a school is concerned, and in disaster in other ways. Since the opening of your training school, a number of cities and towns in the Mississippi Talley have been visited by the yellow fever. At Memphis and other points its fatality has been unusual. The poison by which it spreads has shown a subtle power beyond the control or comprehension of man, aided by all his science, his instruments, and medicines. The whole nation has felt the shock. The coldest sym- pathies have been warmed. Charity with her manifold tokens of ten- derness has descended over the death-stricken cities to relieve the horrors of the scene. The pecuniary damage to the country has been estimated at over two hundred millions. A hundred thousand people have had the fever, and twenty thousand have died. What destitution and suffering have been brought upon surviving widows and orphans! 16 CIRCULARS OF INFORMATION FOR 1379. But sadder than the evils already suffered would be those to follow the neglect of its lessons. Science, statesmanship, philanthropy, patriot- ism, national, local, or individual, are called upon to bring all their powers of sanitation into requisition. Whatever lessons are taught in regard to quarantine or other efforts for prevention or medication, the lesson in regard to nursing is clear and emphatic. All the medical tes- timony which I have been able to gather concurs in enforcing the im- portance of nursing in the treatment of yellow fever patients. The physician may give his directions and absent himself; but the nurse must be constantly present and watch every symptom. Dr. Herrick, of Xew Orleans, a well known physician, and a scientific observer, writes me as follows: “In our late epidemic we were all im- pressed by the immense superiority of experienced and skilled nurses over the average of friends and relatives, who were in attendance in the majority of cases among the middle and lower classes, from their ina- bility to pay the high wages commanded by professional nurses. Aside from the superior knowledge and dexterity of skilled nurses, they are not carried away by their personal sympathies for the patient, and be- sides they know that they have a reputation at stake, and are thereby stimulated to meet the requirements of duty. I am, therefore, clearly of the opinion that a class of professional nurses, which already exists in a very imperfect fashion in our large cities, ought to be recognized as a social necessity in populous communities. # * * Public hospitals are now recognized as indispensable auxiliaries to a medical education, and there is no good reason why they should not be further utilized for sup- plying society with skilled nurses.” Dr. Mitchell, the able medical director of the Howard Association at Memphis, writes as follows: “If we had had trained and faithful nurses, the mortality in the late epidemic would have been less than half what it was. A nurse should possess a natural aptitude to wait on the sick; should be intelligent, honest, and strictly temperate; should under- stand the use of the clinical thermometer and of the syringe for moving the bowels, and should know how to count the pulse and something in regard to its peculiarities. Especially should he learn that discretion which should characterize all his movements, looks, and language in the sick room.” I repeat, therefore, that respecting the lessons taught us by the yel- low fever there is one about which there can be no doubt and in refer- ence to which there should be no delay. This is, educate your nurses; have a corps of persons trained and ready for any emergency. This cannot be done without schools. Aew Orleans, Memphis, and other cities can easily establish them with success, Hay, the lesson should be heeded in all our cities. I have thus far dwelt chiefly upon the training of those nurses who are to have charge of the sick, that being the special aim of this school TRAINING SCHOOLS FOR NURSES. 17 at present- There is another department of nursing to which a brief allusion is proper. A well known author has well said to parents: Select not to nurse thy darling one that may taint his innocence, For example is a constant monitor, and good seed will die among the tares. ******* For a child is in a new world, and learneth somewhat every moment. His eye is quick to observe, his memory storeth in secret, His ear is greedy of knowledge, and his mind is plastic as soft wax.- Beware, then, that he heareth what is good, that he feedeth not on evil maxims; For the seeds of first instructions are dropt into the deepest furrows. The ancients were thoughtful upon this point. Chrysippus wished these nurses, if possible, to be women of some knowledge; Plato em- phasizes this point; Quintilian dwells upon it in his Institutes of Ora- tory. He would have regard to the morals of the nurse, to her propriety of speech. He likens the impression of the nurse upon the child to the colors of wool for which its plain whiteness has been exchanged, calls attention to the tenacity of bad habits, and the ease with which the young part with good ones. He would not have even the infant accustomed to phraseology which must be corrected in after years. Plutarch would have these earliest nurses of children blameless in their lives and not j ustly reprovable for their manners, and of the best experience. It should not be forgotten that this nursing is the child’s education during these years, and must have special reference to its physical condition. In this respect alone it might be expected to lay under contribution the entire system of hygiene, embracing everything that bears on the human body that may injure or benefit its health, vigor, and fitness for action. Hr. Toner has pointedly called attention to the fact that nearly 50 per cent, of the population die before 5 years of age. Who can tell how many of these deaths are due to imperfect conditions of nursing! Dr. Warren, of Boston, observes that few have power to take care of children. It is a still more rare gift to know how to nurse them when sick. APPENDIX. WASHINGTON TRAINING SCHOOL FOR NURSES. This institution was incorporated December 14, 1877, under the pro- visions of the general incorporation act for the District of Columbia, by thirty persons, who presented articles of which the following is a synopsis: Article 1. Such body corporate and politic shall be known in law as “ The Washing- ton Training School for Nurses.” Art. 2. The time for which the society is organized is twenty years. Art. 3. The particular business and object of the society is to educate a body of skilled nurses suitable for the needs of hospitals and capable of being intrusted with the care of the sick at their own homes, which education the society proposes to give by means of lectures, recitations, and oral instruction in the rudiments of medicine and hygiene, and by hospital attendance. Art. 4. The trustees for the first year of the existence of said society, who shall have the management of its affairs, shall be the first twelve persons whose names were subscribed. The first regular meeting of the trustees of the Washington Training School for Nurses was held January 29, 1878, Dr. P. J. Murphy, secre- tary. A committee, consisting of Dr. Howard, Dr. Antisell, and Mrs. Hitz, was appointed to wait on the Secretary of the Interior and solicit his cooperation, in order that nurses trained in the school might have the benefit of clinical instruction in the different hospitals under his care. At the second meeting, February 5, 1878, Dr. Antisell was elected chairman, and the following trustees were appointed a committee to frame by-laws: Mr. Solomons, Mrs. Hitz, Dr. Howard, Mrs. Canfield, Dr. Antisell, Mrs. Tullock, and Dr. Murphy. The election of officers took place February 25, 1878, and resulted as follows: W. W. Corcoran, esq., honorary president; Dr. Thos. Antisell, president; Mrs. J. C. Hitz, first vice-president; Dr. Flodoardo Howard, second vice-president; Mrs. S. A. Martha Canfield, third vice-president; Dr. Robert Eeyburn, fourth vice-president; Mrs. Miranda Tullock, fifth vice-president; Dr. C. C. Cox, sixth wee-president; Dr. P. J. Murphy,, secretary; A. S. Solomons, esq., treasurer. At this and a subsequent meeting committees were appointed as fol- lows : On the qualification of candidates; to submit a plan of instruction and general method of education of nurses; executive committee; on expenditures; on education; on hospitals. At the request of the committee on education, the following named medical gentlemen signified their willingness to lecture during the- course: Dr. J. S. Beale, anatomy. Dr. William Lee, physiology. Dr. P. T. Keene, hygiene. Dr. P. J. Murphy, medical nursing. Dr. Robert Eeyburn, surgical nursing. 19 20 CIRCULARS OF INFORMATION FOR 1879. Dr. J. Taber Johnson, obstetrical nursing and nursing of children. Dr. D. Webster Prentiss, dietetics and medicine. The committee on education suggested that the board of trustees should secure a lecture room, with the usual appurtenances for didactic teaching, and that the instruction should consist in attendance upon lectures on the following subjects: Hygiene, anatomy, physiology, dietetics, medicines, nursing of children, obstetrical nursing, surgical nursing, medical nursing. It was recommended that the lectures should be delivered twice a week during the time of instruction, and that the number of lectures on each subject should be not less than six. It was also recommended that proper text books or manuals upon the subject taught be used by the pupils, and that weekly examinations be conducted by the lady superintendent or some one of the lecturers. About this time, several applications for admission to the training school for nurses had been made by persons who were willing and able to support themselves at home during the period of training, attending the hospital and school in the evening and night, and it was decided that the instruction to be given to the pupils should begin. A notice was inserted in the. daily papers that the school would be opened May 20, 1878, the course of lectures to begin on that evening. On July 8, the committee on hospitals reported that Dr. Palmer, in charge of the Freedman’s Hospital, w as ready to receive four pupils; these he would place in one ward under his immediate supervision, tak- ing special interest in the pupils of the school. The committee also reported that Dr. Murphy would be prepared to admit four pupils into the wards of the Columbia Hospital, for training, the week following. This committee was also directed to look after the pupils in training, to keep up the communication between them and the society, to select such text books (not costing more than $10) for their use as it deemed neces- sary, and to devise some method for the establishment of a library in connection with the school. Number of applicants 16 Number admitted 12 Number serving in hospital 5 Number attending lectures 7 Number dismissed 5 STATISTICS FOR THE YEAR 1878. TRUSTEES AND OFFICERS OF THE WASHINGTON TRAINING SCHOOL FOR NURSES, 1879. W. W. Corcoran, esq., Honorary President. Dr. J. M. Toner, President. Mrs. Jane C. Hitz, First Vice-President. Dr. Flodoardo Howard, Second Vice-President. Mrs. S. A. Martha Canfield, Third Vice-President. Dr. Robert Reyburn, Fourth Vice-President. Mrs. Miranda Tullock, Fifth Vice-President. Dr. S. A. H. McKim, Sixth Vice-President. Dr. Jos. Taber Johnson, Recording Secretary. Mrs. S. A. Martha Canfield, Corresponding Secretary. A. S. Solomons, esq., Treasurer. Flodoardo Howard, M. D. Thomas Antisell, m. d. Robert Reyburn, M. D. A. S. Solomons, esq. P. J. Murphy, M. I). G. S. Palmer, M. d. Trustees. tytrs. JaneC. Hitz. Mrs. S. A. Martha Canfield. Mrs. Miranda Tullock. S. A. H. McKim, M. D. Jos. Taber Johnson, M. D. Thomas L. Tullock, esq. J. M. Toner, m. d. 21 TRAINING SCHOOLS FOR NURSES. Corps of lecturers, 1879. Dr. J. S. Beale, anatomy. Dr. William Lee, physiology. Dr. ,hygiene. Dr. P. J. Murphy, medical nursing. Dr. Robert Reyburn, surgical nursing. Dr. Jos. Taber Johnson, obstetrical nursing. Dr. , nursing of children. Dr. D. Webster Prentiss, medicines and dietetics. TEXT BOOKS ON NURSING, AND SCHOOLS IN WHICH THEY ARE USED. A Manual of Nursing.—New York Training School for Nurses. Dr. Frankel’s Manual of Nursing and Dr. Kitchen’s Manual for Attendants on the Sick.—Charity Hospital School for Nurses. Handbook of Nursing.—New Haven School; Washington Training School for Nurses. Domville’s Manual for Hospital Nurses is used in these and all the other schools. LIST OF TRAINING SCHOOLS FOR NURSES. New York Training School for Nurses attached to Bellevue Hospital, New York, N. Y. New York Hospital Training School for Nurses, West Fifteenth street, New York, N. Y. Charity Hospital School for Nurses, Blackwell’s Island, New York, N. Y. Boston Training School for Nurses attached to Massachusetts General Hospital. New-England Hospital Training School for Nurses, Boston Highlands, Mass. City Hospital Training School for Nurses, Boston, Mass. Training School for Nurses, Woman’s Hospital, Philadelphia, Pa. Connecticut Training School for Nurses, attached to the State Hospital, New Haven. Washington Training School for Nurses, Washington, District of Columbia.