THE HISTORICAL DEVELOPMENT 
OF MODERN NURSING. 
ABRAHAM JACOBI, M. D. 
[Reprinted from The Popular Science Monthly, October, 1883.] THE HISTORICAL DEVELOPMENT OF MODERN 
NURSING.*/'’ 
ABEAHAM JACOBI, M. D. 
[.REPRINTED FROM THE POPULAR SCIENCE MONTHLY., OCTOBER, 1883.J 
is as old as the human species. Even among animals, 
-DN such as they are at present, we find occasional sympathy with 
fellow-suffering, and meet with efforts for the purpose of relief. 
We can not imagine that human beings, in ever so remote prehis- 
toric times, should have lived together, or near each other, without 
mutual attempts at relief, when suffering or sick. But this is pre- 
sumption only, not history. No book, no tradition refers to facts in 
regard to the subject until the times of ancient Hellas and its success- 
or in civilization, ancient Rome. Antiquity yields but few proofs of 
systematic nursing. It is true, hospitality was the pre-eminent virtue 
of the Greek. The stranger was always welcome. If he was sick, he 
was doubly so. In all Hellas poor sick citizens found ready admission 
to and nursing in the houses of the rich. It may be that the facility 
of finding private relief on the part of the sick was one of the causes 
why no systematic and collective efforts for the purpose of attending 
and nursing the sick were ever made to any extent. That such was 
the case, there can be little doubt; for the temples of iEsculapius and 
the adjoining residences of the physicians were probably not hospitals, 
but temporary domiciles for those who congregated in large numbers 
around the homes of the gods. Of the same nature was the edifice 
erected by Antohinus Pius near the temple of the Epidaurian AEscu- 
lapius. In Italy, also, the temple of Aesculapius, on the island in the 
Tiber, between Rome and the outlet of the river, was never of much 
importance as a hospital or sanitarium. The only real hospitals at all 
comparable with institutions such as we have, existed in favor of human 
property, and for the benefit of soldiers. According to the testimony 
of Columella, Seneca, and Celsus, the Romans had hospitals for slaves, 
warriors, and gladiators. In Greece, also, as early as the period of 
* Address delivered at the first commencement of the Mount Sinai Training-School for 
Nurses, May 12, 1883 2 
Solon, those injured on the battle-field were attended and nursed at the 
expense of the community. Of the great Csesar it is well known that 
he had a regular medical service in his armies. 
There is a wrord in the ancient Greek which has given rise to the 
belief that Hellas may have had hospitals. But, as no facts and re- 
ports sustain that supposition, it is probable that larpuov meant a medi- 
cal office, a policlinic, perhaps, but not a hospital. Real hospitals 
were not built by either Greek, Roman, or Hebrew. The common- 
wealth of the latter was hierarchic and intolerant. The stranger— 
though he who was permitted to live in Judea was to be treated like 
a member of the community—was to be exterminated, and must not 
be spared. Thus, while there are no proofs of the existence of hos- 
pitals for the friend, a painstaking care in favor of the stranger was 
out of the question. 
Antiquity, however1, is not without its humane culture. The recon- 
ciling feature in that immense picture of indifference and thoughtless- 
ness is found in Buddhism. We have the reliable report of a genuine 
hospital founded by a king in Ceylon, in the fifth century b. c. One 
of his successors in the second century b. c. is credited with eighteen 
hospitals under regular medical superintendence. In the East Indies 
hospitals are mentioned in the third century. Nor have other civiliza- 
tions been slow in outgrowing the humane exertions of Hellas, Rome, 
and Palestine, for Prescott tells us that there were hospitals in Mexico 
before the Christian Spaniards introduced the blessings of torture, in- 
quisition, and extermination. And when finally the Christians, in the 
second century after Christ, bethought themselves of the poor and sick 
and established hospitals, the largest and most effective ones were 
founded in Asia Minor and Persia, where Buddhism had prepared both 
means and public opinion—Buddhism, under wdiose beneficent rules 
aiding the poor and nursing the sick were two of the religious du- 
ties of kings and princes. Nor has Christianity the claim of having 
the first large hospitals. The Arabs had many good and large hos- 
pitals about 1200. Cordova, in Spain, sustained fifty within its own 
walls. 
The first information in regard to Christian hospitals dates back to 
the second century; other reports go back as far as the fourth, and a 
few others to the sixth century. In most cases the establishments were 
not exactly hospitals, but stopping-places and dormitories for pilgrims 
on their way to Rome. To what extent such institutions were necessities 
is best proved by the order of the so-called “ Bridge-makers ” (Hospi- 
tallers Pontifes), whose original vocation it was to protect pilgrims 
from the robberies and rapacity of the ferry-men on the large rivers. 
They existed a long time, became rich and degenerated, and were 
finally dissolved in 1672 by Louis XIV. 
The hierarchic character of the institutions calculated to benefit 
the poor remained intact until the period of the Crusade wars. At 3 
that time Italian and German merchants initiated the great combina- 
tions of the several orders of Hospital Brothers, 
Their efforts were not isolated or altogether premature. For there 
existed a humanistic movement among the better classes of the Occi- 
dent, on a Christian basis it is true, but spontaneous. Particularly in 
the cities, societies were formed for the purpose of nursing the sick 
and aiding the forlorn. Guy, of Montpellier, France, established a 
hospital in that city, of larger size, while up to that time all the insti- 
tutions of a similar character were small and unavailing, and located 
outside the walls. The new hospital in Montpellier, and seven more 
French houses, and two under the same direction in Rome, are first 
mentioned in a bull of Pope Innocent 111, in the year 1198. The 
secular character of the institutions was at that time fully recognized. 
In connecting four clergymen with them he commanded that they 
were to attend to spiritual duties only (“ sine contradictions et mxirmu- 
ratione ”), and not to intei’fere with the office of the superiors. In 
1204 the same pope recognized the newly established Hospital of the 
Holy Ghost, on the old Tiber bridge, in Rome. With the peculiar 
mixture of ferocity and mildness so common to the mediaeval age, the 
same man who humiliated emperors, dethroned kings, and persecuted 
the French heretics with fire and sword to extermination, looked for 
the helpless and sick in the streets and saved illegitimate babies from 
their watery graves. Guy de Montpellier’s creation, the Order of the 
Holy Ghost, did not remain long in its original condition. Pope 
Gregory X (1271-76) subjected all the houses belonging to the order 
to the one located in Rome, the first step in the attempt at depriv- 
ing the order and its hospitals of their secular supervision. It was 
finally disposed of by the bull of Pope Sixtus IV, of the 21st of 
March, 1477. Meanwhile and afterward the order spread over all 
Europe. With its increasing wealth and power it degenerated in the 
seventeenth century. Though clerical by name, it was the most secu- 
lar of all the institutions of dissipation. Grand-master and officers 
lived on the fat of the land and their immense income. In vain Louis 
XIV attempted to abolish it. The only change French royalty could 
work was its transmutation into a royal order. In some of the prov- 
inces laymen had succeeded, however, in controlling the management. 
Thus it was in many parts of Germany, where, between 1400 and 
1600, several of the institutions belonging to the order were secular- 
ized. In Italy, however, the Order of the Holy Ghost remained exclu- 
sively clerical. As late as in the beginning of the eighteenth century 
it had great possessions in Europe and the West Indies. 
The Order of St. Elizabeth was founded in 1225 by Elizabeth, 
daughter of AndrewMl of Hungary, and wife of Landgrave Ludwig of 
Thuringia. Women need not complain that domestic virtues do not 
warm more than their own home, and do not immortally challenge the 
admiration of posterity. Her name will never die, when many a great 4 
warrior’s memory will be buried out of sight. She founded two hos- 
pitals in Eisenach, and another in Marburg, into which the twenty-two- 
years-old widow retired. The rule was to nurse the female sick only. 
But when Francis-Joseph and Windischgratz (par nobile fratrum) 
let loose their Croats over unhappy Vienna, in our own times in 1848, 
the Sisters of St. Elizabeth were in the front ranks bringing aid and 
comfort. 
In 1171 the orders of St. Protais and St. Gervais were founded in 
France. About the same time, the houses in Roncesvalles and Burgos. 
In 1409 Jose Gilhberto established an order in Valencia for the spe- 
cial purpose of nursing the lunatic. 
Those I have mentioned, with several others, were orders founded 
by the Church, or whose supervision soon became clerical. Those 
which, though all of them were anxious to submit to the Church, for 
spiritual reasons, succeeded in retaining their autonomy, must be cred- 
ited with more real success in accomplishing their ends. Among the 
first we have any information of is the order of St. Catherine. Its 
members nursed poor and strange women and girls three days, and 
buried those who died in prisons or in the streets. In those good old 
times to which many dissatisfied hearts of to-day look back with long- 
ing eyes, those good olden times with their innocence, simplicity, and 
piety, this dying in the street was of common occurrence, and the Sis- 
ters of St. Catherine had plenty of work. We have not only accu- 
mulated seven more centuries, but gained more safety, more comfort, 
and more confidence in the future of mankind. 
In the Hotel-Dieu, the immense Paris hospital, thirty-eight men 
and thirty-eight women served as nurses. The places were, in later 
centuries, filled by Sisters of Mercy. 
The Brothers of Mercy were founded in 1584 by Juan di Dios 
(John of God) in Granada. They were laymen, entered the order at 
between eighteen and thirty-one years of age, and nursed the sick of 
every faith and creed. Within a hundred years they possessed 18 
hospitals, and there was a time when in Spain and the West Indies 
they had 138 hospitals, with 4,140 beds, and 47,000 sick annually, and 
in the rest of Europe 155 hospitals, 7,210 beds, and 150,000 sick. 
Twenty-five years ago they had in Austx-ia alone 29 hospitals, with 
20,000 patients. 
Of similar character were the Obregons, founded about 1600, with 
their complicated duties of nursing the sick, praying, and repenting. 
This multitude of duties must have crippled their efficiency ; they can 
not compare with the Brothers of Mercy. 
The “ Bons Fils ” (Good Boys) were founded in Flanders in 1615. 
They were tradesmen, with the duties of nursing the sick, mainly the 
alienated in their homes, and giving elementary instniction. 
The Confraternita della Perseveranza was established in Rome, in 
1663, for the purpose of caring for the strangers in the taverns. 5 
The Order of the Sisters of Mercy was founded in 1617 by Vin- 
cent de Paul, a preacher. In a sermon he placed before his congre- 
gation the case of a poor and sick family, urging their co-operation 
and sympathy. Enthusiasm and much zeal were roused, and a noble 
and gifted woman, Louise de Marillac, the wife of Legras, the secre- 
tary of Mary of Medicis, enlisted herself at once in the service of that 
family and of many equally indigent. She and her friends worked 
both in private residences and in hospitals, and were soon recognized 
as an order. As early as 1636 a house was founded for the care and 
■education of children and women, a foundling hospital was established, 
and a home for the alienated in 1645. Her order owned, after a single 
century, 290 stations, and had 1,500 members, who entered between 
the ages of eighteen and twenty-four, bound themselves for life to the 
order and the Church, and worked in hospitals and private residences, 
in the interest of both women and men, in rescuing fallen girls and 
educating the young. In Rome, mainly in this century, they assisted 
those taken with infectious and acute diseases who could not be ad- 
mitted to the public hospitals, and everywhere they attended the 
chronic cases of sickness of all denominations. Their foothold in Ger- 
many dates from this century only. Their greatest adversity was the 
all-purifying thunder-storm, the French Revolution. Many emigrated 
to England, but during the Napoleonic wars their services were so 
much appreciated as to procure for Sister Martha the cross of the 
Legion of Honor. 
All of the orders mentioned were composed of Catholics. Not 
one of them but was intimately associated with the Church. In this 
connection it ought not to be forgotten that all the culture and knowl- 
edge of the mediaeval period was confined within the limits of the 
Church. Within its fold the whole progress of mankind, slow though 
it was, toward humanistic evolution, was developed. Thus the efforts 
of the Catholic Church in favor of the poor and sick must be duly 
appreciated, the more so, as the so-called “ Reformation ” party exhibits 
nothing but blank leaves in the history of ethical and humane develop- 
ment. The revolutionary movement prepared by powerful minds for 
centuries, and finally carried out by Luther, did not result in any good 
to the sick and poor for a long time. Indeed, the success of the Refor- 
mation was in part due to the greed of German princes, who gained a 
rich harvest by appropriating monasteries, hospitals, and all other 
possessions of the Catholic Church. Thus the Lutheran Church, or 
churches, were left so poor that if they had the will they had not the 
power to make any pecuniary sacrifices in the interest of the poor and 
sick. But even that will they had not, could not have. For the first 
axiom in Luther’s doctrine was this, that not work performed, but faith 
only, made the Christian. That doctrine was a long stride backward ; 
it fired the imagination of some bigots, chilled the hearts of most men, 
sustained the egotist, and created dissensions. Never was there a 6 
greater failure. The poetry of the Church gone, its efficiency gone, that 
was the “reformation.” Not until some decades ago did we know of 
Protestant unions established on the plan of their Catholic predecessors. 
But the male orders never tried to imitate the useful example of the 
Catholics. They did not care for the sick or the poor. Their aim was 
and is “ home-mission.” They are replete with faith, distribute Bibles, 
and glory in the conversion of that Jew who was baptized, once or 
often, half a dozen years ago, for ready cash. The women, as always, 
have done better. Their hospital orders, mainly the Deaconesses, have 
done good work this half-century, both in public institutions and in- 
private. During the war-times in Germany they and other associations 
established on similar plans did good work, and deserve all the praise 
bestowed upon them. Their recognition was complete. Princesses 
joined hands with them—the Archduchess of Baden, Princess Alice of 
Darmstadt, the Empress Augusta. And not only in military hospitals 
did they earn deserved praise. Some general hospitals, such as the 
Augusta Hospital in Berlin, derive great benefit from their incessant 
and intelligent labors. Ido not mean to stint praise, and therefore 
make this statement of their work, which has been performed under 
apparently great difficulties. These difficulties are the very rules, for 
instance, of the Deaconesses of Kaiserwerth, from which I quote for 
your edification the following introductory paragraph ; 
“ The Christian women who wish to undertake the office of a nursing 
sister, as deaconess for the sick and poor, must possess a somewhat ad- 
vanced Christian knowledge. Mere church-membership, mere attend- 
ance on Christian assemblies, and reading of Christian works of edifi- 
cation, are not enough. The love of reading the word of God, and a 
diligent use of the same for a long time past, must exist, as well as a 
knowledge of the more important histories of the Old and New Testa- 
ments. There must also be a knowledge of the sinful heart from their 
own personal experience, as well as experience of the grace of Christ, 
in order that they may have learned to despair of themselves, and in 
their weakness to trust only to the strength of Christ. A Christian 
walk of life must for a long time have adorned such Christian women,” 
and so on, and so on. You will admit that in the face of so much 
hyper-religious sentiment an active, unselfish, modern woman must 
feel bewildered. 
After all I have said, it is evident that the cause of humanity was 
originally not hampered by the efforts of the Catholic Church. On 
the contrary, many centuries ago it was the only safe deposit, inas- 
much as the Arabs lost their importance in humanistic evolution from 
the fourteenth century, for the gradual development of human feel- 
ing. But that human feeling was not fostered and protected because 
it was human ; the Church had but one purpose, the aggrandizement 
of the Church. The latter has a meaning in the case of the Catholic 
Church, which is at least a union, and has a uniform standard, which 7 
Protestantism never had and never can have. The latter has, in its 
imitation of the ways and words of the mediaeval rules of Catholic 
orders, proved one truth, and I emphasize that because here is the 
great difference between church nursing and modern nursing. “ Cleri- 
cal care of the sick is destined, under the rides, to serve the Church, 
whatever that may mean, while serving the sick ; the main duties and 
aims in view are ecclesiastical, and not humane, and, instead of a nurse 
solely given to the performance of her duties, you deal with ecclesi- 
astical officers ” (Virchow). And the necessity is clear, that what- 
ever organization is deemed advisable in the interest of the sick, that 
organization ought to be in our times w/iecclesiastical and unsectarian, 
I have alluded to the fact that whatever medical knowledge existed in 
the masses centuries ago did so through the medium of the clergy. That 
knowledge was but trifling, for the ancient medicine of the Greeks and 
the more recent labors of the Arabs were sealed books at that time. 
But, then, the clergyman was the doctor. Instead of being so at pres- 
ent, we are daily met with the fact that the exact tendency of modern 
medicine is an unknown territory to the clergy, and that among them 
the upholders of all sorts of doubtful practices find their most sincere 
supporters. Medicine is to them a matter of faith, not science. It is 
not necessary to refer to that Brooklyn impostor whose criminal career 
has been detailed but lately in the secular press. For no church and 
no denomination must be held responsible for his methods of fleecing 
the ignorant and credulous. But the instances where actual clergy- 
men assume responsibilities beyond their clerical powers and duties 
are also very numerous, and the protection by the Church of a regular 
monk in a Jersey monastery, who, in the church of his own institu- 
tion, plies his nefarious trade of laying on hands, and exorcising the 
devils of disease for cash, these ten years, proves to what extent faith 
can be abused and the essence of religion distorted. We still live in 
a time when mediaeval ignorance and modern enlightenment appear to 
find resting-places side by side. That the latter is getting the upper 
hand, after all, this sketch will prove, I hope, for even the mediseval 
organizations in the interest of the poor and sick, which I was anxious 
to estimate at their full value, have finally failed ignominiously. Al- 
most every large society of the kind would degenerate in the end. 
The uniform report concerning most of them, mainly the male orders, is 
this, that with increasing power and wealth the original unselfishness 
of the founder disappeared, the actual work was left to low servants, 
the wealth of the community was accumulated in the Church. Thus 
it was that every great calamity sweeping over the lands was a source 
of riches to the Church. Never was divine blessing more visible 
in the Church than when half the population of Europe succumbed 
under the destruction of the “ black-death.” Never was more busi- 
ness shrewdness developed by “fathers” and “brothers” than when 
a patient, sick with leprosy—much less contagious than was made 8 
out by those who had an interest in exaggerating its dangers—had 
to give up half his property before being permitted to bury him- 
self for life in the out-of-town places provided by the Church. The 
omnivorous taste and good digestion of the Church have become pro- 
verbial. 
The majority of the clerical associations having failed, the seven- 
teenth and still more the eighteenth centuries were far behind former 
periods in regard to systematic nursing. It has taken a long time be- 
tween the church institutions, which no longer came up to the inten- 
tions of their founders, and the spontaneous efforts of free men and 
women who felt the necessity of appropriate efforts on a different 
basis. The history of this slow evolution is very interesting ; it is the 
co-ordinate of the history of a healthy and wdiolesome individualism 
in general, after long indifference and chaos. 
Schools for training nurses were established in Germany fifty years 
ago ; in Berlin by Dieffenbach, Kluge, and Gedike, and in Gottin- 
gen by Ruhstaat. Books to serve the purpose of instructing nurses and 
the public in general have been written by numerous men and women, 
some of them, particularly in our days, by celebrities. Gedike him- 
self published a work, fifty years ago, which is a very readable one 
even now. Passing by Nightingale, who has proved how to become 
immortal without enjoying high office, or playing on cannon, or tyr- 
annizing nations, or being borne on a throne, let me allude to but 
a few illustrious names : Nothnagel, who wrote on the nursing of 
those sick with nerve-diseases ; Billroth, who published a book on 
nursing in general; Esmarch, who taught the first aid in emergencies ; 
and the greatest of the many great men of the century, Virchow, with 
his many contributions to the literature of the subject, and mainly, in 
1869, with a lecture “ On the Instruction of Women in caring for the 
Sick outside the existing Ecclesiastical Organizations.” 
This instruction of women in caring for the sick, and the relation of 
women to nursing as a profession, can be considered from two distinct 
points of view : first, in its influence upon them ; second, in its effects 
upon the public. 
The first consideration is a very important one. The opposition to 
women stepping out of their sphere, which was meant to be cooking and 
washing, knitting and darning, begging alms and taking a daily whip- 
ping, also getting married and raising a family, has been overcome by 
common sense and habit. Common sense ceased to understand why or 
how every woman could or should cook and wash, knit and darn, beg 
alms, or get whipped or married. And habits are formed and reformed 
with such rapidity that opposition becomes changed into favor in a few 
years. It is but little more than a dozen years since women physicians 
were recognized by the profession ; not over half a dozen years since 
you heard of women lawyers. The female part, and, for that matter, 
the male part of my audience also, are sorry they heard so much of a 9 
woman lawyer in a Western town. At all events, the opposition to the 
attempt at widening woman’s sphere, or spheres, has ceased, and the 
recognition of the principles of equal rights, no matter for what color 
or sex, or previous servitude, is all but universal. 
You will not care to go into the question now, whether law or 
medicine will ever be resorted to by women to any great extent. The 
entire liberty given them has proved already, will prove more in fu- 
ture, that neither law nor medicine is an appropriate vocation for any 
but an exceptional class of women, and that the opposition to women 
practitioners of law and medicine will come less from the professions 
than from the public. For the public will never admit that a person 
in the practice of a profession should not give his or her entire atten- 
tion and strength to it, and the women of the country will never admit 
that the superintendence of a home and the proper raising of a family 
are not sufficient employments of all the time and all the powers of 
the most gifted woman. The amateurs are losing ground. Thus it is 
that the professions will never be overrun, and the fear of undue 
competition has long died out, even among the most chicken-hearted 
braves of the professions. But the question is not how many women 
will avail themselves of the opportunities granted, but whether they 
shall have those opportunities, and whether these shall be given the 
women of all walks of life, of all standards of intellect. And the 
question has generally been answered affirmatively, to such an extent 
that it is considered self-understood that, while the mediaeval ages at- 
tempted to help them as much as possible, modern times prefer to give 
them the power to help themselves. In regard to nursing, attention 
was called early to the unmarried and poor among the women. The 
statistics of Berlin, of the year 1872, proved that every third woman 
had to provide for herself. It was remarked with surprise that, of 
407 such helpless and breadless creatures, but a single one went into 
nursing as a business. In other Continental cities it was still worse. 
In Vienna the shiftlessness of women was still greater ; misery and 
poverty reigned supreme, as must be expected when you learn that a 
woman who took the making of her own clothing, even with the aid 
of a professional seamstress, into her own hands was punishable under 
the law. 
The proportion of but one nurse to 407 women, who had to work for 
a living, is remarkable, it is true. For are not nursing, and caring, and 
attending implanted in woman’s nature ? What is the reason that 
so few went into nursing as a business, if not a vocation ? Probably, 
because the women felt, or the public made them feel, that without 
careful preparation no nurse, or soi-disant nurse, can be efficient. 
We have still the remnants, I fear numerous ones, of that self-made 
class of nurses among us. In my own recollection of far-away years 
I remember a great many, and a great many, I was told but lately, 
remember me also, perhaps too well. Some of you may have seen 10 
them—in other people’s houses—wrinkled prematurely, thinned out 
hy temper, contrary by nature, or for the most part fattened in the 
course of their (to them) useful career, complacent, and drowsy while 
everything was going well, incompetent and snappish when danger 
required work and sufficiency, always ready to have their regular 
meals served up-stairs by the help of the house, who breathed freely 
when they finally left, and always willing to spend their time between 
rocking a baby, speaking of their long experience, sleeping ten hours, 
talking gossip all day long, and drinking eleven cups of coffee in the 
twenty-four hours. This is hardly an exaggeration, for the number 
of women who took up nursing as a business, driven to it by some 
natural disposition, gifted with some intellect, modest and willing to 
profit by superior knowledge and experience, interested in the welfare 
of their patients, and never stunted in their human feelings by the 
force of habit, was rather small. But lam glad to say I knew such, 
too. I gladly shook their hands when I happened to meet them on a 
common errand, gladly recognizing the diploma they carried in their 
brains and hearts. But these exceptions proved the rule, and the rule 
conveyed no blessing. It was, it is, a sad fact that nursing all over 
the world grew worse in just the same time when medical science grew 
more exact and medical practice more effective. 
Relief in this city came none too soon. The president has detailed 
to you the history of the training-schools of ISTew York. Since their 
time the practice in hospitals and in private dwellings has changed 
wonderfully. After thirty years’ work in the city, after twenty-five 
years’ constant labor in public institutions, I ought to know the dif- 
ference. And Ido know and publicly proclaim that the results of the 
best of physicians have vastly improved since their cases have been in 
the hands of trained nurses. This is so in private dwellings ; it is the 
same in hospitals. In the hospitals the difference can be measured on a 
large scale. In them the trained nurse has worked a vast improvement. 
Every large hospital ought to perform a double duty. It must 
give the poor patient, and many rich also, the best possible chance of 
recovery from sickness. It can afford to accomplish that, because of 
its pecuniary and intellectual means. Though a hospital be poor, 
there ought to be, there generally are, means enough to fill all the ne- 
cessities required. And the intellectual means are expected, are sup- 
posed to be, above the average of the general practitioner. There are 
a great many reasons why that should be so, why hospital places 
should be open for the competition of the best material among the med- 
ical profession, recognized to he the best by the medical profession 
itself, and why family and personal influence should not fill places 
which are better not filled at all than with indifferent or bad material. 
A hospital must also grant the best possible nursing—attached, wake- 
ful, careful. All this is due to the single patients. 
A good deal more, however, is due to the public at large- A hos- 11 
pital looking for the interest of the single patient only might just as 
well he a private institution, a maison de sant'e for the benefit of a 
landlord. The benefit derived from hospital treatment by a sick per- 
son is not all the satisfaction due to a public who pay four hundred 
dollars a year for every bed. Nor are the public paid sufficiently for 
their sacrifices by the accumulated experiences of a few physicians, who 
enjoy the large field of observation and the opportunity of utilizing it 
for the benefit of private patients. Every hospital which neglects to 
increase the stock of medical knowledge, and to give an opportunity 
of learning the theory and practice of nursing and caring for the sick, 
performs its duties but half, and serves the public but incompletely. 
Every large hospital must be, and will be, a clinical school, and a 
school for nurses. It will be acknowledged that as the presence of a 
nurse in a sick-ward, who is sent there to learn, is considered unobjec- 
tionable, the presence of a few physicians observing a case, which can 
not be injured by their so doing, is not only not injurious, but ought 
to be demanded by the public, who have a right to expect a physician 
in their own families who has seen and knows and understands what 
he is called in to treat. Ido not see why hospital patients only should 
have the best money and service can afford, and why the public at large 
should have to fall back in many cases on untried skill. Thus the people 
have a right to demand that every large hospital should have a clinical 
school, and a training-school for nurses. The public, who are willing 
to pay for it, may also demand that the expenses of the same, particu- 
larly the nurses’ school, should be borne by the hospital. This de- 
mand, if considered theoretical only, must stand as long as a hospital 
is, or claims to be, a public institution. When the board of directors 
of any institution will recognize that they are not the administrators 
of the dollars of a small concern, but the benefactors of the public at 
large, they will also appreciate not only that a few disinterested ladies 
will open their pocket-books, and collect voluntary contributions, but 
that a generous public will pay more willingly and more largely. 
The demand that a large hospital should be a clinical school and a 
school for nurses, and that the expense should or might be borne by 
the institution, is not valid in the case of city or commonwealth hos- 
pitals only. Most of the hospitals of the country are originally pri- 
vate institutions. They obtain the character of being public affairs 
when an always increasing number of men and women become inter- 
ested in and contributors to them. An institution with one or two 
thousand paying members represents ten or twenty thousand families 
—in fact, represents a city. And wdiat it represents, of that it assumes 
the rights and duties. And the main duty the public at large will 
soon know how to enforce from the directors of every large hospital 
is, to administer the public domain to the greatest possible advantage 
for the greatest possible number. The selfishness of an individual 
adversary, the animosity of evil-spirited persons will never weigh,. 12 
ought never to weigh, against the public good ; the latter only is the 
object of those who are placed in trust of money, institutions, and the 
public welfare, because of their actual or supposed public spirited- 
ness and superior intellect. 
Is it necessary to detail the advantages of the services of a trained 
nurse over those of an untrained one ? The latter class, as a rule, 
brings to their work no previous education, no theoretical schooling, no 
technical experience. They come mostly from inferior walks of life, 
with less intellectual power, and less moral force. Only those who 
come from better stock, and raise themselves to higher ambitions, 
will spend money, and two years of their lives, for the purpose of 
learning both theoretically and practically the art of relieving the 
sick, aiding their comfort, taking responsibilities which sometimes are 
as difficult as they are life-saving, and obeying orders with intelli- 
gence and understanding. That such persons are valuable additions 
to our hygienic requirements and sanitary progress everybody can 
conceive. That without them many a case would not recover, in spite 
of the most competent medical skill, all of you may have experi- 
enced. I, for one, know from personal experience that many a case 
can be, has been saved, first by the medical orders ; secondly, and 
often mostly, by the execution of orders, such an execution as is ren- 
dered possible by combined knowledge and skill only. If I say that 
we practitioners have commenced to feel safe in regard to many of 
our cases only since we could rely on the co-operation of a trained 
nurse, I express but a common observation. I trust that there are 
households within hearing which know how to appreciate the services 
rendered them by a trained nurse. 
So much only in regard to individual cases. But the service to the 
public at large hitherto rendered, and constantly increasing, is of a dif- 
ferent and still more important nature. Who is nowadays the teacher 
of the public at large in sanitary matters, in hygienic rules ? The 
knowledge of the Church, when it nursed, was faith, and, let us add, in 
its best times, love. The knowledge of uneducated women was, and is, 
ignorance driven to actual or alleged work by starvation. The knowledge 
of a trained nurse is the result of a two years’ study under competent 
teachers, and a constant practice. Who in the community is her su- 
perior in the knowledge of the facts mostly necessary for the health 
and life of your children, and dear ones in general ? The clergyman 
is no longer the teacher of the mysteries of life and common sense. 
The schoolmaster or schoolmistress knows about the classics, geogra- 
phy, and arithmetic, but no normal school ever taught them the ele- 
ments of applied physiology. The educated member of any profes- 
sion except the medical has not the slightest idea of the necessities of 
the body, the action of food, the effect of clothing, and the hundred 
facts required by different ages, conditions, and states of health. With 
the exception of the physician, whose advice is frequently sought only 13 
to repair the effects of ignorance, the only teacher the public have, and 
will have, is the trained nurse. Ten or twenty families may enjoy her 
presence annually, ten or twenty mothers will learn simple and impor- 
tant truths, knowledge will increase, and prevention of disease will 
become a possibility. Enjoyable and useful as the service of a trained 
nurse is in an individual case of sickness, her services to the commu- 
nity are very much greater, by virtue of her theoretical and practical 
teaching. May I tell you what a good trained nurse may teach, and 
can teach ? How to recognize a fever, how to compare the local tem- 
peratures of the several parts of the body, and howr to equalize them ; 
she knows that ever so many feeble children might have been saved, 
if but the feet and legs had not been allowed to get cold ; how to 
bathe, when, and when to stop ; how to regulate the position of the 
head—l remember quite well the case of inflammatory delirium which 
would alwrays be relieved by propping up the head—how to treat in- 
telligently an attack of fainting; how to render cow’s milk digestible 
by repeated boiling, or lime-water, or table-salt, or farinaceous admix- 
tures ; how to feed in case of diarrhoea ; how to refuse food in case of 
vomiting ; how to apply and when to remove cold to the head ; how 
to ventilate a room without draught ; and a thousand other things. 
She will also use her knowledge and influence in weaning the public 
of nostrums, concerning which hardly anything is known except what 
you have to pay for the promises of the label. She will break the 
public of the indiscriminate use of quinia, with its dangers possibly 
for life ; cure you of the tendency of making the diagnosis of malaria 
the scapegoat of every unfinished or impossible diagnosis ; she will 
teach you that the frequent and reckless domestic use of chlorate of 
potassium leads to many a case of ailment, to chronic poisoning, possi- 
bly in the shape of Bright’s disease or to acute poisoning with unavoid- 
able death. These are but very few of the things she can do, and but 
a little of the knowledge she can not but distribute. With the aid of 
the class of women who frequent our training-schools, the public at 
large must and will gain, in a short time. Let the number of the 
schools increase, and increase the number of pupils, and every one of 
them will be a teacher and an apostle of sound information on sanitary 
and hygienic subjects. And let nobody leave this place to-night with- 
out intending to aid an institution as helpful as this. 
Will the pupils come ? Certainly they will. There is an increas- 
ing demand for their services. Many times had Ito wait a day or two 
before any of the schools could accommodate me. There is no fear 
that there ever will be too many good nurses. There is fear, either, that 
many persons of inferior intelligence and morals will present themselves 
for or obtain admission to a school. By attending the suffering, it is 
true, many a crude or brutal nature is ennobled ; but I should not ad- 
vise to run the risk of admitting that class at the expense of the sick, 
or of a rising and beneficent profession. The occasional specimens of 14 
cold-hearted and arrogant persons one is apt to meet, even among 
trained nurses, must discourage the admission of any but the very best. 
These will apply. The calling is an honorable one, it promises a com- 
petence, it corresponds with the innermost nature of woman. It is not 
true that the Church alone could raise the enthusiasm for hard work, the 
performance of arduous duties, and self-sacrifice. One of the first nurses 
I had in my division in Bellevue Hospital, many years ago, was an ac- 
complished girl, the daughter of a rich man in the far West. After a 
year and a half it took all the influence and begging of her family to 
take her away from us and her hard work among the poorest of the poor. 
The large number of ladies, wealthy and accomplished, who work as- 
siduously and regularly under Felix Adler, and in other places, under 
our very eyes, prove that the very best class of society can be prevailed 
upon to do the hardest and most beneficent kind of work. And the fact 
that the elite of the women of the city are willing and anxious to under- 
take the arduous task of founding and supporting training-schools, in 
the face of all sorts of difficulties, proves also that the work is in ac- 
cordance with the requirements of both woman’s nature and humanity. 
There will be many trained nurses who will work for humanity’s sake, 
as centuries ago they claimed to serve for God’s sake. Many a woman 
w'ho would have buried herself in a monastery centuries ago, driven 
from the face of the living earth by misunderstood and unsatisfied long- 
ing, I believe, would nowadays become a nurse, knowing and enthu- 
siastic. 
Ladies of the graduating class : The remarks I was expected to 
make have extended into a lecture. You have been used to lectures, 
however ; if you had not enjoyed them, and profited by them, you 
would not be here to-night, the most honored and most conspicuous of 
this assembly. Thus I thought I might be permitted to speak, instead 
of to you, of you, and your chosen calling and its history. From noth- 
ing can any profession derive so much advantage as from the history 
of its development. It is certainly an interesting spectacle to see how 
your profession depended intimately on the changing conditions of 
thought and feeling among mankind. You are happy enough to live 
and work in a time when, while following individual tastes and having 
individual motives, your labors are given to the suffering for no out- 
side reason, no church command, but from the free choice of free 
women in the interest of humanity. I had also to allude to several 
subjects which may to some appear a little outside the legitimate do- 
main of your ambition and duties. You know better. An intelli- 
gent woman will not spend two of her young years in acquiring a 
certain knowledge without enlarging her horizon in general. You 
have chosen a profession as noble and as deserving as any there is 
in existence. You will be the interpreters and right hands of the 
physician, and the connecting link between the physician and not 
only the single patient, but also the public at large. My opinion 15 
of the services you can render is high, but I trust not exaggerated. 
When your numbers shall increase, and the character of those who are 
admitted remain of the same standard, your importance will grow. 
In your hands will, to a great extent, lie the opportunity for removing 
prejudices, spreading knowledge, healing and preventing disease. 
Even those of you who will not always consent to serve in other 
people’s homes, will, by example and by teaching, remain in close 
alliance and co-operation with such as intend to remain in the ranks 
forever. As you now mean to leave us, endowed with the certifi- 
cate of the required accomplishments, I can only add, while offering 
my best wishes for your future, that I trust you will never forget the 
place which gave you so ample opportunities for perfecting yourselves. 
You will never forget the gentlemen who taught you, nor that accom- 
plished young woman who impressed all of you with the fact that the 
charms of womanhood will not suffer from hard work, from a classical 
education, and thorough medical or other knowledge. Do not forget, 
also, at the beginning of your independent career, the ladies to whose 
care and sacrifices and labors you owe the existence of the school 
which sends you forth as its first graduates, nor the great charitable 
institution which, after having given you your practical training, hor 
ors you to-night by the presence of many of its officers, and designates 
its president to deliver to you your diplomas.