, AMERICAN 
SOCIAL SCIENCE ASSOCIATION. 
TRAINING SCHOOLS FOR NURSES 
IN 
AMERICA. 
Read at the Annual Meeting of the Association, 
OCT 0,#E R- 1874, 
BY 
OHAS. P. PUTNAM, M. P>. TRAINING SCHOOLS FOR NURSES. 
THE systematic education of women for nurses, has not attracted 
much attention in America until within a few years. This is 
rather surprising, in view of the fact that the Nightingale School 
for training nurses was opened fourteen years ago (June 24, i860,) 
—others perhaps earlier still—and that in every respect, so far as 
we can learn, the system has operated well in England. The 
agitation of the subject now is, perhaps, a part of the general move- 
ment for the better education of women, or, indeed, for 
the better education of all persons, which has been felt 
all over our country. If so, it belongs to a class of reforms which 
stands second to none among those arising from this movement 
—to a class which will receive a more general support than any other, 
its tendency being, not to open to women a new and contested 
field, but to advance the standing of a profession which is already, 
by general consent, almost entirely conceded to women. 
Some of the nurses who have practiced here hitherto, have had the 
advantage of having served in hospitals under the direction of 
physicians, and the opportunity of watching older nurses at their 
work; but the great majority have learned nursing as best they 
could, which in many cases means not at all. For instance, the 
list of nurses in the Boston Directory, contains 126 names, and 
many more must in fact be practicing in the city, for I find that 
the names of several well-known nurses are not included in the 
list; of these, probably not more than thirty or forty have had 
hospital experience for any great length of time. Now we have 
begun to realize what in England, France, and some parts of Ger- 
many, has long been regarded as a settled matter—that it is neces- 
sary to educate nurses, just as it is necessary to educate medical 
students or architects. In this respect, however, nursing has only 
shared a similar fate with most of the other occupations usually 
performed by women, dressmaking, cooking, etc. None of them 
until lately have been thought to require any systematic training. 
About thirty years ago there were no Normal Schools in this 
country. It was not even thought worth while to teach women to 
be teachers. A few years hence schools for nurses may be held to 
be as indispensable as Normal Schools are now. 4 
Training Schools For Nurses. 
The community has doubtless been much benefited by the 
experience which certain nurses have gathered when employed in 
the large hospitals, before going into private practice. Besides 
this unsystematized means of obtaining experience, women have 
been received, for several years past, at the New England Hos- 
pital for Women and Children, with the understanding that they 
were to serve there for a definite time, in order to become profi- 
cient in nursing; and for the past two years a regular system of 
practical and theoretical instruction has been organized, so that 
this hospital is now prepared to send out, every year, eight or 
nine women who have received one year’s training, and have 
served in all the departments of the hospital in turn. 
Everywhere the need is felt of nurses well educated in their 
profession, and nowhere has the supply of them kept up to the 
demand. In an account of the Liverpool school, written in 
1865, we read : “The fact that the Nursing Institutions now ex- 
isting are quite unable to supply applications for those willing to 
pay for the superior nursing, shows that the public are becoming 
aware of its importance. One single institution, in the space of 
six months, was compelled to refuse fifty applications. People 
willingly bring nurses from London institutions to Liverpool, and 
from Liverpool to London, at great additional expense, rather 
than, having once experienced the benefit of trained service, be 
obliged to fall back on the aid of the untaught.” This report is 
the more striking when coupled with the statement that, at the 
census of 1851, 14 years earlier, there were in England 25,466 
nurses by profession, and 2,822 midwives. In Boston, of the ten 
nurses graduated during the past two years from the New England 
Hospital, after a year of training there, almost all were engaged 
in advance, before their term of service at the hospital was ended, 
to take charge of cases in private families, and they have still 
continued to find more work than they could do, even during the 
past year, when the majority of nurses at large have been com- 
plaining, to physicians and at the intelligence offices, of lack of 
employment. 
The following letter, comparing a nurse from this hospital with 
other nurses who had been employed by the writer, shows very 
clearly some of the results of careful training : 
“ Twelve different nurses I can easily remember who were in Traming Schools For Nurses. 
5 
my family, each from four to six or eight weeks. Of all these, 
the only one I ever wanted a second time, or felt perfectly satisfied 
with, was a trained nurse from the New England Hospital, who 
had gone through the entire course of lectures and instruction, 
and nursed there for some time. She was quiet, orderly, neat, 
strictly attentive to the orders of the physician, even against the 
wishes of the patient, never suggesting an idea or opinion of her 
own,—a machine in his hands so far as treatment went, and a 
perfect one, while equally self-reliant and capable when an 
emergency made her independent action needful. Her cooking 
was exquisite, and everything was served with the tempting nicety 
so necessary to an invalid appetite. Her temper was even; no 
tales of servants down-stairs or former employers, or gossip of any 
kind, ever came into the sick-room, giving one a comfortable 
certainty that none would ever go from it. This woman being in 
no manner a superior, or intellectual, or gifted person, all these 
excellencies seemed to me to come from her training—the in- 
grafting of all she had heard, and learned and practiced at the 
hospital. Of other nurses who were excellent in some respects, 
I remember Miss M , an old favorite nurse in Boston, who 
was also, I think, a hospital nurse, but had not gone through the 
training. She was faithful and efficient as long as the sickness 
was severe, but with no tact, and unreasonable and capricious as 
soon as the patient was out of danger. Mrs. N , an excel- 
lent woman, with all the natural qualities which make a good 
nurse, lacked just the training and knowledge which would 
have given her self-reliance and promptness, and taken from her a 
superstitious fear of omens and warnings, distressing to the pa- 
tient.” 
I believe that this letter points out, none too plainly, diffi- 
culties which are well recognized by both patients and physicians. 
With hearty recognition of the cheerful devotion and untiring 
service rendered by those nurses whose long experience in the sick- 
room has taught them much that is essential to good work, let us 
remember that this experience must have been partly earned 
through many a blunder at the outset, and at the expense of many a 
helpless patient. To avoid these blunders; to give to the intelli- 
gent pupil the benefit of the well-tested experience of others, in an 6 
Training Schools For Nurses. 
intelligent and systematized way, is the object of the Nurses 
Training School, as of all other schools worthy of the name. 
The New York school has lately begun to send out to private 
families those nurses who, having been pupils for a year, still re- 
main connected with the school for another year. The Directors 
report: “We now have four (nurses) out, and could have em- 
ployed three times that number, if we could spare them, to meet 
the applications for their services. They are highly approved by 
the physicians and families so far, and we receive high wages for 
them.” Even those who have learned nursing as well as they 
could, simply serving, without receiving systematic instruction, in 
the great hospitals of the city, are sought for and recognized as 
superior nurses. Although the Training School at the Massachu- 
setts General Hospital, has only been open for a year, a great many 
applications have been made for nurses, all of which the Directors 
have, of course, been obliged to decline. Dr. Wylie of New York 
writes from England that, while he was at the Liverpool Training 
School, a surgeon came in to engage a nurse, and adds, “ He told 
me it was customary with almost all medical men of Liverpool to 
get their nurses from this school, and the trained nurses were 
looked upon as an absolute necessity.” Doubtless physicians in 
this country will soon come to the same opinion. A correspon- 
dent of the Boston Medical and Surgical Journal writes : “ If we 
desire to make a science of our art, to know if, and exactly how 
much, and after what time, and in what respect, our digitalis 
affects the pulse, and our calomel the temperature, or the daily or 
hourly variations in pulse and temperature from any cause, or if we 
wish to know the character of the excretions through the day, oi 
to test the doctrine of crisis in our practice ; or if we wish to give 
cold baths of a definite temperature in typhoid fever, or to have 
the ear syringed out, so that the fluid will go where it is wanted, 
or leeches or cups applied, or subcutaneous injections given, we 
cannot do it without the aid of skilled nurses, and we can do it 
with them, as has been abundantly demonstrated. With the sur- 
geon the case is not very different. As matters stand, he must, in 
private practice, spend much time in doing what a skilled assistant 
could do as well and often better. There is no reason why the 
long list of surgical dressings, including the application of splints, Training Schools For Nurses. 
7 
etc., should not be done by trained nurses, and the hurried surgeon 
be given the opportunity of eating his dinner in comfort and get- 
ting to the polls at election time. There is no reason why regu- 
larly educated physicians should be electricians or masseurs. The 
specialists for nervous diseases should know how electricity ought 
to be used in their department, and the surgeon in his, and the 
details could be perfectly well intrusted to skilled assistants.” 
Nursing of the poor at their homes has not as yet been under- 
taken by any American School, though, under the name of dis- 
trict nursing, it has been carried on successfully in England for 
many years, and has proved a great benefit to the poor, and a 
source of valuable experience to the nurses. Every dispensary 
physician will agree that in many of the cases to which he is called, 
a nurse’s services would be more valuable than his own, and there 
are but few dispensary physicians who have not been obliged to 
learn in their districts to make beds and cook gruel. 
As regards hospital work, the Nightingale School system has 
been directly a lopted in the American schools as far as circum- 
stances would allow, the changes which have been made, being 
more nominal than real. 
A school arranged on this system consists of a superintendent, 
of head nurses, and of pupils who serve as assistant nurses. The 
practical instruction of the pupils goes on in the hospitals, and 
consists largely of nursing performed by the pupils themselves, 
under the direction of the superintendent and head nurses. All 
the nurses and pupils live at the so called “ Home ” belonging to 
the school. The Home of the Nightingale School, at St. Thomas’ 
Hospital, in London, is in a building attached to the hospital, 
and the Home of the Liverpool School stands within the grounds 
of the Royal Infirmary. As an arrangement of this sort was im- 
practicable for the New York and Boston Schools, their Homes 
were placed in houses secured for the purpose near the hospitals— 
Lectures on subjects connected with nursing, are given by physi- 
cians, either at the homes or in the hospitals. The schools supply 
the service in the wards under their care, except that done by the 
scrubbers and ward-tenders or orderlies. The night nursing is 
done by the pupils in turn. 
The first regularly organized school was opened in New York, Training Schools Por Nurses'. 
at Bellevue Hospital, on May ist, 1873, the second in Boston, at 
the Massachusetts General Hospital, Nov. ist, 1873.1 
Bellevue Hospital in New York, is an old building, with low ceil- 
ings and dark wards. A large part of the service in the wards is 
done by ten-day prisoners, who, in many cases, have been arrested 
for drunkenness. Under the old system, all the paid nurses were 
much over-worked, and many of them are said to be of low 
character. The improvements introduced by the school are 
very striking. As one passes from a ward nursed in the old sys- 
tem into one of those under the care of the school, the visitor 
will very likely not have noticed any nurses at work in the wards 
he has just gone through ; but in the school wards they seem at 
all times busily, though quietly engaged about their patients. 
Their neat dresses and uniform caps have all the attraction 
of the uniforms of Sisters of Charity, with the advantage that 
they seem more convenient for work. It is but fair to quote a 
few words from the report of the New York school, with regard 
to the present behavior of the prisoners who work in the school 
wards. “In this connection, we would mention a result unfore- 
seen by us, which shows the moral influence of our nurses upon 
the lowest class in the hospital, namely, the helpers or prisoners 
employed to clean the wards. Formerly these women were the 
scourge of the place, and in all reports of the ‘ Local Visiting 
Committee for Bellevue Hospital,’ their presence and their foul 
language were represented as insulting to the patients. Now, in 
the wards of our school, many of these women have proved 
obedient and respectful, and some have begged to be allowed to 
remain after their time had expired, and have done so, serving 
without pay for three months, saying, ‘It was so like home.’ 
Such are the results which Christian kindness produces upon the 
most degraded natures.” 
The Massachusetts General Hospital, in Boston, has long had 
the well-deserved reputation of a model hospital. From one end 
to the other* everything appears neat and clean. Some of the 
1 A school was also opened in New Haven in connection with a State Hospital, 
at'about the same time, but the writer has not been able to learn anything with 
regard to the details of its work. In Philadelphia instruction in nursing is 
given .at .the “Woman’s Hospital,” and at the “Lying-in and Nurse Charity,” 
but they do not appear to be regularly organized schools. Training Schools For Nurses. 
9 
nurses (not connected with the school) have been in the hospital 
many years, and most of those who have not been there so long 
have caught the habit of excellence which pervades the building 
throughout. No new system of nursing could develop the con- 
trasts which are so evident at the New York Hospital. The two 
wards which were first placed under the care of the School are in 
the building which is used for some of the most severe and diffi- 
cult cases, and which, from its construction, can hardly be made 
pleasant and attractive. The new Warren Ward, however, which 
is also under the care of the School, is a large pavilion very sim- 
ply constructed, and in every respect the opposite of the Bellevue 
Hospital. It is but one story high, and its ceiling, which is close 
to the roof, is at the highest part over twenty-five feet from the 
floor. On three sides there are high and broad windows, so that 
the sun may shine into the ward at every part of the day, and 
under the eaves is another set of windows, hinged at the lower 
edges, to admit air as well as light. There are four open fire- 
places around a ventilating shaft, and even when the windows 
are not open enormous quantities of air are thrown into and drawn 
out of the ward, both day and night, by artificial means. No 
ward could be more attractive and cheerful either for patients or 
nurses. 
After breakfast the day nurses come from the Homes to the 
Hospitals, in New York at eight o’clock, in Boston at seven. 
The work of the day begins with the breakfast of the patient, and 
for the rest of the day, except while they are at the Homes for 
dinner, the nurses are pretty steadily occupied till they are re- 
lieved at evening by the night nurses. Regular arrangements are 
made for exercise and recreation. The pupils receive no wages, 
but ten dollars a month is given them for clothing and personal 
expenses. At the end of the year of pupilage they become full 
nurses, and receive a salary about equivalent to that usually re- 
ceived by hospital nurses. They remain, however, for another 
year under the direction of the School, and may be emplojed 
either in the School, taking care of the wards and teaching others, 
or in other hospitals, or nursing both in poor and in rich families. 
In the latter case, the money paid for their services belongs to 
the School, and in this way'the nurses may repay the School in 
part for what they have received in the previous year. Tiainnig Schools For Nurses. 
The Boston School has but just arrived at its second year. The 
organization of this School was begun many months before it was 
opened. In Boston a circular inviting applications was issued 
early in August, 1873. This circular was similar to that used by 
the Nightingale School, but altered in some respects. Three hun- 
dred copies were distributed, mainly to physicians in Massachu- 
setts. Up to November 1st, 1873, when the School opened, nine- 
teen candidates had applied, and from these the six pupils were 
selected who entered the School at the beginning. Up to the 
present time fifty-one applications for admission have been re- 
ceived. Of these forty-two came from different parts of Massa- 
chusetts, three from New York, two from Rhode Island, and one 
each from Illinois, Pennsylvania, Maine, and Connecticut. As 
to the previous occupations of the applicants, sixteen lived at 
home, ten were engaged in manufactures or business of some sort, 
ten were doing housework, nine were nurses or were employed in 
public institutions, and six were school teachers. At present there 
are fifteen pupils in the School, who are earnest and intelligent, 
and give good promise of becoming first-rate nurses. New appli- 
cations are constantly coming in, and whereas at first the commit- 
tee had to decline a large proportion of the applicants, as unsuit- 
able, at the present time most of those who apply are such as it 
would be desirable to admit. 
In New York seventy-three applications had been received at 
the time of the first annual report, nine months after the school 
opened, “from all parts of the Union, including Colorado terri- 
tory, Minnesota and California.” The New York School opened 
with nine pupils and two head-nurses in six wards. It now has 
charge of eight wards, and there are in all twenty-five nurses and 
pupils, but four of them having finished their year of pupilage, as 
has been mentioned, are sent out to nurse in private families. 
They are, however, still under the direction of the school, and 
subject to the following rules, which are similar to the rules used 
for the same purpose in England. 
Rules for nurses going out to private service: 
1st. That the nurses are to attend the sick, both rich and poor, 
at hospitals or private houses, as the committee or lady-superin- 
tendent may appoint. 
2d. That when sent from the Home to attend a patient, they Training Schools For Nurses. 
11 
receive their 'n.-tructions from the lady-superintendent, and do 
not leave ihe case without communicating with her; this they 
can do bv letter at any time. 
3d. That while on duty in the Home, at the hospital, or in 
private houses, the regulations of the school with regard to dress 
are to be observed by the nurse. 
4th. That a nurse is always to bring back with her a certificate 
of conduct and efficiency from the family of her patient, or from 
the medical attendant. 
It is expected that nurses will bear in mind the importance of 
the situation they have undertaken, and will evince, at all times, 
the self denial, forbearance, gentleness and good temper so essen- 
tial in their attendance on the sick, and also to their character as 
Christian nurses. They are to :ake the whole charge of the sick- 
room, doing everything that is requisite in it, when called upon 
to do so. When nursing in families where there are no servants, 
if their attention be not of necessity wholly devoted to their pa- 
tient, they are expected to make themselves generally useful. They 
are to be careful not to increase the expense of the family in any 
way. They are also most earnestly charged to hold sacred the 
knowledge which, to a certain extent, they must obtain of the 
private affairs of such households or individuals as they may 
attend. 
Communications from or on the subject of nurses may be made 
personally, or by letter, to the Lady-Superintendent, Nurse’s 
Home, 314 E. 26th street, New York. 
The important diffkulties encountered by the Training Schools 
in America, have not arisen from any serious lack of suitable 
pupils. There are women enough of education and intelligence 
who are willing to spend one year in the hospital, learning to 
nurse, and a second year in nursing under the control of the 
School, in order to become thoroughly trained. The great diffi- 
culty has been that we were obliged to begin the work in New 
York with only a trained superintendent, and without trained 
head-nurses, and in Boston with neither a trained superintendent 
nor trained head-nurses. Had these schools been established 
immediately after the War of the Rebellion, we should doubtless 
have found women of sufficient experience in nursing to be head- 
nurses, but none who were thoroughly acquainted with the system Training Schools For Nurses. 
of Training Schools. When the School opened in New York, head- 
nurses were with great difficulty found to take charge of the 
wards. At the end of six months, however, they had all left the 
School or had been discharged, and pupils of five months’ standing 
were appointed to supply their places. In Boston two head-nurses 
were engaged at the outset, one for each of the wards—and up to the 
present time, there have been in all, five head-nurses who have re- 
mained in the School for longer or shorter periods Only one of 
them, however, who had been a nurse in the hospital for more 
than ten years, is still retained. One not having had enough ex- 
perience for the place, became a pupil, and the others were dis- 
charged as being unfit for the position. 
Now that there are three wards under the care of the 
Boston School, the superintendent has, besides the general 
supervision, also the special supervision of one ward, while 
the head-nurse is over the other two. The real trouble 
arises from a want of experience in this country in the 
practical management of this (to us) new institution, and of the 
technical knowledge of the subject which it is intended to teach ; 
but this difficulty is rapidly being overcome, with as few draw- 
backs as could be expected at the beginning of so great an under- 
taking. With the excellent material which is in them we need 
have no doubt but that the American Training Schools will take 
a high place among nursing institutions all over the world. It 
has been abundantly proved that there is a demand for trained 
nurses, and women enough of the right sort are coming forward 
to be edit&ted as fast as the opportunity is given to them.