; 'iuits I panw i92£ history OF THE MASSACHUSETTS GENERAL HOSPITAL TRAINING SCHOOL FOR NURSES 53930750R NLfl Q52fl37fl7 b NATIONAL LIBRARY OF MEDICINE SURGEON GENERAL'S OFFICE LIBRARY. Section----- no. 2.£J3£ O W.D.S. G.O. 3—513 NLM052837876 DUE m m LAST DATE Ml W& OfC 251975 MAR 9 1876 JON 8 W6 JAH24 197* The Bulfinch Front, Massachusetts General Hospital 1 History of the Massachusetts General Hospital Training School for Nurses By Sara E. Parsons WHITCOMB & BARROWS Boston, 1922 \2> Copyright, 1922 by Massachusetts General Hospital Nurses' Alumnae Association Thomas Todd Company, Printers 14 Beacon Street, Boston, Mass. MADE IN U. S. A. mnin J ©C1A690328 -wo V This Book is Gratefully Dedicated to the Memory of the First Board of Directors of the Boston Training School for Nurses CONTENTS Introduction..........xi FIRST PART Chapter Page I Pre-Training School Days.....3 II Preparation........19 III Probation . . .......28 IV Organization........35 V Development........42 VI Miss Maxwell's Leadership.....53 VII Transfer of the School......64 VIII The Board of Directors ...... 79 IX Pioneers....... 86 SECOND PART X Renaissance........97 XI Eventful Years......• 107 XII War Service........123 XIII War Service—continued......134 XIV Survey of the School......144 XV Survey of the School—continued .... 156 XVI Training School Relationships . . . .170 XVII The End of Half a Century.....177 Chronological List.......182 Appendix ....-'••• 204 LIST OF ILLUSTRATIONS The Bulfinch Front Nurse of Pre-Trainlng School Days Mrs. Samuel Parkman Mary von Oenhausen Linda Richards Elizabeth Scovil Anna C. Maxwell Nathaniel Thayer . The Thayer Building Group of Nurses in the Eighties Maria B. Brown The Thayer Library Dr. W. L. Richardson Members of the Board of Directors Members of the Board of Directors Ward 7 Sophia F. Palmer . Mary E. P. Davis . Alice Scott Mary L. Keith Operating Room, Ward E Pauline L. Dollher Sara E. Parsons Annabella McCrae Helen Wood Mrs. Alexander Whiteside Nurses of Base Hospital, No. 6 . Colonel Frederic A. Washburn Reception Room, Nurses' New Home "Her Ivied Columns" Mrs. Nathaniel Thayer Mrs. W. W. Vaugiian Sally Johnson Student Nurse, Preliminary Student, Gradi ate Nurs- INTRODUCTION The Boston Training School for Nurses, attached to the Massachusetts General Hospital, was organized Novem- ber 1, 1S7.'J, the third training school to be established in the Lnited States in connection with a general hospital. As one of the oldest and largest schools it seemed fitting to commemorate the fiftieth anniversary with a history of its development and achievements, both for the pleasure and information of all those who are interested in the School and the Hospital. It is hoped that this history will prove also to be an inspiration to those nurses who will graduate from the School in the future. The writer has learned that most of the improvements of later years, which were considered original wrhen made, were comprehended in the founders' conception of the School; that those ideas wrere later revived by the Advisory Com- mittee in 1900; and that the Alumnae Association, in its effort since 1015 to raise an endowment for the School, has been nurturing unconsciously an expressed need of the Direc- tors of 1879 and of the Advisory Committee of 1900. If the history is to have any value, it must be true; un- palatable facts must not be concealed, the difficulties of the work must not be minimized or exaggerated. Mere facts, however, are comparatively uninteresting unless illumed by the spirit behind them. The value of the history, there- fore, is dependent upon the reader's ability through imag- ination to invest the facts with the thought, customs, ideals of the locality, time, and persons who were making history. xi xii Introduction In the records, idealism, courage, and sacrifice shine through and obliterate doubt, prejudice, and fear. This story of half a century of endeavor in the making of nurses is a sincere effort to portray as true a picture as possible of the events that seemed most significant in the development of the School. Grateful appreciation is ex- tended to the trustees of the Hospital, and to those friends who, by their cooperation, have made the work possible. Sara E. Parsons. FIRST PART CHAPTER I Pre-Training School Days The history of the first training schools for nurses por- trays the manifestation in this country of the idea that Florence Nightingale first conceived of developing woman's humanitarian impulses to relieve the disease of ignorant, poor, and sick mortals into well-ordered, intelligent, skillful, and constructive nursing methods. The Nightingale School at St. Thomas's Hospital, Lon- don, had been in existence thirteen years when in April, 1873, the Woman's Education Association of Boston sug- gested the organization of a school for nurses as offering a desirable occupation for self-supporting women, and at the same time meeting the recognized need for good private nurses in the community. The history of this School is closely interwoven with that of a group of individuals who were identified with any movement related to the welfare of Boston, especially in education and philanthropy. Much of the interest of the School's development consists in the way the ideals of the founders have manifested themselves through the product of the School. First, however, a picture of pre-training school days is essential as a background against which the work of the School may be shown in relief. Such a background is furnished in articles by Georgia L. Sturtevant, entitled "Personal Recollections of Hospital Life before the Days of Training Schools," which appeared in The Trained Xurse in 1805. The extracts which follow, 3 4 Massachusetts General Hospital and which are reproduced by the courtesy of the editors, give not only a vivid picture of the nursing conditions of the sixties, but also some illuminating portraits of the hos- pital staff and pungent impressions of the conditions during and after the Civil War. We gain an insight also into the character of the old-time nurse of better type, and apprecia- tion and respect for those women who took up the work for love of it, in spite of the extraordinary obstacles and hard- ships then accepted as a necessary part of the nurse's life. Miss Sturtevant entered the Hospital as assistant nurse in 1862. She was put in charge of a ward two months later, and in 1869 was made matron, a position she held until December 14, 1894. If one is in a receptive mood, one's first visit to a strange city usually makes a more lasting impression than any other subsequent visit ever will. One thing that a stranger in Boston is quite sure to be told, at almost every turn, is that the ground on which he is treading is not original soil, but that the blue waters of Massa- chusetts Bay, or some of its tributaries, once had the right of way over what is now hallowed ground. And he begins to feel that it is not an easy matter to find a sure footing in that historic city. As I stood on Charles Street bridge, looking over the stretch of marsh that lay between the river and the mainland, my atten- tion was attracted to a beautiful granite building, with a fine grassy lawn dotted here and there with clustering shrubs, and almost surrounded by many gracefully drooping elms. This build- ing was noticeable, standing as it did, the only one of its kind, among its sober brick neighbors; and as a work of art I was sure I had seen nothing in the whole city to compare with it in archi- tectural beauty. On questioning my companion as to the character of this build- ing, the answer, "That is the Massachusetts General Hospital," astonished me, it was so unlike the somber abode, with closed shutters and sawdust bestrewn walks, I had always pictured to myself a hospital to be. . . . I determined before leaving the city Training School for Nurses 5 to learn something of the history of this institution, and the work it was doing. I did learn, somewhat to my surprise, that it had been in existence nearly forty years, having been opened for patients in 1S21. It was incorporated in 1811, before Boston had become a city, but the work of erection was not begun till July 4, 1818, when the corner stone was laid. I also learned that it had two distinct departments—the asylum for the insane, situated in Somerville, and the hospital for the sick in Boston—both belong- ing to the same corporation, and under the direction of the same Board of Trustees. In 1802, the second year of our Civil War, I felt that I ought in some way to take a part in that great struggle, and about de- cided to offer my services as an army nurse, but my friends per- suaded me to abandon that idea, and remain at home. I, accord- ingly, gave up my army plans, and accepted a position as assistant nurse in the Massachusetts General Hospital, at a salary of $7.50 per month. The head nurses at that time received $12 per month. My first introduction to a hospital ward was a pleasant sur- prise. ... I was prepared to see the most shocking sights and sounds, and to be brought face to face with sickness and suffering in every form. But instead of this, I was ushered into a large, bright, airy room, the pretty white-curtained beds, with their strip of bright carpet beside each bed, and in almost every window pretty flowering plants gave the room a most cheerful and homelike appearance. And yet, as I soon learned and saw, there was suffer- ing in almost every form within those four stone walls. Some of the wards at that time were divided into two rooms, with the nurse's room between them. The only building used for patients, besides the main stone building, was a detached building of two stories known as the "Brick." This building, which was used for isolating infectious or delirious cases, was divided into small rooms and accommodated about thirty patients. When this building was erected, it was built upon the very water's edge, and boats were moored under the shadow of the eaves. All the other buildings on the Hospital grounds were the kitchen and laundry building, exactly as it appears today, with the exception of the drying room on the roof, which has since been added; the post- mortem building, which stood only a few feet from the present surgeon's entrance, and a very small porter's lodge. 6 Massachusetts General Hospital My first day at the Hospital was full of surprises. All the nurses were required to go on duty promptly at 5 a.m. The night watchers who lived outside the Hospital left at that hour, after making a verbal report to the head nurse. The nurses slept in little rooms between the wards, two nurses occupying one bed, which was folded up during the day, and the room used for a sitting room, and frequently for a consulting room for the doctors, or for minor operations. One required to be on duty at 5 o'clock must, as can readily be imagined, make rather a hasty toilet. Consequently, the difficulties under which nurses labored, to keep themselves presentable in their little rooms, which were used as thoroughfares during the day, can hardly be exaggerated. On being shown to the nurses' dining room—all the employees of the Hospital ate in the same room—I really thought I must be dreaming, or that time had indeed turned backward in its flight. This room, which was on the ground floor, was a dark, dingy room, with a brick floor that looked as if it had seen much service and hard usage. On one side was an empty fireplace, a large unused brick oven with the usual accessories, and various other reminders of by-gone days. The tables, running the whole -length of the room, were spread for dinner, with a service corresponding to the other appointments of the room. Beside each plate was a pewter tumbler, which greatly heightened the effect which the last century appearance of the room had already made upon me. This room, as I afterwards learned, was originally used as a kitchen, and with very few changes had been made to serve its present purpose. The food was of the plainest, but fairly good. I would not for a moment question the wisdom or large- heartedness of those men who devised and perfected such a won- derful scheme, the result of which was to produce a structure that must endure for ages to come—a building that has sheltered and surrounded with many luxuries, has healed and nursed back to life its many thousands of unfortunates who have been brought to its doors. But that these men—I would speak reverently, for they are not here to defend themselves—should so strangely forget to provide for the health and comfort of those who were to be the chief instruments in carrying out their charitable designs, seems Training School for Nurses 7 almost beyond belief. For example, while the patients, no matter of what nationality, or in what station of life, reposed on dainty, dimity-curtained beds, and used only solid-silver (spoons), the nurses, after being on duty for sixteen hours, were shut up in little boxes of rooms between two wards, and sipped their "sou- chong"—or whatever brand it might have been—from pewter teaspoons, and drank their ice-water, when they were allowed that luxury, from pewter tumblers. And yet, that the responsibilities of a nurse were great, and her duties extremely arduous, seems to have been fully appreciated. In a circular letter written in IS 10, appealing to the people of the commonwealth to aid in establishing a hospital in the town of Boston, a strong point is made of the fact that the poor would have the advantages of good nursing, which they lacked in their own homes. I quote from this letter: "In a well-regulated hospital they would be attended by kind and discreet nurses, under the direction of a physician." Another clause in this letter reads: "In these officers (nurses) must be placed trust and confidence of the highest nature. Their duties are laborious and painful." But the novelty of the situation made the work interesting, and as one's interest increased, dis- agreeable things were in a measure forgotten. Other parts of the Hospital were as uncomfortably crowded as were the nurses' quarters. The four house officers, the number in the Hospital at that time, and the apothecary, all occupied one room—a room now occupied by one person only. But a would-be army nurse must not be driven from her post by the sight of bunk beds or pewter tumblers. I went into hospital work with no poetic ideas about nursing; I was fully prepared for hard, disagreeable duties, and for long, tedious days. The nurses were required to go on duty at 5 a.m. and remain until 9.30 p.m., with an occasional hour off, if the work could be so arranged as to make it expedient. There were eleven head nurses, and usually about sixteen assist- ants, employed in the Hospital at that time, besides the night watchers. These extra assistants were sent from ward to ward where they were most needed, and had their sleeping room in the attics over the wards. I was not, however, prepared for the drudgery that was required of a hospital under-nurse in those days. I refer especially to the washing of filthy clothing and foul dress- 8 Massachusetts General Hospital ings that the assistant nurses had to do. Cotton could only be bought at the most fabulous prices, and it is not exaggeration to say that every inch of old cotton and gauze had to be carefully saved and washed, and used over and over again. . . . All this foul washing was done in the ward bathroom, and then sent to the general laundry to be more thoroughly washed and made ready for use. I think the most uncharitable must give those women credit for some nobler inspiration, to keep alive their enthusiasm, than the $7.50 a month which they received for their service. Though the nurses received no special training, were given no systematic instruction, everything impressed me as being exceedingly syste- matic, and the smallest details important. At a certain hour the heavy counterpanes, wdiich were used at that time, were carefully folded back and extra blankets substituted in their places. The strips of bedside carpet were swept and shaken and laid away till morning, the linen stand covers were also removed at night, and were not put on again until after the dressings were done and the last touches given to the ward. Everything must be in order before the "visit." This ceremony of putting in order impressed me so much, I began to regard its observance at the exact time of as vital importance as the administering of the "Smith & Mel- vin's" to the restless patient. The assistant nurses went to their breakfast at 6 o'clock, after working in the ward an hour, making beds and assisting the head nurses in the general care of the patients. On their return to the ward, the head nurses went to their own breakfast, and from there to the kitchen, where they prepared breakfast for their patients, or rather, where they filled their trays with whatever their diet lists called for, ready to be taken to the ward. The nurses carried their trays, which were heavy wooden ones, to the kitchen themselves. Both nurses assisted in serving the breakfast. After breakfast the assistant had the washing of the dishes to attend to, there being no ward maid, her sweeping and dusting to finish, and meanwhile to assist the head nurse in doing her dress- ings, if in a surgical ward, or in any other way that she might be needed. Then came the rinsing of soiled clothing, the washing and ironing of bandages, etc. This, with other duties, filled up Training School for Nurses 9 the day. These may seem unnecessary and unimportant detai 3, but I give them to show some of the difficulties that women en- countered who desired to get an education in nursing thirty years ago. It is not to be supposed that the patients had, or could have, the watchful care and skillful nursing that they have under the present system. But it was the system that was wrong. Some of those women would gladly have devoted their whole time to the better care of the patients and for their own instruction as well, instead of wasting it in those offices which should have been delegated to laundry women, but which, for some unexplained reason, were strangely enough included in the duties of a nurse. It may have been good discipline, but it consumed valuable time, and wasted valuable strength that might and should have been used to better purpose. There being no definite standard as to the qualifications a woman must possess to be considered eligible for a hospital nurse, the result was a much greater diversity in age and general intelligence among the nurses than is seen today among the same number of women in this work. And with motives as diverse as were their other characteristics. Some of these women were quite young and had evidently taken up this wTork simply as an avocation, small as the induce- ment seemed, and were ready to lay it down when anything better presented. Consequently, there were frequent changes among that class of women. There were others of quite a different stamp, who were earnest workers, and showed a determination to over- come obstacles and excel in what they had undertaken. And with no hope of any emolument, other than to gain the gratitude of those to whom they ministered, and earn the reputation of being the "best nurse" in the Hospital—a reputation, however, not to be despised. Private nursing had not become popular, and was only considered suitable employment for elderly women. There was little, therefore, to look for in that direction. After two months' probation as assistant nurse, I was put in charge of a male surgical ward containing twenty-one beds, with about as much knowledge of nursing as one usually has after that length of service in a hospital ward. My only salvation was the fact that I was conscious of my ignorance, and saw the importance of learning from some source the things I must know, or ignomin- 10 Massachusetts General Hospital iously retire from the work I had entered into with considerable enthusiasm and determination. To the kind encouragement of Dr. B. S. Shaw, the resident physician, and the matron, and the valuable instruction I received from the house officers—to whom I shall always feel greatly in- debted—I owe any success I may have had in my work. The visiting staff were more chary of giving information, and a nurse was pretty apt to be rather summarily silenced, if not peremptorily snubbed, if she allowed her inquiring mind to venture over certain limits. There were exceptions to this rule, however, and notable among them was Dr. Henry J. Bigelow. Though towering as he did above ordinary men, he was always ready to come down from his lofty height and answer kindly, and in a manner no one could ever forget, any questions we had the temerity to ask. Other members of the staff were equally considerate. Although "rules and regulations" were conspicuously placarded in various parts of the Hospital, a new nurse was pretty sure to run against some traditional rule that, like a treacherous reef under a smooth sea, had not been suspected, and sometimes caused disaster to the innocent offender. I very soon encountered such a "reef." The "quarterly meeting" of the Trustees in those days was an event—the event of the qiiarter. On that occasion the whole Board of Trustees (twelve) visited the wards in a body, and it really did seem to me rather an impressive ceremonial. It was one of the rules that all the patients should be in their places; if not in bed, they must be beside their bed when this "procession" passed. I had only been in charge of a ward a few weeks, when one of these "quarterly meetings" occurred. I was very anxious that everything should be right, and tried to remember all rules relating to this event. But I failed miserably. The visit was late and the patients were getting restless with sitting so long in one position, and while the nurses were occupied in another part of the ward, "No. 21" had hobbled over to "No. 16," and was having a social little chat, all unconscious of the catastrophe he was bringing upon the defenseless head of his nurse. Before he was missed from his place the door opened, and the "board" entered, but it was too late! All my frantic gesticulation could not avail Training School for Nurses 11 to attract the notice of "No. 21." The member carrying the "blue book" looked to me for an explanation. The name was on the book, but the bed was vacant! And the chair was vacant! "Why this disregard of rules?" I was in disgrace, and I tried to falter out an apology; but with twelve pairs of reproachful eyes focused upon me, I felt unequal to the occasion, and I wished from my heart, at that moment, that I had carried out my original design and gone to the battlefield. As the war progressed, we felt and saw its effects at every turn, and it was most forcibly impressed upon those in hospital work. Prices advanced in almost every commodity, and especially in those things most needed in the care of the sick. But more de- plorable still were the wrecks of men that it brought to our Hos- pital wards. It depressed while it inspired us. Our insufficient supply of linen made it at times extremely difficult to keep our patients in that state of cleanliness that was required of us, and that we knew by intuition was important. A hospital nurse of the present time would look with dismay were she required to keep her ward tidy on the little pile of linen that represented our "weekly wash" in 1862. To supplement this small stock, when we found by the closest calculation we could not make it go round, we sometimes surreptitiously washed pieces ourselves and by so doing escaped censure from the doctors for untidiness. All the mending for the wards was done by the nurses, or the convalescent patients. Instead of conning her lessons or attending her lectures, as the nurse of today has the privilege of doing, the nurse of that time, after attending to the wants of the patients, sat in her little room between the wards and patched the Hospital linen, and at the same time on the alert for the calls that were sure to come from time to time from the ward outside. With cotton sheeting, such as is now used for hospital sheets, at $1.32V2 per yard (I quote from the price list of a well-known New York firm of that time, which I have before me, with a marginal note, "Prices Advancing"), it is not surprising that alarm should be felt and economy urged and enforced in the most rigid manner. The war was not over and no one could foresee the end. It is of course understood that we had no wounded soldiers direct from the battlefield; but those who were out on furlough, 12 Massachusetts General Hospital or were discharged for disability, were brought to us from time to time. The Boston City Hospital was begun, but was not ready for the admission of patients. The Soldiers' Hospital (a temporary arrangement that was afterwards opened in Pemberton Square) was not in readiness. Therefore, the Massachusetts General Hos- pital was the only hospital of any importance in the city. In 1*63, more than 200 United States soldiers were admitted to this Hospital, besides those treated as out-patients. The Hospital had then no building especially for out-patients; those patients were treated in the Hospital accident room, or a little room adjacent. There had evidently been very little building or repairing done in any department for several years. Whether for the want of funds or the belief that such changes were not needed, I cannot say. The foul ward, or the "Brick," as this building was commonly called, was built in 1S54, and from that time till 1867, when the Operating Theatre and Out-Patient Department was built, no additions had been made to the Hospital. It would probably sur- prise the present generation of Hospital workers, could they see beneath a few coats of paint in some of those wards, to discover artistically frescoed walls that did service for more than a quarter of a century and were the pride and glory of the generation before. The original Operating Theatre was at the top of the central building, directly under the dome. As there were no recovery rooms connected with this room, the patients had to be taken directly to the wards as soon as the operation was over, in the various stages of etherization in which the operation left them. This arrangement made it extremely unpleasant for the other patients and very hard for the small number of nurses that was allowed to a ward. But it w7as the best that could be done under existing conditions. This Operating Theatre was the scene of the first capital opera- tion performed under ether, as I presume is generally known to those in hospital work, and those interested in the discovery of this wonderful anaesthetic. One cannot help envying those who were connected with the Massachusetts General Hospital in 1846, when this great blessing wras first given to the world. The differ- ence between a victim writhing in agony, and a weary sufferer enjoying a peaceful slumber, must have been a change that Ian- Training School for Nurses 13 guage is too feeble to describe. Though I was not connected with the Hospital myself till sixteen years later, I had the privilege of seeing ether administered by Dr. Morton to his own son; a pretty convincing proof that the discoverer fully believed in its efficacy and its safety. This old room under the dome, which deserves to be looked upon as a "shrine," has passed through many vicissitudes and has been used for many purposes since the new operating room was built. But after passing through these various changes, it now presents about the same appearance that it did thirty years ago, it having recently been fitted up for a lecture room. The large coal stoves, however, have been replaced by the more modern steam radiators, and other recently invented appliances have been introduced. The story of the riot in Boston in the summer of 1863, the result of the draft for army recruits, has gone into history and is doubtless familiar to most Bostonians who had arrived at the years of understanding when it occurred. The mob had attempted to break into the armory and seize the arms, but, the plot being discovered, the militia was called out and fired upon the rioters. When word was brought to the Hospital that the mob had been fired upon, and that the accident room would soon be filled with the wounded, the excitement was intense. The report was not exaggerated. The accident room was, indeed, soon filled with the wounded. We had to do our duty as nurses, no matter what our personal feelings may have been in the case. Five of the wounded were brought to my ward that night, all with gunshot wounds in various parts of the body. This was, indeed, a taste of war in our very midst. War, with all its horrors, with all its long retinue of evils, is, nevertheless, an educator. One of the results was to bring our hospitals more prominently before the public, and call urgently for the much-needed improvement, not only in their construction and organization, but in providing facilities for educating women in the art of nursing the sick—an art which up to that time they had apparently been supposed to know by intuition, and were blamed for their ignorance if they failed in some point, and were reprimanded rather unpleasantly if they knew too much. 14 Massachusetts General Hospital The provision made for the care of the sick, at the time of which I write, though in some respects almost luxurious, in other ways fell far short of what it should have been, looked at from a sanitary point of view. There were only a few bathrooms in the whole Hospital: none were provided for the nurses or any of the employees. Even the resident physician's family had only portable bathtubs. At that time, Boston had been supplied with water— from a common source—only about fourteen years. Previous to that, water had been furnished from wells and aqueducts. Many of the old houses still had cisterns, the same as any country house. In 1862, several of these old wells were in use on the Hospital grounds, and really furnished excellent water. These wells have since been filled up to make room for other things. Doubtless, in the years to come, some needed excavation will bring them to light again. But the architects of this Hospital "builded better than they knew," when they devised those capacious old fireplaces, that were still in use for heating purposes in 1863. In the coldest weather the furnaces, though there were several, were insufficient, and in the cool autumn days before the furnaces were lighted, these fireplaces, and the large coal stoves that were furnished for some of the wards and corridors, were the only means of heating which the Hospital had. And while the unfortunate—or fortunate ones, perhaps—who gathered around the cheerful fireside forgot for a time the aching head or the crippled limb, as they watched the myriad sparks chase each other up the broad chimney, many an unwary "germ"—unseen by mortal eye—must have perished in that same cheerful blaze. Widespread interest in hospitals was beginning to be shown, and we had from time to time many celebrated visitors from dif- ferent parts of the country, either from curiosity or from a real desire to inspect our wards, and learn the system on which the Hospital was conducted. Among these visitors was a party from Washington, headed by a famous army general, who at one time was commander-in-chief of the army. ^lany prominent Boston- ians, among them Dr. Oliver Wendell Holmes, acted as escort to this military party. We were seldom without a number of returned soldiers in our wards; not only while the war lasted, but for years after. Though the Boston City Hospital, which was opened in Training School for Nurses 15 1804, took many of the city patients, it did not reduce the number of patients in the other hospital very materially. But it changed their character somewhat, as many of the accidents and free patients were taken to the new hospital. Quite a rivalry sprang up between the two hospitals, as might be expected. A healthy, friendly rivalry, however, which, like competition in trade, is always a powerful incentive to action. The Massachusetts General had at this time seven private rooms of different sizes and grades situated in different parts of the institution, not in a separate building, as they are at present. Some of these rooms were fitted up quite luxuriously, and very little about them suggested a "sick room." The heavy damask lambrequins, surrounded by gilt cornices and the lace draperies and soft carpet, dispelled all thoughts of a patient's room in a hospital; looked at from a sanitary point of view, such appoint- ments were certainly not above criticism. But here again comes in the "saving clause" in the shape of the large open fireplace which must have offset a multitude of evils. The world at large was not then so familiar with hospitals as it has since become, and these homelike surroundings, which are now condemned as unsanitary, robbed a hospital of some of its unpleasant features. Mr. George Sumner occupied one of these private rooms for many months, and the majestic form of our beloved statesman, Charles Sumner, his brother, was a familiar figure in the Hospital cor: ridors in the frequent visits to his brother's room. It has always been a rule of the Hospital that all cases of accident should be admitted, if admission was sought, no matter what the case or the pecuniary condition of the patient. This rule brought to our accident room representatives from every class and condition of life. In 1867 an innovation, which caused quite a little flurry, was the admission of two women medical students to the Clinics at the Hospital. And though they were championed by some of the most popular of the visiting staff, they were really allowed this privilege under protest, and were under many restrictions, and were only allowed to visit in certain wards. One of these young ladies attracted much notice, not only for her sweet young face and girlish figure, but for the energy and determination she 16 Massachusetts General Hospital evinced to overcome all obstacles, and win laurels for herself and for the profession she had chosen. And her most sanguine hopes must have been more than realized. Although cut down as she was in the very morning of her life, she had already made an enviable name for herself in the medical world, and a brilliant future seemed before her, when she met her untimely death. I refer to Dr. Susan Dimock, who was lost on the ill-fated steamer Schiller, April 7, 1875. Although only twenty-eight years of age at the time of her death, she had been in charge of the New Eng- land Hospital for Women and Children, as resident physician, for three years. And, as some one said who knew her in her work, "She ruled the hospital like a Napoleon." As I turn back page after page of Time's "Record Book," and smooth out the crumpled leaves, familiar faces and forms stand out so clear and distinct, I ask myself, can it be true that so many years lie between that time and this? I see again the youthful, genial face of Dr. Gay, who always carried sunshine wherever he went. And Dr. Shattuck, with his kind heart shining out through sympathetic eyes, whose presence in a ward was a benedic- tion to all with whom he came in contact, is indelibly stamped upon the page. Another figure, a little farther away, is the patri- archal form of Dr. Bowditch, his silvery hair making him vener- able, even in middle life, and whose coming inspired one with profoundest awe, but always with hope and confidence, as, with his army of devoted followers, he walked with regal step those Hospital wards. Several generations must pass before the effects of a serious war are entirely obliterated; in fact, they are never wholly wiped out. But by the law of compensation good results last longest. Those who had probably never before seen the interior of a hos- pital, now walked unflinchingly in, and offered their services in a variety of ways. Some brought material aid in the form of clothing for needy patients, and many delicacies for the more feeble ones, that the Hospital at that time could ill afford to furnish. Others brought books and games, and others gave freely from their open purses. The inside of a hospital ward was evi- dently a great revelation to many. People who had looked upon a hospital simply as a house of misery, where only cries of distress Training School for Nurses 17 were heard continually, were surprised to find cheerfulness and happy faces under the same roof with suffering and death. In 1870, a committee of ladies was appointed to visit the Hos- pital. Not only the wards, but other departments as well. This was a step in the right direction and the arrangement has been kept up to the present time, and the committee appointed each year. Previous to that time there had been many enthusiastic visitors, who were interested in hospital work and who rendered many services to the patients by providing clothing for the needy ones and assisting others in finding situations on their discharge from the Hospital. Miss Sturtevant was matron in the Hospital when the writer was a student nurse. The pupils did not dream of the heroic experiences through which the quiet, efficient little woman had risen to her position of recognized responsi- bility. The unappreciated and vain efforts she made to curb the extravagant use of linen and surgical supplies are re- membered vividly, and one regrets that in the course of thirty years the bitter lessons of the Civil War, which had been so impressed upon Miss Sturtevant, should have been lost for the rest of us. Miss Sturtevant resigned December 14, 1894, and at a subsequent meeting the Trustees passed a vote appropriat- ing a "suitable sum" as a gift to Miss Sturtevant on her retirement, in recognition of her services, which had ex- tended over more than thirty years. Another lady who was acquainted with the conditions of pre-training school days gives a description that brings out the darker side of the nursing department in its care of patients: The fact that the clean linen was kept between the mattresses, indicates the inconveniences under which the nurses worked in those days. Many of the nurses were of the poorest grade, women such as one would not have admitted to one's own household. 18 Massachusetts General Hospital Cleanliness was not especially considered, and the wards were often dirty. The whole Hospital had the peculiar hospital smell. The night nursing was very poor; patients got along as best they could and helped each other. There were occasional cases of drunken nurses, and accidents arising therefrom. Among these ordinary nurses there shone out some who were born to the work, and who have never had their superiors as fine nurses, comforters of the sick, and as good women. It is gratifying to know7 that these untrained women had the appreciation of those for whom and with whom they worked. It has been believed by some that even a thought generates a wave which has its eternal influence, and that the very walls and arches of the old world cathedrals "which have heard the daily chants of the priests for many centuries, have come to vi- brate in unison therewith, so that the same singers, if transported to another spot, fail to produce the same sonorous, musical effect." Is it too imaginative to believe that the thoughts of our de- voted predecessors still wield an influence in our beloved Nurse of Pre-Traixixg School Days Massachusetts General Hospital and find a response in the minds of the twentieth century student nurses? CHAPTER II 1873 Preparation It was from the Industrial Committee of the Woman's Education Association1 that the first suggestion came of establishing a training school for nurses. This committee was searching for new occupations for self-supporting women, and Miss Sarah Cabot, one of its members, thought of trained nursing in that connection. She consulted Mrs. Samuel Parkman, who proved to be much interested in the idea. Mrs. Parkman, widow of Dr. Samuel Parkman, who had been connected with the Massa- chusetts General Hospital up to the time of his early death in 1854, had recently been in England, where she had met Florence Nightingale and had learned something of the system of training in Miss Nightingale's School in London. This consultation led to a self-formed committee of ladies and gentlemen who met at Mrs. Parkman's home frequently during the winter of 1872 and 1873 to consider ways and means of organizing such a school in Boston. At a meeting held in April, 1873, the Committee on In- dustrial Education definitely suggested to the Woman's Education Association the establishment of a training school for nurses. As a result of this recommendation, the Association asked a committee to prepare and present plans for the school's organization. This committee, which consisted of Mrs. S. Parkman, Mrs. G. H. Shaw, Miss Sarah Cabot, Miss M. A. Wales, Mr. 1 The Woman's Education Association is not to be confounded with the Woman's Educational and Industrial Union. 19 Mrs. Samuel Parkman Training School for Nurses 21 J. M. Codman, Dr. Calvin Ellis, and Mr. F. B. Sanborn, issued a circular inviting to a meeting all who were in- terested for or against the training of nurses. The call met with ready response. Other members were added to the committee, and eleven committee meetings were held between April and November, 1873, when the School was started. The minutes of these meetings give little idea of the work and thought expended by this small group of in- terested persons during that summer of 1873. The meetings were held sometimes at the house of Mrs. William Claflin, 03 Mount Vernon Street, and sometimes at Mrs. Parkman's. The Trustees of the Massachusetts General Hospital wrere asked if a school might be established in connection with that institution. After a conference between committees representing the Hospital and the Training School, the Trustees proposed putting into the hands of the prospective School two wards in "The Brick," as it was then called. Miss Cabot, Mrs. Parkman, Mr. Brimmer, Mr. James Cod- man, and Dr. Ellis formed the Committee representing the future managers of the School. In the Committee's report of a July meeting it is stated uthat we should take, at first, the Brick Building only, for these reasons: it stands by itself; represents both medical and surgical departments; and offers the hard labor desir- able for the training of nurses.'' The mutual arrangement for what may be termed the probationary period of the School is defined in the follow- ing papers: In committing the charge of nursing the patients in the Massa- chusetts General Hospital to the Training School for Nurses, the Trustees of the Hospital propose the following conditions: 22 Massachusetts General Hospital 1. This relation between the Hospital and the Training School shall continue during the pleasure of the trustees. 2. Such of the nurses now employed by the Hospital as the trustees wish to retain shall be adopted by the Training School. 3. Nurses and pupils of the Training School shall not attend the patients of the Hospital without previous training in moving and caring for persons in bed. Their training within the walls of the Hospital shall include such instructions in cooking and in the making of poultices and other appliances for the sick as are essential to good nursing. 4. Nurses appointed by the Training School to serve in the wards of the Hospital shall agree to continue in service at least two years but the trustees retain the right to discharge them from service in the wards for sufficient cause. 5. Superintendent, nurses, pupils, and all persons employed by the Training School at the Hospital shall be subject to such rules and regulations as may be prescribed by the trustees. They shall be under the exclusive medical jurisdiction of the physicians and surgeons of the Hospital, and no instruction of or interference with said persons within the Hospital shall be permitted without consent of said physicians and surgeons. 6. The number of nurses and pupils boarded, lodged, and paid at the expense of the Hospital shall be fixed by the trustees. 7. Wages shall be paid directly by the Hospital, and not through the Training School. 8. The duties of the Superintendent of the Training School shall not conflict with those of the Matron of the Hospital, as- signed to her by the trustees. S. Eliot, Esq., Chairman, etc. My dear sir: I am instructed to say, on behalf of the directors of the Training School, that the conditions under which the trustees propose that the School shall continue its connection with the Hospital seem to them satisfactory—with the following limita- tions and explanations, which they propose to the trustees: As to condition No. 1, that the connection of the School with the Hospital may be dissolved at the desire of either the trustees Training School for Nurses 23 or the directors upon reasonable notice—say not less than two months; as to No. 3, that it is understood that facilities for in- struction in cooking shall be given within the Hospital; as to No. 4, that the directors of the School also retain the right to discharge any nurse or pupil; as to No. 5, that the word "interfer- ence" shall not be held to apply to the rules and discipline which (subject to the regulations of the Hospital) the directors may judge necessary for the good government of the School, nor to the visits of the directors made to inform themselves of the con- dition of the School. As the wages of each pupil have to be fixed in the original agreement with her, we propose that the present rate (ten dollars a month for the first year and sixteen dollars a month for the second year) be accepted by the trustees for the existing agreements, and that any change in the rate in future agreements be. made by consent of the trustees and the directors. The directors have voted to agree to the conditions if it shall seem proper to the trustees to consider the above explana- tion to be a part of them. I am, etc., M. Brimmer. By this time the Woman's Education Association had severed all connection with the project, its function being to initiate educational movements which are given over to other control as soon as feasible. The Committee had but three or four months in which to make all the necessary provisions for taking over the nursing care of the most serious medical and surgical patients in the Hospital, for they had agreed to start the School November 1, 1873. First, as well as last, the question of finance was upper- most as a necessary consideration. Fortunately, through the efforts of the Committee and their friends, sufficient money had been contributed so that they were not obliged to issue the circular which they had prepared, "stating the proposed plan and appealing to the public for cooperation." 24 Massachusetts General Hospital There were no trained nurses from whom to choose a superintendent, so a Mrs. Billings,1 who had done hospital nursing during the war and who was highly recommended, was chosen to take charge of the new School. Arrange- ments were made for her to have a three months' course writh Sister Helen, the English superintendent of the Bellevue Training School, New York, who "reluctantly" consented to take Mrs. Billings for such a short period, stipulating that there should be no responsibility for her work afterwards. By circularizing Massachusetts through the Medical Society and advertising in the daily papers, the Committee were soon able to engage twTo head nurses, and they had four pupils enrolled for the School. The head nurses were chosen from applicants who had been successful as practical nurses in private families. A house at No. 45 McLean Street was engaged for the School and put in order by the Committee, who assumed all expenses for maintaining it. The Hospital agreed to pay the School $150 a month for nursing service. The superintendent's salary for the first three months was fixed at a rate of $700 a year, but was afterwards changed to $600. Each head nurse was. to re- ceive $25 a month, and this was later reduced to $20, although after some years the head nurses received an extra $5 for teaching the impils. The probationers were to serve one month without pay, after which they were to receive $10 a month the first year. The final action of the Committee, before closing its con- nection with the School, is given in the following extracts from the clerk's minutes. 1 In none of the records is her full name given. Training School for Nurses 25 November 5, 1873. VOTED: That the entire control of the School, together with all its property, be transferred to a Board of Directors, which shall consist of the following persons: President, M. Brimmer Treasurer, LeBaron Russell, M.D. Secretary, Mary Anne Wales Mrs. S. Parkman Mr. J. M. Codman Mrs. Francis Brooks Dr. C. Ellis Mrs. G. II. Shaw Dr. C. P. Putnam Mrs. J. M. Codman Dr. F. Winsor Miss A. D. Sever Dr. R. H. Fitz Miss Anne S. Robbins Dr. O. F. Wadsworth ]\Iiss Louisa Bangs Mr. F. B. Sanborn Miss S. Cabot Mr. C. G. Loring Miss E. F. Mason Mr. Henry L. Higginson Miss Maria Revere Mr. Henry Cabot Lodge and shall have power to fill all vacancies. VOTED: That it shall be the duty of the Board of Directors to call a meeting at some convenient time before the first of November, 1874, of all person- who shall be or have been contrib- utors to the amount of ten dollars, managers or members of this committee, and to present to such meeting a written report of its doings, and of the condition and prospects of the School; and the meeting shall then decide what further action shall be taken in regard to the School. VOTED: That the first meeting of the Board of Directors shall be held at 45 McLean Street, on Monday, the 10th day of November, at 11 o'clock, and that this committee be dissolved at that time. After a discussion as to what the School should be called it was agreed that the name should be The Boston Training School for Nurses. The following Rules and Regulations of the School give an idea of the burden carried by the Directors throughout the period of the School's existence as a corporation inde- pendent of the Hospital: 26 Massachusetts General Hospital RULES AND REGULATIONS FOR THE TRAINING SCHOOL November, 1873. 1. The regular meetings of the Board shall be held on the first Tuesday of each month at 11 a.m. Special meetings shall be called by the Secretary at the request of the President or of any two Directors. Five shall constitute a quorum. 2. There shall be a standing committee of three on supplies and the house, whose duty it shall be to direct the purchase of supplies and furniture for the house and the expenditure for repairs. 3. There shall be a standing committee of five on admissions, whose duty it shall be to keep a record of all applications and to determine upon the admission and discharge of head nurses and pupils. 4. There shall be a standing committee of three on the hospital, who shall have charge of the relations between the School and Massachusetts General Hospital. 5. There shall be a visiting committee of two for each month, whose service shall begin on the first Tuesday of the month, and whose duty it shall be to visit the house at least twice a week, to inform themselves of the condition and management of the School and house, to have a general supervision of them, and to report at the monthly meeting. The visiting committees shall be composed of the Directors in rotation. Committee on Supplies and House Miss Bangs, Mr. Codman, Mrs. Parkman Committee on Admissions Dr. Putnam, Miss Cabot, Mrs. Shaw, Mr. Sanborn, Miss Wales Committee on Hospital Dr. Ellis, Dr. Putnam, Dr. Winsor Training School for Nurses 27 All the arrangements being completed, the Directors were ready to fulfill their contract with the Hospital. They knew their work was entirely experimental and that the Trustees could sever the connection at any time. They had undertaken to graft onto the Hospital system of nursing, with which the staff was satisfied, a new system, which would be difficult to demonstrate under the most favorable conditions. They were obliged to please the Hospital authorities, to prepare nurses who should be satisfactory in the homes of their contributors later on, and they had to depend upon voluntary contributions for the maintenance of the School, which was bound to be expensive. Not a small undertaking, as all will agree. The need for good nurses in homes was appalling. At one time two members of Mrs. Parkman's family were ill with typhoid fever, of which her husband had died. For weeks Mrs. Parkman nursed these patients by day, and medical students were sent by the doctors from the Hos- pital for night, because there wrere no nurses available. Fortunately, the first committee commanded the respect of the community and of the physicians and trustees of the Hospital, which aided in overcoming their prejudice and opposition to the idea of trained nurses. It is a fact that the opposition to the idea of trained nurses was such that less influential people could not have persuaded the staff and trustees to permit the experiment of a school for nurses. CHAPTER III 1873-1S74 Probation The officers of the Massachusetts General Hospital in 1873, when the School was started November first, were: President, Edward Wigglesworth Vice-President, Nathaniel Thayer Treasurer, I. Thomas Stevenson Secretary, Thomas B. Hall Superintendent of Hospital, Dr. Norton Folsom The only physician connected with the Hospital at that time, who was favorably disposed to the organization of a nursing school, wras Dr. Samuel Cabot, brother of Miss Sarah Cabot. In "The Reminiscences of Linda Richards'' we learn that the Hospital staff refused to lecture to the pupils during the School's experimental stage, so lecturers were secured by the Directors from the staff of the Boston City Hospital and other physicians. As there had been no "dark ages" at the Massachusetts General Hospital when the neglect of patients was so fla- grant that the situation became a public scandal, it is not too difficult to understand why the staff wTere opposed to a change. When November came, the Superintendent, Mrs. Billings. an army hospital nurse; two head nurses, Mrs. Patrick and Miss Fisher, both practical private nurses; and four pupils, were established in the home, ready to assume their new duties. The fact that Mrs. Billings resigned her position three months later, in January, 1874, suggests that all had 28 Training School for Nurses 29 not gone smoothly. She was succeeded by an unusual woman, the Baroness von Olnhausen, who carried on the experiment for the next ten months. James Phinney Mun- roe, her nephew, in a recent letter concerning his aunt, writes as follows: I remember very clearly, as a hoy of eleven or twelve, visiting quite often my Aunt Mary, who lived in one or two rooms on Allen Street while in charge of the Training School for Nurses. She used to utilize me in reading aloud to some of the patients, in what was then a new one-story ward called, I think, Ward A. I can still see that sunny and attractive room, for, whatever may Mart von Olnhausen 30 Massachusetts General Hospital have been my aunt's shortcomings as an administrator, she had a genius for giving to the wards over which she presided an ex- traordinarily homelike atmosphere. Some facts concerning Mrs. von Olnhausen are quoted from Mr. Munroe's "Adventures of an Army Nurse." Mary Phinney was born just north of the Waltham-Lex- ington line, February 3, 1818. She was brought up in a home noted for its hospitality, which was a center for learned and brilliant men. She was educated in the local school and at Lexington Academy. She is described as an emancipated young woman, loving nature intensely, and possessing an artistic taste that served her wrell at certain crises in her life, for after her father's death she was obliged to earn her own living, and w^as enabled to do so as a de- signer of calicoes in a New Hampshire cotton factory. It was there that she met Baron von Olnhausen, one of a group of German republicans who, after the unsuccessful revolution of 1848, had been forced to leave his country. Theodore Parker said that the Baron was one of the most learned men he ever knew. Several years later the Baron met, loved, and won Mary Phinney, and they lived very happily until his death, two years later. Again she was thrown on her own resources, and was free in 1862 to volunteer as one of Dorothy Dix's war nurses. These women, whose environment and education separated them widely from those who usually made a business of nursing, were decidedly not wanted in the Army. Mrs. von Olnhausen had to overcome many obstacles, created by prejudice and inefficiency. Her real interest in the patients, however, her untiring zeal, hard work, increasing skill and persistence, won the approbation of the surgeons in a few months, and she was given the severest cases and became a Training School for Nurses 31 famous surgical nurse, being allowed to put up in splints the wrorst compound fractures. During her service, she nearly died of epidemic dysen- tery, and at another time of yellow fever, yet she stuck to her work, enduring great hardships and many unnecessary deprivations, owing to prevailing drunkenness and the graft of petty officers. When she was eventually discharged from the army, the Medical Director wrote of her thus: Not one of the nurses, whom I have known or heard of, is bet- ter entitled to eminent and substantial notice than is Mrs. Mary von Olnhausen, of Lexington. Her whole soul has been in the work. She very early acquired marvelous dexterity in the manage- ment of the wounded. Soldiers who owe their lives to her care and skillful attention are now scattered over nearly all the Northern States. They will remember her with gratitude. I presume that is all she will wish for. When the Franco-Prussian War began, in 1870, she wras immediately fired with a desire to be of service to her hus- band's countrymen. With a good knowledge of French (she had almost none of German) she began a vigorous study of the language. Armed with highest credentials from our Government and Surgeon-General, and with strongest pos- sible recommendations from the American Association for Relief of Misery of Battle Fields (the precursor of our American Red Cross), Mary von Olnhausen, now fifty-two years of age, went to Germany. Unfortunately, she lost her trunk and credentials, and it was only after difficulties and rebuffs that she succeeded in reaching the battlefield, and not until she happened upon the Knights of St. John—of the old order of Knights Hospitalers—that she found work in the Hospice at Vendome. There, for two months, she had her hands full. Besides the wounded, there were typhoid 32 Massachusetts General Hospital and smallpox to be cared for, and, worst of all, before the patients were fit to leave their beds, came the orders to move them back to Germany, as the army was evacuating Prance. That was a terrible journey, and after it Mary von Oln- hausen's war work was ended. For her services in Germany, Mrs. von Olnhausen re- ceived the Iron Cross and the Cross of Merit. After two years' stay wTith her husband's sister in their ancestral Saxon home, she came back to America, one of our most celebrated war nurses. Then it was that for ten months she had charge of the young training school in the Massachusetts General Hospital. Mr. Munroe sums up an estimate of Mrs. von Olnhausen's work in the Massachusetts General Hospital as follows: I am certain that she keenly enjoyed her work and that any want of success was not due to indifference or laziness on her part. She worked, as always, at top speed, and with enormous energy. If she fell short of full achievement, it was because she had been induced to undertake a piece of constructive work for which, temperamentally, she was not well fitted. Mrs. von Olnhausen was one of the ladies received by Prince Henry, of Prussia, wdien he came to Boston in 1902. She was then living in humble quarters on Shawmut A venue, supporting herself by embroidery, in which she was an artist. Her desire for an independent, self-supporting life could not be overcome by her devoted relatives and friends. At the age of eighty-four, April 12, 1902, she died of apoplexy, and now lies buried in Mount Auburn Cemetery. In about three months after the School opened, the pupils had caught up in knowledge with Miss Fisher, one of the head nurses, who decided to enter the School herself as a pupil, February 19, 1874. She did not, however, finish the course. The Directors concluded soon that a trained Training School for Nurses 33 nurse was needed in charge of the School, and they began to correspond with friends in England, to learn if some nurse might be received into the Nightingale School, for special training, or whether there was any chance that a Nightingale nurse might be sent over for the Boston Train- ing School. Miss Nightingale replied that either could be done, but not for some months, on account of the numerous applications. The School was not satisfactory during the first year, and for a time it was considered doubtful whether the Trus- tees of the Hospital would consent to the continuation of the experiment, but the Directors of the School did not lose faith in their project and earnestly sought an experienced superintendent. The Superintendent of the Hospital and some of the staff complained of the "indefiniteness of the head nurses," which was not strange, considering that they were changed every day! Also the fact that the nurses looked to the Training School rather than to the Hospital for their authority was objected to, but of course could not be altered. The House Committee, meanwhile, had its domestic troubles. The nurses complained of the matron's untidiness and lack of method, and mention is made of a frequent change of cooks. Lectures were given every Saturday at 3.30 p.m. The nurses wrere much pleased with them, and although dis- appointed in their instruction during the first year, they looked hopefully to the future under the new superintend ent. The Trustees had decided to continue for another year the connection with the School, and the Directors were able to secure the services of Linda Richards, who had been graduated from the New England Hospital for Women and Children in 1872, and had been employed at Bellevue Hos- pital, under Sister Helen, during 1873. Linda Richards America's First Trained Nurse CHAPTER IV 1874-1876 Organization It is but to keep the nerves at strain, To dry one's eyes, and laugh at a fall, And baffled, get up and begin again. Robert Browning. With Linda Richards at the helm of the School, the second year of its existence started auspiciously. Miss Richards, an American, was inspired by the divine love of service, and gifted with a pleasing personal appearance, with charm and dignity. She was one to command respect and admiration from all her associates. Miss Richards herself says of this stage in the organization of the School: Mrs. Billings and Mrs. von Olnhausen were both ladies, born and bred. They were good army nurses, but knew nothing of the organization of training schools. Could I have left, with honor to myself and the profession, I should have done so. It was no easy task to prove to unwilling minds that trained nurses were superior to untrained nurses, and the weight of responsibility was heavy for young shoulders. At that time the nurse would begin a day by washing poultice cloths and bandages, and it would often be two o'clock before her work was finished. She then went off duty for the afternoon. The second day the same nurse helped in the dining room service and in washing dishes. After this was done she was -ready to do little incidental things as need arose. The third day she went into the wards, washed the patients' faces, made beds, swept floors, and did this, that, and the other duty until night. The fourth day she would act as head nurse. The fifth day she would begin as general utility nurse, but at nine 35 36 Massachusetts General Hospital o'clock would go off duty to sleep so as to be ready to go on duty that night. The sixth day she had to herself, then the same rota- tion of service began again. . . -1 We had many trials before order was brought out of confusion, and a regular system finally settled upon. The first decided change made by the Superintendent was to place a nurse in charge of each ward with an assistant, one of these two nurses to be present on the ward at all times, aside from meal times, and to appoint a nurse for night duty for each ward, these nurses to serve a month. The second change of note was the hiring of a woman to wash poultice cloths and bandages outside the ward. A second woman was employed to do the mopping and general cleaning. By the addition of these two scrub women it was found possible for the School to take over another ward without adding to the list of pupils. Some of the ladies of the Board were sisters of some of the trustees of the Hospital, and to this fact may be attributed the success of the School in a hard struggle for existence during its first year. The medical and surgical staff had said, "Put it out; we do not want it; it is no good; our former way was better." But finally the trustees yielded to the pleas of the ladies, and the School had been given one more year of life, provided a graduate nurse could be found to take charge. ... I realized the signifi- cance of the hope expressed by the Board that in time the School might prove by the excellence of its nurses their superiority over nurses who were untrained. This begot in me a strong determina- tion to prove the truth to them by my own personal work as nurse, in addition to my work as Superintendent of the School. So it came about that I often took charge at night of some specially serious case, and sometimes I would be on night duty three nights in succession while doing my regular work during the day. We at once began class instruction as a regular part of the nurses' education. The only book at that time was the "New Haven Text Book for Nursing." Very soon we changed the routine of work. From the beginning the School had an excellent 1 "Reminiscences of America's First Trained Nurse." Training School for Nurses 37 course of lectures given by physicians from the Boston City Hos- pital and other outside lecturers, whose services were secured through the untiring efforts of the committee of lady trustees. At the end of the year I had nurses sufficiently well trained to be intrusted with responsibilities, and the work of the Superin- tendent was made easier. From this time on the Hospital staff lectured to the nurses, and Dr. H. J. Bigelow began the practice of taking nurses with him on his visits to the wards. Members frequently spoke of "our School" with interest and pride. The change was marvelous. Dr. Norton Folsom was Superintendent of the Hospital the first two years I was there, and but for his patience and kindness I doubt if the growth of the School would have been so rapid. During the two and a half years that Miss Richards was at the head of the School, there was a wonderful change in the organization and quality of the work. Her first re- quest was for a thermometer for the School and for uniform collars and cuffs. The desire for instruction on the part of the pupils them- selves must have been stimulating. They asked for cooking- lessons and for more "direct teaching on the ward." One of the Directors suggested that there should be an instructor to assist the Superintendent. We can only surmise the reason why such a good and reasonable suggestion should not have been adopted.1 It may have been because the Directors were limited to a certain number of nurses by the Hospital Trustees, or it may have been the expense of her salary and maintenance. At the end of the course the final examination disclosed the fact that the nurses needed more instruction in "sick cookery" and medical nursing. The pupils were sent regularly to the Eye and Ear In- iThe introduction of nurses to training schools for the special Pwpose of teaching pupils practical nursing methods did not become customary until about 1918. 38 Massachusetts General Hospital firmary for instruction, and a two months' course in ob- stetrics was given at the Boston Lying-in Hospital. These affiliations gave the pupils a better practical experience than many had who followed them several years later. In 1875, Mrs. Parkman suggested giving the nurses train- ing in the care of the insane at McLean Hospital or else- where. That the plan was too difficult to be put into prac- tice can be easily understood by those who have contended with the problem of affiliations. The adjustments that have to be made in the effort to give the pupil her affiliated courses, besides providing suitable nursing for the hospital patients, are very expensive; indeed, it is impossible to manage without ample funds. During the first year the pupils had complained of their matron in the nurses' home, but they are reported later as "liking the new matron, who made a real home for them," and as being "satisfied and content." They observed, how- ever, that house-students (now called house-officers) showed different degrees of interest in teaching the pupil nurses. One member of the Board of Directors suggested quizzes in place of lectures for the nurses, and later on several members of the staff concluded that it was inadvisable to give the nurses lectures, although they were willing to give them bedside instruction. This implied criticism must have made difficulties for the Directors, but the lectures con- tinued, somewhat irregularly, as was bound to be the case when busy men were expected to lecture gratuitously. The first class of three was graduated in 1875. Two of its members continued in institutional work, while one began private nursing. Those who remember these first graduates speak very highly of them, and in 1916 a friend of the School contributed $200 to the Training School En- Training School for Nurses 39 dowment Fund in memory of two members of the class, Mrs. Kelly and Miss Russell. The first form of diploma read as follows: This certifies that.................... has completed the term of two years at the Boston Training School for Nurses connected with the Massachusetts General Hospital; that she is a person of good character, and has a knowledge and ability requisite for a competent nurse, and that she has passed with credit the required examinations. The diplomas were presented to the graduates at the Directors' Meeting. At the end of 1875, the first successful year of the School, in the Hospital report of the Trustees the following state- ment is made: The Training School for Nurses has been continued with gratifying success under the superintendence of Miss Linda Richards, and an arrangement has been made to extend its use- fulness, by gradually placing all the wards in the charge of the School, under the Regulations and the pleasure of the Trustees. George S. Hale. Charles H. Dalton. Early in 1876, signs pointed to the later disintegration of the early plan for fairly complete training. The Boston Lying-in Hospital authorities began to complain of the short period the pupils spent in their hospital, and the physicians on the Hospital Committee suggested that "it would be as well to drop that branch of training for a while." Fortu- 41) Massachusetts General Hospital nately for the pupils then in the School, the affiliation was continued until some years later. Bedside instruction, which is now considered so desir- able, was first mentioned in lS7(i, when Dr. C. 15. Porter is referred to as "agreeing" to take sixteen or seventeen pupils on his rounds, and Dr. Henry Bigelow was already taking pupils to the operating room for clinical instruction. Dur- ing this year the proposition was first made that the pupils should have cooking lessons by a paid instructor. In June, 1870, the School was moved from McLean Streel into "The Brick," which was no longer used for patients, and had been renovated and made over into a comfortable home for the nurses. This change did not meet with the approval of all the Directors, but seemed to be inevitable, as the Trustees of the Hospital wished the nurses to live on the ground, and the expense and responsibility of maintaining them outside the Hospital was an ever-increasing problem and burden to the Directors as the School increased in size. By the end of 1876, Miss Richards had charge of all the nursing in the Hospital, and her pupils were employed in eight wards. During these first years there was much sick- ness, fatigue, and complaint of "lame nurses." Frequently "night watchers" at a dollar a night were employed to re- lieve overtired pupils, and one of the lady visitors suggested that more attention should be paid to sick nurses. At this time nurses were still mopping floors, carrying ice, food trays, etc. Miss Richards had wished for some time to go to Eng- land to study nursing methods, and her plans were now maturing rapidly. In the spring of 1877 she left the School for that purpose. Before leaving she asked the Directors for a sitting room for the nurses, and for a man to carry Training School for Nurses 41 ice to the wards. She also asked for a watch for the nurses' use, and the Directors voted that one should be purchased, "the cost not to exceed $20." When leaving for England, Miss Richards stated that she did not intend to return to the Hospital, but that she should go to one needing her more. To that principle she was true, for her work of organization thus begun continued for thirty-five years. Accordingly Anna Wollhampton, a graduate of the New England Hospital for Women and Children in 1874, was secured as Acting Superintendent. The following interesting quotation from the Hospital Report for 1S7G expresses the attitude of the Trustees towards the educational venture that had been thrust upon them in 1X73: The incorporation of the nurses of the Training School into the service of the Hospital is a success. There are at present fifty-two of them, and their number can be increased when proper accommodations can be furnished. The Brick, now called the Nurses' Building, has been altered at a cost of $3,700, and is occupied by them. Their employment is a mutual benefit to the School and to the Hospital, and with right notions of their duties, they will eventually prove a blessing to the sick of all classes in the community. J. C. Morrill. P. C. Brooks, Jr. CHAPTER V 1877-1880 Development The next few years showed a steady improvement in the School, with increasing interest on the part of the students who were now of a superior type. In April, 1877, pupils began to go to Dr. Beach in the Out-Patient Department for instruction. Dr. Minot gave bedside clinics and answered questions twice a week. In 1878 nurses were sent to a cooking school and four head nurses were required to teach classes. The first mention of bandage lessons is in April, 1879, when "Mr. George W. West, house-student" offered to teach the nurses. Meantime the pupils became conscious of their needs. A vacation longer than two weeks was asked for; pupil head nurses objected to serving in that capacity because owing to the duties of the position they lost so many of the lectures. There were also desirable candidates who disliked signing a contract to stay two years, but the custom was not abolished in the School until 1910. The Directors were disturbed when it was learned that some of the graduates did not continue in the profession after graduation. The advisability of asking pupils to promise to nurse for at least a year after finishing their course was discussed, but so far as the records show, nothing came of the idea. Miss Wollhampton left in August, 1878, to the regret of the Directors, and in February, 1879, Jane E. Sangster, a graduate of Bellevue Hospital in 1877, succeeded her. By degrees the heavier manual wrork was taken from 42 Training School for Nurses 43 the nurses; during 1878 pupils were relieved of carrying ice; and in December, 1880, ward maids were installed in the lower wards for cleaning corridors, for mopping and dish- washing. Parchment diplomas were first given in 1878, and it was in this year that two of our most prominent graduates received their diplomas, Sophia F. Palmer and Mary E. P. Davis. In November of the same year caps were first intro- duced, against the wishes of some of the nurses! After the nurses had adopted caps the maids also requested them. In 1879 the Superintendent of Nurses, instead of the Directors, began to receive and discharge pupils. Another important change in the policy of the School was the intro- duction of a graduate night superintendent. A night super- intendent had been recommended in the latter part of 1877, but at that time the Superintendent of the Hospital did not think one was necessary. About this time another story was added to the nurses' home, thus furnishing more suitable living accommodations. As the health of the nurses was still a problem, a physician was appointed to examine the probationers during their first month to see if they w^ere strong enough for the work. During 1879 a graduate course of two months in the Boston Lying-in Hospital was arranged, and it was also agreed to receive paying pupils who should be allowred to live outside the Hospital. Sending pupils out to private cases was approved by the Directors, but as so few were ever sent, it would seem that the needs of the Hospital increased too rapidly to permit a policy that time has proved to be undesirable because of its abuse in most schools where it has prevailed. Mr. Frank B. Sanborn, of Concord, a member of the 44 Massachusetts General Hospital Board of Directors and an historical figure in his day, sug- gested that there should be a library for the nurses. This was a seed which bore fruit later. Miss M. E. P. Davis has given an account of the condi- tions in the Hospital at this period. She unconsciously reveals something of the pioneer type of woman as well as of the School. She writes: We had a lecture once a week for about eight months of the year. All who could be spared, seniors and juniors, attended. At the end of the lecture, which was written up from notes taken' at the time, the lecturer had a quiz. The written lectures were examined and marked by some member of the Board of Directors who was present at the lecture. There were lessons on nursing subjects once a week given by the Superintendent of Nurses. We studied Domville and later, I believe, Hartshorn. Nursing was practiced under the head of Medicine and Surgery even though Dr. O. F. Wadsworth had eye cases, Dr. J. J. Putnam, nerve, and Dr. G. G. Tarbell, gynecological cases. Obstetrics was elective. We had massage given by Dr. James Putnam, mostly didactic. We also had cooking by some one of the Directors' cooks, who taught us how to make good stuff to eat, but not dietetics. The Boston Training School was started and run as a two-year course, and never sent the nurses out to make money for the Hos- pital or School. We did the sweeping in all the wards and ward corridors, but not in the main corridors. We washed the bedsteads and bedside tables. If the head nurse was very particular about the looks of her ward, we had to mop it every day except the day it was scrubbed by the cleaners. We did the dusting, we carried the clothes to the laundry, and the poultice cloths and used bandages to the rinse house. After they were returned to us, washed and dried, we went to the rinse house and ironed them. We washed dishes twice a day, for we had but one maid for three wards. If the ice gave out after the morning supply, we had to go to the basement of the main building and bring more. Training School for Nurses 45 We realized early in our training that many things we had to do had little relation to nursing. We took the training as a fundamental, not as an incidental occupation, and though the incidentals were many and grievous, we saw the opportunity to get what we were after. Along with it was developed the mental attitude that has placed nursing in the rank of a profession. Elizabeth Scovil, 1880, supplements the description of training in the early days given by Miss Davis: Nurses mopped every day after sweeping. Every Monday wooden bedside tables were scrubbed and inside shutters washed. Pewter lard oil lamps were used, one on each end of long tables, cov- ered with a tall, round, tin shade with holes near the top that made the light cast shadows on the ceiling. The head nurses slept in the little sitting rooms between the wards, on folding cots with cane bottoms, the bed clothes and mat- tresses being kept in the closet. As many of the assistant nurses as there was room for slept in The Brick. The re- mainder of the nurses were in the attic of the main Hospital, three in a room. Our room over- looked Blossom Street, and whenever the fire bell, which was just across the street, rang, we were wakened until Elizabeth Scovil 46 Massachusetts General Hospital we learned to sleep through the noise. It was stiflingly hot in summer, and must have been bitterly cold in winter. We had to take care of our own rooms, no time being allowed for the pur- pose. Hours of duty were from 0.45 a.m. to 8.45 p.m., with every other afternoon off duty, until the time was changed to 6.45 a.m. to 8 p.m., with one afternoon off, and one hour off duty each day, and five hours off on Sunday. The beds in the female wards had white dimity curtains, fas- tened to a projecting shelf or head board. These could be drawn together, thus shielding the face of the patient. They were done away with on account of difficulty in keeping them clean. It is no wonder that these nurses, who were usually mature and intelligent women, resolved that they would do all they could in the future to eliminate the unnecessary hard work that then wras borne by the pupil nurses, and that was undoubtedly the cause of the great amount of sick- ness and of many breakdowns. But although mopping and the heaviest manual labor have been abolished for many a year, the reputation for drudgery established in those days still clings to our profession, and deters many parents from sending their daughters to nursing schools. The first report of the School was issued in 1879 and wras written by Mrs. Samuel Parkman. It is such an in- teresting and illuminating document that it is reproduced in full: REPORT OF THE TRUSTEES OF THE BOSTON TRAINING SCHOOL FOR NURSES 1879 The Boston Training School for Nurses has been in operation nearly five years. It was liberally assisted to make a beginning, it has attained a reasonable success, and it seems fit to give an account of our work to those who have helped it and to those who naturally profit by it, and by showing what are our desires and our difficulties, to gain an intelligent comprehension thereof, and we trust, further aid from our friends and the public. Training School for Nurses 47 There were two doubts in the minds of those who began the Training School: Whether there would be a sufficient number of applicants of a desirable sort; and whether we could find a hos- pital ready to receive us, where nursing could be taught and practised. We found the number of women who desired to become pupils sufficient at that time, and it has so continued for our increased work. The Massachusetts General Hospital gave its wards gradually into the care of our nurses, and at present the School furnishes nurses for the whole hospital—excepting to one ward. We have also sent out sundry nurses for private nursing. We are sometimes asked, how many first-class nurses can you send out? To which our answer may fairly be, as many as you will send us of first-class women. We have good means of teach- ing. Members of the Hospital staff, both for in-door and out-door patients, have given to our nurses admirable lectures, clear in practical detail, and enabling those among their hearers who are capable of it, to appreciate the general principles which underlie their work. To these gentlemen and to all who have believed that improvement in the standard of nursing was possible, practicable, and desirable, and who have helped our endeavors toward that end, we offer our hearty thanks. Whatever measure of success we have attained is only an incentive toward further improvement, and we shall welcome aid and counsel. Our Superintendent teaches the nurses from the best manuals we can procure, and examines them on the lesson. There are quarterly examinations by the lecturers, and by the medical men among the Directors, and every endeavor is made to detect igno- rance or stupidity. The ladies among the Directors divide the duty of knowing and visiting the nurses, that they may be in- formed as to their capacities and constitution—physical and mental. The nurses come to the Hospital for a course of two years. This time is spent partly in medical and partly in surgical nurs- ing; each nurse takes her turn of night duty, and by a valued arrangement with the Lying-in Hospital, each nurse has an op- portunity of working there for two months. Dr. C. J. Blake most kindly permitted several of our nurses to come to him at appointed hours, that they might see something of what is required in trouble of the ear. 48 Massachusetts General Hospital Nursing must be learned at the bedside, and at the bedside of hospital patients, accuracy, fidelity to instruction, and skillful manipulation may be learned, so that these may be fairly required of our graduates. If they possess, in addition to good character, tact and decision, they go armed at all points to their first private patient; but those whose first duty in the Hospital is implicit obedience and subordination can hardly be expected at once to develop a spirit of resource and clever suggestion. We ask of the public to have patience with our nurses during their first year's work, and to recognize that they are to require from them trust- worthiness and fidelity to essentials rather than, at first, the deli- cacy and refinement which are the fine fleur of nursing. If a nurse is incapable of acquiring these also, she will never have the success which is possible; but at the time of graduation she has no opportunity of testing their possession, and they are not always innate. With all the care that we can take, the pupils sometimes come near to the time of graduating before we are clearly convinced of their deficiency in one or another qualification which we con- sider essential. In such cases we withhold the diploma, and we hope that physicians and others employing our nurses will ask for their diploma. No women whom we are willing to endorse will be without it. We give, at the end of this Report, a list of the nurses who have been graduated from the School, and it is proposed to send out, at intervals, a printed list of the names of the nurses to whom the diploma is given. As some of the nurses who have not received a diploma, print upon their cards, "From the Training School at the Massachusetts General Hospital," it seems best to take pains to aid the public in discriminating be- tween those whom we mark satisfactory or otherwise. So much in explanation; and it is but fair to say, on the other hand, that both in the Hospital and outside, we see, with the greatest pleasure, the good character, fidelity, and intelligence of the women who come to the School, and we have the best testimony to their good work. Dr. Minot says: "I always recommend my patients to procure, if possible, the service of one of the nurses who have graduated from our Training School; they are far more efficient and acceptable than any others." Training School for Nurses 49 The thirty-nine nurses on the printed list, and forty-eight in the service of the Hospital, represent the result of one hundred and five persons who have entered the School. Sixteen of these left during the month of probation, thirteen have been dismissed; while deficient health, intention of marriage, indecision, and in- efficiency account for the balance. Applications for admission continue to be sufficient in number, and there has been, since the beginning, a marked improvement in the average quality of the applicants, while some of the best nurses are among the earlier pupils. It is sometimes supposed that the adoption of nurses from our School by the Hospital precludes any further need of money for its use. This is not so; our monthly expenses, though not very large, are continuous, and we earnestly hope that if our work is approved and our graduates do themselves credit, we may come to be endowed with money sufficient to carry out our plans in the best way. Our subscribers are not many, and income from sub- scription is always fluctuating. We should be thankful to estab- lish a nurses' home, where the nurses could live when not on duty. The Hospital accommodations are limited; they cannot give us a nurses' sitting room or separate bedroom, and our graduates are scattered the moment they leave the School. If we could provide a home, where the nurses serving in the Hospital could live when off duty; where the night watchers could have their daylight sleep under favorable circumstances, and to which our graduates could return in the intervals between their cases, we could better provide the most favorable conditions, and could more satisfactorily in- fluence and control our nurses. The annual report of the Training School for Nurses in New York says: "The founders of the School were impressed from the beginning with the importance of giving the nurses a home; not a mere lodging, but a comfortable home, where after their daily labors they may find relaxation and rest, free from the depressing influences of the Hospital," and adds that "there is no doubt that the unusual exemption from illness which the nurses have enjoyed is largely owing to their cheerful and healthy surroundings," etc. After using neighboring houses, more or less suitable for the purpose, the New York School has this year received the gift of a house for a term of years, so arranged as to be "a complete and beautiful home for sixty nurses and the 50 Massachusetts General Hospital necessary servants." If we had such a home we could do what we should gladly arrange for—send out nurses among the poor. There are women just fitted for such work, if they could have their hands strengthened by encouragement and such assistance as a good home gives, and it would be a great satisfaction to make such work possible. It is from the ablest physicians that we learn what share good nursing has in the cure of many diseases, and we would gladly put this agency at the service of the poor. While urging our wants we do not forget our benefactors. Those who gave us money at first, to try an experiment, deserve grateful remembrance while the School lasts; and we have received during the last year five thousand dollars from the executors of the late Augustus Hemenway's estate. Owing to the wording of the form of gift, the money does not come into our hands as a lump sum. We therefore lay aside our other small possessions as the beginning of a fund, and use this bequest for our daily needs. We were incorporated under the name of the "Boston Training School for Nurses," March 17, 1875. We claim to be careful and economical in expenditure, and we are confident that when the knowledge of our work and our wants has entered into thoughts of the bountiful givers who mean that Boston shall not be back- ward in any good thing, we shall be helped in a work which neces- sarily makes no show, but whose results may at any time deal with the vital question of our own lives or of those dearer than our own. It may be added that, up to November, 1878, there have been forty graduates from the School, some of whom are holding the responsible position of head nurses at the Hospital, while many others are constantly engaged in their calling in our community and the vicinity. In December, 1879, the School met with a grievous loss in the death of Mrs. Samuel Parkman, whose efforts in be- half of the School are well expressed in the following tribute offered by Dr. Russell: Mrs. Parkman was one of the first to take an active part in the foundation of the Training School, and in the early part of the year 1873, by the request of herself and Miss Cabot, I went to her house to consult on the expediency and practicability of es- Training School for Nurses 51 tablishing a School for Nurses in Boston. The plan then formed was carried out in all its essential particulars. Other friends joined, and in November of that year the first Superintendent was appointed and the first pupils received into the School. From that day to the time of her last illness Mrs. Parkman's interest in the School never abated, and I think we shall all agree that to her activity and perseverance and to her good judgment and wise counsel it has been largely indebted for its success. It is a pleasure to remember the cheerfulness and courage with which she met all the difficulties which were encountered in the early days of the School, and the patience with which she bore all the trials and discouragements of the new undertaking. In all the discussions which arose in regard to the proper measures to be adopted we remember the perfect readiness with which she heard and gave due weight to the opinion of others, even though they differed from her own. There were no special events in the School's history dur- ing the year 1880. The affiliation for obstetrics was severed in the fall of 1881 because the Boston Lying-In Hospital refused to take the pupils for less than six months. The Directors tried to secure an affiliation for obstetrics with the New England Hospital for Women and Children, but in vain. Thus ended, for many years, one of the most im- portant features of the School. We know, however, that the Directors had the vision of the practical requirements which constitute a good course. During this year one of the lady visitors suggested a uniform for the nurses. At this time, and for several years later, the nurses wore print dresses of an inconspicuous pattern, and one of the graduates who wras in the School says, "If any nurse wore a dress of pronounced design, she was threatened with a uniform." Miss Sangster, who had worked hard and efficiently in behalf of the School, was obliged to resign in 1881 on ac- count of her health. Anna C. Maxwell, R.N., M.A. Photograph taken while Miss Maxwell was Superintendent of Nurses at the Presbyterian Hospital, New York City CHAPTER VI 1881-1889 Miss Maxwell's Leadership To fill Miss Sangster's place, the Directors had the great good fortune to secure Anna C. Maxwell, a graduate in 1880 of the Boston City Hospital. Miss Maxwell had been at the Montreal General Hospital for the purpose of establish- ing a school for nurses, but finding that conditions were not then favorable to do so, she resigned, went to England for three months, and then came back to Boston to do private nursing. While on her first private case the Train- ing School Committee offered her the superintendency of the Massachusetts General Hospital School. By her brilliant work Miss MaxwTell demonstrated her natural talent for constructive leadership. She came to the position young and inexperienced, but full of enthusiastic devotion for the cause of nursing education, reenforced by unusual personal charm. She found insufficient and un- suitable accommodations for the nurses, and the scarcity of applicants a problem. The excessively hard work in the School was evidently becoming a detriment to its popu- larity. Miss Maxwell investigated conditions and reported to the Directors that three more maids were essential to give the pupils greatly needed relief. Only superintendents of nurses under the old regime can know how great the strain is of holding students up to high standards of ethics and practical efficiency when the condi- tions under wdiich they work and live are contrary to all the theory taught them; so it is that even now we are 53 54 Massachusetts General Hospital thrilled to read in the Directors' report of April, 1882, that "ground is broken for a nurses' home," knowing what that meant for the comfort and health of the pupils. In the Hospital Report of 1882 one reads that the Trustees have for a long time felt that the accommodations provided for the nurses were altogether insufficient, and not at all suitable for the class of women who are now taking up the profession. For the last five years, all our nurses have come from the Training School for Nurses, and the result has been that we are continually getting not only much better trained nurses, but also a class of women much superior in every respect to those who formerly performed the service. Plans were submitted about a year ago, and it was finally decided to erect a building 155 feet long on the line of Allen Street, at a cost of about $35,000. It is intended that each nurse shall have a room to herself, and a large sitting room has been placed on the lower floor. The following resolution was adopted March 31, 1882: Voted: That in grateful recognition of the long-expressed good will and. generous contributions to the Hospital by Nathaniel Thayer, Esq., the new building be called the "Thayer Building." It will be ready for use by March. N. Thayer, Jr. Roger Wolcott. Miss Maxwell concerned herself promptly with the health of her pupils and sought to free them of some of the heavy domestic labor. Within a few months the nurses were re- lieved from carrying food and medicines to and from the wards, and eventually ward maids and scrubwomen were added to the staff in sufficient numbers to take from the nurses the mopping and some of the dish washing. Miss Maxwell also recommended proper shoes for the proba- tioners on account of the great trouble many of them had with their feet, some of them being incapacitated by exces- sive pain. Training School for Nurses 55 The School had now become so much a part of the Hos- pital that members of the staff began to ask for nurse assistants in their various departments and the surgeons Nathaniel Thayer, Esq. urged that nurses "be advanced as far as possible in learn- ing to dress wounds." So Miss Maxwell requisitioned for two sets of forceps and scissors for each ward. Clara Weeks's text-book was adopted for the School in 1883, and 56 Massachusetts General Hospital a little later anatomical charts w7ere requested for the Superintendent's classes. The first special student, Miss Kalopothakes, entered the School July, 1883, for a short course, paying a fee of $10. A graduate who entered a medical school about this time was the inciting cause of a rule made by the Directors that no woman who intended to study medicine should be accepted as a pupil. The tenth anniversary of the School's foundation, coming in 1883, the Trustees commemorated the occasion by the following statement in their annual report: Early in the year, the new building for the nurses of the Hos- pital was occupied. It had been named the "Thayer Building" previous to Mr. Thayer's death, in recognition of his valuable services and generous donations. At our request a portrait of Mr. Thayer was given to the Hospital by Mrs. Thayer, which has been hung in the "Thayer Building." It is now ten years since the Training School for Nurses was organized, and it seems proper that the Trustees should express to the officers of the School, more fully than has hitherto been done, their high appreciation of the services rendered the Hospital. The Hospital has, from the beginning, had the advantage of many excellent and skillful nurses, but since the training has been wholly in the charge of the Training School, there is no doubt that the average quality of the service has been higher than ever before. The institution began in 1873 with four pupils, who were allowed to take charge of two wards as an experiment. It in- creased steadily until 1877, when the nursing of the whole Hos- pital was placed in its charge. At the present time, the Training School consists of forty-two pupils, twelve head nurses, a night superintendent, and a super- intendent of the whole School, all these being under the super- vision of a Board of Directors, several of whom are physicians connected with the Hospital. Training School for Nurses • 57 The general management of the health, discipline, and educa- tion of the nurses rests with the Board, though the School is, in fact, a part of the active staff of the Hospital, and acts under the direction of the Resident Physician. As a result of this organization, the character of the nursing in the Hospital has materially improved, and the public has bene- fited by the yearly graduation of fifteen to twenty well-trained nurses. Thomas E. Procter. Edmund Dwight. The Thayer Building 58 Massachusetts General Hospital The establishment of a very good library for the nurses occurred in 1883, one of the most important events in the history of the School. A library had been suggested at different times, and through the interest and initiative of Dr. William L. Richardson, and the generosity of Mrs. Nathaniel Thayer, the library was opened with seven hun- dred and twenty-six volumes. LittelVs Living Age, Popular Science Monthly, Harper's, and the Century were also sub- scribed for. The cost was $740.52. Four years later Dr. Richardson reported that only four books had been lost, and that great use had been made of the library. In a reg- ister provided for that purpose the nurses themselves re- corded the names of the books taken out, with date of taking and returning the same. The contents of the library catered to a cultivated and intellectual taste, and continued to be a. great source of enjoyment until the Warren Library for patients was opened to the School; since then the Thayer Library has not been kept up and most of the books, except a few classics, have worn out and have been discarded. Miss Maxwell and Lucy Pickett, 1882, gave lessons in massage to the pupils. This created so much interest that the head nurses asked for a course at their ow7n expense, and the doctors began to prescribe massage treatments for their patients. This led, in course of time, to regular classes taught by a professional teacher. Through a conference between committees representing the Boston City Hospital, the New England Hospital for Women and Children, and the Massachusetts General Hos- pital, a better scheme for lessons in cookery was now worked out and the course made compulsory. Mrs. Mary J. Lincoln, the instructor, agreed that each pupil should practice every recipe theoretically taught. Training School for Nurses 59 The first gift from a student to the School is recorded in the spring of 1884, when Elise Steinemann, 1SS5, gave five dollars to the library as an expression of gratitude for care received during illness. At this time came also the first suggestion for some kind of social gathering once or twice a year, when diplomas were given. This idea wras advanced by one of the Directors in order to increase the interest of graduates in the School. Twenty years later, this plan, so full of helpful possibilities, was realized. Until 1886 the Directors had corrected all the students' notebooks, but the task having become too burdensome, they engaged Dr. C. P. Strong to correct the books of the seniors, at one hundred dollars a year. His comments were considered so valuable that he corrected all the lecture notes the next year. The intimate relations with the Training School at Mc- Lean Hospital for the Insane make an extract from Dr. Edward Cowles's Hospital Report in 1882 interesting, be- cause we learn that the woman in charge of the McLean School, during its transition from the old system to the new, was a graduate of the Massachusetts General. Dr. Cowles had recently accepted the superintendency of Mc- Lean, coming to it from the Boston City Hospital, where a nursing school was established under his regime. To him belongs the distinction of having organized the first success- ful nursing school in connection with a hospital for the insane. Concerning his plan for establishing a school at McLean, he says: The appointment of a superintendent of nurses has already been mentioned. Miss Mary F. Palmer, who was appointed to 60 Massachusetts General Hospital the office in November, had had twelve years at the Vermont Asylum as attendant and matron, and is a graduate of the Massachusetts General Hospital Training School for Nurses. The arrangement between the Schools of McLean Hos- pital and the Massachusetts General which exists at the present day, with some modification, wfas consummated in 1885, and provided that graduates of either School could go to the other for one year's experience as advanced stu- dents, and could receive the diploma on satisfactory com- pletion of the course. Lucinda S. Lovell (now a practicing physician) was the first McLean pupil to avail herself of the affiliation. A large number of ambitious, successful women followed her example. Sara E. Parsons, 1893, was the first to take the course at McLean, and Charlotte E. Blackwell, 1896, is the only other Massachusetts General graduate, to date (1922), who has taken the McLean course and received the School diploma. When Miss Maxwell took over the housekeeping for the wards from Miss Sturtevant in 1884, her responsibilities were greatly increased. She secured maids from the Immi- gration Bureau and taught them herself, as she had no assistant and the head nurses were too busy to teach them. Miss Maxwell's continued efforts for the well-being of the nurses procured a three weeks' vacation for the pupils, and it Avas during her superintendency that the third and fourth stories were added to the "Thayer." Previous to that time the quarters were so crowded that ten night nurses were sleeping in day nurses' beds. She persuaded the Directors to have a badge made for the School and she planned a uniform for the pupils, a gingham dress of turquoise blue and white broken check; a gathered apron with bib straps pinned at the shoulder Training School for Nurses 61 and tied about the w7aist with bow and strings. Straight collars and cuffs were worn inside the neck band and sleeves. The cap was practically like the one worn today (1922), only it was then nearly large enough to cover the hair. Much less was said about sickness during Miss Maxwell's term of service. Publicity was given the School by Eliza- beth Scovil, 1880, whose articles on nursing, published in various popular magazines, greatly relieved the shortage of applicants. During Miss Maxwell's stimulating period of leadership, the nurses showed considerable initiative. Several were commended by the Directors.for showing presence of mind in emergencies and conspicuously good judgment in caring for their patients under difficult conditions. The nurses are recorded as asking for a class in reading, and they requested the privilege of having a course of lec- tures (at their own expense) by Annie Payson Call, on "Conservation of Human Energy." The request was re- ferred to a committee composed of Dr. Richardson, Dr. Fitz,'and Dr. Wadsworth, who said they would look up Miss Call and her book. They reported back to the Directors that the nurses would not profit greatly by the book, but they could see no objection to their having the lectures at their own expense, if they did not neglect their work. Concerning Dr. Whittemore, who was superintendent of the Hospital for a time during Miss Maxwell's incumbency, she said that he was an administrator of the first class, receptive to new ideas, and cooperative when convinced that a project was right. Soon after she came he told her to feel free to come and go as she thought desirable, because if her work was properly organized it would run by itself for a period of a few weeks. Thus she had the official sup 62 Massachusetts General Hospital port and the freedom wThich are so necessary for one doing constructive, responsible work. In February, 1889, Miss Maxwell resigned, to the great regret of the Directors. The Hospital had recognized her official position in 1885 by putting her name among the officers in the Annual Report. Throughout her service to the School she showed those personal characteristics of justice and generosity that have so endeared her to the nurs- ing profession at large during her long and brilliant career. It is gratifying to the profession to know that her serv- ices to the public as an educator and organizer were recog- nized by Columbia University in 1917, when the honorary degree of A.M. was conferred upon her. A Group of Nurses in the Late Eighties On the left, the first nurse standing is Pauline Longhurst Dolliver (1889) CHAPTER VII 1889—1899 Transfer of the School Maria B. Browtn, 1883, was selected as Miss Maxwell's successor. Miss Brown, a Canadian, had graduated with honor and remained in the School as a most efficient head nurse. She was young, attractive, and had a great deal of dignity and reserve. Not long after Miss Browm took charge of the School dissatisfaction was expressed about the new blue and white uniform because it faded when laundered. As a result of this the black and white checked gingham was introduced, which has since been a permanent feature of the uniform. The string ties on the aprons were changed for the plain band. During Miss Brown's superintendency, nurses were in- troduced to the operating room on Saturdays. Anna M. Blair was the first nurse assigned to that duty, and it is stated that the surgeons "were very much pleased" writh her services. Lectures in the chemistry of cooking supplemented the practical demonstrations which the nurses had had previously. In March, 1892, Mrs. Nathaniel Thayer presented the School with a skeleton, and Dr. Scudder added interest to his lecture course on Surgery, wdrich was always carefully planned and presented, by illustrating his lecture with cases from the Accident Room. There was a red-letter day in the autumn of 1X93 when five o'clock dinner was introduced. The question of diet 64 Training School for Nurses 65 for the nurses had been a difficult one. The Sunday dessert of corn meal mush and milk, with molasses if wished, was a classic. The menu for years was meager and monotonous, and it was rumored among the nurses that no authority was powerful enough to change the bill of fare while the cook w7ho had presided over the kitchen for many years remained in her position. Consequently, when a chef was installed and evening dinners introduced, it was indeed an historic occasion. The responsibility for the School, with ever-increasing expenses and insufficient funds, bore heavily upon the Direc- tors. Good suggestions were considered but not acted upon, owing, no doubt, to uncertainty of income and of adminis- tration. Miss Brown was asked to prepare a scheme for graduation exercises, and although she approved of having them, it was several years before graduation was recognized as a formal occasion. The spirit of the Directors at this period was increas- ingly conservative, probably on account of unsatisfactory results from earlier experiments. Requests for special privileges in the way of attending lectures, etc., were re- fused for protegees of people as prominent as Miss Maxwell, Dr. Scudder, and Dr. Alfred Worcester. Events leading to the transfer of the School to the Hos- pital are not especially dealt with in the records, but the reports of November and December, 1895, show copies of the following letters which were exchanged between the Direc- tors of the School and the Trustees of the Hospital, and which resulted in the formal surrender of the School and its funds to the Hospital on January 1, 1896. 66 Massachusetts General Hospital Hon. Henry Parkman, President of the Board of Managers of the Training School for Nurses: The Trustees of the Massachusetts General Hospital desire to express their high appreciation of the long devoted and efficient interest that has been shown since the foundation of the Train- ing School for Nurses by the ladies and gentlemen identified with its management. The enterprise was a wholly new one to this community, and the energy and ability shown from the time of the earliest steps toward organization, the excellent judgment, and the unfailing patience and tact which have been displayed in connection with the arduous and ceaseless labor inseparable from the management of an institution of this class, are matters of history. The School has justified the highest hopes of its founders. It has proved to be a great benefit to the Hospital. It has been if possible a still greater benefit to the community at large. It has set an example which has been followed in other cities through- out the country. Its organizers and managers are entitled to the greatest recognition alike of the Trustees of the Hospital and of the general public. Without modifying this attitude toward the School, the Trus- tees of the Hospital have gradually come to the belief that the best interests of the Hospital will be promoted by the establishment of a closer relation between the School and it; and that this can be best accomplished by placing the School under the management of the Hospital Trustees, in conformity with the custom of which experience has elsewhere demonstrated the advantage; and which has been followed, with a single exception, by every similar in- stitution in the country. The Trustees, therefore, respectfully submit for the considera- tion of the Directors of the School a suggestion that, for the advantage of the Hospital, the control and management of the School be made over to the Hospital Trustees at such a time, mutually agreed upon, as may be agreeable to the Directors of the School. In concluding, the Trustees desire to express their recognition of the great value of the assistance of ladies in the management Training School for Nurses 67 of a Training School and their hope that the ladies who have been so long identified with this School may not allow the pro- posed change of administration to abate their interest in its welfare, and that some, at least, of them may be found willing to continue their work in its behalf, the exact details being left for future arrangement. William Sturgis Bigelow, Chairman. For the Special Committee of the Trustees of the Massachusetts General Hospital. At a special meeting held in December, Mr. Parkman read the draft of his reply to the chairman of the Committee of the Hospital Trustees:— W. S. Bigelow, Esq., Dear Sir: We beg to acknowledge the receipt of your communi- cation of November 26th, and the same has been laid before a special meeting of the Corporation of the Boston Training School for Nurses held this day. The corporation has voted to comply with the request of the Trustees of the Massachusetts General Hospital conveyed through you, and to surrender to the Trustees the management of the Training School for Nurses connected with the Hospital. We would suggest if agreeable to the Trustees, that January first proximo, being the beginning of our fiscal and school year, would be a convenient date for such surrender. I am further directed by the ladies at present connected with the School as Directors, in answer to your courteous suggestion as to future assistance from them, to say that they will be ready at any time individually to render such aid in the future man- agement of the School as they may be asked by the Trustees to give, retaining, as they undoubtedly will, a deep interest in its future welfare. In thus bringing to an end the existing relations between the School and the Hospital, the Directors of the School wish to convey to the Trustees of the Hospital their recognition of the facilities which the Trustees have placed at their disposal and 68 Massachusetts General Hospital of the various acts of courtesy which they have received during the existence of the Training School. I remain, Respectfully yours, Henry Parkman, President of Boston Training School for Nurses. At the same meeting the following votes were passed:— Voted: That the Boston Training School for Nurses accept the legacy of $5,000 under the will of John Foster, deceased, upon the conditions contained therein, and Charles P. Curtis, Treas- urer of said Training School, is hereby authorized to receive and receipt for the same. Voted: That the Treasurer be authorized and directed to pay over the said legacy to the Treasurer of the Massachusetts Gen- eral Hospital upon the same terms and conditions as contained in the will of John Foster; viz., that it be held as a fund, the income whereof, together with the income of the funds hereto? fore transferred to said Hospital by this Corporation, shall be devoted and expended towards the training of Nurses by said Hospital. Voted: To comply with the request of the Trustees of the Hospital and to surrender the management of the School to the Trustees of the Hospital on January first, 1896. Voted: That the Corporation known as the Boston Training School for Nurses be dissolved and that the President be a Com- mittee to take the necessary legal steps for such dissolution. Voted: That authority be asked for permission to turn over the funds of this Corporation after the payment of all legal debts to the Massachusetts General Hospital as a fund, the income of which shall be used for the training of Nurses. On January 11, 1896, the annual meeting was held, followed by the usual monthly meeting. As the School was dissolved on January 1, the Superintendent sent in no report. The visitor for the month had met Dr. Bigelow on January 1 and trans- ferred the School through him to the Trustees of the Hospital. Caroline G. Curtis. M. H. Denny. Maria B. Brown 70 Massachusetts General Hospital Perhaps a description of the system wdiich obtained in the School under Miss Brown's regime, and which was largely evolved by Miss Maxwell, may be interesting and instructive before passing on to the history of later and more rapid evolution in educational methods. Miss Brown followed Miss Maxwell's example and wore no uniform. She had no assistant. When she went out of the Hospital one of the head nurses was left in charge. Her routine was inflexible. In her sitting room in the Thayer, which also served as her office, she attended to her corre- spondence and records in the morning. At ten o'clock she started on her daily rounds, going first to Ward E, where the maid had a cup of tea ready for her. She would stop at the door of each ward a few minutes, talking with the head nurse about the work and the pupils, meanwhile with keen eye searching out defects in the appearance of person- nel or ward. Occasionally she inspected closets and service rooms. Not often enough, as it seems in retrospect, to account for the acute anxiety experienced by most of the nurses concerning every detail of the housework. Once a week she relieved the night superintendent and made rounds between ten and eleven o'clock. It was seldom that she was seen on the wards at irregular times, and her criticisms of the pupils were almost always made through the head nurses; therein, teaching by example one of her best lessons. Miss Brown's attitude towards the pupils was exceedingly cold and formal. Her manner changed in such a marked degree when the pupil was given a "black band"1 and made a head nurse that it must have been a deliberate policy. Those who never became head nurses usually left the Hospital not knowing in the least the most attractive side of Miss Brown's nature. 1 A black velvet band on the cap was and is the insignia of a head nurse. Training School for Nurses 71 She had scant patience with what she deemed minor ailments; colds, temperatures, and lame feet usually had to be "worked off." Those who worked under Miss Brown's direction could learn valuable lessons from her example. She never raised her voice in anger; never corrected a pupil publicly, and she always supported the authority of the head nurses, making them feel a great personal responsibility for their wards and for the bedside instruction and discipline of their probationers. The course was two years, and probationers entered every month. They were given a short preliminary talk by Miss Brown, and in the morning assigned to some ward. Each head nurse usually had a new probationer every month or two, and perhaps the "prob" would be an "extra" in the ward for three or four days before she was given "a side," but sometimes she had patients assigned to her immediately. The efficient head nurses demonstrated every household and nursing procedure once as it came along in the course of events, beginning with the task of washing the refrigerator. The model head nurse would supervise the pupil's first attempt to demonstrate these procedures alone. After that, woe to the pupil who forgot any detail of the technic. Some of the head nurses were excellent teachers, and took great pains to explain the cases and the desired effects of medica- tion. Fortunate w7as the probationer who started with such a helper. The female wrards usually had three assistant pupil nurses, and each pupil nurse had six or seven patients for whom she was entirely responsible. The nurses took turns in being "dish," "medicine," and "lavatory week," which was extra responsibility added to her "side." As "dish week" a pupil was responsible for setting the trays, 72 Massachusetts General Hospital serving meals, and other duties pertaining to diets. "Medi- cine week" nurse gave the medicines before and after meals and was responsible for renewing the medicine supply and for the cleanliness of the bottles and closet. "Lavatory week" attended to the soiled linen and the cleanliness of the utensils in the lavatory. These duties were assigned to the pupils in rotation. In those days the nurses did all the sweeping and dust- ing, scrubbed chairs, tables, and bed legs weekly, and washed the dishes when the maid was off duty. They also emptied the waste pails if they were having "dish week." It was the custom then to make empty beds into "show beds" which wrere elaborate and awesome affairs, to say nothing about being time consumers. Nurses were allowed three thermometers to a ward, and it was the early nurse who secured the thermometers and thus got a good start with her work. Pupils usually spent four months in a female ward, the last month being night duty, preceded by a month as senior nurse. In a male ward, two months' day duty and one month of night duty was the rule. Service in male and female wards, medical and surgical wards, usually alter- nated, and after nine months or a year spent in the upper, open wards, the pupils were advanced to the downstairs, private or closed wards.1 As a rule, only advanced students were ever sent to "Ward B," which was the only strictly private ward. Pupils were sent to assist in the Out-Patient Department, in connection with ward work, at any time during the course. As there were no graduate head nurses in this department, the pupils had no supervision, and but little instruction from the busy doctors in charge. 1 The closed wards consist of private rooms in which patients with the more serious illnesses are cared for. Training School for Nurses 73 In the wards the nurses wrere required to keep close track of the doctor's order books, and much of the instruction was given incidentally by the house officers while the pupils wrere assisting them. Most of them enjoyed explaining their cases to an interested nurse. The head nurses could learn a great deal during their daily visits with the doctors, and were often asked to assist them and to do difficult dressings. As there wrere no nurses on regular duty in the Accident Room, the head nurses were required to send pupils to chaperon female patients and they themselves often helped in emergencies. Whether or not they could leave their wards was left to their discretion. The Training School Office, as it now exists, was not then known, and its creation was, perhaps, what some might designate as "a necessary evil." The "Thayer" Library 71 Massachusetts General Hospital The comparative freedom from official supervision which then existed was no doubt a great stimulus to the head nurse, who was obliged to rely upon her own judgment; whereas in later years complexities of the growing Hospital and School compelled an intermediate set of officers between the head nurses and the Superintendent of the School. The nurses in those days, particularly the head nurses, were usually women of considerable experience and discre- tion. It was not considered "good form" for a head nurse to help her assistants with the ward work, no matter how pressed or desperate they might be. The head nurses' duties were specifically those of administration, supervision, and instruction, and in addition, the care of the linen closets and supplies. The surgical appliances, which wrere pre- pared by the head nurses, w^ere marvels of neatness, and in order to have the beds always spotless there was a most extravagant use of linen. Economy was no part of the instruction, either by precept or example. It always seemed as if more was required from the pupils than it wTas humanly possible to accomplish, but pupils learned under the system that their capacities exceeded their expectations. Discipline was supposed to be very severe, but most of it was administered by the head nurses. It was indeed a serious offense for which one was summoned to Miss Brown's room. Occasionally a nurse would mys- teriously disappear from the fold and the other nurses seldom knew for what reason. That fact kept all in con- stant fear of dismissal, and no one felt sure of her diploma until it was in her hands. In those days the Directors had stopped presenting the diplomas to the nurses, and they were usually found in the bedrooms, after the recipients had been told by Miss Brown that they had finished their Training School for Nurses 75 time and were graduates. Usually she added some word of approbation. The examinations were all oral and were held in Miss Brown's sitting room. She sat behind her desk, which was across the far corner of the room. The examining physician sat in front and a lady visitor sat beside the desk. A chair for the nurse was placed in front of the doctor. There were printed lists of the subjects on which the pupils were to be examined periodically, but most wrere nervous wrecks by the time their turn came to go in and occupy the chair. The lists of "marks" were always posted where all could see. "Changing day" was a great event. At the end of every month the night nurses were all changed, and great was the excitement anticipating the wards or service to which they might be assigned. Unfortunate was the pupil who failed to please her first head nurse or the house-officer on her ward} for their opinions were sure to precede her to the next service, and it was difficult to live down a bad start. Night nurses cooked their own suppers, using whatever material was left in the ice box for them by the day nurses. Several of the house-officers had a friendly way of con- tributing to the midnight meals. For a long time it was not taboo for a house-officer to have a midnight lunch on his wards, but there came a time wrhen the privilege was abused. Nurses were then forbidden to prepare any food for a house-officer, and he was forbidden to cook anything for himself except in Ward B. After a time, when the sup- pers in Ward B became too elaborate and time consuming, the house-officers were forbidden to have any food there other than bread and milk. The night superintendent always had her supper with the night nurse in Ward B. 76 Massachusetts General Hospital There was no time to waste in the wards, for there were no extra nurses and each had from seventeen to twenty or more patients, among whom there were usually some criti- Dr. W. L. Richardson A very active member of the Board of Directors for many years cally ill. Each night nurse was supposed, if she had time, to mark patients' clothes, wash the refrigerator, and to make several show beds in the morning, besides giving the treat- Training School for Nurses 77 ments, lunches, and washing the patients' faces. Of course the night report had to be ready for the night superin- tendent on her last rounds. It would have been an intoler- ably hard life for which one had to sacrifice everything, except for the gratitude of the patients, who were almost invariably grateful for the least kindness. Indeed they were very thoughtful about showing their appreciation in small ways. It was a joy to greet them in the morning and often a regret to leave them at night. The hours of duty were from 6.45 a.m. to 8 p.m., with twenty minutes to half an hour for meals and one hour off duty daily; one half day weekly and four hours off on Sun- day. Night nurses were on from 8 p.m. to 7 in the morning for one month. Very few nurses, during training, had energy enough to go anywhere or to do anything outside the Hospital in "off duty time." Most slept during the hour off duty, and wrote up lectures and studied lessons during the half day. Nurses who were naturally studious usually bought Gray's "Anatomy" and Osier's "Practice of Medi- cine" in order to get more insight into the cases. There was no time to read patients' histories, even if it had been permitted. Through a mistake when the "Thayer" was furnished, there were no springs provided for the beds and there was no heat in the bedrooms, but this lack of comforts was scarcely noticed for the reason that most of the time off duty was spent in bed, too tired to notice hard beds or cold rooms, and the library served very well for what little studying there was time to do. There was no piano, but the nurses' feet were too tired and sore to dance as the nurses do now. In spite of this life of comparative hard ship, the large majority loved the work and were very happy. 78 Massachusetts General Hospital During the years between 1890 and 1900 there was an agitation among nurse leaders for longer and more thorough courses in Nursing Schools, shorter hours, more time and provision for recreation, as well as plans for preliminary courses, paid lecturers, equipped class rooms, etc. These changes failed to reach the Massachusetts General until several years later. CHAPTER VIII 1873-1895 The Board of Directors Since taking the Training School for Nurses, the Trustees have been more than ever impressed with how much the School owes to the wisdom and devotion of those under whom it was founded and developed. From the Hospital Report hy the Trustees, 1897. For twrenty-two years a small group of men and women carried the responsibility of the School for Nurses, doing an extraordinary amount of work, and to a considerable extent financing the School as well. The earnest desire of the writer is that every nurse shall see in the facts recorded concerning these twenty-two years the self-sacrificing devotion, the wise kindness, the unselfish vision and patient persistence of a small group of men and women who wrorked indefatigably week in and week out, year in and year out, handicapped by lack of funds, but always believing in the value of their work for the com- munity. They were undaunted by criticism of their nurses, were generous in their defense, and rejoiced in their success; all Massachusetts General Hospital nurses who have loved their work and the Hospital should reverence the memory of those who made the School. First and last there were sixty-five men and women who were on the Board of Directors. In figuring out the time that they spent on the Board, it has been reckoned from the first meeting attended to the last one at which they are reported as present. This does not do justice to their term 79 80 Massachusetts General Hospital of service, because the connection of some with the School was only severed by death. The following are names of those appointed on the first committee, and wrho later be- came Directors of the School, with the length of time they were active members of the Board. Years Months Mrs. Samuel Parkman 4 10 Mrs. G. H. Shaw 7 9 Miss Sarah Cabot 2 9 Miss Mary Anne Wales 19 8 Miss Louisa Bangs 1 2 Mrs. Frances Brooks 5 Miss Ellen Mason 4 10 Mr. J. M. Codman 15 5 Mr. F. B. Sanborn 16 5 Mr. Martin Brimmer 3 11 Dr. LeBaron Russell 11 11 Dr. F. Winsor 5 6 Dr. C. P. Putnam 12 2 Mr. C. G. Loring 4 7 Mrs. J. M. Codman 12 The record even as reckoned is remarkable. For eleven years monthly meetings were held straight through the year and only twice was a quorum lacking. The average attend- ance at the regular monthly meetings was fourteen or fifteen, and there were various committees that w^ere con- tinuously occupied with their several duties concerned with finance, hospital and training school relations, education and discipline. Mrs. Samuel Parkman was acknowledged to be the soul of the organization for the five years preced- ing her death. The Directors not only visited the wards to see the nurses, but they attended the lectures and examinations, and corrected the lecture notes until 1888. They solicited Mrs. Frances Brooks Mrs. C. P. Curtis Martin Brimmer Sarah Cabot 81 82 Massachusetts General Hospital the money by which the School was maintained; they bore the expense of the salaries of the Superintendent of Nurses and the Night Superintendent; they paid the scrub women until 1887, and supplemented the pay of the head nurses. They worked untiringly for the wrell-being of the nurses, and as one reads the Training School reports, one realizes that the Directors were constantly trying not only to educate nurses, but to educate the public as to what was reasonable for them to expect from the graduates; also how to protect themselves from impostors. Mr. Martin Brimmer, Mrs. Samuel Parkman, Mrs. G. H. Shaw, Miss Sarah Cabot, Mr. J. M. Codman, Dr. LeBaron Russell, Miss Mary Anne Wales, and Dr. C. P. Putnam constitute a small group who bore the burden of organiza- tion and adjustment and wdio may be regarded as chiefly responsible for the School's existence. Among those who directed the School, a few stand out conspicuously because of their long years of active service. Chief of these is Mary Anne Wales, whose connection writh the School lasted from 1873 to 1893, when death claimed her. She acted as Clerk of the Board most of the time, and seldom missed a meeting. She was a generous contributor as well. Mr. and Mrs. J. M. Codman, Mrs. G. H. Shaw, Dr. C. P. Putnam,. Dr. O. F. Wadsworth, Mrs. C. P. Curtis, Mr. T. B. Curtis, Miss A. M. Storer, Miss M. H. Denny, Miss Sarah C. Paine, Miss Eliza Goodwin, Dr. William Richardson, and Dr. LeBaron Rus- sell were among those who were a very part of the School's life. Mr. Martin Brimmer in the early years, and Mr. Henry Parkman during the later years of the School's existence independent of the Hospital, served as Presidents of the Board. Mrs. W. W. Vaughan was an active member during Mrs. G. II. Shaw Mary Anne Wales Dr. C. P. Putnam Dr. LeBaron Russell 83 84 Massachusetts General Hospital the last fourteen years, and Mrs. Nathaniel Thayer for three years before the Board surrendered the School. These two ladies are the only representatives of the Boston Training School for Nurses who are now, in 1922, connected with it as members of the Hospital Training School Committee. In so far as the nursing department has been a factor in the success of the Hospital, and in so far as its graduates have served the world, to that extent is credit due all these men and women who worked for the School's success. Four hundred and thirty-one nurses were graduated under the Boston Training School, and their records have been a credit to the Hospital and to the School. CHAPTER IX Pioneers The good reputation of the School has been sustained to such an extent by the work and character of its early graduates that the first part of this history would not be complete without brief mention of a few of those who have shared largely in making nursing history. Best known is Sophia F. Palmer, 1878. She was born in 1853 in Milton, Massachusetts, and was a direct de- scendant, on her father's side, from Betty Alden. Her father was a graduate of Yale and of Harvard Medical School. Her family lived on Beacon Hill when Miss Palmer entered the Training School, but her chosen occupation was so objectionable to them that they refused to call on her at the Hospital. For a time after graduating Miss Palmer did private nursing and was probably the first trained nurse to cross the Rockies in a professional capacity, General McDowell's daughter being her patient. She had a long and successful career as an organizer and administrator of hospitals be- fore she began what may be called her life work. With a small group of nurses, she helped to organize the American Journal of Nursing, of which she was the first editor, a position she held from 1900 to the time of her death in April, 1920. As editor of the Journal, Miss Palmer traveled all over the United States, speaking before nurses at many state, national, and international conventions. Through the Journal, she was able to wield a great in- fluence in everything pertaining to the advancement of the 86 Training School for Nurses 87 nursing profession. She took an active part in the legis- lative work in New York and assisted the nurses in other states in their efforts to secure legislation favorable to good Sophia F. Palmer standards for nursing schools. With Miss M. E. P. Davis, she took the initiative in organizing the Massachusetts General Hospital Alumnae Association. Miss Palmer's editorials and articles expressed her ad- 88 Massachusetts General Hospital vanced views with courage and decision, but it was neces- sary to know her well to appreciate her nobility of character and the many sacrifices she made in the interest of her profession and of humanity. In 1906 she adopted an eight- year-old girl whom she educated and loved with a mother's devotion. The death of this adopted daughter at the age of twenty was a profound grief. Miss Palmer was alert and active in her editorial duties, up to the time of her death. Mary E. P. Davis, 1878, a graduate of the same class as Miss Palmer, her intimate friend, and for many years asso- ciated with her in all organized nursing activities, also has taken a conspicuous part in the making of nursing history. She, too, had the inspiration of distinguished ancestry, but valued only personal worth. Having chosen nursing as a profession when it was regarded as a vocation only by idealists, while to others it seemed a form of personal serv- ice for hire, dependent upon and subordinate to the medical profession, Miss Davis sturdily and steadily sought to up- hold the dignity of nursing, and to demonstrate its wonder- ful possibilities as a profession allied to medicine but neces- sarily independent in its ultimate development. She has organized and superintended hospitals and training schools, one of the most important being the University of Pennsyl- vania Hospital, with the first three-year course for nurses. It is conceded by her contemporaries that the organiza- tion of the American Journal of Nursing is due more to her initiative and business ability than to any other one factor. For a considerable time she was business manager for the Journal, and both she and Miss Palmer gave their services for the first year, and worked for small salaries afterwards. Training School for Nurses 89 Miss Davis organized the Nurses' Central Directories in Philadelphia and Boston. She has advocated central schools for nurses for many years, and was one of the group Mary E. P. Davis who first proposed a nursing course at Simmons College. In a paper presented at the first national convention of nurses held in Chicago at the World's Fair in 1893, she also suggested the need of graduate schools to prepare nurses for the more responsible positions. 90 Massachusetts General Hospital The training school for nurses at the Boston State Hos- pital was organized by her in 1899, when the idea of schools in state hospitals for the insane was just developing. For several years she has been corresponding secretary for the Massachusetts Nurses' Association, and during the World War she did, in addition, a great deal of Red Cross work. Eva Allerton, 1885, was probably one of the most able women ever graduated from the School. Like so many nurses in those days, she went to Philadelphia to care for patients of Dr. Weir Mitchell. She later returned to the Massachusetts General Hospital as Night Superintendent, and finally became Superintendent of the Homeopathic Hospital, Rochester, New York. This position she retained until her death. The Trustees of the Hospital provided her with a pleasant private residence where she lived with mem- bers of her family. She had an important part in procuring the Nurse Practice Act in New York, and it is believed that over-exertion during the political campaign for this Bill was the predisposing cause of her death in January, 1907. Elizabeth Robinson Scovil, 1880, is the literary repre- sentative of the pioneer graduates. Her many articles writ- ten about nursing and published in various popular maga- zines in 1879 and 1880 were the means of bringing in many applicants for training. The twenty-five dollars which was paid for her first article by Scribncr's she then regarded as riches. That article was on Home Nursing, and might be read profitably at the present day. By reading it one con- ceives a substantial respect for the quality of nursing taught and practiced in 1879. For twelve years, Miss Scovil was Training School for Nurses 91 Associate Editor of the Ladies' Home Journal, and for twenty years a Department Editor of the American Journal of Nursing. At present she is on the staff of the Canadian Nurse. She has published several books that have for their ob- ject the better physical and spiritual education of youth. Her latest wrork is a series of ten books of Bible Stories for Children. It was Miss Scovil's good fortune to visit Flor- ence Nightingale at three different times, and the Sophia F. Palmer Memorial Library collection which the Alumnae started shortly after Miss Palmer's death is enriched by a very interesting autograph letter from Miss Nightingale to Miss Scovil concerning the latter's book, "Preparation for Motherhood." Alice Scott, 1883, born in Kentucky, was one of the characters who impressed herself upon the Hospital during her thirty years' service as matron of the Convalescent Hos- pital in Waverley. She received her appointment in 1884, and hundreds of patients, nurses, and house officers will remember her as one of the most vital, invigorating per- sonalities that ever served the Hospital. She was a South- ern lady, refined, resourceful, high-minded and of a true nobility, who, in her devotion to her work, scorned no task that enhanced the comfort of her household. Many a time when her cook took French leave, Miss Scott presided in the kitchen, as well as at the table. The Convalescent Hospital was really a home under her care, but woe to a doctor or nurse who did not measure up to her high standard! She often went out to the sick in the neighborhood after her long day's work in the Hospital, and the people in Waverley testify to her kind and generous 92 Massachusetts General Hospital spirit. After she retired on a small pension, which with her savings enabled her to live simply at the Franklin Square House, Miss Scott showed her devotion to her School Altcr Scott by pledging $25 a year to the Training School Endowment Fund, which was redeemed by making and selling work bags of pretty cretonne. Sometimes these bags wrere sewed by aching, rheumatic fingers which could not have functioned Training School for Nurses 93 at all except for the indomitable courage and devotion that urged them on. She died in the Massachusetts General Hospital May 22, 1920. Fanny R. Slay ton, 18S2, a native of Bangor, Maine, was a good representative of successful private nurses. Kind, motherly, intelligent and conscientious, she ended her long term of private nursing by caring for Dr. Henry J. Bigelow during the last three and a half years of his life. Dr. Bigelow had heart disease, and one time when he was living in the country, Miss Slayton asked him what doctor she could call in if he had a "bad spell." "D—n the doctors, you just stick to me; the doctors don't know any- thing!" was his reply. As a reward for her devoted care, when he died Dr. Bigelow left her a small bequest, the income of which was sufficient to support her in modest comfort during her last years. Out of her small means, Miss Slayton contributed ten dollars a year to the Endow- ment Fund, and during the war, when asked if she ought to afford it, she said, "I might as well give it anyway, because you can't buy anything with ten dollars now." Miss Slay- ton's death occurred August 23d, 1921. Among the graduates of the Boston Training School for Nurses, sixteen later studied medicine and became success- ful physicians. To the waiter's knowledge twenty-six who graduated during that period became Hospital adminis- trators of unusual excellence. Perhaps a fitting ending to this chapter is a copy of a letter written to Miss Wales, Secretary of the Training 94 Massachusetts General Hospital School Directors, by Edward Everett Hale, regarding a nurse who had been employed in his family. 39 Highland St., Roxbury, February 1, 1877. Dear Miss Wales :— We all regard Miss Sinclair1 as a near and dear friend now, and it is difficult to think that she was once a stranger. She seems to me (and I know Dr. Goss has the same impres- sion) an admirable nurse in every way. I could ask for no quality or accomplishment for her profes- sion which she does not have. I do not suppose the Training School expects to train many such nurses, but it is a great gift to the community to train one or two. Truly yours, Edward E. Hale. 1 Class of 1376. Mary L. Keith SECOND PART CHAPTER N The Massachusetts General Hospital Training School for Nurses 1896-1909 Renaissance In the Hospital Report for 1895 is found the following statement: The Training School for Nurses of the General Hospital voted, on December 11, to surrender to the Board of Trustees the man- agement of the School, the vote to take effect on the 1st of January, 1896. In acknowledging the courtesy of the Directors of the Training School in thus acceding to the wishes of the Trustees, it is neces- sary to note that, although this step will undoubtedly add to the efficiency both of the School and of the Hospital, it must also make an additional tax on the fund for current expenses. Again in the Report of 1897 the Trustees say: The value attached to the instruction given in this Training School is indicated by the fact that there were 836 applicants (in one year) for it. The benefit of this work to the general public is great, since through it there is developed a large body of skill- ful and highly trained nurses of excellent character. Since taking the Training School for Nurses into their imme- diate charge, the Trustees have been more than ever impressed with how much the School owes to the wisdom and devotion of those under whom it was founded and developed. Miss Brown continued as Superintendent of the School until January, 1899, when her resignation went into effect. One marvels at the executive ability of a woman who car- ried on so large a School for so many years without an 97 98 Massachusetts General Hospital assistant. Her records were scrupulously kept and every pupil nurse felt that Miss Brown knew everything about her. The spirit of thoroughness concerning every detail of the work and consideration for the patient were indelibly impressed by Miss Brown upon each one. After her resignation she retired permanently from executive work, much to the regret of her nurses, and after a few months' rest entered the field of social welfare. Death claimed Miss Brown while riding on a street car August 13, 1917, in the midst of active service as investigator for the South End and Sunnyside Day Nurseries. Meanwhile the superintendency of the Hospital had passed from Dr. John Pratt, Resident Physician, to Dr. Herbert B. Howard, under whom the Hospital made great progress. Pauline L. Dolliver, 1889, a Massachusetts woman by birth, was called from her position as assistant to Miss Maxwell in the Presbyterian Hospital, New York, to succeed Miss Browrn. With her coming in January, 1899, began a period of great educational development for the School. There are no reports from 1896 to 1899 and there was no Training School Committee. The first report of the School under its new management was written by Miss Dolliver and appeared in the Hospital Report of 1899. In it she suggested an obstetrical affiliation for all pupils, and that the monthly allowance for each should be reduced to six dollars throughout the course. A very important action was taken at a meeting of the Trustees, November 28, 1899, when it was voted that: The Trustees' Committee on the Training School for Nurses shall have power to appoint a convenient number of ladies and gentlemen to act as an Advisory Committee to the Chairman of the Trustees, and they shall be chosen for one year from March Training School for Nurses 99 1st each calendar year. The Chairman of the Trustees' Commit- tee on the Training School shall be Chairman of the Advisory Committee. This Advisory Committee was divided into special com- mittees as followTs: On Instruction— Dr. J. J. Minot Dr. R. C. Cabot Dr. H. F. Vickery Mrs. H. L. Burrell Mrs. W. W. Vaughan Mrs. F. L. Higginson On Health, Exercise, and Amusement— Dr. J. M. Jackson Mrs. G. H. Monks On Special Training— Dr. F. B. Harrington Dr. J. J. Minot Mrs. N. Thayer Mrs. Alex. Whiteside On Discipline and Probation and Graduates— Dr. J. C. Mumford Miss M. B. Lothrop Ladies' Friendly Committee— All of the ladies The Resident Physician and Superintendent of the Training School were members ex officio of all special committees. At a meeting of the Advisory Committee January 2, 1900, there was discussion regarding more time for meals and shorter hours for work. The Committee on Health, Exercise, and Amusement reported that the nurses had at most three and three-quarters hours for study, exercise, recreation, etc., allowing seven and one-half hours for sleep. They recommended that more time be allowed for meals, Operating Room, Ward E—used 1889 to 1913 Training School for Nurses 101 for exercise, amusement, rest, and study. The Committee on Discipline, Probation, and Graduates made the following- interesting report: To us it has seemed that the subject of graduates is of im- mediate interest. It would be well for us, for them, and for the community to arouse and stimulate their interest and loyalty towards the School and Hospital, by aiding them educationally. As the length of training had been two years, during which theoretical instruction was very meager and the prac- tical experience limited to what could be obtained in the Massachusetts General Hospital, the following vote, which was adopted at a meeting of the Trustees held January 26, 1900, was epoch making for the School: The Advisory Committee of the Training School for Nurses of the Massachusetts General Hospital will oblige the Trustees if they will formulate a scheme of studies and training for the nurses, both within and without the Hospital and with outside institutions, intended to occupy three years, and Dr. Howard is authorized to make such arrangements with hospitals and institu- tions as may seem wise to him and are recommended by the Committee. Thus was inaugurated a most generous and cooperative movement between different hospitals and eventually with Simmons College which resulted in great benefit to the School, a benefit that was retroactive as well as progressive in its effects. For the condition of a school affects the reputation of the remotest graduate as well as the interests of those who are in training. As a result of the recommendations of the Advisory Com- mittee the Amphitheatre and the Out-Patient Department were placed in charge of graduate nurses. A preliminary course for probationers was started which began with demonstrations in practical nursing procedures and sixteen 102 Massachusetts General Hospital lectures in anatomy, physiology, and hygiene, and was later maintained and amplified for all the pupils who did not have the Simmons College Four Months' Preparatory Pap line L. Dolliver Course,1 for which the first group of eight pupils entered Simmons College September 8, 1904. The hours on duty were shortened somewhat and the number of nurses increased. 1 The four months' Preparatory Course for Nurses offered by Simmons College was the first of its kind so far as the writer can learn. It initiated a development in the education of nurses that has become widespread. Training School for Nurses 103 In the course of time an exchange of nurses between the Children's Hospital and the Massachusetts General Hospital was arranged, to be ended as far as the Massachusetts General Hospital nurses were concerned when their own pediatric department was created. The Children's Hospital School continued to send its pupils to the Massachusetts General Hospital until June, 1922. Head nurse conferences were held with Miss Dolliver and suggestions made which brought about the establish- ment of a two months' course in the Diet Kitchen and the inauguration of formal graduation exercises. The follow- ing invitation was issued to the friends of the Hospital and Alumnae: The Trustees of the Massachusetts General Hospital request the honor of your presence at the Graduating Exercises of the Training School for Nurses on Monday, February 16, 1903, at 8.30 o'clock at the Hospital Addresses by Bishop Lawrence and others The exercises were held in the Operating Theatre. Dr. H. P. Walcott presided; Bishop Lawrence delivered the address; Miss Dolliver gave her report for the year, and Dr. Walcott presented the diplomas. The doctors' choir, led by Dr. R. C. Cabot, furnished the music and the exer- cises were followed by a collation. At succeeding graduations there have been many eminent speakers, representing the laity and the medical and nursing professions. 101 Massachusetts General Hospital The course had been extended to three years in 1901, during the third year of which a course of special lectures was given and pupils were sent for special training in other hospitals; sciences were taught by the class method, instead of by lectures; bedside clinics for study of diseases were conducted by Dr. G. S. C. Badger in Medicine and Dr. T. J. Monahan in Surgery, who were paid three dollars an hour for their services. Affiliation with Sloan's Maternity Hospital and the Bos- ton Lying-in Hospital; with Corey Hill Hospital for three months' experience with private patients; one month of dis- trict nursing; classes in reading aloud; physical exercises; instruction of pupil nurses in specialing by Miss McElligot; and a six months' Administration Course were all started during Miss Dolliver's leadership of the School. The effort to abolish the "payment system" and to estab- lish a $50 tuition for students who attended Simmons Col- lege proved unsuccessful, but when it was learned that all of the students could not pay the tuition, the Trustees generously assumed the expense and also furnished com- fortable living accommodations in a Jamaica Plain residence. Tlie efforts of the Committee to create satisfactory con- ditions for rest, recreation, and study were futile, due to the ever-increasing demands of the Hospital and to insuffi- cient housing room, in spite of the addition to the Thayer in 1902 and the leasing of part of a house on McLean Street. All the recommendations of the Committee on Educa- tion, which included affiliation with McLean Hospital for mental experience, and with the Eye and Ear Infirmary, did not become effective for some years, but the suggestion which was first made in 1874, and again in 1904, was taken Training School for Nurses 105 up nine years later and resulted in an affiliation with Mc- Lean Hospital in 1913 and with the Eye and Ear Infirmary in 1915. The introduction of all these improvements required a great deal of planning and hard work on the part of the Training School office staff, which had been increased to four members, and the three year course proved undeniably hard for the students on account of the long hours which were forced upon them by the pressure of an increasing amount of work in the Hospital. In 1904 the Advisory Committee, realizing that the recommended changes in the School would mean a large increase in expense, for which the interest on the small Training School Fund of $18,386.42 was entirely inadequate, made an effort to raise a $50,000 endowment. Unfortunately only $12,500 was realized, to which the Trustees added $10,000 from the Codman Estate. In 1906 a committee consisting of Dr. J. G. Mumford, Mrs. Whiteside, Mrs. Vaughan, Miss Dolliver, and Dr. Har- rington was appointed to study the state of the Training School. A very thorough study was made of different types of schools, of the reports on nurses at the Boylston Street registry, and of letters from fifty nurses and forty-one doc- tors ; from which conclusions wrere drawn regarding dif- ferent methods of training, regarding results obtained by the Massachusetts General Hospital method, and sugges- tions were made for remedying obvious defects. One statement from the report made by this committee in February, 1907, is so pertinent that it should be quoted: It has appeared to us that our Training School, as it now exists, is an outgrowth of conditions, and in a sense represents a 106 Massachusetts General Hospital development which has been reached through no systematized program, but through a process of adapting ourselves to circum- stances as they have arisen from time to time. Perhaps such a chance method of growth yields the best results, but we question whether it may not be advisable, occasionally, to look farther ahead, and to contemplate some more formative and definite system. The criticisms of the training, given by graduates and doctors, coincided in the opinion that the nurses were not properly prepared for private duty. These criticisms led to changes in the system whereby the pupils, when special- ing hospital cases, received instruction on the refinements of nursing private patients, and recommendations were made that more attention should be paid to instruction on the humane and ethical side of nursing, as contrasted with the material and wage-earning view. In 1909, Miss Dolliver resigned for a much-needed rest and the following testimonial expresses the appreciation of all who had an opportunity to observe her work: Miss Dolliver served the Hospital faithfully and ably for ten years. It is with great regret that her resignation was accepted. It may well be the ambition of servants of the institution to leave behind them as good a record as has Miss Dolliver.1 After Miss Dolliver's death, August 11, 1921, Miss Max- well, under whom Miss Dolliver was trained and with whom she later worked as assistant and intimate friend, said of her: No tribute that can be paid to the life, character, and work of Pauline Longhurst Dolliver can fully express the influence she exerted over the nursing profession. Of a singularly upright and straightforward character, she combined with a New England conscience a love for suffering humanity, rare judgment, fearless- ness, and clear vision. 1 From Hospital Report by Dr. F. A. Washburn. CHAPTER XI 1909-1920 Eventful Years Georgiana J. Sanders was Superintendent of the School following Miss Dolliver, from October, 1909, to March 1, 1910. Miss Sanders was an English-trained nurse and had been in charge of the training school in the Polyclinic Hos- pital, Philadelphia. Although her stay was brief, she emphasized effectively the need for more nurses and for shorter working hours. The Advisory Committee approved, and the Trustees con- sented to Miss Sanders's request for fifty-two more nurses, and houses wrere rented on Charles Street for the authorized increase. The temporary accommodations in McLean Street were renovated and made much more attractive during her superintendency. Miss Sanders started the experiment of pupil head nurses on the open wrards in the Bulfinch Build- ing under surgical and medical nurse supervisors. When Miss Sanders resigned, to succeed her Sara E. Parsons, 1893, a Massachusetts woman, was called from the superintendency of the Griffin Hospital, Derby, Con- necticut. Her preparation for the work consisted chiefly of the course in Hospital Economics taken at Teachers Col- lege in 1904 and 1905, and the knowledge of people and organization gained by establishing schools in hospitals for the insane after graduate work at McLean Hospital. With the increasing number of students, some readjust- ment in the curriculum was necessary. It was impossible to send more than eighteen or twenty students a year to 107 108 Massachusetts General Hospital Simmons College, consequently it was thought wise to ter- minate that affiliation and to establish a more comprehen- sive preliminary course in the School, wrhich should be given Sara E. Parsons to all probationers; and to persuade as many prospective probationers as possible to take the course at Simmons be- fore entering the Hospital, if they had not already studied- elementary courses in the sciences, chemistry, etc. Training School for Nurses 109 Amy P. Miller, a graduate of Johns Hopkins Hospital, who had taken a special course in the Department of Nurs- ing and Health, Teachers College, wras secured in September, 1910, as the first full-time instructor of the sciences. Hav- ing a full-time instructor made it possible to give the night nurses late afternoon classes, and to establish quiz classes on the doctors' lectures and clinics. Mrs. Nathaniel Thayer provided a course in Current Events in 1911 which was attended by the seniors and grad- uates. For two or three years afterwards, the graduates financed the course themselves and invited the seniors to attend. Like almost everything else that depends upon voluntary contributions, these lectures were unfortunately given up. An affiliation was made with the Wesson Maternity Hospital of Springfield, that offered the advantage of nurs- ing private patients and enabled the School to discontinue the affiliation at the New York Lying-in Hospital. Bedside clinics in the pediatric and orthopedic wards were initiated; visits to other hospitals by the seniors, a course in Invalid Occupation and a course in Social Service were inaugurated during 1910 and 1911. In 1912, a most important step was taken in improving the preliminary course by thoroughly equipping a room in the ''Thayer" for the instruction of students in practical nursing procedures, and installing as full-time instructor Annabella McCrae, who had been first assistant in the Training School office. If one were to ask any of the graduates of the last twenty vears what was the most inspiring and potent influence on their career derived from this School, undoubtedly a chorus would answer "Miss McCrae" with one accord. 110 Massachusetts General Hospital Since 1912, Miss McCrae has served the Hospital with great zeal and efficiency as Assistant Superintendent of Nurses and Instructor. During these years she has taught Axnabella McCrae all the probationers their practical nursing procedures. Her quick, keen eye and critical tongue, combined with a warm heart, intense loyalty, high ideals and keen sense of humor, have enabled her to impress her ideals upon her students Training School for Nurses 111 in such a way that few could ever go into the world without recalling her example and her admonitions for thoroughness in method and her sympathy for all human suffering. Hers has been the longest continuous service in the Nursing Department, and its distinguishing characteristic has been a never flagging effort to teach the best and latest methods along with right ethical standards. Many visits to colleges and schools were made by Miss Parsons during 1910 and 1911 to present to the students the subject of nursing as a profession, and a decided increase in the number of well-educated applicants resulted. Whereas before there had been an occasional college graduate in the School, they began to come in increasing numbers until there were from 20 to 30 students with degrees at one time, and about fifty per cent of the student body who had some col- lege work varying from a few months to three years. In former days so little was thought about a college prepara- tion that if a nurse had a degree it was not mentioned in the records. A matron was placed in the "Thayer" to take charge of the maids, to preside at afternoon tea, and to look after sick nurses who were off duty with minor ailments. The non-payment system for students was again tried, this time successfully. The students paid forty dollars as deposit for their preliminary course, and for a year or so this sum was refunded at the time of graduation or for- feited if for any reason the student did not finish her course. Later the tuition for the preliminary course was increased to fifty dollars. Through the kindness of Mrs. Nathaniel Thayer, Mrs. Charles Mason, and the Alumnae Association, there were a few scholarships available for students wdio otherwise could 112 Massachusetts General Hospital not have entered the School under the non-payment system. When it was instituted, the Hospital assumed the respon- sibility of furnishing text-books, uniforms which were kept in repair and renewed, and the diploma and pin at gradua- tion. For several years previously Mrs. Thayer presented the graduates with their pins, which had never before been generally purchased and worn. Now one seldom sees a grad- uate without her pin when she is in uniform. Mrs. Thayer also offered prizes for the two best papers written by the seniors on some nursing subject, and has continued these prizes annually. As the Hospital increased its capacity, the number of student nurses was increased until dormitory accommoda- tions were quite inadequate. Chiefly through the earnest efforts of the ladies on the Advisory Committee, sufficient money was raised to warrant the Trustees in building a fireproof home for nurses on Fruit Street, which accom- modates one hundred nurses. In February, 1914, this New Home was opened, and for a short time the School was enabled to abandon all tem- porary residences. The Home was planned very carefully by Dr. F. A. Washburn to provide every reasonable comfort for the nurses. Mrs. Charles F. Mason furnished the beauti- ful reception room in memory of her mother, Mrs. J. T. Andrews, daughter of Mr. Nathaniel Thayer, who had been interested in the School in its early days and who had furnished the library and living room of the "Thayer" which was built in 1882 and occupied in 1883. Two groups of Donatello's Singing Boys wrere placed in the reception room by Mrs. W. W. Vaughan and Mr. Henry Parkman, in memory of their mother, Mrs. Samuel Parkman. Soon the growth of the Hospital staff in other depart- Training School for Nurses 113 ments encroached upon the nurses' quarters, since matrons, dietitians, and pupil dietitians were lodged in the nurses' homes. In 1916 another residence was seriously considered. Plans wrere drawn that should provide a dining room, kitchen, and infirmary. Educational changes continued. In 1914, an 18-month course for McLean graduates was substituted for the 13-month course, in order to give them operating-room work and obstetrics. This added to the School burden, but the School's diploma stood for better prepared graduates. The case method of teaching private nursing was started, and affiliations were made with McLean Hospital for the Massachusetts General pupils and again after many years with the Eye and Ear Infirmary, thereby enriching the training greatly. These special courses were elective, since only a limited number of students could have them each year. There wTere given also elective courses in etherizing, in instructing (as Miss McCrae's assistant), and in research work with medical patients. A short course in drugs and solutions was given to all students by Mr. Godsoe, in the pharmacy. The course in the Instructive District Nursing Associa- tion was reorganized so that pupils who took four months' training there received a certificate for public health nursing. In 1914 surgical bedside clinics wrere started, which greatly improved the course in surgical nursing. While the educational development was going on, more opportunities were opening to the students and graduates in all departments. The experiment of having pupil head nurses in charge of wards was not successful, so the School went back to graduate head nurses on all wards except two of the easier surgical wards. 114 Massachusetts General Hospital The New Home had made it possible for the nurses to have a more normal social life. A class in folk dancing was held, but social dancing proved more popular. Dancing parties were given occasionally and the nurses gave fairs, benefit entertainments, receptions for incoming classes, etc. A Glee Club, which furnishes music for the graduation exercises and carol singing at Christmas, became a standing organization and disclosed much talent among the students. In recognition of the Club's work, the Ladies of the Advisory Committee gave the School a new piano. The size of the School increased to such an extent that the Charles Street houses wTere again in commission. There were three quite important events in 1915. The School was made responsible for the orderlies, to whom some instruction is given; the Alumnae started an Endow- ment Fund for the Training School; and Student Govern- ment was instituted. Pupils and graduates began to mani- fest definite interest in the School, working hard to promote its welfare, and giving to it substantial sums of money. In 1916, Miss Agnes West gave one hundred dollars to the School to start a Students' Loan Fund in memory of her deceased sister, Marion Moir West, 1889, and Mrs. Amelia Crane, a student nurse, added eighty dollars to the fund, which has been increased somewhat by other gifts, so that it has been possible frequently to help some nurse in a financial emergency. The war cloud which had been lowering since 1914 be- came a grim reality. In 1916, U. S. Army Base Hospital No. 6 was organized, with Dr. F. A. Washburn as Com- manding Officer and Miss Parsons as Chief Nurse. July 9, 1917, saw the Unit en route for Europe, leaving Dr. Joseph B. Rowland as Acting Superintendent of the Hospital and Helen Wood, 1909, Acting Superintendent of the School. Training School for Nurses 115 Meantime young women who desired to be of service in army hospitals during the wrar as Nurses' Aids had been training in the Hospital up to the number of seventy-four. Helen Wood From this class Barbara Bennett and Clarissa Howland later entered the School as regular students. With about one-half of the regular nursing staff in Europe and others constantly leaving, it was no easy task 116 Massachusetts General Hospital to carry on the School. But for the loyalty of old graduates who came back to help, it would have been a hopeless task. The Hospital's administrative and medical staff were also sadly depleted, and nurses were substituted for physi- cians as assistants in the Administrator's Office, where they seem to have become permanent officers. About this time the School and Hospital suffered a severe loss in the death of Mrs. Alexander Whiteside, who had been an active member of the Training School Advisory Commit- tee. Her youthful enthusiasm and keen sense of humor made her peculiarly sympathetic and understanding with the joys and sorrows of young people. Yet the work went on and demands upon the School increased. The Phillips House, a one hundred bed hospital for private patients, was opened, and seventeen pupil nurses were1 required there as assistants, the number increasing to twenty-six as it became more and more difficult to get grad- uates for floor and special duty. The old Lodge was fitted up for a cooking laboratory, and a matron was placed in the Charles Street Home, the School fortunately securing a former graduate, Lucia Brown, 1889, to fill the position. "When sorrows come, they come not single spies, but in battalions." Difficulties created by the Avar were increased an hundred fold by terrible epidemics of scarlet fever and influenza. Eighty-five nurses were sick with influenza after the epidemic of 1917 when it struck the country again in 1918. Fortunately only one nurse in the Hospital died, but many were on the danger list. Several graduates outside of the Hospital, most of them young, died of influenza, and it was indeed a heart-breaking season. At this time a few of the Aids who had not been allowed by the Government Mrs. Alexander Whiteside 118 Massachusetts General Hospital to go overseas came into the Hospital and proved themselves very helpful. They also gave a generous sum of money to the Chief Nurse of Base No. <; to use as she saw fit, and sent boxes full of presents to be distributed to the patients. The Boston Metropolitan Chapter of the Red Cross made it possible for the School to give twelve students scholar- ships for a Public Health Course. Two of these students were allowed to finish their period of training outside the Hospital. Marie Kouroyen went to Europe under the Greek Commission and Margaret Harry went to Richmond, Vir- ginia, to do Public Health work. By 1918 about two hundred alumnae were in military service. By this time the Army School of Nursing was ready to send its students out for affiliated experience, and several were received in the Hospital. Also in 1918 an important affiliation with Simmons Col- lege was arranged whereby a five-year course was estab- lished between the College, the Massachusetts General Hos- pital, and the Instructive District Nursing Association. At the end of her course, the graduate receives a B.S. degree from Simmons, a diploma from the Massachusetts General Hospital School for Nurses, and a certificate of Public Health from the Instructive District Nursing Association. Meantime the affiliation with McLean had unfortunately been abandoned as one of the results of war conditions. At last the war was over and the Base Hospital Unit landed in New York, March, 1919—at least as many as were able to get away and had not signed up for Red Cross work overseas. Miss Parsons was given a five months' leave of absence, during two months of which she received salary and spent the time visiting leading schools in the East and Middle *felow one hundred and ten in the middle of the night. As for the daytime, it kept about one hundred and twenty to one hundred and twenty-six in the shade. The native life at Ashar was a revelation to me, the population being mostly Arab, with their picturesque though often dirty appearance. The town lies up a creek where crowds of natives bathe. The banks are thronged with hundreds of Arabs curled up on benches, smoking their hookahs, or fingering their beads. After a short stay at Basra, fifteen of us started for Amara, greatly to my joy, as it was as high up the river as sisters were 138 Massachusetts General Hospital allowed to go, and a better climate than Basra, being a good deal drier. The greater part of a very hot afternoon was spent trans- ferring ourselves and belongings to the paddle steamer. Not only did we take our rations, but drinking water, too, and a basket of soda-water packed in straw, which had to be kept constantly damp to prevent an explosion, and numerous other packages. We made the journey most comfortably. The stern of the boat was given up to us, and we spread all our little beds out and lived there, but were fortunate in having some little cabins below, where we could at least dress in privacy; otherwise we all lived in the open. The medical officer of the boat was most kind in detailing some orderlies to do our cooking and kept us supplied with washing water; otherwise, I don't know how we should have fared. Some officers occupied the bow, and the center of the boat was given up to R. A. M. C. men, British and Indian. In addition, we towed on either side a big fiat barge, full of Indian stretcher-bearers, etc. The riverboats return in exactly the same manner, only full of sick. After leaving Kurna (the supposed site of the Garden of Eden) at the junction of the Euphrates and Tigris, which boasts one tree, and Temptation Square, where one can buy watermelon, there is scarcely anything green to be seen. The country is the last word in countries, as far as one can see, nothing but absolutely flat mud lands, occasional villages of grass mats, and the most poverty-stricken people, Chaldeans, Medes, and Persians—they are exactly like Bible characters. I could almost believe I could see Abraham pointing out the land to Lot. It may have been fair in his day, but certainly is not now. It made me sad to think of our poor men marching across this dreary country, with not a twig to shelter them; and one could appreciate Jonah's feelings when the gourd sprang up to protect him from the sun. We carried a machine gun, and part of the boat was protected by steel plates, as she had been in several "scraps." One of our night anchorages was at Ezra's Tomb. It is rather picturesque, with seme fine palm trees, and a striking looking cupola of blue enamel tiles. Amara was reached in three days. It is quite a large town, about 10,000, about halfway between Basra and Bagdad. All the Training School for Nurses 139 principal buildings are on one side of the Tigris, and some fine date plantations on the other, which made a pleasant and restful picture for the eye. The river is crossed by a good pontoon bridge. We were fortunate in securing a Turkish barrack for our hos- pital, and very quickly had the place whitewashed and cleaned, and full of patients. It was built in the form of a quadrangle, and whenever a sand storm was blowing the results were distract- ing. The ceilings were made of grass matting and heavy rafters, where the birds built their nests, and many cats and rats found their homes; and I have even found convalescent patients snake- hunting with large sticks! The ants, too, were a great trial, es- pecially a very tiny variety, which swarmed everywhere in mil- lions ; and it was quite impossible to stand the leg of every article of furniture in water, the only means of keeping them away. Scorpions, too, and bats abounded, and often during the night jackals would find their way into the hospital, notwithstanding armed sentries at the entrance. The floors and walls of the build- ing were made of native brick, mud, and straw, and any time if we wanted to empty a glass of water, for instance, all we had to do was to throw it on the floor, and it was immediately absorbed! The nurses were never allowed out alone on account of snipers and possible insult from the natives, and we drove to and from the hospital in bullock tongas, horrid springless carts, which were also our only ambulances, but now, I am glad to say, they have motor ones. Though sickness is a very depressing thing, the men were astonishingly cheerful; indeed, I think the spirit of the British soldier is wonderful—no matter how uncomfortable he may be, he always has a smile and makes the best of things. For many weeks the heat seemed almost unbearable. We our- selves wore very thin overalls, and yet were always bathed in perspiration, and it was perspiration which literally ran off in rivers. Any time we could have done as one thirsty Tommy sug- gested, held a cup to our cheeks to catch the drops. By degrees the hospital became fairly ship-shape, though we were put to it even to find sufficient bottles, etc., to contain medi- cines, and had to improvise all sorts of contrivances to use till supplies began to come pretty regularly up the river; occasionally 140 Massachusetts General Hospital everything would be held up for days by a boat sticking in the mud, for, as the summer advanced, the river got lower and lower; in October one could almost wade across. All our supplies came from India; and with the irregularity of service and shortage of transport at times, the difficulties were great. As we had no other but Tigris water to drink, it all had to be chlorinated with un- pleasant results and a most disagreeable taste. I am afraid I have dwelt rather long on the discomforts; October really is a lovely month. The days still very warm and the nights very cold. Rarely have I seen more beautiful starlight nights or lovelier sunsets, which reminded me greatly of Egypt. Along with the horrors of war all who lived through it will remember the awful experiences at home and abroad during the influenza epidemic. A letter from one of the nurses who was working with the Red Cross at home gives a picture quite equal to any- thing that happened abroad. Bombs and bullets are not the worst enemies of mankind or the worst feature of war. Frieda Bullock, 1918, was sent to Muscle Shoals, Ala- bama, during a typhoid epidemic. Selections are made from two letters describing her experience: On arriving I learned that only a few actual cases had devel- oped, but the Federal Bureau of Public Health had sent for four doctors and four nurses to give typhoid inoculations and teach hygiene. Muscle Shoals was a great cotton field swamp as recently as last Christmas; now it is a large camp, a plant of a nitrate manufacturing company making ammonium nitrate for high ex- plosives and operated by the Government. Since some of the men employed have brought their families, it means about twenty thousand people to be inoculated. Room 30, Federal Building, Florence, Alabama, October 30, 1918. Your good letter was enjoyed as ever, though I couldn't answer it before, because the "flu" is down here too, and we are having Training School for Nurses 141 a time. As you know, there are the tri-cities, Florence, Sheffield, and Tuscombia, and besides that, Plant No. 1 and Plant No. 2. The tri-cities and Plant No. 1 were duly warned and promptly closed their schools, churches, movies, etc., but Plant No. 2, fear- ing that labor troubles might arise if the "flu" was officially recog- nized, refused to close its movies and crowded meetings or to take proper care of the sick. On October 2 our Federal Health officer received instructions from Washington to take charge of Plant No. 2, and our poor little force of three doctors and four nurses flung itself into the breach. For days and nights the doctors walked through the bunk houses and tents of the twenty thousand men, women, and children living in Muscle Shoals, separating the dead from the dying and handing out medicine. I went, too, the first day, but at once it became necessary to evolve emergency hospitals and so six, one after the other, were hastily assembled. All of us, nurses and doctors alike, had sad and funny experiences, but I'll just tell you of my own. October 3d I explored bunk houses in search of the very sick from 7 a.m. to 4.30 p.m. I was then put in charge of one emergency hospital consisting of one hundred and fifty iron folding cots, as many mattresses, a wagon full of sheets, blankets, and pillow cases, and patients pouring in as fast as the ambulances could bring them. As staff nurses I had five negroes scared to death of catch- ing "that there influence"—a fireman and a policeman, while my doctor was an old man of seventy who had not been a practicing physician for four years; in fact, was then employed at the plant as a bricklayer. The hospital consisted of three rough wooden shacks without a stick of furniture beside "these cots. I stayed on until 9 a.m. the next morning and found "my staff." I had put to bed one hundred and eleven patients during the night. For ten days and nights after that another Red Cross nurse and I worked all of the twenty- four hours except the six or so we had to sleep in, being nobly assisted by carpenters, bricklayers, electricians; in fact, anybody that volunteered. The Red Cross sent us three extra nurses after a while, but llli Massachusetts General Hospital even now, after four weeks, when the number of our patients is but seventy in each emergency hospital, we have to depend upon these untrained men. Ward E (at the Massachusetts General Hos- pital) was never quite as bad as some days and nights I put in with delirious pneumonia patients, groaning pleurisy patients, and just plain, uncomfortable "flu" patients, stacked up on beds three rows deep. No dishes, no drugs, no thermometers, no hot water, not anything such as one would find even in an ordinary household was available at first, and was only remedied by degrees. To this day we have no bedpans! The men who helped me were certainly fine, and washed and fed patients, did up "Allen Streets,"1 or scrubbed the floor as oc- casion might require. I wish I could show Miss McCrae a big policeman carrying trays, with a towel before his front, looking like a Kewpie; or a huge and floury mason gently rubbing lini- ment on to chests. The sickness is growing less rapidly, and we hope to close the emergency hospitals in a couple of weeks. Meanwhile we have got down to a twelve-hour day and feel somewhat less rushed. One of the Red Cross nurses sent here caught the "flu" and died, but the rest of us have been leading charmed lives. There is fortunately a pleasanter side of war work, but equally important. In Rochester, New York, Mrs. W. S. Fly (Helen Gam well, 1900), a widow, with her one son in the Aviation Service, opened her spacious home as a surgical dressing center. There she taught one thousand women to make dressings, and when our country became involved she was summoned to Washington to organize a department there. Mrs. C. W. Hoyt (Mary B. Wellington, 1907), of Roches- ter, organized and trained an ambulance corps of Rochester young women who are said to have rendered most valuable service. Mrs. Hoyt was detailed to similar work in Wash- ington while Dr. Hoyt was in service overseas. lAn expression used in the Massachusetts General Hospital to designate bodies prepared for the Allen Street Morgue. Training School for Nurses 143 It has been impossible to get a complete list of nurses whose services were recognized during the war by decora- tions. A great many were cited for conspicuous efficiency and courage. The following are those whom we know to have received special recognition: British Royal Red Cross, 1st Class Annie C. Strong-Shaw Rose K. Butler Carrie M. Hall Minnie McAffee British Royal Red Cross, 2nd Class Alvira B. Stevens Hanna S. Peterson Croix de la Guerre Maude G. Barton Medaille d'Honneur Bernadette Cormier Frances E. Ricker Mary A. Diamond Maria Llewellyn Card Reconnaissance Francaise Margaret Stevenson Muriel Gait Carrie M. Hall Medaille des Epidemies en argent and Insigne d'Honneur Marie Sirois Mons Star Decoration Vera Benjamin Decoration from Greek Government Margaret M. Tymon Decoration from Italian Government May Warner Bronze Edith Cavell and Marie Depage Medal given to the Massachusetts General Hospital Training School for Nurses from the Belgian Government. CHAPTER XIV Survey of the'School If you would make other people respect the profession which you have chosen, respect it yourself, and do all that lies in your power to elevate it. Dr. 'William Richardson to the nurses in 1886. We are drawing toward the end of the story as far as the School is concerned, but the picture would not be com- plete without a survey, brief as it must be, of the habitual activities of those who call the Massachusetts General Hos- pital Alma Mater. The Student Body With the relaxation of the strain from excessively long hours of work, the activities of the student body have con- spicuously increased. In the nineties there were no routine parties, even at Christmas time, and "spreads" in the nurses' rooms with an occasional party were practically all the festivity that broke the routine of work and sleep. Gradually the social spirit has developed into a pretty well organized system. Formal social dances are held twice a year, and informal dances at irregular intervals. It is customary for each class to give a party for the entire stu- dent body once a year, and the party may be a circus, min- strel show, drama, or something original, according to the inspiration of the class. The Student Government Associa- tion gives a welcoming party for each group of probationers. The students and graduates in the Hospital have been very generous in responding to charitable appeals. They 144 Training School for Nurses 145 contributed one hundred and twenty-eight dollars to the Cavell-Depage Memorial Hospital in Belgium and one bun dred dollars to the Florence Nightingale School in Bor- deaux, France—the American Nurses' Memorial to the nurses who died overseas in service. Beginning in 19B>, each graduating class has presented a gift to the School, most of them substantial and beautiful things that will be a permanent source of pleasure: 1913, a framed photograph of Florence Nightingale in memory of Claire Mainini, a classmate who died in her senior year. 1!»14, a mahogany mantel clock for the Reception Room. 1915, a tea carriage with silver tea set and complete furnishings. 1916, brass andirons and screen for both fireplaces in the Re- ception Room. 1917, a handsome Irving-Casson library table. 19is, a tennis court. 1919, reading and piano lamps. 1920, a victrola. 1921, refurnished the kitchenette and sitting room. 1922, book cases for classroom. The singing of Carols on Christmas Eve and early Christinas morning all about the Hospital and residences by the Glee Club is one of the pleasantest traditions, and a graduation would not seem natural now wdthout their contribution. The St. Barnabas Guild connected with Trinity Church has been for many years a pleasant and helpful factor in the lives of many nurses. Dr. Mann, the rector of Trinity, usually speaks to the nurses each year concerning the Guild and its activities. Mrs. Arthur D. Hill, a Guild Associate, also a member of the Hospital Ladies' Visiting Committee, has for some years given delightful teas for each incoming class of probationers. Annually during Lent some member 146 Massachusetts General Hospital of the Guild conducts Bible classes in the New Home for those who desire to attend. The outstanding personality connected with the Guild is, however, Miss Marion Fenno, an active member of the Advisory Committee. Miss Fenno has arranged the Bible classes and has spared no effort in promoting the social and religious interests of the School. There is danger of thinking of the student nurse as part of a machine when she is in a large hospital; yes, there is danger of her thinking of herself as a cog in a wheel, yet the students are seldom that, especially on night duty. Lest we should forget the student nurse as a human being with a heart and soul, this section is closed with a paper written by Clare Dennison, 191.8, who gives a reveal- ing picture of the sweet, benignant force "whose soothing shadow falls" on the walls of myriad wards: THE NURSE WHO STAYED AT HOME The Nurse Who Stayed at Home sighed a very tired sigh. Now this was all wrong, because it was only nine o'clock at night, and nine o'clock at night is the time when sick-a-bed people drop into their first weary doze, and night nurses catch their breaths after the first two hours' flurry, and gather their forces together for the long, hard night. But the Nurse Who Stayed at Home was unhappy anyhow. She had not slept well that day, and the city had seemed to roar with discordant sound. Of course she was accustomed to these annoyances, but in her mail that night had been a letter from "Somewhere in France." A sister nurse who had gone across with the first Red Cross unit wrote enthusiastically of the trials and achievements of life there, a life filled with heroic endeavor and mighty work. "Something worth while," the little nurse thought bitterly, and her own humdrum existence rose in com- parison. Other people really helped in the world, while she plodded along—just over the same unending round of the same troubles and soul-wearying labor. Training School for Nurses 147 She sighed again; this time it was more of a snort, and stepping gingerly (night nurses acquire a funny flat walk peculiarly their own), started on her rounds. Once away from the bright spot of light around the desk, the ward stretched dim and eerie, the figures lying on the little white beds, some quiet, some tossing restlessly, but all enshrouded in gloom. Here was Mrs. Abrams; very cautiously she tiptoed past that bed, certain that the minute Mrs. Abrams wakened, the rest of the ward woke too. There was Mrs. Jalson, wheezing uncertainly. Mrs. Jalson had asthma, and was getting in her first sleep before her nightly demonstration of dying. Mrs. Catalina was crying softly in the next bed. Poor Mrs. Catalina missed her babies sadly at night, and sometimes it was almost impossible to console her. In the corner bed was the pneu- monia admission of that day, and the Nurse Who Stayed at Home paused there with a troubled frown, then went back to the desk to read again the orders which were those used only in the direst extremity. Back again at the bed she noticed pitifully how pretty and young the little thing was. Most of her life before her and now, "No," said she sternly to herself, "she just sha'n't die." Nurses love to promise themselves things like that. Mrs. Donahue snored blissfully in the farthest corner, and the cardiac smiled wistfully at her as she went softly by. She spent a satisfied moment at the typhoid's chart. That had been a long, hard fight, and the Nurse Who Stayed at Home felt that she had a little share in the victory, and so she passed down the long ward. The night superintendent came for the first report. She shook her head over the pneumonia's chart, and left, leaving behind her, as always, the sense of a burden made easier, and the Nurse Who Stayed at Home settled down to obey the hundred whispered de- mands—fill hot water bottles and ice bags, deal out cold drinks and hot drinks, beseech Mrs. O'Connor not to pound on her table with her water pitcher when she desired attention, rub backs, block out her night report, make visits with various wandering internes, and never to be more than five minutes away from the little pneumonia lady. It was on about the fiftieth trip to the kitchen that she met a wild-eyed, haggard man, who seized her by the arm. "My wife," 148 Massachusetts General Hospital he gasped. "I just got word. Tell me. Isn't there any chance?" The Nurse Who Stayed at Home sought frantically for words. She knew in her heart. But, oh, what could she tell him? "We—we never give up hope," she said gently, "we never stop trying, and you mustn't go in to her with a face like that, you know." She sniffled fiercely afterward, as she put milk to heat, and pounded ice for Mrs. Moriarty's ice cap, which after five minutes of use adorned the bedside table. "If only we can save her," she whispered. "If only we can!" But the interne on his midnight visit gave her little encourage- ment. He listened to her report, and after gloomily watching for fifteen minutes said, "Do the best you can," and departed. Trot, trot, trot, kitchen, linen closet, and lavatory. Hot water, cold water, sponges, treatments, and medicines. Mrs. Jalson woke up, and that meant a rush for a noisy hour. Mrs. Jalson was really rather proud of that cough, and was wont to remark, with ostentation, that it never lasted less than an hour. So by that time every one was wide awake, and demanding attention. Gradually it grew quiet, and the fight in the corner bed went on with undiminished ardor. Somehow at night, Death seems almost a tangible object—hateful, insistent, and so powerful. The Nurse Who Stayed at Home felt that every time she turned her back he gained, and Death was gaining despite her work, her heartache, and the little whispered prayers which night nurses make when they are all alone and feel so helpless against such a mighty foe. She felt again for the barely perceptible pulse. "Nurse," a hoarse staccato whisper, "get me a hot drink, will yuh?" Certain that delay meant noise, she flew for the kitchen; and when the drink was finally prepared, brought it in to find its intended consumer snoring. Dawn was coming grayly in the windows when she went back to the bed behind the screen. After it was all over, and the little bed was made fresh and orderly for its next occupant, she felt very old. Her knees knocked together too. Of course she had not been even a little while in hospital without meeting Death in its grimmest aspect before. But somehow, "And I wasn't even with her when she died," she gulped to herself as she pulled out her handkerchief and sat down on a stool. She decided to take time to cry. Training School for Nurses 149 "Oy-oy-oy-I die," a long-drawn howl. So away she went to prove the contrary to Mrs. Abrams—quite a lengthy process; and when that was over, it was time to embark on the flood of morning work. No one who has not taken charge of a heavy ward between the hours of 5 and 7 a.m. can know what that means. Mrs. Dona- hue, whose snores had ascended to heaven since nine, loudly be- wailed a sleepless night. Mrs. O'Connor could have slept, but her feet had been "that cold all night." The street noises had proven to be the fly in Mrs. Polansky's ointment, and her critical glance convinced the night nurse that she alone was to blame for that. Back again in her bed that morning she tossed in restless thought. That morphine—did she chart it ? and oh, heavens above! she had completely forgotten that Mrs. Smith's tonic. Such a little thing, and so young. Too bad, too bad! Just a grind any- way.—Useless.—Other people did big things.—Then quite irrele- vantly her drowsy consciousness flashed into remembrance of the way Mrs. Gottelieb had smiled when she took her fifth hot drink, "You goot girls," she had said, "goot girls." And all of a sudden the tired little Nurse Who Stayed at Home was fast asleep. Affiliated Nurses There have been affiliations with the following schools in Massachusetts with very pleasant results: Boston Children's Hospital New England Baptist Hospital, Roxbury Choate Memorial Hospital, Woburn J. B. Thomas Hospital, Peabody Sturdy Memorial Hospital, Attleboro Holyoke City Hospital Faulkner Hospital, Jamaica Plain North Adams Hospital Franklin Hospital McLean Hospital, Waverley Melrose Hospital Whidden Memorial Hospital, Chelsea Morton Hospital, Taunton To these should be added the Army School for Nurses, Wash- ington, District of Columbia. 150 Massachusetts General Hospital About three hundred and fifty students from them have been at the School from two to four months each during the last eleven years. There has never been any friction or unpleasantness in connection with all these young women, and although there are difficulties in carrying so many special students, the contacts have no doubt been stimulat- ing and helpful to all concerned. Foreign Nurses During the last twenty years, there have been many students and graduates from foreign countries who have been sent to the School to prepare for executive or public health work in their own countries. They have come from Switzerland, Greece, Italy, Armenia, Albania, Syria, Ger- many, China, Czechoslovakia, Poland, and India; and graduates have come from Finland, Germany, Belgium, Greece, and the Philippines for observation in our wards and classrooms. McLean Nurses Since Lucinda S. Lovell (now an M.D.) came from Mc- Lean Hospital in 1SS7 to take the graduate work leading to a diploma offered by the Massachusetts General Hospital School, two hundred or more have followed her example up to date (1922), and the advantages of the affiliation have been mutual. From their work with mental cases in the atmosphere of a hospital like McLean, nurses derive something that cannot be gained in any general hospital. The finer the type of woman, the more she gets from her contact with this most unfortunate class of patients. Undeviating kindness, sympathy, and tact on the part of the nurse are necessary, with self-sacrifice and devotion of a high order. These Training School for Nurses 151 qualities have been exemplified in a marked degree by most of the officers at McLean, and no one who has listened to the lectures and worked with Dr. Edward Cowles, Dr. George T. Tuttle, Miss Lucia Woodward, and many others who have been identified with the hospital can ever forget the beautiful spirit of their example and instruction. Besides these advantages, the environment at McLean is one of refinement and beauty, which will leave an impres- sion on a receptive individual; so it is not strange that many fine women have graduated from this school, and have lent luster to the reputation of the Massachusetts General Hos pital School. Administrators Since the organization of the Administration Course for Nurses, which has been one of the notable services to the hospital world made by the institution and initiated by Dr. F. A. Washburn, thirty-five graduate nurses have taken the course, seventeen of whom were Massachusetts General Hos- pital alumnae. Private Duty Nurses As is generally the case, more of the graduates go into the private duty field than into any other one branch of nursing work. One of the first class of three was a private nurse, and probably that has been approximately the per- centage of those doing private duty among all who are in active work during later years. That they are successful wre know because they have always been in demand, and the most serious criticism we hear of the School is that more of the graduates do not take up private work. 152 Massachusetts General Hospital Private duty in the home, as it used to be known, is rapidly passing with the increase of private hospitals and all their conveniences for the practice of modern medicine. The public health field is now appealing more to those who most enjoy service that has close personal contacts. There are various reasons for this preference, one potent factor being the extensive publicity given to the importance of this specialty. When the School was organized there were no precedents as to the position of the trained nurse in a family, and it was many years before her employers and the nurse herself knew exactly how she should be placed in relation to the family and to the domestics. The first registry for nurses was established at the Bos- ton Medical Library, and managed, to a considerable extent, after the customs of an employment bureau. There are nurses still living who remember their interviews with the Registrar, who asked them to read a little from a book so that he could estimate their educational qualification and their fitness for entertaining the patient by reading aloud. Papers were sent out for employers to fill in concerning the qualities of the nurse and her work. These papers wrere kept on file at the registry. For some years it was stated in the circulars that the nurse wTas to eat in the kitchen with the servants. Eventually this was recognized as an unwise arrangement, as well as objectionable to the nurses, and was so stated in an admirable lecture on private duty given to the students in 1886 by Dr. William Richardson. One criticism by an employer sent to the Directors in the early days of the School wTas to the effect that graduates should be 'iess particular Avhere they ate and more particu- Training School for Nurses 153 lar about the niceties of their work!" The answer made to such criticisms by the wise and kind Directors in 1886 was: We do not claim to turn out perfect nurses. Perfection hardly belongs to human nature, certainly not to nurses when they first leave the Hospital and suddenly find themselves called on to do their accustomed work under new methods and strange surroundings. The approach to the highest rank in their profession which they succeed in making depends upon their natural qualifications. We are glad to find a decided gain in this respect as years go on. Not that any nurses will probably surpass some of our early graduates, but we have now many more who are likely to make their mark than in the early days of the School. Some of our graduates may never be superior nurses; and some are open to criticism for defects, perhaps not very serious when compared to their merits. But many of the community will bear warm testi- mony to the comfort brought into their families by nurses from the Boston Training School. A superintendent in New York who was interested in starting a registry there in the early eighties, wrote to the Registrar in Boston concerning the details of organizing it. He wrote back not to start one, that she would hate herself and everybody else before she got through. Thus one sus- pects that the registry had its own troubles. In the early reports of the School there are constant warnings to employers urging them to ask for the diplomas of the nurses, for many who were discharged from the School went into private practice and sometimes put "From the Massachusetts General Hospital" on their cards. This ad- vice is equally applicable today. Experience has demonstrated that the private duty nurse should indeed be a woman of the highest integrity, 154 Massachusetts General Hospital refinement, and skill. These qualities, desirable in a hospi- tal, are much more desirable under all the varying condi- tions found in home nursing. That the School has graduated its reasonable quota of nurses with these qualifications is due to the traditions established in the early days, of careful choosing and training the best candidates wdio presented themselves to the School. In comparison with the demand, there is at present a scarcity of the best type of nurse in all fields. For several years the number of schools was few, varieties of occupation for intelligent women wrere limited, and the first schools were in a position to demand qualifications that are absolutely impossible requirements today. The average age of pupil nurses, even in the nineties, was from twenty-five to twenty- seven years, and the majority came from homes of thrift, industry, education, and refinement, if not of wealth. Many had been teachers, and these brought to their wrork self- confidence and judgment. We still have this type of women in our schools, but there are not enough of them to meet the demands of all the hospitals that rely upon students for their nursing person nel. The young girl who now enters brings compensations for her lack of years in the way of enthusiasm, adaptability, and habit of study, but she requires different conditions and can scarcely be expected to take just the same kind of re- sponsibilities as can her older colleagues, with their advan- tages in general experience. The following compilation of statistics from annual re- ports speaks for itself: Training School for From 1875 To 1888 Total number of graduates 204 Deceased 8 Status unknown 15 Married 32 Private duty 86 Superintendents or Assistant Su- perintendents of Training Schools 8 Superintendents or Matrons of Hospitals or Homes 18 Head Nurses of Wards or Depart- ments 15 At Home 13 Masseuse 2 Misc. (artists, librarians, etc.) 1 School Nurses—Public, Private, College 1 Medical Students 2 Doctors of Medicine and Osteo- pathy 2 Students 2 District and Public Health Nurses 2 Missionaries and Sisters Office Nurses Dentists Instructors of Nurses Editors Social Workers Army Nurses Anaesthetists X-Ray Technicians Executive Secretaries Red Cross Nurses CHAPTER XV Survey of the School—Continued In 1907 the nurses themselves said "their training in the Massachusetts General Hospital was calculated to develop in them capacity, activity, and wage-earning power." It can also be truthfully said that the Hospital environment has instilled integrity, self-restraint, and endurance. Dur- ing late years the various affiliations, both in and out of the Hospital, have tended to develop adaptability and a broader outlook than the experience gave in previous years. The work of the graduates as a whole has leaned more to the executive and practical than to the educational and preventive lines. Owing to the long connection w-ith Mc- Lean Hospital nurses, the composite character of the work of the graduates has a strong tincture of service for mental patients, in the private, executive, and educational field. Out of the eighty or more schools which have been superintended by Massachusetts General Hospital graduates, eighteen have been connected with institutions for nervous and insane patients. The special work in which graduates have most prom- inently figured has undoubtedly been hospital administra- tion. More than one hundred and sixty institutions have been superintended by them. These hospitals have been in twenty-two different states, in the District of Columbia, in Canada, Scotland, and Greece. Some of these superintend- ents are well known in the hospital world, particularly Mary Keith, 1888, Superintendent of the Rochester General Hospital, and Emma Anderson, 1896, of the New England 156 Training School for Nurses 157 Baptist Hospital, Roxbury, Massachusetts. Many have opened, equipped, and developed their hospitals from private houses into institutions wmose administration would be spoken of as "men's jobs." One of the pioneers in this field was Imogene Slade, 1885, of whom the President of the Woonsocket Hospital Board writes: She was the first superintendent of our hospital, being engaged at its opening, and remained here for over twenty-two years. . . . She was a wonderful woman of great ability, and no words of mine could give her adequate praise. A few years ago a children's ward was opened at the hospital, and was named after her as a tribute to her memory. In 1921 thirty-eight hospitals were in the charge of Massachusetts General nurses, twenty-nine of wrhich are in New England. The following hospitals in or near Boston in 11)21-1922 had for superintendents Massachusetts General graduates, some of them continuously from their opening: Robert Brigham Hospital Boston Lying-in Hospital Infants' Hospital St. Luke's Hospital for Convalescents, Roxbury Corey Hill Hospital, Brookline Faulkner Hospital, Jamaica Plain Vincent Memorial Hospital Stillman Infirmary, Cambridge Eliot Hospital New England Baptist Hospital, Roxbury Cambridge Hospital Milford Hospital Cable Memorial Hospital, Ipswich Holyoke City Hospital Hale Hospital, Haverhill Maiden Hospital Quincy Hospital 158 Massachusetts General Hospital Wesson Maternity Hospital, Springfield Melrose Hospital Framingham Hospital Copp's Private Hospital, Cambridge Cooley-Dickenson Hospital, Northampton Beverly Hospital Anna Jaques Hospital, Newburyport J. B. Thomas Hospital, Peabody Trumbull Hospital, Brookline There are about eighty schools for nurses that have been superintended by Massachusetts General graduates, not counting those schools in hospitals where both school and hospital are under one head. Six of the widely known schools which are directed by them in 1922 are: The Boston Lying-In Rochester General, Rochester, New York Washington University School, St. Louis, Missouri Peter Bent Brigham, Boston University of California, San Francisco Massachusetts General Hospital It is only recently that the alumnae are becoming identi- fied in any special degree with public health work, for in 1910 there were only eleven working in that field. Sixty-six nurses are now (1922) identified with public health in various sections of the United States, country and city; others are working in Poland, Turkey, France, China, and India. Mary L. Cole, 1893, is supervisor of public health work on the Pacific coast, and Erna Kuhn, 1914, in South America is assisting in organizing a school for nurses and in establishing public health work in Rio de Janeiro. The list of specially prepared instructors is a lengthen- ing one. There are now three non-resident instructors in Boston and vicinity, Helen Redfern, 1907, having blazed the way. Training School for Nurses 159 In wrhatever State you find them, the graduates are usually represented on the Examining Board and in official capacities in State and National organizations. Alice Gorman, 1889, was one of the first two nurses to take a graduate course at Teachers College, Columbia Uni- versity, when the present popular Department of Nursing and Health was initiated as the Department of Hospital Economics. Since then a large number of Massachusetts General graduates have availed themselves of the oppor- tunity offered there for advanced work. There are fifty or more different kinds of positions held by Massachusetts General nurses, with each year showing an increase in variety of occupation. A few graduates have done distinctive work, which indicates the scope of oppor- tunities open to nurses. Dita H. Kinney, 1892, was the first nurse superintendent of the Army Nurse Corps, a position she held for about ten years. Jessie I. Belyea, 1898, Executive Secretary of the Massachusetts Society for the Prevention of Cruelty to Children; Anna C. Phillips, 1907, for some years Executive Secretary for the American College of Surgeons; and Sarah F. Martin, 1886, Secretary of the Travellers Aid Society, Baltimore, Maryland, have done interesting work somewhat out of the beaten path for nurses. Lelia H. Ashley, 1911, with her diploma from Sargent's School of Gymnastics and her nursing education, has had an interesting combination of work as School Nurse and Physical Director in the schools of Perry, New York. Gladys Farrar, 1910, occupied an unusual position at the Barnes Hospital, St. Louis, for several years, as chief anaes- thetist and instructor in anaesthesia of the Washington University medical students. 160 Massachusetts General Hospital Agnes Aikman, 1892, was given charge of the Bellevue School of Midwifery which was started while Miss C. 1). Noyes was superintendent of Bellevue and Allied Hospital Training Schools. Miss Aikman possessed the training, ex- perience, and personal characteristics to make the work a complete success, and it now stands as an exceptional dem- onstration of an effective measure for meeting an urgent health need among an immigrant population. Probably one of the most important historical beginnings in connection with hospital work was the organization of the Social Service Department under Dr. Richard C. Cabot's leadership. The nurse chosen as Chief of the department was Garnet I. Pelton, 1903, about whose work Dr. Cabot writes: Miss Pelton was, in many ways, the best social worker I have ever seen. She was a genius, and very little that we have done since is more than an extension of what she thought out in the few months that she was with us before she broke down. Her work was full of originality and insight, as well as devotion. Miss Pelton's health broke down while the work was in its infancy and compelled her retirement for several years. She is now (1922) Executive Secretary of the Colorado Tuber- culosis Association. Margaret Gilson Reilly, 1916, welfare worker in the Skin Department of the Massachusetts General Hospital, has achieved a position of unique usefulness as a result of her intelligent study and devoted care of these cases. The Chief of the department states frankly that she increases its effi- ciency fifty per cent. Her skill is exceeded only by her personal interest in her patients' welfare—physically, spirit- ually, and socially. Training School for Nurses 161 The Alumnae Association While this is not the place for a full history of the Alum- nae Association, the history of the School would not be com- plete without mention of the Association's activities. It was organized February 14, 1895, at a meeting held at Hotel Thorndike, Boston, in response to the call sent out by Sophia F. Palmer and Mary E. P. Davis, who came from Philadel- phia to conduct the meeting. Eighty-one graduates re- sponded to the call and became charter members. The first officers of the Association were: President, Maria B. Brown, 1883 Vice-President, Alice O. Tippet, 1889 Secretary, Florence F. Rice, 1882 Treasurer, Mrs. Dita H. Kinney, 1892 The Association was invited by Miss Dolliver in Feb- ruary, 1900, to hold its meetings in the "Thayer," and during that year the subject of an endowed bed in the Hospital and a fund to purchase a piano wTere discussed. The sum of $5,000 was raised, for which the Trustees gave the graduates the use of a private room. As time went on the Sick Relief Association grew out of many discussions about a Sick Benefit Fund. Mrs. Cheney (Julia Arthur) gave the School a piano, so the Alumnae voted that Miss Dolliver should use for the benefit of the School the piano fund of $128 which had been collected. This gift to the School from the Association is the first recorded. It has been followed by many others. When the Advisory Committee started to raise an endowr- ment for the School in 1907, the Association contributed over one hundred dollars. The first dinner given by the Alumnae to the graduating class was at the Copley Square Hotel, March, 1904. Training School for Nurses 163 When the New Home was opened, the graduates gave several handsome presents to it that will testify of their loyal interest in the School for many years after the donors have passed on. The beautiful hall clock; pictures of Linda Richards and Anna C. Maxwell; an embroidered Chinese scarf; a Philippine table cover; and the urn and two Jaco- bean chairs in the entrance hall were all gifts from individ- ual graduates or classes. The Quarterly Record became the graduates' "hold- together" since 1911, when it wras launched with Alice O. Tippet, 1889, as its able first editor. It has proved a bless- ing to the graduates and to the School, for through it the Alumnae have been able to keep in touch with each other, and it has been an inspiring letter from home to many a wanderer. Among the many graduates wdio have worked most faith- fully for the Association are Jane Riley, Esther Dart, and Bessie Fullerton. Jane Riley, 1888, has worked indefatigably on commit- tees for many years, and in a modest but effective way she has represented the School, or seen that it was represented in the state and national organizations. Her heart has been large for the unfortunate and no one is more greatly missed when absent from the meetings. Esther Dart, 1891, and Bessie Fullerton, 1895, have served the Association as officers for many years, cheerfully carrying the extra burden of work as one way of showing love and loyalty to their School and profession. Their hands have been upheld by many others who could always be counted upon to assist when in Boston. Minnie S. Hollingsworth, 1897, has been the graduate who has not only wrorked for the Alumnae untiringly, but 164 Massachusetts General Hospital has been very active in promoting the professional organiza- tion of private duty nurses in Massachusetts. Training School Endowment For the third time there is an organized—if feeble— attempt to put the School for Nurses on a financial basis so that its development may proceed unhampered by lack of money. When the Directors of the Boston Training School for Nurses gave the School to the Hospital, they also gave a Training School Fund of $18,386.42. When the Advisory Committee attempted in 1907 to raise a small endowment of $50,000 additional, the original sum was augmented by $22,500. In the Hospital Report for 1920 the Training School Fund stands at $40,022.92. Needless to say the in- terest on this sum is but a very small part of the annual expense of maintaining the School. If the School were to be abolished and attendants and graduate nurses substituted for the students who now do the nursing, the expense of the department would be much increased, while the character of the care given patients would deteriorate. Consequently it is of the utmost impor- tance to the future welfare of the Hospital that the School should be so maintained that it may continue to rank as one of the first class schools in the wrorld. This cannot be done in the future as cheaply as it has been done in the past on account of the change in standards of nursing education, working hours, and living conditions. Where there were a dozen good schools in the country a few years ago, mostly in the East, there are now twice as many throughout the West and Middle West, some of which are in connection with universities, and if the Eastern schools Training School for Nurses 165 could be maintained under the old conditions, it would not be right that they should be. Results of the old system have taught hospital administrators and the public that the same conditions cannot conscientiously be imposed on students, even if they and their parents would accept them. The older graduates, realizing this fact keenly, resolved in 1915 to start an endowment fund, aiming at nothing less than $250,000 before the interest should be used. This is the most important act of the Association in its relation to the School. The need of an endowment for a school for nurses is still ' so little realized by the philanthropic public that this modest sum may appear to be excessive to those who have not given serious thought to the situation, but the subject is worthy of careful analysis by those who believe in the work that our teaching hospitals are doing, and in the service that an intelligent, wrell-trained nurse renders the community. The Alumine have never given publicity to their work for an endowment, and the war diverted their efforts for four or five years, but donations have come in steadily never- theless from many loyal graduates. The Trustees have invested about $9,000 of the fund for the Endowment Committee, and the Alumnae Association has pledged an additional $10,000 for the fiftieth anniver- sary, with as much more as they may be able to raise. With Miss Dolliver's bequest and the sale of this History, the proceeds of which are to go to the Endowment, the Associa- tion hopes to have made an appreciable beginning by 1923. The generous assistance of other friends of the Hospital and School will be needed in order to realize the hope for a real endowment, and the nurses have such faith in the ideals ;ind accomplishments of the Hospital and School that they believe their hope shall become realization. 166 Massachusetts General Hospital If Florence Nightingale is correct when she says The small, still beginning, the simple hardship, the silent and gradual struggle upward, these are the climates in which an enter- prise really thrives and grows, this enterprise must result in accomplishment. Summary Have the children been worthy of their mother? The committee wTho in 1907 investigated the records at the Nurses' Registries, and invited criticisms from nurses and doctors concerning their "estimate of the value of the in- struction given, the character of the trained nurses grad- uated, and the sentiment of the community towards our nurses," reported: ''All of our information shows that the general standard of our graduates is high." During the fifteen years since this study was reported there have been great changes in the School, and a special effort has been made to correct deficiencies that were pointed out in the report, but meantime the type of student has changed very much. There are comparatively fewT Cana- dians entering the School, and about half of the candidates are young girls just out of high school, with a sprinkling of mature women. About one-third of the students are from Massachusetts, one-third from other states in New England, and an interesting third from various parts of the United States, w7ith a fewT from Canada and Europe. Considering the youth of present-day nurses, naturally many more marry and leave the ranks and fewer care to do private work. The graduates are sought for to fill interesting and well- paid positions in all parts of the country, and many of the young graduates prefer institutional work, wTith its oppor- tunity for advancement, its assured salary, and a certain Training School for Nurses 167 amount of time for one's self. The older graduates, who would be best fitted for private duty, are choosing public health in rapidly increasing numbers as offering the best field for what they believe to be constructive work. Some say that the School is not sending enough grad- uates into the private field, and it is certain that there are not enough w7ith executive qualifications to meet institu- tional demands. No one can know the shortcomings of the School better than those responsible for it. The best and the worst in our nursing work are not due to the schools primarily, what- ever be their virtues or faults, except as conditions in them are such that good applicants are deterred from entering, but are due to the inherent qualities brought to the schools in the persons who present themselves as applicants. If by birth, environment, and education they have ideals, in- telligence, and mental culture, the result is almost sure to be satisfactory, and every effort made to attract that type of young woman redounds to the credit of the hospital and school from which she graduates. All the graduates ac- knowledge that the prestige of the Hospital has added much to the value of the diploma. It has opened the doors of opportunity all over the country and the graduates have felt a sense of noblesse oblige. 'TIlk Ivied Columns Risk to Meet Tic Gi.ort or tbe Bilfinch Dome" AN ALUMNAE SONG FOR THE MASSACHUSETTS GENERAL HOSPITAL Words by Margaret Dieter, 1916 Her ivied columns rise to meet The glory of the Bulfinch dome; Serene, unruffled, beautiful, She waits to bid us welcome home. From many lands, o'er many days, We brought to her our restless youth, And she with patience took us all And set us in the way of truth. Stern Teacher, kindly too, withal, Who saw the faults we could not hide, And building on our better selves, She wrought results that shall abide. What if she gave us arduous toil? She taught us reverence for our work, To ease the suffering, lighten pain— There is no task we dare to shirk. Where life and death are side by side, And creeds and races strangely blend, To share these things from day to day She helped us each to find a friend. Oh, Gracious Guardian of our past, Thy children rise to honor thee; God bless and keep you, M. G. H., Secure through all the years to be. 169 CHAPTER XVI Training School Relationships Trustees The Board of Trustees seemed to the nurses quite re- mote in their relation to the School, considering that the Board has been the ultimate authority for all that has tran- spired in the School during the last twenty-six years, until Mrs. Nathaniel Thayer became a member of the Board. As Chairman of the Trustees' Training School Committee and of the Advisory Committee, she has been a strong connect- ing link betwreen the Board and the School. One of the Trustees has been a generous benefactor to several student nurses who developed tuberculosis during training and who required long residence in private sanatoria. When the nurses raised f5,000 for an endowred bed for the graduates, the Trustees gave the bed in a private room with all the privileges that go with a $10,000 bed endow- ment. The 15,000 wrould ordinarily have simply endowed a bed in an open ward for two lives.1 Hospital Superintendents After the Training School was finally accepted by the Hospital it has found sympathetic allies in the Hospital Superintendents. The fact that throughout the years the Superintendents of the Training School have had no ap- proach to the Trustees except through the Hospital Super- 1 Two lives is understood to mean that an endowed bed is available for free patients during the life of the donor and of one other person named to succeed him as the patron of the bed. 170 Training School for Nurses 171 ■ intendents indicates that such advances as have been made have had their endorsement. To Dr. Herbert Howard, Dr. Frederic Washburn and his former assistant, Dr. Joseph Howdand, the School ow-es much for their very real personal interest in the nurses, both during training and as graduates. They have been sympa- thetic and helpful in supporting the nurses' efforts to obtain good educational standards. Also they have insisted upon proper professional recognition for those whom they recom- mended to responsible positions. It may truthfully be stated that much of the administra- tive success of the Massachusetts General Hospital nurses is due to the fact that they could always go to the Hospital Superintendents for advice, which has been given in the most generous spirit. Many of the nurse superintendents would wish to acknowledge indebtedness to Mr. Joseph Godsoe, the Hos- pital's capable pharmacist; to Miss Mary Clark, the matron ; and to Mr. Frankson, the storekeeper, who have long been in the service of the Hospital and have extended a helping hand to all who sought their assistance. Medical Staff One of the first directors of the School said that she should never forget the early opposition of the staff to even the idea of a trained nurse. No less a light than Dr. Oliver Wendell Holmes once affirmed that a trained nurse would be a danger both to the doctor and to the patient. It has, however, been the boast of the School that it has been most fortunate in the medical staff; Since the first year seldom, if ever, has one refused to,lecture and to assist in the instruction of the nurses. With very few exceptions **i ■.*>.•*/•*• ■£ s^^V'V. Mp W 4 .1 i. * ]\Ihs. Nathaniel Tiiayek Training School for Nurses 173 the members of the staff have chosen from the first to repose great confidence in the skill and judgment of the Massachu- setts General Hospital nurse. And when nurses are ill, how kind the physicians are, and always have been! There are so many to whom the School owes much that it would be impossible to name them. Dr. Richard C. Cabot, through his services to the School as a member of the Ad- visory Committee for several years, as a lecturer to the School, and as an officer in Base Hospital No. G, where he worked untiringly to promote the physical and social wel- fare of the personnel, holds a particularly warm place in the regard of a large number of the graduates. Advisory Committee The spirit of the first Board of Directors is perpetuated in the present Advisory Committee of the Training School, particularly in the sub-committee of ladies which meets every month. Mrs. W. W. Vaughan and Mrs. Nathaniel Thayer were active and influential members of the Board of Directors several years before the School was adopted by the Hospital, and they have been members of the Advisory Committee from its organization in 1S!)9. Dr. Henry 1\ Walcott, Chairman of the Advisory Committee for many years, wTas a constant and sympathetic member. On this new committee the Alumnae had for several years unofficial recognition through the membership of Mrs. Caroline Cay- ford Burrell, 1892. During the reconstruction of the School under Miss Dol liver, the various sub-committees did most effective work, and Mrs. Vaughan, Mrs. Burrell, Mrs. Higginson, Dr. Minot, Dr. R. C. Cabot, and Dr. Vickery gave much time and thought to establishing educational advantages for the 171 Massachusetts General Hospital nurses. If the hours on duty wrere not shortened to the extent that they should have been, it was not the fault of the members of the Committee on Health, Recreation, etc., but of the acceleration and increase of work on the wards Mrs. W. W. Vaughan which has always kept ahead of the supply of nurses, maids, and orderlies. The Hospital, when organized, included in its plan no intention of a school. The care of the sick poor in the best possible way was to be its great consideration, and all who Training School for Nurses 175 have ever been connected with the institution are proud that through all the changes in administration and the pressure of scientific interests, humanitarian consideration for the patients has been maintained. The Advisory Committee, with the Superintendents of the Hospital and of the School, is the body that really con- trols the destiny of the School, for although it has no ulti- mate power, the Trustees seldom refuse to sanction any important recommendation that it makes. Especially to the Ladies of the Advisory Committee is the School indebted for many of its comforts, and these have a very direct bearing upon the success of the School, reckoned in the number and quality of nurses. That the noisy cobble-stones around tbe New Home were replaced by asphalt was due entirely to the personal efforts of Mrs. Vaughan and Mrs. Whiteside. The ladies refurnished the "Thayer" Library and Sitting Room, and have added many gifts of money, books, and social entertainment. Indeed, as one reviews past records, the benefits conferred by them on the School are innumerable. The importance of their relationship to the School is hard to state in wrords, but its Superintendents have found them towers of strength and comfort. Infinite patience and tact with new administrations; never suggesting that some of the supposedly new proposals had been tried and failed; never discouraging the new Superintendents with the bulk of their own experience; but listening, counseling, and working always for what they believe to be good and gen- erous—such is the record of this Committee. Association with these women gives assurance that the integrity of the Massachusetts General Hospital Training School shall be sustained. Compete it must with the new 17(i Massachusetts General Hospital schools, change and adapt itself to new conditions and new demands, but to lower its standards or to die, never! so long as the Massachusetts General and its friends are a factor in the community. Sally Johnson CHARTER NVII The End of Half a Century Sally Johnson, 1910, was called from her position as Superintendent of Nurses in the Albany Hospital, Albany, Xew York, to succeed Miss Parsons, October 1, 1920. Miss Johnson, a native of Connecticut, a teacher before she became a nurse, brought to the position many qualities that fitted her preeminently for the responsibilities involved in the future development of the School. The need of a new home, with a dining room, kitchen, and infirmary for the School, still existed, and with the increasing demands made upon the nursing staff it seemed imperative that ways and means of eliminating waste in the use of the nurses' time should be considered. The sub- ject of ward helpers had been discussed during recent years, but the cost was prohibitive to an institution that con- stantly had a deficit. The position of Superintendent of the School had never been an easy one, but in 1920, when the School was just recovering from the strain of war emergencies and epidemics and was laboring with a chronic condition of insufficient funds for its increasing demands, it needed the loyalty and experience that Miss Johnson brought to bear on her problems. Public interest in nursing, which had been excessively stimulated during the wrar, had slumped. There were fewer applicants than at any time since 1911, and though in that respect the School was well off in comparison with many other schools, the prospect was not altogether cheerful. One 177 Student Nurse, Preliminary Student, Graduate Nurse 1922 Training School for Nurses 179 great redeeming feature was the fact that in the School was as fine a set of young women as ever gladdened the heart of a superintendent. During 1920 Miss Johnson and Nellie Hawkinson, the instructor in theory, correlated the courses more effectively; courses in medicine and pediatrics were strengthened, and Miss HawTkinson was given a much needed assistant. A rearrangement of living conditions brought all the students and most of the probationers into the "Thayer'' and the New Home. Student Government took on a new lease of life and did effective work. Student social activi- ties, which had been abandoned during the war, revived. Moving with the times, ward helpers wrere introduced to relieve tbe student nurses of certain routine duties. The School has almost completed half a century of existence. No one questions the wisdom of its inception or the value of service rendered to the Hospital and to the world, for there is scarcely a country where its graduates have not worked successfully. Those who are watching the signs of the times know that the education of nurses and the relation between schools for nurses and hospitals is a problem not yet solved. Consequently it is of the greatest importance that the lessons learned from the history of the past fifty years shall be applied in shaping the policy of the School for the future. Although much has been done for the improvement of the School during the last fifteen years, there is still enough of truth in the report made in 1907 by a committee appointed to study the state of the Training School to warrant re- newed consideration: It has appeared to us that our Training School, as it now exists, is an outgrowth of conditions and in a sense represents a 180 Massachusetts General Hospital development which has been reached through no systematized pro- gram, but through a process of adapting ourselves to circumstances as they have arisen from time to time. Perhaps such a chance method of growth yields the best re- sults, but we question whether it may not be advisable occasionally to look farther ahead, and to contemplate some more definite and formulative system. Eleanor S. Whiteside Ellen T. Vaughan Pauline L. Dolliver Francis B. Harrington James G. Mumford Four of the members of this committee who held the welfare of the Hospital and School very dear have passed on. One of them, Pauline Dolliver, who for ten years gave all her mind and strength to the development of the School, has sealed her confidence in its future by bequeathing her estate to the Endowment Fund. The one outstanding error that has prevailed throughout the whole nursing system, and this School cannot be ex- cepted, has been the assumption that overwork and severe discipline were necessary and even desirable concomitants of nurses in training. When it began to be understood that there was a difference between the self-imposed hardships and sacrifices of the religious orders and the preparation of modern young women for a profession, it was then impos- sible for economic reasons to lift the superfluous load that had broken the health of so many good women during the early years of training schools for nurses, when only about fifty per cent of the pupils could or would stand the strain. The half century is closing without seeing definite finan- cial relief; nursing schools still remain under the shadow of an inherited system that is only beginning to be amelio- Training School for Nurses 181 rated. Saner policies claim for the workers a right to health, happiness, and reasonable freedom. Nursing will always be a profession that requires voluntary self-sacrifice from those who have a "call" to this field of service. We begin to see, howrever, that self-abnegation must be voluntary and not imposed. To go on as in the past almost entirely under the appren- ticeship system is impossible. The needs of the hospitals and the educational requirements of the students must be harmonized in those institutions that wish a high grade of nursing service. The only factor that remains unchanged is the unalter- able desire to nurse the sick that is implanted in the hearts of many young women. Therein lies the hope that the sick shall be nursed by good women in the future in spite of all the errors, short-sightedness, and obstacles that must be overcome while wTe are striving to find the best wray to serve the sick, to conserve health, and to deal justly by students as wrell as by patients. Chronological List of Events 1873 April November 1874 January February March May September November December 187.") January Boston Training School for Nurses 1873-1895 A training school for nurses first suggested by the Woman's Education Association through their Industrial Committee. School opened. Mrs. Billings, Superintendent of Nurses, November 1st. School in charge of two "foul wards in the 'Brick'." First meeting of Board of Directors, November 10th. Mrs. Mary Phinney von Olnhausen takes charge of School. First suggestion of a bedside instructor in addition to the Superintendent of School; also of a Matron for the Nurses' Home, 45 McLean Street. Miss Sarah Cabot suggests lectures for the pupils. Dr. F. C. Shattuck asked to lecture. Dr. C. P. Putnam suggests a monthly report from the Superintendent of School for the Directors' meetings. Vacation of two weeks allowed pupils. Trustees agree to continue connection with School. Linda Richards takes charge of School at salary of $600 a year. Miss Richards asks for a thermometer for the School and for uniformity in aprons and cuffs. Miss Richards recognized as Superintendent of Nurses by Dr. Norton Folsom, Superintendent of the Hospital. Pupils go regularly to the Eye and Ear Infirmary for instruction. 182 Training School for Nurses 183 One pupil employed on case outside of Hospital. One physician thinks instruction in cookery much needed. March School incorporated, March 17th. April Two scrub women engaged. Jane A. Seaman, pupil, goes to the Boston Lying-in Hospital for two months' course and "profits by it." Dr. Folsom satisfied with School. Pupils ask for cooking lessons. May Arrangements for six cooking lessons of two hours each. Mrs. Parkman asks that the subject of giving pupil nurses training in the care of. the insane, at Mc- Lean Hospital or elsewhere, be considered. June Pupils say they "do not have enough direct instruction on the ward." Directors decide that to make arrangements for all pupils to have training with the insane is too difficult. July First examinations. Examiners, Dr. R. IT. Fitz and Dr. F. Winsor. October Four night nurses caring for fifty-six patients. Miss Richards engaged for another year at $900, with a room in the Hospital. November First class, of three nurses, receive diplomas. As a result of an examination by two outside doctors, recommendations are made that the nurses be taught more cookery and medical nursing. All wards except B are placed under the care of the Training School, namely, the "Brick"; Wards 14, 16, C, 21, 23, 30. Introduction of a few ward maids. December Dr. C. P. Putnam recommends a recitation after each lecture. First classes in cooking. "No theory but good prac- tical lessons." First suggestion of a complete uniform. 184 Massachusetts (ieneral Hospital 1876 January Pupils taught bandaging by Dr. J. C. Warren. March "hady visitor" suggests that all nurses take notes at lectures. Miss Richards suggests a nursing text-book. May "Lady visitor" thinks more attention should be paid to the health of the nurses. Diplomas given to graduates at the Directors' meet- ings. June Dr. V. B. Porter agrees to take sixteen or seventeen pupils on his rounds for instruction. School moves from home on McLean Street to "Old Brick," which has been renovated and furnishes comfortable sleeping and dining rooms. September Miss Richards in charge of nursing in entire Hos- pital. November Miss Richards asks for a sitting room for nurses; for a man to carry ice to the wards to relieve the nurses; asks for a watch and one is to be pur- chased, cost not to exceed $20. Miss Richards gives pupils evening classes, reading to them, showing them plates and quizzing them. December Dr. Henry Bigelow takes pupils to the operating room for clinical instruction. 1877 April Pupils go to Dr. IT. H. A. Beach in Out-Patient Department for instruction. May Miss Richards goes to England. Anna Wollhampton comes to School as Substitute Superintendent. Pupils ask for more than two weeks' vacation. June Some pupils object to serving as head nurses because deprived of lectures thereby. Dr. J. J. Minot promises to have bedside clinics and to answer questions twice a week. October Some pupils expressing a preference for institutional work instead of private duty. November Some promising candidates have scruples about sign- ing a contract to stay two years in the School. Training School for Nurses 185 December Miss Richards returns from England and France, but decides not to return to the School. Miss Richards advises a night superintendent, and female nurses for male patients. Dr. Whittemore, Superintendent of the Hospital, thinks a night superintendent not necessary. 1878 July Mr. Frank Sanborn suggests a library for the pupils. August Pupils relieved from carrying ice and some other heavy work. Parchment diplomas given. November Miss Wollhampton leaves. Caps adopted. 1879 February Jane E. Sangster takes charge of School. Nurses sent to cooking school. Four head nurses teaching classes. April Miss Sangster begins a report book of nurses' duty. Mr. George W. West, "house-student," offers to teach the nurses bandaging. June Night superintendent to be procured. A physician to be appointed to examine the proba- tioners during the first month to see if they are strong enough for the work. Post-graduate course of two months at the Boston Lying-in Hospital arranged. Arrangement made for outside paying pupils. November Superintendent of Nurses "to accept and discharge pupils." First Report of School issued; written by Mrs. Samuel Parkman; contains the first request for an endowment for the School; also states need for a comfortable nurses' home with separate rooms and recreation room. 1880 , ,11. January A tribute read at the Directors meeting on the death of Mrs. Parkman, which occurred in December, 1879. 186 Massachusetts General Hospital December Maids installed in lower wards for cleaning corridors and for mopping and dish washing. 1881 March "Lady visitor" suggests uniform dress. July Scarcity of applicants, and School advertises in news- papers. August Directors suggest that scarcity of applicants might be because the work was represented as so very diffi- cult. October Boston Lying-in Hospital refuses to take any more pupils for less than six months. Miss Sangster leaves on account of health. Anna C. Maxwell chosen as Superintendent of Nurses. December Directors try in vain to effect an affiliation for ob- stetrics with the New England Hospital for Women and Children. 1882 April 1883 February March Ground broken for a nurses' home. Pupils relieved from carrying food and medicines to and from the wards. Directors vote to express to Elizabeth R. Scovil, 1880, their thanks for various magazine articles written by her which had brought in many applications to the School. April Miss Maxwell recommends a uniform. Nurses move into the "Thayer Building," their new home. Dr. William Richardson estimates that $600 is needed to fill the large bookcase in the parlor. He has secured $400. Clara Weeks's Text-Book of Nursing introduced. May More ward maids employed to take the hardest clean- ing from the nurses. Miss Maxwell recommends two sets of forceps and scissors for each ward. Surgeons urge that nurses be "advanced as far as possible in learning to dress wounds." Training School for Nurses 187 June Miss Maxwell recommends proper shoes for proba- tioners on account of the trouble—sometimes to the point of disablement—with their feet. Miss Maxwell urges measures for the safety of the new home. Library ready for use. Seven hundred and twenty- six volumes, also subscriptions to LittelVs Living Age, Popular Science Monthly, Harper's, and the Century. Cost, $740.52. Miss Kalopothakes, first special student, enters for a short course and pays a fee. Directors vote to refuse all applicants who intend to make medicine a profession. Dr. Russell reports that there is much less house work done by nurses at the Boston City Hospital. The statement confirmed by Dr. W. L. Richardson. Miss Maxwell investigates the work at the Boston City Hospital and finds that the Massachusetts General Hospital needs three,, more maids to equalize conditions. Miss Maxwell asks for anatomical charts. Miss Maxwell and Lucy Pickett start classes in mas- sage and recommend a professional teacher. May Elise Steinemann, pupil nurse, gives five dollars to the library as token of gratitude for care received during illness. Visitor for month suggests social gatherings once or twice a year for graduates when diplomas are received, to increase the interest of graduates in the School. June Care of wards transferred from Miss Sturtevant, matron, to Miss Maxwell. Three new ward maids allowed. Alice Scott appointed matron of the Convalescent Hospital, which had been dedicated May 5, 1882, July November December 1884 January March 188 Massachusetts General Hospital Any nurse could pass her vacation at the Conva- lescent Hospital free of expense. "Long Days"1 given to pupils and much appreciated. November At Dr. W. L. Richardson's suggestion, committees from the Boston City Hospital, the New England Hospital for Women and Children, and the Massachusetts General cooperated to construct a new program in cooking. Renewed request for instruction in massage. Doc- tors requiring it for patients. Mrs. Mary J. Lincoln agreed to the committee's plan for cooking lessons, and said that each pupil should practice everything she was taught theo- retically. Head nurses want to take massage lessons at their own expense. Dr. W. L. Richardson arranges for a set of charts to be drawn for Miss Maxwell to use in class. Nurses wish to form a class for instruction in read- ing with Professor Fobes once a week. Daisy A. M. McKeon, 1885, goes to Philadelphia to nurse for Dr. Weir Mitchell. Directors arrange for one lecture a year to be given on private nursing. September Dr. W. L. Richardson suggests it might be well for physicians who lecture to nurses to have a hired subject from outside for illustration. Miss Maxwell allowed $25 to spend on lectures for the year. November Eva Allerton, pupil, much commended by the physi- cians for careful attention to certain patients ill from blood poisoning, whose lives she was thought to have saved by properly changing their diet. Nurses wish a course of lectures at their own expense from Annie Payson Call on her book "Conserva- 1 For several years it was customary to let each nurse have one whole day off duty sometime during the summer. Usually two friends were allowed the same day, and were notified when called in the morning. December 1885 January April Training School for Nurses 189 1886 July September November tion of Human Energy." The matter referred to Dr. W. L. Richardson, Dr. R. Fitz, and Dr. O. F. Wadsworth. Training School recognized for first time by placing Miss Maxwell's name as Superintendent of Nurses in list of Hospital officers. Affiliation with McLean Hospital agreed upon for one year post-graduate course. First mention of graduates doing district work, also of one who graduated in medicine. This nurse was the cause of the rule made in 1883 excluding those who intended to study medicine. Miss Maxwell proposes that pupils have three weeks' compulsory vacation—one week at their own ex- pense. Lucinda S. Lovell, the first pupil to come from Mc- Lean Hospital under the new arrangement. 1887 March April June December Hospital assumes the expenses of the scrub women. Directors vote to pay Dr. C. P. Strong $100 to correct the seniors' lecture books. Dr. Richardson reports that in four years only four library books had been lost and that the library has been much used. Nurses anxious to have their names printed instead of written on their diplomas. 1888 April May At Dr. Richardson's suggestion the Directors voted $200 and two weeks' leave of absence for Miss Maxwell to visit other schools. Dr. C. P. Strong employed to correct all the lecture books. His comments on the lectures found very valuable. Thayer Building enlarged. 190 Massachusetts General Hospital 1889 January February April May December 1890 January May 1891 October November December 1892 February March Miss Maxwell and nurses want badges. The die of the Hospital seal costs $50. Nine out of seventeen schools then in existence had badges. Miss Maxwell resigns to great regret of the Directors. Last report from Miss Maxwell. Nurses in uniform. One lecture on insanity and one on bacteria added to course. Maria B. Brown, 1883, elected Superintendent of School. Voted: That outside graduates of recognized schools be allowed to attend the lectures by pay- ment of a fee of $5. Head nurses to be paid by directors $5 a month extra for instructing pupils. All head nurses appointed after this date to wear uniforms. Dr. Richardson, Chairman of Instruction Committee, arranges schedule of lectures. Dr. C. B. Porter and Dr. J. C. Warren suggest that some of the pupils be present at operations on Saturdays. Pupils take charge of cleaning and sterilizing in- struments for Saturday operations. Dr. C. P. Putnam moves that a committee be ap- pointed to consider starting a training school for male nurses. Miss Brown speaks of the course of lectures on the chemistry of cooking given at Johns Hopkins Training School. Miss Maria Daniell to give lectures on the chemistry of cooking. Mrs. Nathaniel Thayer presents School with a skele- ton. A committee considered a plan for "extra- Training School for Nurses 191 1893 January October 1894 January March October December 1895 January February mural" nursing, but it would necessitate a longer course, so nothing was done about it. Mrs. W. W. Vaughan procures diet lists from other schools to compare with the Massachusetts Gen- eral Hospital menu for the purpose of improving the diet. Five o'clock dinners started for nurses. Gift of $10 to Training School from former graduate, Mrs. Caroline Houdlette Preble, 1881. Miss Mary A. Boland engaged for cooking lessons at $200 a year. Trustees give use of Hospital kitchen Saturday after- noons for one and one-half hours. Sara E. Parsons resigns from Ward A as head nurse to go to McLean Hospital, the first to go from the Boston Training School since the affiliation was established. Dr. Burnham invites pupils to attend autopsies, the demonstrations proving helpful. Miss Brown asked to prepare a scheme for suitable exercises at the graduation of the nurses. Dr. C. L. Scudder illustrates his lectures with cases from the Accident Room. Miss Annabella McCrae, graduate of McLean Hos- pital, asks to have her time as pupil extended six months as she considers one year too short for medical and surgical training. Miss Brown asks committee to express an opinion as to a three years' course. Anna Blair, 1895, sent to assist at operations on Saturdays. Surgeons much pleased with arrange- ment. The graduates form an Alumnae Association of the Boston Training School for Nurses, attached to 192 Massachusetts General Hospital the Massachusetts General Hospital, February 14th. Fifty graduates present at the meeting. March Mrs. Vaughan reports that a person asked to contrib- ute to the support of the School would not sub- scribe unless an agreement was made that some portion of the nurses' pay should be refunded by them in consideration of their education. October Funds for the support of the School a serious ques- tion. Voted: That Mrs. C. P. Curtis should meet Dr. William Sturgis Bigelow and learn whether the Hospital Board was prepared to make any proposi- tion with a view to joining the School to the Hospital, or for taking over any part of the expenses. November Dr. W. M. Conant presents nurses' library with Kim- ber's Anatomy. December School to be surrendered to the Hospital January 1, 1S96. The funds of the Corporation to be turned over to the Hospital, the interest of which is to be used for the training of nurses. Chronological Events of the Massachusetts General Hospital Training School for Nurses 1896-1922 1896 January School taken under control of Hospital Trustees. No reports published between 1896 and 1899. 1899 Miss M. B. Brown resigns. Pauline L. Dolliver appointed Superintendent of School. First report of Training School by Miss Dolliver appears in the Hospital Report. An obstetrical course for all students recommended. Monthly allowance for pupils decreased to $6. Probationary period increased from one to two months in addition to the two years' training. Advisory Committee organized. 1900 Beginning of preliminary course of instruction. Sixteen lectures on anatomy, physiology, and hygiene given to probationers. September Graduate nurse in charge of surgical amphitheatre, September 12th. Pupil nurses assist at operations and in etherizing. October Daily hours on duty decreased one hour. A graduate assistant employed for Miss Dolliver. 1901 January Affiliations with Sloan Maternity and Boston Lying- in Hospitals, January 18th. Course extended to three years. Third year devoted to special subjects, affiliated experience, and ad- ministrative duties. Science taught by class method instead of by lectures. 193 194 Massachusetts General Hospital Bedside clinics in medicine for pupils. Teaching of sciences to nurses by Dr. S. C. Badger (medical) and Dr. T. J. Monahan (surgical), $3 per hour. May Head nurse appointed for Out-Patient Department. Interchange of four pupils with the Children's Hos- pital for four months. Second assistant for Miss Dolliver employed. 1902 Advisory Committee recommends that all pupils be taught to give hypodermic medication, formerly given by head nurses. Gymnastics for probationers twice a week taught by Charlotte E. Maxwell, sister of Anna C. Maxwell. Addition to the "Thayer" with gymnasium, reception room, and elevator. October Diet Kitchen opened with Isabel C. Marshall, grad- uate of Pratt Institute, in charge. Eleven hours' instruction in principles of cooking given each week to the two pupils on duty in Diet Kitchen. Two months' graduate course in medical and surgical duty offered. Pupils withdrawn from Children's Hospital on ac- count of proposed children's ward at Massachusetts General. 1903 Probationers admitted twice a year. Special diploma designed for McLean nurses. February First public graduation, February 16th. 1904 Three months' private duty at Corey Hill Hospital, Brookline, added to curriculum. Six months' preliminary course and $50 tuition recommended. Skeleton given to School by Mr. J. Arthur Beebe. September Eight pupils entered Simmons College Nurses' Pre- paratory Course. Small number of scholarships made available for course. Training School for Nurses 195 1905 One month district nursing offered to two pupils at a time. Classes in reading aloud for seniors. Allowance of $6 withdrawn. $50 tuition required for Simmons' Course. March School goes back to old basis of paying pupils a monthly allowance of $6. October Ether Day, October 16th, observed as public operat- ing day for Massachusetts General visiting nurses; tea served afterwards in the Dome. Advisory Committee attempt to raise an endowment of $50,000 to increase the number of nurses. $12,500 realized and Trustees set aside $10,000 from Codman Estate. 1906 Pupil nurses from small hospitals accepted for affil- iated experience in medical, surgical, and Out- Patient work. June Affiliation with Sloan Maternity Hospital ^ stopped because managers of Sloan decided to affiliate only with New York schools. Affiliation for two nurses at a time for six months' course at Boston Lying-in Hospital arranged. Course arranged for other nurses at the New York Lying-in Hospital. 1907 February Report of intensive study of the "State of the Train- ing School" by Dr. J. G. Mumford, Chairman; Mrs. Alexander Whiteside; Mrs. W. W. Vaughan; Miss Dolliver, and Dr. F. B. Harrington. May Pupils from McLean Hospital received for eight months out of three years' course started at Mc- Lean Hospital. Pupil "specials" instructed in detail of nursing private patients by Mary E. McElligot, head nurse of Ward B. Encouragement of social recreation by plays, con- certs, and readings inaugurated. 196 Massachusetts General Hospital "The Thayer" overtaxed when probationers enter. Rooms taken on McLean Street for nurses' residence. Two senior pupils on duty one month with Instructive District Nursing Association. Graduate Nurse in charge of Female Surgical Out- Patient Department. Unusual amount of sickness noted. Towers in Bulfinch Building made over and appliances for sterilizing dishes installed. 1908 Six months' course in institutional management offered for two students at a time. Dr. H. B. Howard resigns and Dr. Frederic A. Wash- burn succeeds him as superintendent of Hospital. Three assistants in Training School Office. Trustees pay pupils' tuition at Simmons College. Alice Tippet, 1889, installed as Executive Assistant to look after patients' social needs. First nurse to be placed on administration staff. Plan for McLean nurses eight months' course aban- doned. Urgent need for a new home. Helen G. Altimus, 1907, and Grace Perkins, 1907, appointed as permanent anaesthetizers for East and South Surgical Services. Miss Dolliver resigns, September 1st. Georgiana J. Sanders installed as superintendent. Trustees authorize an increase of fifty-two in num- ber of pupils, total number to be about two hun- dred, including probationers. Pupil head nurses placed in charge of open wards. 1910 Supervising graduate nurses appointed for wards in charge of pupil head nurses. March Miss Sanders resigns. Sara E. Parsons, 1893, succeeds Miss Sanders. 1909 September Training School for Nurses 197 September Simmons College Course given up and a three months' preliminary course substituted for all students. Amy P. Miller, graduate of Johns Hopkins School, Baltimore, with special course at Teachers Col- lege, New York, is first full-time nurse instructor in theory applied to nursing. Training School record system changed to card system. "Show beds" abandoned. Signing contract to stay three years stopped. Late afternoon classes for night nurses. Weekly talks on Current Events by Professor William G. Ward, expense of first course borne by Mrs. Nathaniel Thayer. Course in materia medica with Mr. Joseph Godsoe in the pharmacy. Affiliation with Wesson Maternity Hospital, Spring- field, arranged and pupils withdrawn from New York Lying-in Hospital. A graduate nurse assistant assigned to Surgical Building to instruct student nurses. Matron recommended to look after the "Thayer" and to care for sick nurses. Mrs. Nathaniel Thayer gives graduates their class pins. 1911 Ladies of the Advisory Committee raising money for a new home. Mrs. Andrew Wheelwright, formerly Sarah Cabot, gives $20,000 in memory of the committee of ladies and gentlemen who started the School. Nurses' Glee Club organized and sings at graduation. Clinics for student nurses in Children's and Ortho- pedic Wards. Course in Invalid Occupation by Susan E. Tracy. Second graduate nurse instructor added to Surgical Building staff. Students given two hours off duty daily. 198 Massachusetts General Hospital 1912 Graduates finance Current Events class and invite senior class. Work started on New Nurses' Home. One nurse withdrawn from Instructive District Nurs- ing Association for a three months' course in the Social Service Department, Massachusetts Gen- eral Hospital, which becomes a regular feature of curriculum. Case method of teaching private nursing started. Gymnasium in "The Thayer" equipped as classroom for instruction in practical nursing methods. January Annabella McCrae, 1895, installed as full-time in- structor of practical nursing procedures, January 15th. Return to non-payment system. Forty dollars re- quired as deposit for preliminary course and refunded to nurse at graduation. School pin given with diploma to students under non-payment system. Another nurse anaisthetizer added to graduate staff. Three hundred dollars in scholarships given by Mrs. Nathaniel Thayer, Mrs. Charles Mason, and the Alumnae Association. Eighteen months' course substituted for thirteen months' post-graduate course for McLean grad- uates, to include obstetrics and operating. Students raise $90 for Sick Relief Fund and piano rental. Seventy-five dollar scholarship given by Dr. Fritz B. Talbot for Elizabeth Sullivan, 1913, to visit pedi- atric centers to learn as much as possible about nursing methods in the care of children. Mrs. Nathaniel Thayer gives three school pins for prizes to senior nurses who wrote best essays. Plenty of applicants. Only those having a high school education or more accepted. Two microscopes given School by Trustees. Training School for Nurses 199 1913 1914 February May Singing of Glee Club inspires the Ladies of the Ad- visory Committee to give "The Thayer" a good piano. Harriet W. Barnes, a pupil nurse, gives $50 to the Training School Fund. Second nurse assigned to social service in Children's Out-Patient Department. New Home finished. Reception Room furnished by Mrs. Charles Mason in memory of her mother, Mrs. J. T. Andrews. Amelia Crane, a pupil nurse, gives $50 for furnish- ings in New Home. Instructive District Nursing Association gives a cer- tificate to nurses who finish a four months' course. Class in folk dancing. Massachusetts General Hospital students have a three months' course at McLean Hospital. Formal opening of New Home. Two nurses detailed to assist in research work. Twelve-hour night duty reduced to ten hours on wards C, D, and F. Surgical bedside clinics started. 1915 May August Margaret Gibson Reilly, 1916, first affiliate at Eye and Ear Infirmary since the early days of the Training School, May 1st. Pupil nurse assigned to X-ray department. Senior nurse assists Miss McCrae in teaching pro- bationers. Training School takes charge of orderlies and their instruction. Training School Endowment started by the Alumnae with gift of $200 from a graduate. Mrs. Nathaniel Thayer presides at Graduation Exer- cises. Student Government started. 200 Massachusetts General Hospital September First reunion cf graduates at the Hospital. September 13th and 14th. 1916 1917 Revert to graduate head nurses on medical wards as most satisfactory system. Charles Street Houses again in use for probationers. United States Army Base Hospital Unit organized under the Red Cross in connection with the Massachusetts General Hospital. Second assistant given to Miss McCrae. Miss Agnes West gives $100 to start a Student Loan Fund in memory of her sister, Marion Moir West, 1889. Amelia Crane, pupil nurse, adds $80 to the Marion Moir West Student Loan Fund. Plans made for another nurses' home with kitchen, dining room, and infirmary. Massage taught in Zander Room by Ruth M. Dupee and Dr. C. Hermann Buchok. United States Army Base Hospital No. 6 left New York for France, July 19th, Dr. Frederic A. Washburn, Commanding Officer, Sara E. Parsons, Chief Nurse, with twenty-six officers, sixty-five nurses, one hundred and fifty-five civilians. Helen Wood, 1909, Acting Superintendent of Nurses. Seventy-four nurses' aids trained in Hospital. Phillips House, for private patients, opens and takes seventeen pupils as assistant nurses. Boston Lying-in Hospital affiliation changed from six months to four. Old Lodge on Blossom Street fitted up for Cooking Laboratory. Course in institutional management given up because of change in administrative policy of Hospital. Lucia A. Brown, 1899, chosen Matron in charge of Charles Street houses. Training School for Nurses 201 1918 January Mrs. Alexander Whiteside, an active member of the Board since 1899, died January 11th. The Boston Metropolitan Chapter of the Red Cross gives twelve scholarships for four months' courses in public health. Three small houses fitted up on Grove Street for graduate nurses employed in Hospital. Severe epidemics of scarlet fever and influenza. Eighty-five nurses ill with influenza and one death. Nurses' Aids very helpful during epidemic. Two students allowed to finish course outside of Hos- pital. Margaret E. Harry in public health in Richmond, Virginia. Marie Kouroyen, under Greek Commission for Relief Work in Europe. About two hundred alumnae in military service. Miss McCrae loaned to Camp Devens for six weeks as instructor. Trustees set aside $600 yearly as scholarships for students of more than average ability and with limited financial resources. A vote of appreciation to the pupil and graduate nurses from the Advisory Committee for their unusual interest and helpfulness in matters per- taining to the welfare of the School. Five years' course arranged with Simmons College whereby students obtain a, B.S. degree, a diploma in nursing, and a public health certificate. Army School students come for four months' affiliated work. Three months' affiliation with McLean discontinued, due to war conditions. 1919 Fifty-two-hour week for day nurses started. Ladies' Visiting Committee gives the Hospital $5,000 as a Memorial Fund to the doctors and nurses who died in the World War during 1917 and 1918; the income to be used for the maintenance of 202 Massachusetts General Hospital April October 1920 February September 9-10 October free beds, but always preferably for needy grad- uate nurses of the Massachusetts General Hospital. Colonel Frederic A. Washburn, M.D., returned to the Hospital, April 1st. Sara E. Parsons returned to duty October 1st, after five months" leave of absence, during which time she was paid salary for two months and visited prominent nursing schools in the East and Middle West. Helen Wood, 1909, resigns to go to St. Louis as Director of the Washington University School for Nurses, February 1st. Fifty-two-hour week for night nurses started. Representatives of the School sent by Student Gov- ernment to the International Convention of Stu- dent Volunteers, which was held in Des Moines, Iowa. Ward helpers asked for, but the estimated expense of $9,000 a year prohibitive. "The Lowell" fitted up for Phillips House graduates; which relieved strain on the Nurses' Homes. Superintendent of Nurses meets Executive Commit- tee of the Hospital, for the first time, to present Training School problems. Second reunion of graduates as guests of the Trustees. Unveiling of Memorial Tablet to nurses who died in Service. Miss Parsons leaves Hospital, October 1st. Sally Johnson, 1910, elected Superintendent of School. Hospitality Committee formed with representatives from Ladies of the Advisory Committee, Student Government, and classes. Musicales given every two weeks during winter. Army School affiliation closed. Courses in medicine and pediatrics strengthened. Vacation during three years' course increased from seven to nine weeks. Training School for Nurses 203 Ladies' Committee renovate "Thayer" Library and Sitting Room. 1922 May Trustees vote to allow Miss Johnson to employ at least nine ward helpers to relieve students of cer- tain routine duties. July Julia Mason, the first student to complete the Five- Year program in nursing conducted by the School of Public Health Nursing in affiliation with the Massachusetts General Hospital Training School for Nurses. APPENDIX COPY OF AGREEMENT OF ASSOCIATION We, whose names are hereto subscribed, do, by this agreement, associate ourselves with the intention to constitute a corporation according to the provisions of the three hundred and seventy-fifth chapter of the Acts of the General Court of the Commonwealth of Massachusetts, passed in the year eighteen hundred and seventy- four, approved June twenty-seventh in said year. The name by which the Corporation shall be known is the Boston Training School for Nurses. The purpose for which the Corporation is constituted is the instruction and training of nurses for the sick. The city within which the Corporation is established or located is the City of Boston, within said Commonwealth. In witness whereof, we have hereunto set our hands, this second day of February in the year eighteen hundred and seventy-five. Cora L. Shaw Martin Brimmer Mary E. Parkman Sarah Cabot Caroline G. Curtis LeBaron Russell Louise Brooks Charles P. Putnam Henrietta Codman F. B. Sanborn Abby M. Storer O. F. Wadsworth Maria A. Revere Anne S. Robbins Mary Anne Wales COPY OF NOTICE OF THE FIRST MEETING To................ You are hereby notified, that the first meeting of the subscribers to an agreement to associate themselves with the intention to con- stitute a corporation to be known by the name of the Boston Train- ing School for Nurses, dated February 2, 1875, for the purpose of organizing said corporation by the adoption of By-Laws and elec- tion of officers and the transaction of such other business as may 204 Training School for Nurses 205 properly come before the meeting, will be held on Tuesday, the second day of March, at 11 o'clock a.m., at No. 45 McLean Street. Martin Brimmer one of the subscribers to said agreement Boston, February 19, 1875 I, Martin Brimmer, on oath, declare that I did, seven days, at least, before the second day of March, A.D., 1875, that being the day appointed for the first meeting, deposit in the post office at Boston, postpaid, notice, signed by me, and addressed to each of the subscribers to the above written agreement of association, a copy of which notice is herein before written. Martin Brimmer. Suffolk Js. March 2, 1875. Subscribed and sworn to before me I. IT. Sweetser, Justice of the Peace. FIRST MEETING OF SUBSCRIBERS Pursuant to said notice, a meeting of subscribers to the above written agreement of association of the Boston Training School for Nurses was held on the 2d day of March, 1875, at 11 o'clock a.m., at No. 45 McLean Street, Boston. Present: Mrs. Henrietta Codman, Mrs. Caroline T. Curtis, Mrs. Mary E. Parkman, Mrs. Cora L. Shaw, Miss Sarah Cabot, Miss Maria A. Revere, Miss Abby M. Storer, Miss Mary Anne Wales, Messrs. Martin Brimmer, LeBaron Russell and Charles P. Putnam. On ballot Mr. Charles G. Loring was elected clerk, and was duly sworn to the faithful discharge of his duty. Suffolk Js. March 2, 1875. Then personally appeared before me the said Charles G. Loring, and took oath that he would faithfully discharge the duties of temporary clerk of the meeting. I. H. Sweetser, Justice of the Peace. 20G Massachusetts General Hospital Mr. Brimmer was called to the chair. The By-Laws here tran- scribed were read and unanimously adopted. By-Laws of the Boston Training School for Nurses: 1. The Corporation shall consist of all persons who signed the agreement by which it was constituted, and all persons who shall be members of the Board of Directors. 2. The officers of the Corporation shall be a President, a Treasurer, a Clerk, and twenty-two Directors, who together shall constitute the Board of Directors. The officers shall be elected by ballot at the first meeting of the Corporation, and shall hold their offices until the next annual meeting or until the election of their successors, and shall thereafter be elected at the annual meeting for one year, or until their successors are chosen. The Board of Directors may fill any vacancies. The officers elected at the first or any annual meeting shall have the power of a full Board, notwithstand- ing that less than the full number of Directors may have been chosen. The first meeting of the Board of Directors shall be held immediately after the first meeting of the Corporation. 3. The Board of Directors shall have the entire control of the School, and may make any By-Laws not inconsistent with those of the Corporation. The Treasurer shall keep an account of all receipts and payments, shall present a state- ment thereof at each regular meeting of Directors and a report for the year at the annual meeting, and shall make all payments authorized by the Board of Directors or its Committees. The Clerk shall notify and keep a record of the meetings of the Corporation, and of the Directors. 4. The annual meeting shall be held on.the first Tuesday of November, at such hour and place as the Directors shall appoint. Special meetings may be called by order of the Board of Directors. 5. The By-Laws may be amended at the annual meeting, or at any special meeting called for the purpose. Training School for Nurses 207 The meeting then proceeded to the election of officers; on ballot the following names were elected: as President, Martin Brimmer Treasurer, LeBaron Russell Clerk, Miss Mary Anne Wales as Directors: Mrs. Louise Brooks, Miss Sarah Cabot, Mrs. Henrietta Codman, Mrs. Caroline T. Curtis, Mrs. Mary E. Parkman, Dr. Charles P. Putnam, Miss Maria Revere, Miss Anne S. Robbins, Mrs. Cora L. Shaw, F. B. San- born, Miss Abby M. Storer, Dr. O. F. Wadsworth all of whom subscribed the original agreement of association. The Clerk of the Corporation was then duly sworn. Suffolk Js. March 2, 1875. Then personally appeared before me the said Mary Anne Wales, and took oath that she would faithfully discharge the duties of Clerk of the Corporation. I. H. Sweetser, Justice of the Peace. A true record, attest. Charles G. Loring, Temporary Clerk. March 2, 1875. The First Annual Meeting of the Boston Training School for Nurses was held at 45 McLean Street, on Tuesday, November 2, 1875, at 11 a.m. The Annual Report of the Treasurer was read. From this it appeared that the expenses of the School from November 1, 1874, to November 1, 1875, were $10,102.14; the net expenses for this time were $5,626.58. The average net expense per month was $468.88. This last average was about $70 less for the last six months than for the first six, as more had been received from the Hospital. 208 Massachusetts General Hospital Dr. Putnam moved that a committee of three be appointed by the chair to nominate officers for the ensuing year. The motion was carried and Dr. Putnam, Miss Storer, and Dr. Wadsworth were appointed. They reported the following list: President, Mr. Martin Brimmer Treasurer, Dr. LeBaron Russell Clerk, Miss Mary Anne Wales Mrs. F. Brooks Dr. IT. P. Bowditch Miss S. Cabot Mr. James Codman Mrs. James Codman Dr. C. Ellis Miss Harriet Denny Dr. R. H. Fitz Miss Ellen Mason Mr. IT. L. Higginson Miss Maria A. Revere Mr. C. G. Loring Miss A. S. Sever Dr. Charles P. Putnam Mrs. G. H. Shaw Mr. F. Sanborn Miss A. deV. Sohier Dr. O. F. Wadsworth Miss Abby M. Storer Dr. F. Winsor Mrs. S. Parkman These officers were elected. On Dr. Russell's motion it was Voted, That the By-Laws be amended by the insertion of the words "by ballot" in the second By-Laws. Mary Anne Wales, Clerk. COURSE OF LECTURES* For the Year 1882-83 DR. FRANCIS MINOT Relation of nurse to family and physician. Care of patient. Special nursing in diseases of women. Special nursing in diseases of children. DR. JOHN COLLINS WARREN Theory of wounds, gangrene, erysipelas. Training School for Nurses 209 DR. GEORGE W. WEST Surgical dressings, plasters, poultices, bandages. Fractures and Splints. DR. JAMES C. WHITE Care of skin of new-born child. Care of skin in general. DR. ELBRIDGE G. CUTLER Topographical Anatomy. Care of the dead and autopsies. Pulse, respiration and temperature. Dropsy. DR. CHARLES B. PORTER Anaesthesia. Operations. DR. ARTHUR T. CABOT Food, doses and preparations of medicine. Chills and hemorrhage. Convulsions and collapse. Special nursing in urinary diseases. Special nursing in tracheotomy. DR. WILLIAM L. RICHARDSON Confinements. Obstetric emergencies. Care of new-born child. DR. SAMUEL L. ABBOTT Nursing in fever. Special consideration of typhoid fever and acute rheumatism. DR. EDWARD N. WHITTLER Care of diseases of thoracic organs. Care of diseases of abdominal organs. DR. JAMES J. PUTNAM Special nursing in nervous diseases. Massage. DR. OLIVER F. WADSWORTH Diseases of the eye. * First published outline of lectures. 210 Massachusetts General Hospital LIST OF LECTURERS AND SUBJECTS For the Year 1888-89 DR. FREDERICK C. SHATTUCK September 6, 13 Care of the sickroom. Ventilation, temperature, furnishing, arrangement. Use of disinfectants and deodorizers, with especial reference to the care of contagious diseases. DR. WILLIAM W. GANNETT September 20, 27 Topographical anatomy. Care of the dead. Autopsies. DR. GEORGE M. GARLAND October 4, 11 Account of the circulation, the pulse, respiration, and tem- perature. Secretions and excretions. Examination of urine. DR. GEORGE M. GARLAND October 18, 25 The physiology of digestion. The preparation and methods of serving the various foods, including the use of nutri- tive enemata. DR. FRANK B. HARRINGTON November 1, 8 The preparation of medicines; their doses and methods of administration. DR. JAMES C. WHITE November 15, 22 The anatomy and care of the skin. DR. SAMUEL L. ABBOTT November 29 General medical nursing, including the use of leeches, blisters, cuppings, enemata, and baths. DR. SAMUEL L. ABBOTT December 6 Special nursing in cases of fever. DR. MAURICE H. RICHARDSON December 13, 20, 27 The administration of anaesthetics. Care of patients before, during, and after operations, with possible emergencies (shock, hemorrhage, and collapse). DR. JOHN W. ELLIOT January 3, 10, 17 Surgical dressings. Fractures and the application of splints. Training School for Nurses 211 DR. ARTHUR T. CABOT January 24, 31, February 7 Theory of wounds, including inflammation, suppuration, ery- sipelas, septicaemia, pyaemia, and gangrene. Principles of antiseptic surgery. DR. CHARLES P. STRONG February 14, 21, 28, March 7 Special nursing in obstetric cases. DR. E. G. CUTLER March 14, April 21 Rest cure. Special nursing in convalescence. DR. CHARLES P. STRONG March 28, April 4 Special nursing in gynecological cases. DR. FREDERICK C. SHATTUCK April 11 Special nursing in diseases of children. DR. JAMES J. PUTNAM April 18, 25 Special nursing in diseases of the nervous system. Massage. DR. HERMAN F. VICKERY May 2, 9 Special nursing in diseases of the thoracic and abdominal organs. DR. MYLES STANDISH May 16 Special nursing in diseases of the eye. DR. J. ORNE GREEN May 2:! Special nursing in diseases of the ear. DR. ARTHUR T. CABOT May 30 Special nursing in cases of tracheotomy and of abdominal surgery. DR. F. WINSOR June 6 Duties and conduct of nurses in private nursing. 212 Massachusetts General Hospital LIST OF LECTURERS AND SUBJECTS For the Year 1895-96 Lectures to be given Thursdays, at 4 p.m. DR. ARTHUR K. STONE September 19, 26 The physiology of digestion. The preparation and methods of serving the various foods, including the use of nutri- tive enemata. DR. WILLIAM M. CONANT October 3, 10 Topographical anatomy. DR. FREDERICK C. COBB October 17, 24 Care of the sickroom. Ventilation, temperature, furnishing, arrangement. Use of disinfectants and deodorizers, with especial reference to the care of contagious diseases. DR. JAMES C. WHITE October 31, November 7 The anatomy and care of the skin. DR. JAMES J. MINOT November 14, 21, 27 General medical nursing, including the use of leeches, blisters, cuppings, enemata, and baths. MISS ANNIE PAYSON CALL November 23 DR. JAMES J. MINOT December 5 Special nursing in cases of fever. DR. JAMES M. JACKSON December 12, 19 The preparation of medicines; their doses and methods of administration. Poison emergencies. DR. CHARLES A. PORTER December 27 Care of the dead. Autopsies. DR. WILLIAM A. BROOKS, JR. January 2, 9 Account of the circulation, the pulse, respiration, and tem- perature. Secretions and excretions. Examination of urine. Training School for Nurses 213 DR. CHARLES L. SCUDDER January 16, 23, 30 Wounds. Methods of repair in wounds. Inflammation. Sur- gical fevers. The principles of antiseptic and aseptic sur- gery. Preparations to be made for a surgical operation in private nursing. DR. CHARLES L. SCUDDER February 6 Special nursing in cases of tracheotomy, intubation of the larynx, and abdominal surgery. DR. CHARLES W. TOWNSEND February 13, 20 Special nursing in obstetric cases. DR. HERMAN F. VICKERY February 27, March 5 Special nursing in diseases of the thoracic and abdominal organs. DR. MAURICE H. RICHARDSON March 12, 19, 26 The administration of anaesthetics. Care of patients before, during, and after operations, with possible emergencies (shock, hemorrhage, and collapse). DR. JOHN W. ELLIOT April 2, 9, 16 Surgical dressings. Fractures and the application of splints. DR. FREDERICK C. COBB April 23 Special nursing in diseases of children. DR. JAMES J. PUTNAM April 30, May 7 Special nursing in diseases of the nervous system. Massage. Chorea. Convulsions. Epilepsy. DR. HENRY C. BALDWIN May 14, 21 Special nursing in mental diseases and for the insane. DR. J. ORNE GREEN May 28 Special nursing in diseases of the ear. DR. H. C. ERNST June 4, 11 Bacteriology. DR. F. E. CHENEY June 18 Special nursing in diseases of the eye. 214 Massachusetts General Hospital CURRICULUM, 1921-22 SUMMARY SUBJECTS Lectures and Lab. Total Hours Points Instructor Classes r - 80 4 Nurse Inst. 12 112 24 1 Nurse Inst. in 15 :;o 1% Nurse Inst. 5 10 ]." y2 Nurse Inst. 8 8 y2 Soc. Serv. Worker 16 *>o 48 2 Dietitian 16 10 i Supt. of Nurses 90 90 204 Preliminary Course Anatomy and Physiology . Chemistry..... Bacteriology .... Drugs and Solutions Social Service .... Dietetics and Cookery . History of Nursing and Ethics..... Practical Nursing Demonstrations Practice in classroom Supervised practice on ward..... Total of practical nursing Junior Year (last half of first year) Materia Medica Bandaging and First Aid . Medical Nursing, 1st half . Intermediate Year Medical Nursing, 2d half . Massage...... Sanitation..... Urinalysis..... Surgical Nursing Senior Year Obstetrical Nursing Nursing and Its History, Problems and Oppor- tunities Special Lectures Oral Hygiene X-Ray, Radium Tuberculosis . Syphilis Diseases of Eye, Nose and Throat Skin Diseases Nutrition . Serum Therapy . Occupational Therapy Social Hygiene Hospital Administr Ethics .... Ear tion 20 6 24 384 3 2 Nurse Inst. 20 1 Nurse Inst. 14 % Surgeon and Nurse Inst. 32 credited Physician and below Nurse Inst. 24 8 32 3% Phys. and Nurse Inst. 4 8 12 1 Masseuse 8 8 % Phys. and Inst. 1 1 2 Phys. and Inst. 32 32 64 3y2 Surgeons and Nurse Inst. 30 15 45 21/2 Obstetricians and Nurse Inst. 30 30 2 Supt. of Nurses 30 30 2 Specialists 426 4(JH 894 39 Training School for Nurses 215 QUESTIONNAIRE RECEIVED BY THE DIRECTORS IN 1887 FROM THE DIRECTORS OF THE ILLINOIS TRAINING SCHOOL FOR NURSES 1. Have you ever met with any difficulty in retaining your pupil nurses to the end of the two years' course of study? (Answer. No.) 2. If so, what is the nature of the difficulty ? (No answer.) 3. Has it ever occurred to you that the principle is wrong which gives gratuitous education, and at the same time a moneyed compensation ? (Answer. It has occurred to us that it might be, but we do not think that it is.) 4. By placing our training schools more nearly upon the same business basis of other educational institutions, would we not attract a higher grade of women? (Answer. We are contented with the grade we get.) 5. As at present organized, there seems to us too much of the charity element in our system. The difficulty of raising money to carry on these institutions has only to be suggested in order to be appreciated. Would you be willing to cooperate with us in an effort to dispense with the moneyed compensation? (Answer. We should be obliged to say No.) 216 Massachusetts General Hospital DIRECTORS .BOSTON TRAINING SCHOOL FOR NURSES With Terms of Service Miss Louisa Bangs Mrs. Francis Brooks Miss Sarah Cabot Mr. J. M. Codman Mrs. Samuel Parkman Dr. John P. Reynolds Dr. LeBaron Russell Mary Anne Wales Martin Brimmer Ellen F. Mason Frank Sanborn Dr. F. Winsor Dr. Charles P. Putnam Dr. Calvin Ellis Mr. Charles G. Loring Mrs. G. H. Shaw Miss Anne S. Robbins Dr. Reginald H. Fitz Miss Maria Revere Dr. Oliver F. Wadsworth Mr. Henry Cabot Lodge Miss A. D. Sever Mrs. James M. Codman Mrs. Charles P. Curtis Mrs. Abby M. Storer Miss A. deV. Sohier Miss M. H. Denny Miss E. F. Ware Dr. Henry J. Bowditch Miss Sarah C. Paine Mrs. C. W. Peabody Dr. T. B. Curtis Dr. William L. Richardson June 2, 1873—August 4, 1874 June 2, 1873—April 2, 1878 June 2, 1873—March 7, 1876 June 2, 1873—November 13, 1888 June 2, 1873—April 2, 1878 1 meeting June 2, 1873—May 12, 1885 June 2, 1873—February 14, 1893 June 9, 1873—May 1, 1877 June 9, 1873—April 2, 1878 June 9, 1873—November 12, 1889 June 9, 1873—December 3, 1878 July 10, 1873—September 8, 1885 July 24, 1873, 1 meeting July 24, 1873—April 6, 1878 August 7, 1873—May 3, 1881 2 meetings November 10, 1873—January, 1879 November 10, 1873—May 8, 1883 November 10,1873—January 8, 1884 1 meeting December 2, 1873—June 6, 1876 January 24, 1874—May 11, 1886 January 24, 1874—January 14, 1896 March 3, 1874— April 9, 1889 April 6, 1875—February, 1878 July 6, 1875—January, 1896 January 4, 1876—January 12, 1886 2 meetings November 7, 1876—January, 1896 November 7, 1876—July 4, 1878 July 3, 1877—January, 1896 December, 1877—January, 1896 Training School for Nurses 217 Mrs. Eliot C. Clark Mrs. William B. Sweet Mrs. Dwight Foster Miss Eliza Goodwin Mrs. J. Elliot Cabot Dr. Fred C. Shattuck Dr. Arthur T. Cabot Miss Parkman (Mrs. W. W. Miss Mary Thomas Miss Fanny G. Bradford Miss Amelia Morrill Dr. George W. West Mr. Robert M. Cushing Mrs. E. G. Cutler Miss E. O. Guild Miss Jessie Motley Miss Annie L. Rotch Dr. Charles P. Strong Dr. G. M. Garland Mr. Henry Parkman Mrs. J. Parkinson Miss A. H. Thwing Mrs. B. R. Curtis Dr. Samuel J. Mixter Dr. Frank B. Harrington Miss E. Rodman Mr. D. L. Pickman Mr. F. H. Appleton Mrs. Nathaniel Thayer Miss H. J. Minot Mrs. James G. Mumford Miss Putnam May, 1878—November, 1878 July, 1878—November, 1881 October, 1878—June, 1887 March, 1879—January, 1896 September, 1879—May, 1882 October 7, 1879—March, 1880 April, 1881—April, 1887 Vaughan) February 14, 1882—January, 1896 February 14, 1882—April, 1893 November 14, 1882—May, 1885 December, 1882—January, 1896 February, 1883—March, 1889 March, 1885—December, 1888 November, 1885—May, 1893 December, 1886—November, 1892 April, 1887—January, 1890 February, 1888—December, 1889 July 1, 1888—October, 1889 December, 1888—January, 1896 April, 1889—January, 1896 January, 1890—January, 1896 April, 1890—January, 1896 November, 1890—January, 1893 February, 1891—November, 1893 1 meeting March, 1891—January, 1896 March, 1891—January, 1896 January, 1892—January, 1896 March, 1893—January, 1896 December, 1893—January, 1896 January, 1894—January, 1896 1 meeting 218 Massachusetts General Hospital LIST OF MEMBERS OF ADVISORY COMMITTEE 1899-1922 Mr. Edmund Dwight, Chairman. Died June 6, 1900. Mrs. G. W. Myers, Secretary. Dr. Herbert B. Howard, Resident Physician, Resigned May, 1908. Dr. William L. Richardson, Resigned January 15, 1900. Dr. Frank B. Harrington, Died June 8, 1914. Dr. James G. Mumford, Resigned 1912. Dr. James M. Jackson, Resigned 1911. Dr. Richard C. Cabot, Resigned 1911. Dr. James J. Minot. Mrs. Alexander Whiteside, Died January 12, 1918. Mrs. Nathaniel Thayer. Mrs. W. W. Vaughan. Mrs. H. L. Burrell, 1892, Resigned May, 1920. Mrs. G. H. Monks, Resigned September 24, 1910. Miss Lothrop, Resigned October, 1910. Miss Pauline L. Dolliver, Superintendent Training School. Resigned July, 1909. February, 1900 Dr. Herman F. Vickery. Resigned February, 1915. June, 1900 Dr. Henry P. Walcott. Resigned February 21, 1919. May, 1902 Miss Isabel Fabyon. Resigned March, 1908. Miss Susan D. Dalton. Resigned November, 1904. Miss Mary Sargent. Resigned February, 1906. May, 1904 Mrs. Francis L. Higginson. Resigned 1915. November, 1904 Mrs. Philip L. Saltonstall. Resigned April, 1907. November, 1905 Dr. F. A. Washburn, Superintendent Hospital. February, 1906 Miss Mary Wheelwright. Resigned November, 1908. May, 1907 Mrs. Robert H. Gardiner. Training School for Nurses 219 . May, 1908 Mrs. Susan Thayer (Mrs. H. E. Bigelow). January, 1909 Dr. Joseph B. Howland. Resigned May 1, 1919. Miss Marian Homans. Resigned January, 1914. September, 1909 Miss Georgiana Sanders, Superintendent of Nurses. Resigned March, 1910. March, 1910 Miss Sara E. Parsons, Superintendent of Nurses. Resigned October 1, 1920. November, 1910. Miss Marion H. Fenno. February, 1911. Dr. William H. Smith. Dr. Daniel F. Jones. February, 1912. Mrs. Thomas Motley. May, 1912. Mrs. Charles E. Mason. Mrs. Charles P. Curtis. Resigned January, 1914. May, 1913 Mrs. Samuel Cabot. Resigned 1915. Mrs. Hugh Cabot. Resigned 1919. Mrs. Freeman Allen November, 1915. Miss Ella Lyman (Mrs. R. I. Lee). Mrs. G. Tappan Francis. January 1, 1917. Mrs. Thomas Motley, Jr. General Francis H. Appleton. May 31, 1918. Mrs. Robert Soutter. September 6, 1918 Dr. Charles L. Scudder (Acting for Dr. Jones until May, 1919). May, 1919 Dr. Harold W. Hersey. Resigned September, 1919. June, 1919. Dr. Edward P. Richardson. Dr. Henry S. Forbes. Resigned September, 1920. Dr. Lloyd T. Brown. Miss Sylvia Warren. June, 1920. Dr. Nathaniel W. Faxon. Mrs. John F. Lawrence. Mrs. Paul Jones, 1910. 220 Massachusetts General Hospital December, 1920. Dr. Richard S. Eustis. January, 1921. Dr. James M. Means. October 1, 1920 Miss Sally Johnson, Superintendent of Nurses. COMPARATIVE STATISTICS 1911 19U 19 IS 19 Ik 1915 1916 1917 1918 1919 19S0 1921 Average Number of Graduates 31 29 29 28 29 30 30 27 33 29 31 Average Number Accepted Pupils 128 143 139 157 146 183 211 217 202 192 187 Average Number Probationers 12 15 28 24 33 27 21 25 25 25 30 Average Total* 171 187 196 209 208 240 262 269 260 246 248 Total Number Proba- tioners Admitted 90 100 97 92 90 106 88 90 85 76 99 Probationers Dropped and Resigned 53 51 30 30 24 19 15 21 21 12 15 Accepted Pupils Dropped and Re- signed 16 7 8 10 6 4 13 6 3 4 6 Total Dropped and Resigned 69 53 38 40 30 23 28 27 24 16 21 * In previous reports, " average number of pupils " included probationers as well as accepted pupils. 1/ N \ >c WY 19 P271h 1922 53930750R *1 NLN 052fl37fl7 t> is NATIONAL LIBRARY OF MEDICINE lilpi] :'f.ll NLM052837876