R f- I fI EMAMS ON THE TRAINING- OF NURSES Eead Originally as a Report before the American Medical Association at its Meeting at New Orleans, May, 1869, and referred by it to the several State Medical Societies. -''BY S. D. GROSS, M. D., LL. D. PROFESSOR OF SURGERY IN THE JEFFERSON MEDICAL COLLEGE OP PHILADELPHIA, AND LATE PRESIDENT OF THE AMERICAN MEDICAL ASSOCIATION. TRANSACTIONS OF THE MEDICAL SOCIETY OP THE STATE OF PENNSYLVANIA. EXTRACTED FROM THE PHILADELPHIA: COLLINS, PRINTER, 105 JAYNE STREET. 1869. REPORT OF THE COMMITTEE OK THE TRAINING OF NORSES. The undersigned, acting as a special committee under an appoint- ment of this Association to report on the best method of organizing and conducting institutions for the training of nurses, beg leave to state that they have had the subject under consideration, and now offer the following suggestions for'its practical and efficient execu- tion. The establishment of schools for the education of nurses, for private and public purposes, is a desideratum which has long been keenly felt in this country, both by the medical profession and by the people at large. That this want should not have long ago been supplied is a curious anomaly in the history of human enterprise and of Christian charity, well calculated to cause surprise, if not positive astonishment. Considering the wonderful mental and phy- sical activity of the age in which we live, and the numerous expe- dients that have been devised for the improvement of the comfort and happiness of our fellow-beings, it is remarkable that the subject in question should have hitherto been so singularly neglected by all denominations of Christians, except the Catholic, whose noble deeds in preparing nurses for the sick and infirm of their own church reflect so much credit upon their charity and philanthropy. Good nursing, as has very justly been observed by an intelligent writer, is half the battle in disease; if the other half be as well managed, the result can hardly fail to be all that the nature of the case demands. It is often incomparably more valuable to a sick man than the most skilful medication. It is the right hand of the medical practitioner. Thousands of human beings are daily lost by bad nursing. However thoroughly a case may be understood, or however judiciously it may be prescribed for, it is evident that, if the injunctions of the medical attendant are not faithfully, hon- estly, and intelligently carried out, the treatment must fail of the 4 end intended, or, what is worse, produce results the very reverse, perhaps, of those desired. There should, in every instance, be the best possible understanding between the physician and the nurse, inasmuch as it is their sacred duty to co-operate with each other, to the best of their ability, in their efforts to arrest disease and stay the hand of death. Harmony and honesty of purpose should mark every step of their progress. An educated, intelligent, conscientious nurse is a great blessing, and an invaluable member of the com- munity, as one of an opposite character is a great evil, if not a positive disgrace. In either event, she may, by the exercise of her power, hold in her hands the key of life and death. In the former case, she may do much to correct the errors of an ignorant, careless, or unscrupulous physician; in the latter, the best directed efforts of the most enlightened practitioner may be effectually thwarted, and a disease or injury, originally insignificant in itself, be hurried on to a fatal crisis. The subject of nursing possesses a deep national interest. It personally concerns every human being, of whatever age, rank, or condition in life—alike the rich man in his palatial residence, the mechanic in his cottage, and the peasant in his humble hovel. All are alike intimately interested in its faithful administration and in its final issue. It is perhaps fortunate that the mortality occa- sioned by bad nursing cannot be properly estimated by those more immediately affected by it, as a knowledge of it would entail upon them an immeasurable amount of misery and mental anguish. Mankind look with horror upon the destruction of human life upon the battle-field and during the prevalence of epidemics, as cholera, scarlet fever, and smallpox, because its appalling character is every- where patent to the public eye; every one sees and hears and talks about it; but few persons can form any adequate conception of the vast number of human beings who are daily, nay, hourly, sacrificed upon the unhallowed altar under consideration. Nursing, in its more exalted sense, is as much of an art and a science as medicine. The educated physician is sought for far and wide; his skill is in constant requisition; day and night he is at the bedside of the sick and the dying; at every visit he makes his prescription and leaves his instructions; he literally wars with dis- ease and death; he necessarity, from causes which no human agency can control, loses many patients, and many also who could be saved if his efforts were properly seconded by efficient nursing. The commander of an army cannot be victorious if he is not property aided by his subordinates, the lieutenants, whose duty it is to carry out his orders and the minor details of the campaign. In private 5 life there is hardly one really good, intelligent, or accomplished nurse in a hundred who exercise the functions of that office, one who is perfectly familiar with all the duties and requirements of the sick-room; and what is true of private society is still more true of the hospitals, almshouses, infirmaries, asylums, jails, workhouses, and similar institutions, in the United States. It is a mistake to suppose, as is so often done, that any and every individual, whether male or female, is fitted for such an occupation, as if nursing, like poetry, were a gift of nature. Many persons are utterly incapaci- tated by their constitution and habits for such a task, and yet, as society is now constituted, there is hardly one who may not, sooner or later, be compelled to exercise it. In private families, this duty usually devolves upon the mother or daughter, who, in cases out of a hundred, are totally ignorant of the first principles of nursing, and therefore wholly unfit for the discharge of so sacred a duty as that involving the health and life of a human being affected by disease or injury. In public institutions the same igno- rance prevails, superadded, not unfrequently, to the basest moral delinquencies, as intemperance, indifference to duty, and positive disregard of the orders of the medical attendant. Male nurses are everywhere notoriously bad and incompetent. Few, even in our large towns and cities, are qualified for their business. Drunk- enness and male nursing are almost synonymous terms in the experience of the American physician. How are these defects, so glaring in their character, and, in their results, so fraught with danger to health and life, to be remedied? By the organization of institutions for the training of nurses ? Such institutions are undoubtedly much needed, and they should be established in every town and city in the United States. That they would or could, however, fully, or even in a considerable degree, accomplish the object, no one acquainted with the subject would for one moment assert. They would, compared with our great wants, be as a drop in the bucket, or, to employ a still more forcible expression, like the attempt of a husbandman to fertilize a vast field with a handful of lime. We need good, well-trained nurses by the thousand. Every community, throughout the length and breadth of the land, should be supplied with them, in order to do full justice to the subject. On the continent of Europe institutions for the training of nurses have existed, either independently of or in connection with certain hospitals, for centuries; and, while no one can deny that they have been productive of incalculable benefit, it must be obvious to every reflecting mind that their influence has been exceedingly circum 6 scribed. The Sisters of Charity, as they are denominated, those angels of mercy who shrink from no duty enjoined by suffering humanity or the requirements of a holy religion, have for ages been the ready servants of the medical staffs of these institutions in carrying out their behests, and in smoothing the pillow of the sick and the dying wherever their presence is needed. It is not accurately known when or by whom Sisterhoods, which have done so much to advance the interests of nursing, were origi- nally founded. The honor, however, is generally ascribed to Paula, a Roman lady of noble birth, and a lineal descendant of the Scipios and the Gracchi, who, disgusted with the demoralization of her native city, gathered up her broken fortune, and, with her daughter, settled at Jerusalem, near the close of the fourth century. Here, as the story goes, she assembled around her a number of her sex, in various stations of life, some rich and others poor, and devoted herself and her order, withbut taking or exacting any vows, to works of charity and the nursing of the sick; in a word, to what is now called parish visiting. When Landi, Bishop of Paris, in 650, founded the Hotel Dieu, he placed it under the direction of the hospitallers, or nursing-sisters, who have retained their position and influence in this old receptacle for the sick down to the present moment, through all the changes and vicissitudes of the French government. At the commencement of the French Revolution, that revolting and sickening period of human crime and human history, the Sister- hood of Charity had four hundred and twenty-six houses in France, as well as many in other countries, with six thousand members actively engaged in the exercise of their peculiar vocation. Prior to that time, the chief military hospitals and the naval hospitals at Brest, Saint-Malo, and Cherbourg had been under the charge of these noble women. At present, and, indeed, for many years past, the naval hospitals at Toulon and Marseilles, in addition to those just mentioned, have been attended by members of the Sisterhood. The whole number of females embraced in these charitable orders was in 1848, according to Mrs. Jameson,1 to whom we are indebted for these facts, at least twelve thousand. The nursing in all the civil hospitals of France is performed by these Sisters; and similar regulations exist in most, if, indeed, not all, the Catholic hospitals in other parts of the wTorld, both Old and New. In the United States and Canada the presence of these noble, self-sacrificing women forms a striking feature in every institution of the kind. 1 Sisters of Charity, p. 69 ; Boston, 1857. 7 Many of them, as we know from personal experience, are highly educated and refined ladies, whose whole existence is devoted to the care and nursing of the sick. The Committee cannot permit this opportunity to pas§ without paying a feeble tribute of respect and admiration to the Sisters of Charity, on account of the noble work in which, for upwards of twelve centuries, they have been steadily engaged in carrying out the objects for which their order and the various branches growing out of it were originally instituted. A more honest, upright, de- voted, self-sacrificing body of women never existed. The Catholic church, under whose direction and auspices they have so long and so faithfully labored, has set an example worthy of the imitation of all denominations of Protestants, who, it cannot be denied, have too long stood aloof from this great work which reflects so much credit upon their Catholic brethren. No one can witness* the dis- interested sacrifices of the Sisters of Charity—their unceasing devotion to the sick and the dying, their unflinching courage in times of epidemics, their daily toils, and their midnight vigils for the benefit of suffering human beings—without the most profound admiration for their character, and a deep sense of gratitude to Almighty God for permitting such beings to dwell among men. The Protestant church, so long idle in this great wrork, is begin- ning to perceive its importance, both as a matter of duty and of self-interest in sustaining her religious and charitable character, and is, apparently, girding her loins for active exertion. Numerous women, many of them of high birth, excellent education, and great refinement, are ready to enter the field, and are willing to spend their time and talents, nay, if need be, even their very lives, in the furtherance of its great objects. Much good has already been effected; and the Committee are sanguine that a work so auspi- ciously commenced will be steadily carried forward until the num- ber of women engaged in it shall rival that noble band known by the expressive name of “Sisters of Charity.” The establishment of the Protestant Sisterhood is of recent origin. In 1836, an obscure but most worthy clergyman, Mr. Fliedner, opened at Kaiserwerth, a small town near Dusseldorf on the Rhine, a training school for female nurses. Every one who offers herself is admitted on trial for six months, during which she is obliged to pay for her board, and wear her accustomed garments. If, at the end of this time, she is satisfied with her vocation, she undergoes a further probation of from one to three years, puts on a distinctive dress, and lives at the expense of the institution. After her education is completed, she receives annually a small 8 sum for clothing, but nothing more, as the sole object is to work for the sake of God and humanity. If, however, she should become disabled by age or disease, the parent institution obligates itself to receive and protect her. A certain number of sisters are educated for the office of parish visitors. The establishment, in 1855, had one hundred and ninety members, of whom sixty-two were still probationers. Of the hospital sisters, eighty were stationed at different hospitals in Germany, five in London, three at Constanti- nople, five at Jerusalem, two at Smyrna, and two at Pittsburg, Pennsylvania. As outgrowths of Mr. Eliedner’s establishment are the sister- hoods and schools for the training of nurses at Berlin, Dresden, London, Paris, Strasbourg, and other cities in Europe. It is not without interest to state that Miss Florence Nightingale, who had charge for some time of the Female Sanitarium in London, and who earned such a world-wide reputation by her philanthropic labors during the war in the Crimea, had been a regular pupil for several years at Kaiserwerth. The institution at Berlin is under the special care of the Queen of Prussia; and the one at Dresden was founded by the Countess Hohenthal, a lady celebrated throughout Germany for her charitable acts and amiable qualities. In Great Britain the parent institution for the training of nurses is St. John’s House and Sisterhood, founded at London, in 1848, the first meeting for the purpose having been held under the auspices of the Duke of Cambridge, assisted by a large number of prelates, noblemen, and other eminent persons. It is an establishment of the Reformed Church of England, in which Christian women, members of that church, are associated in a community under the presidency and visitatorial sanction of the Bishop of London. The chief function of the inmates is to elevate the profession of English nurses by giving them the best possible training in the hospital ward, and uniting them, under a sense of religious responsibility, into a sisterhood as members of a Christian family and home. Everything has, from the beginning, been conducted on the volun- teer system, both on the part of the sisters and nurses, without the exaction of vows, monastic obedience, celibacy, cloistered seclusion, or other restraint whatever. In a word, they are all, both in wishes and inclinations, free agents, wholly devoted to the cause of Chris- tian charity. It is worthy of remark that all the sisters at St. John’s House are ladies. The members of this establishment are divided into three classes, sisters properly so called, associates, and probationers, who all wear a cross with a badge of the institution upon it. The nurses 9 are provided with a medal bearing a similar device, which they wear so long as they remain in service. The dress is simple, cheer- ful in appearance, and, in every respect, well adapted to the nature of the work to be performed. The sisters, who are also called deaconesses, rise early, attend prayers four times a day at the chapel, visit the sick in their particular districts, and spend several hours each day in the wards of some hospital, in the general super- vision of the nurses. In addition to these duties they devote themselves to the training of nurses for public institutions, the poor, and private families. St. John’s House and Sisterhood furnished, some of the first women who accompanied Miss Nightingale to the East in 1854; and in the following year it prepared and sent upwards of twenty lady nurses to the seat of war. It established training schools in 1856 at King’s College Hospital, at the English Galignani Hospital in Paris in 1865, and at the Charing Cross Hospital, London, in 1866. The board of managers of the first-named institution, in January, 1862, set apart a ward of ten beds, on an upper floor in that building, as a midwifery ward, for the reception and treatment of poor married women, and for the training of midwifery nurses for country districts, under the supervision of the sisterhood of St. John’s House; an arrangement productive of great good and highly satisfactory to all concerned. It is quite impossible, with the slender data before the Committee, to determine, with any degree of accuracjq the present number of these institutions in Europe: the probability is that it is not far short of one hundred. In London, besides St. John’s House and its appendages, already referred to, there are the training schools for nurses at St. Thomas’, the Middlesex, and University College Hospitals, all in a highly flourishing condition. The first named of these establishments is Supported by the “Nightingale Fund,” under the immediate superintendence of Miss Wardroper, a most estimable and efficient lady, aided by a council of eminent and influential men, among whom are Lord Houghton, Sir James Clark, Mr. Bence Jones, and Mr. William Bowman, the distinguished anatomist, surgeon, oculist, and author. The school for midwifery nui’ses in this institution was recently closed for the want of suita- ble accommodations; but there is reason to believe that it will be reopened upon the completion of the new hospital edifice. The Middlesex Hospital designs to erect, at an early day, and at a great cost, a building capable of lodging sixty-six inmates. The school, under the admirable supervision of Miss Martyr, is in excellent working order. 10 The Liverpool Training School and Home for Nurses, established under the auspices of the Royal Infirmary of that city, has been in successful operation for several years; and, under the wise and efficient management of Miss Merryweather, the lady superintend- ent, has been productive of an amount of benefit which it would be difficult to overestimate. The object of the institution is to pre- pare women desirous of working as hospital, district, and private nurses, and to afford them every facility for future usefulness by the most thorough S3'stem of training in the wards of the Royal Infirmary. From the Report for 1861, now before us, it appears that seventy-seven women were on the staff at the end of the year, of whom twenty served as nurses and twenty-seven as probationers in the hospital. About one hundred cases of sickness in private families were attended by the nurses, and upwards of four thousand sick poor were visited and relieved in the districts under the charge of this noble establishment. At least two training schools for nurses, both founded in 1866, are in successful operation in Dublin. One of these is under the charge of Stevens’ Hospital, and the other under that of Sir Pat- rick Dun’s Hospital, the latter being under the direct management of Miss Probyn, a lady preeminently qualified, by education and habit, for so important a position. The principles on which these institutions are conducted are essentially the same as in the sister establishments in Londob, Liverpool, and other cities in England. So far as the information of the Committee goes, little has been done in the United States in regard to the training of nurses out- side the Catholic Church. It is believed that the oldest institution of the kind in the country is the Nurse Society of Philadelphia, established upwards of a third of a century ago by an association of Friends, and amalgamated with the Lying-in Charity in 1844 under the name of the “Philadelphia Lying-in Charity and Nurse Society.” From the Annual Report of the Board of Managers of this excellent Institution for 1861, it appears that there were then twenty-two resident and eleven registering nurses at the Home. Of the 361 applications for nurses received from citizens during the year, only 205 had been answered, thus showing how entirely in- adequate the demand was to the supply. The Bishop Potter Memorial House, opened in 1861 in connection with the Episcopal Hospital of Philadelphia, is conducted upon the same principles as the Protestant training houses and sisterhoods in Germany, England, France, and other countries; and, under the discreet and admirable management of Mrs. Jackson, a lady of high mental culture and social position, holds out great promise of future 11 usefulness. The institution has three departments—nursing, mis- sion work, and parish schools—the primary object of each of which is religious visitation and instruction. The nursing branch does not embrace any menial service, and has hitherto been confined almost exclusively to the wards of the hospital. The number of inmates at present is very limited, but it is intended, as it increases, to extend the sphere of their operations into the surrounding dis- tricts. In Boston, at the Xew England Hospital for Women and Children, attempts have been made, but thus far with little success, to educate nurses for public and other purposes. The inducements held out are the advantages of the practice of the hospital with boarding and washing, and also a small sum after the first month of probation; but, notwithstanding this, there have, it seems, been few applicants who are willing to dedicate themselves to the work. The Committee have entered into these historical details with a view of showing how little the Protestant church has as yet accom- plished in this important field of human enterprise and Christian benevolence. In this country, so replete in energy and progress, and so thoroughly alive to all the wants of a great people, the ground lies literally fallow, hardly a furrow having been drawn to serve as a> landmark to arrest public attention. It will be difficult, half a century hence, to account for the utter apathy that has hitherto existed upon this subject; to find a reason why in a country and in an age which have provided a remedy for almost every other necessity, this alone should have been so sadly over- looked and neglected. This want of enterprise has not been due to any want of material. Thousands of good and noble women are ready to enter upon the good work. All that they need is proper encouragement and a little aid at the outset, until, by a course of practical training, they are fitted for the discharge of their onerous and responsible duties. The late war afforded a striking illustration of what woman, roused b}r a sense of patriotism and humanity, is capable of accomplishing when her services are required by her bleeding countrymen. Every- where, by day and by night, in season and out of season, she was seen amidst the sick, the maimed, and the dying, alleviating suffer- ing, smoothing the wrinkled brow, inspiring hope and confidence in the desponding, and performing the most trying, menial, and revolt- ing offices, without the hope or expectation of pecuniary reward. The mortality, great as it was, would have been vastly increased if the efforts of the surgeons had not been faithfully seconded by these warm-hearted and generous women, so utterly forgetful of 12 self, and so full of sympathy and tenderness for others. The good effected by Florence Nightingale and her brave and devoted band in the Crimean war called forth the strongest acknowledgment of O O the British government, and elicited the admiration of the civilized world. “ Henceforth,” says a distinguished female writer, “ the name of Florence Nightingale is dear and familiar in our house- holds; women glory in her, men rise and call her blessed.” What this good and noble woman accomplished on the other side of the water our women accomplished on this. Their angelic deeds con- stitute one of the brightest and most enduring pages in the history of the late war, so distinguished for the Christian exploits and heroic devotion of American ladies. It will be perceived from the above account of these institutions that the number of nurses educated under their patronage and direction is exceeding!}’ limited, and therefore entirely inadequate for the public demand ; that the nurses themselves, in a majority of them, consist of two distinct classes, the ladies, or deaconesses, whose labors are mainly of a parochial character, and the nurses, properly so called, the latter of whom, of course, occupy a sub- ordinate rank; that the training is conducted in a desultory and irregular manner, without any definite system or order; and, lastly, that they embrace no provision whatever for the education of male nurses. The latter are, it is true, not as necessary, either in public or private practice, as the former; still, there are cases in which the female nurse is comparatively powerless, and where, consequently, the aid of the other sex is indispensable. This is particularly true of all cases of severe injuries, as wounds, compound fractures and dislocations, and the capital operations, where much lifting or fre- quent change of posture is required for the comfort and welfare of the patient. These, however, are exceptional cases, and the fact has long been established that, as a rule, female nurses are incom- parably better adapted to the work than male, who are, as already remarked, too often coarse in their language, unfeeling in their manners, impatient, intemperate, and devoid of that tenderness and sympathy so characteristic of the other sex, and so necessary in the sick-chamber. Even in lunatic asylums, where one might, d priori, suppose that male nurses were, from the boisterous and unmanageable nature of many of the inmates, perfectly indispens- able, women are, it would seem, better fitted to calm and soothe the irritated mind and to maintain discipline than men. In England, through the exertions of Dr. Maudsley and Dr. Chrichton Browne, an effort is now on foot to substitute female for male nurses in many of the lunatic wards throughout the country. It has been 13 ascertained that the mortality of male lunatics in asylums is nearly one-third greater than that of female lunatics; that the deaths are most numerous when nursing is at its point of greatest relaxation ; and that the presence of female nurses in male wards is much more effective in restraining the outbursts of violence, abusive language, and offensive habits than of male nurses. “In a word,” says Mr. Browne, “their whole conduct seems to be softened, and their tone of feeling ameliorated, by the simple expedient of introducing kind- hearted female nurses among them.” Another fact determined b}7 the experience of the last ten years is that there is not only a marked diminution of mortality in those hospitals in which the nursing is performed by trained women, but a decided diminution in their expenditure, and a great improvement in the moral condition of the inmates. The wards are kept in a more clean and orderly manner, the ventilation is much more care- fully attended to, the medicines, food, and drink are administered with greater regularity, and a moral atmosphere prevails, the sana- tive and purifying influence of which it would be difficult fully to estimate. Taking, then, all these circumstances into consideration—the pro- motion of health and comfort, the saving of life and money, and the improvement of the moral and religious condition of the sick—the Committee would respectfully urge upon the medical profession and the country at large the absolute necessity of employing none but well-trained nurses both in public institutions and private families. It is believed that such an arrangement is demanded by the interests alike of society and of individuals, and it may be boldly asserted that the time for its accomplishment is at hand. The late war made many thousands of widows, and doomed many thousands of young women to perpetual celibacy, who, in consequence of their straitened circumstances, are ready to enter upon this good work, and devote themselves, heart and soul, to its behests. To afford the proper facilities for carrying out this grand design, the Committee are of opinion: Ist. That every large and well- organized hospital should have a school for the training of nurses, not only for the supply of its own necessities, but for private fami- lies, the teaching to be furnished by its own medical staff, assisted by the resident pli37sicians. 2dly. That, while it is not at all essential to combine religious exercises with nursing, it is believed that such a union would be eminently conducive to the welfare of the sick in all public insti- tutions ; and the Committee therefore earnestly recommend the establishment of nurses’ homes, to be placed under the immediate supervision and direction of deaconesses, or lady superintendents, an arrangement which works so well in the nurses’ homes at Lon- don, Liverpool, Dublin, and other cities in Europe, and at the Bishop Potter Memorial House in Philadelphia. 3dly. That, in order to give thorough scope and efficiency to this scheme, district schools should be formed, and placed under the guardianship of the county medical societies in every State and Territory in the Union, the members of which should make it their business to impart, at such time and place as may be most con- venient, instruction in the art and science of nursing, including the elements of hygiene, and every other species of information necessary to qualify the student for the important, onerous, and responsible duties of the sick-room. The Committee would further suggest the importance of forming in every convenient place nurses’ societies, the regular members of which should, in all cases, other things being equal, have the pre- ference, as it respects the recommendation of the practitioner over the ordinary ignorant or uneducated nurse. In this manner an esprit de corps could be established which could not fail to be highly advantageous to the public as well as to the medical pro- fession. In conclusion, it may not be amiss to offer a few remarks upon the qualifications of a nurse; or, in other words, the duties which she may be required to perform in the wards of a hospital and in the private sick chamber. Ist. To do justice to her vocation, or to perform her labor with alacrity and efficiency, a nurse must be of sound constitution, of good muscular strength, and of great powers of endurance, capable of bearing up manfully under fatigue and loss of sleep. 2dly. Her age, at the commencement of her career, should not be under twenty-two or over thirty-five. 3dly. She should possess a certain amount of common education; at all events, she should be able to read and write; be of a gentle and refined disposition, courageous, patient, temperate, punctual, cheerful, discreet, honest, sympathizing, and ever ready and willing to perform every service, however menial or disagreeable. Her moral character should be of the purest kind, and she should be willing to devote herself unreservedly to the duties of her vocation. 4thly. She should possess the faculty of observation in order that she may be able to notice with advantage the character of the secretions and excretions, and the changes in the skin, pulse, counte- nance, eyes, tongue, mind, and temperature of the patient. sthly. Her education should embrace a knowledge: Ist, of the 15 principles of hygiene, especially of ventilation, clean linen, tempera- ture, and the nature and use of disinfectants ; 2dly, of the methods of preparing food'and drink; 3dly, of the administration of medi- cines, and of the doses of the more common articles of the Materia Medica; 4thly, of the application of leeches, Blisters, bandages and Other dressings, as cataplasms, unguents, and lotions; and sthly, of making up beds, changing sheets, and handling patients ex- hausted by disease and injury. The Committee, in view of the importance of the subject dis- cussed in this report, beg leave to offer the following resolution: Resolved, That a copy of this Report, authenticated by the signa- tures of the President and Secretary of this Association, be sent to the State Medical Societies of the different States of the Union, inviting their cooperation in the establishment of schools for the training of nurses for hospitals and private families, in accordance with the principles therein advocated. S. D. GROSS, M.D., LL.D., Chairman. The Committee desire to express their obligations for some of the facts contained in this report to John Croft, Esq., Surgeon of St. Thomas’s Hospital, London ; to Miss Merryweather, of Liverpool; Miss Probyn, of Dublin ; Mrs. Jackson and Mrs. Baner, of Philadelphia ; Dr. Cheever, of Boston; and, above all, to Mrs. Jameson, whose work, entitled “ Sisters of Charity,” is full of interest. Since this Report was presented to the Association a house for deaconesses has been opened in Boston under the supervision of Dr. Charles Cullis, whose connection with other institutions of a kindred nature is well known. The school is to be conducted upon the same principle as that at Kaiserwerth on the Rhine, although the plans of the founders are not yet fully developed.