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A History of Nursing

9305

A History of Nursing

From the Earliest Times to the Present Day

with Special Reference to the Work of

the Past Thirty Years

Edited, and in Part Written, by

Lavinia L. Dock, r. n.

Secretary of the International Council of Nurses, Graduate of
Bellevue Training School, New York City

In Four Volumes
Volume IV

With 34 Illustrations

G. P. Putnam's Sons
New York and London

LAVINIA L. DOCK

The work of preparing Vols. Ill and IV has been contributed for the service of
the nursing profession, and the amount accruing from the sales is to be utilised for
the fund of the International Council of Nurses.

Sixth Impression

Made in the United States of America

CONTENTS

PAGE

CHAPTER I

THE RISE OF THE GERMAN FREE SISTERS . . I

CHAPTER II

OUTLINES OF PIONEER WORK IN SWITZERLAND,

HOLLAND, AND BELGIUM 52

CHAPTER III
MODERN NURSING IN AN ANCIENT SETTING . . 79

CHAPTER IV
NURSING IN NEW CONTINENTS . . . .122

CHAPTER V
NURSING SISTERS OF THE ORIENT . . . 229

CHAPTER VI
SOME ISLAND HOSPITALS AND NURSES . . 288

BIBLIOGRAPHY ..•••*• 323

INDEX • 331

111

ILLUSTRATIONS

PAGE

Nuns in Class .... Frontispiece

Sister Agnes Karll 8

Founder and President, German Nurses' Association.

A Business Meeting of the Officers of the

German Nurses' Association ... 32

Sister Agnes Karll to the right.

Miss J. C. van Lanschot Hubrecht . . 68

President, Dutch Nurses' Association.

Miss C. J. Tilanus 68

Late President, Dutch Nurses' Association.

Amy Turton, the Pioneer of Modern Nurs-
ing in Italy 86

Grace Baxter 100

Superintendent, Blue Cross Nurses in Naples.

Dorothy Snell 112

Superintendent of Nurses, Queen Helen's Training School
in Rome.

A Ward in the Polyclinic Hospital, Rome . 116

Sister Marie Zomak and a Group of Spanish

Probationers ...... 120

Mary Agnes Snively 134

Taken when Lady Superintendent, Toronto General
Hospital. •

vi Illustrations

PAGB

Norah Livingston . . . . , . 134

Lady Superintendent, Montreal General Hospital Train-
ing School for Nurses.

A Nurse in Labrador Sculling for Supplies 172

By courtesy of the American Journal of Nursing.

Julia Rachel Ayres 180

Late Matron of Alfred Hospital, Melbourne, Victoria.

Susan B. McGahey 180

Hon. Vice-President. International Council of Nurses
from Australia.

A Group of St. Helen's Nurses . . .208
Akenehi Hei 212

The first Maori Nurse fully trained and qualified to
register.

Nurse Akenehi Hei 212

On duty in her Tent Hospital.

Grace Neill 216

First Assistant Inspector of Hospitals and Asylums,

New Zealand.

Hester Maclean 216

Assistant Inspector of Hospitals and Asylums, New Zealand ;
Editor of Kai Tiaki.

English Hospital, Zanzibar ; Miss Breay and

Miss Brewerton in the Background . 224

Cama Hospital, Bombay . . . .242

Miss Tindall handing instruments.

Martha Phullo 244

A Brahman Nurse, Lucknow Hospital.

Illustrations vii

PAGE

A Parsee Trained Nurse .... 244

By courtesy of the Presbyterian Board of Missions.

Miss M. E. McDonnell and Nurses at Neyoor 250

The Empress Komeyo Distributing Medicines

in her Charity Hospital . . .256

Choko Suwo 276

The first Japanese Nurse to undertake District Nursing.

Take Hagiwara 276

Red Cross Superintending Sister and Hon. Vice-President,
International Council of Nurses.

Chinese Pupil Nurses ..... 280

By courtesy of the American Journal of Nursing.

Esther Shields and her First Class of

Corean Nurses 286

A Group of Cuban Nurses .... 292

M. Eugenie Hibbard 300

A leader in Cuban Nursing.

Isabel McIsaac 3°6

Formerly Superintendent of the Illinois Training School
and then Interstate Secretary ; Head, Army Nurse Corps.

French Sisters of the Leper Colony of

Manila 310

By courtesy of the American Journal of Nursing.

A HISTORY OF NURSING

CHAPTER 1

THE RISE OF THE GERMAN FREE SISTERS

ONE who found it interesting to study the calling
of the nurse, under the varied forms it took on
in its evolution from the Middle Ages to the present
day, would have been richly rewarded by a visit to
Germany at the end of the last century. There,
side by side, in full panoply, with all their character-
istic features still in the bloom of vigorous life,
could have been found nursing orders illustrating
each historic variation, each successive phase in re-
ligious and economic status, as rural, feudal Germany
changed to a modern industrial empire.

The industrial revolution, silently and irresistibly
advancing, altered nursing communities, too, as it
shook the foundations of home, turned wealth away
from the convent, built the factory town, and cast
thousands of women out into a new world to support
themselves and, often, others dependent upon them,
as they best might. The churchly orders that had
been so harmoniously adapted to the social conditions
of a different age saw their supremacy slipping away.

VOL. IV. — I I

2 A History of Nursing

Germany shows perfect examples of hardworking
and efficient Catholic nursing orders. They are
practical, and follow the lead of medical science, but
their numbers no longer sufficed to meet demands,
nor did they as yet open secular schools. Then came
the deaconess Motherhouses, but they, too, soon
found that their patriarchal basis was too limited — ■
they could not expand indefinitely. Next were the
first large secular schools for nurses upon the English
pattern, Victoria House in Berlin and the Nursing
Association of the City of Hamburg. The former
was the creation of the Empress Frederick, who was
a woman of advanced views.1 Fraulein Louise
Fuhrmann, the first superintendent of the house, in
an account of it which she wrote in 1893, 2 said that
the Empress had two purposes in view : one to prepare
nurses for the care of the sick in their own homes, so
that they might there have the same skilled care as
in hospitals, and the other to open to educated young
women an honourable and blessed vocation free from
all the restraints of ' ' confession. ' ' This meant simply
that pupils were not to be limited to one religious
faith, but should be accepted without reference to
their creed. Though it seems a matter of course

1 In 1869, the great scientist Virchow gave a lecture before an
association of women in Berlin, in which he declared that nursing
should be organised on strictly secular lines, with purely humanitar-
ian purposes, and urged the following proposals: 1. Men's wards
should be nursed by women. 2. Every large hospital should have
a training school. 3. Small localities should have training com-
mittees. 4. Nurses should unite in organisations. 5. Special
institutes should provide preparatory teaching in hygiene, dietetics,
etc. Ges. Abhandl., off. Med., vol. ii., pp. 55-56.

3 Report of the Congress of Hospitals and Dispensaries, World's
Fair, Chicago, 1893.

The German Free Sisters 3

now, it was revolutionary, or at least daring,
then.

The Empress laid her views before the Society
of Domestic Hygiene, of which she was patroness,
and the school began in a small way in 1881-82,
without definite hospital connection, but finally, in
1886, with Fraulein Fuhrmann, who had meantime
been trained at the Nightingale school at St. Thomas's,
as its head, it was attached as an independent as-
sociation to the public hospital at Friedrichshain,
where the nurses were to receive their training.
There was a board of trustees, and a very pleasant
and attractive home was built for the pupils. The
training lasted for one year, but the pupils signed a
three-year contract, and after this term were free
either to leave the association or to remain in its
service throughout their lives. If they chose the
latter, they were supported in sickness and old age,
the general plan being similar to that of the religious
orders, though the whole standard of living was more
ample and a far greater degree of personal liberty
allowed. At sixty, if in the service of the associa-
tion, the nurses received pensions. (This detail has
recently been altered. They are now insured.)
Victoria House, in its day, was considered to be ex-
tremely advanced. It has always attracted a superior
type of women and they enjoy the advantages of a
good position. Its pupils, however, are badly over-
worked in the course of their training, owing, no
doubt, to the necessity of making thrifty contracts
with the city hospitals for their services.

The Hamburg nurses, whose home is the Erica
House at the immense Eppendorf Hospital, were

4 A History of Nursing

organised on similar lines. If the nurses, at the end
of their hospital training, separated themselves from
the control of the association in the management of
which they had no share, they then ceased to have
any claim on it or any right to its benefits. The
same arrangement and the same defects continued
in the associations of the Red Cross, which, after the
war of 1870, had a period of remarkable growth, and
developed thirty or forty Motherhouses for the train-
ing of nurses. Within one generation, these houses
collected under their wings a staff of more than three
thousand Sisters, and turned the tide in the direction
of religious freedom, for the Red Cross necessarily
carried on a lively competition with the religious or-
ders for desirable probationers; religious tests were
discarded, and a free intellectual atmosphere was
encouraged by the dedication to large national
service and by the stimulus of international relation-
ships. The ideals of the Red Cross were drawn on
heroic lines: the love of country, the service of the
Fatherland, and even beyond that, of humanity, —
for no frontiers were known to the succour offered
to the wounded or calamity-stricken. But the Red
Cross Motherhouses, like the religious orders, were
hampered by the necessity of supporting a large staff
of workers and maintaining them in their old age or
invalidism. The nurses were, so to speak, the tools
of charity, receiving shelter, food, clothing, pocket
money, and provision for old age, and in return for
this, being bound to the Motherhouse for life. In
the struggle for existence the competition between
nursing associations often assumed a cut-throat
character, and many Red Cross Sisters were over-

The German Free Sisters 5

worked, undert aught, and in short, exploited. The
course of instruction given never exceeded six
months, and teaching was often entirely sacrificed
to the exigencies of getting work done. This was not
always the case; there are some excellent Red Cross
hospitals, and the service has attracted an admirable
and talented set of women.

Of progressive tendencies, also, in its recognition
of the economic situation, was the Evangelische
Diakonie Verein. This association owed its incep-
tion to Professor Zimmer, who was for some time
its director, and who recognised the necessity of
opening new fields of occupation to young women
of good education. Professor Zimmer held that
the Sisters joining the society should retain as much
individual freedom and independence as possible.
They, therefore, after passing through definite pre-
paratory stages, shared in the management of the
society's affairs, and were expected to choose their
own work, a radical departure from the custom of
the older associations. It retained, however, a
strongly religious stamp, being almost as defin-
itely confessional as the deaconess house. The
society offered three branches of work: nursing,
teaching, and household economy. These different
professions were taught in various selected institu-
tions, and paths of promotion led to the higher
posts, and to the inner circle of Verbandsschwestern to
which the Sisters might pass by election from the
outer circle of Vereinsschwestern. The Diakonie
Verein was at first very successful; it soon became
self-supporting, and attracted a superior set of
women. It now (191 1) numbers about one thousand

6 A History of Nursing

members, but seems to have attained its maximum
of growth.

There were also nurses trained by the modern
societies of St. John, usually women of good family
who would not voluntarily work for a living, and were
satisfied with a superficial training for philanthropic
work,1 and cottage nurses, trained in rural districts
or in provincial towns, who were expected to perform
the labours of five women (mother, nurse, cook,
cleaner, and housekeeper) in the homes of the poor,
and whose willing patience and industry often ex-
cited the envious admiration of philanthropists from
countries where women were not quite so strong or
so submissive.

xThe Rules of the Johanniter-Orden say: The time of training
shall be as long as the Motherhouse deems necessary for giving a
good training, but not over six months. . . .

Neither probationer nor Sister receives salary. Their service is a
voluntary labour of love for suffering humanity and to the glory of
God. After training, the Sisters of St. John were to return to their
own homes and apply their knowledge for the benefit of the poor, so
far as possible. They were to respond to calls from the head of the
order when they were needed, either for war, epidemic, or some
special emergency in the hospitals of the order. They were not to
join other associations, except such as were allied to their order.
The report for 1905 shows 1099 nursing Sisters, of whom 964 were
fit for service, and 85 were ill. For various reasons the rest were not
in line of duty. The hospital training was given in deaconess estab-
lishments or others with which the Order of St. John affiliated. 10.7
per cent, of the Johanniterinnen had devoted themselves to the
deaconess service. During the year, 1 19 Sisters had been detached
from the order, either because of chronic illness or precarious financial
situation, or because, contrary to their promise, they had taken up
private nursing for pay. In this case they had to refund the cost
of their training, while in all cases of separation their badges had
been recalled. Thirty-six had died, 296 had been devoting them-
selves to district nursing, while 255, either through illness of their
relatives or themselves, had been unable so to serve.

The German Free Sisters 7

At the beginning of the new century all the signs
indicated the coming of a change in German nursing.
The associations whose more or less rigid forms we
have outlined were wholly unable to meet the de-
mands of an adequate public hospital service, and
yet a steady exodus of nurses from their gates was
going on, and hundreds of women, driven chiefly by
the need of earning a more ample living, but partly
also by revolt against an arbitrarily narrowed exist-
ence and starved personality, were leaving the
deaconess orders, the Red Cross service, and the
nursing associations, and, lonely and isolated, atoms
tossed about in the labour market, were trying to
support themselves at private duty or in positions.
They were called the "Free" or the "Wild" Sisters.
In reality these were pioneers in the revolt against
the unpaid labour of women. They had been toiling
for a mere subsistence. So much did the Mother-
houses regard this as the order of nature, that they
could not dream of altering it, nor would they have
known how to do so. The problem facing the free
Sisters was to obtain a living wage ir competition
with Motherhouses partly supported by charity or
endowments, which had set the price for nursing
service at a minimum impossible for those who were
self-dependent workers. Behind and over the eco-
nomic situation was the power of the Church, here-
tofore the chief employer of women. A foreign
nurse, observing these things sympathetically in
1899, wrote of the free Sisters: "Their lives are
rather forlorn. The doctors and patients do not like
them as well as the deaconesses (or pretend they do
not), they are meagrely paid, and have not learned

8 A History of Nursing

to strengthen one another. One longs to help them,
but does not know how. Their help must come from
themselves and will be the result of a long, slow
process.'* She described the various forms of or-
ganisation and added: "The last stage of develop-
ment, that into self-governing associations, has not
yet come."

A leader was needed. Who was it to be? There
were women of commanding personality, great execu-
tive talent, character, and force, who we e then con-
spicuous in the German nursing world, but they
had not large vision. Their interests were provincial.
The looked-for leader, however, had even then been
storing heart and mind with evidence of the friend-
less, helpless state of nurses, and when the opportune
moment came, she was ready, a woman more forceful
and able than those already prominent, of executive
ability superior, and with a sympathy and compre-
hension that excluded none.

In 1902, a German magazine devoted to nursing
interests contained an article by Sister Agnes Karll,
giving the history f the formation of a modern,
independent union of nurses,1 in which she ^aid:

The need of an organisation for the hundreds of nurses
who had withdrawn from the existing orders has been
widely realised in the last few years. At the meeting of
the National Council of Women, it was first openly
urged by the widow of Professor Krukenberg, Bonn, and
agreed to by the two hundred and thirty representatives
of eighty thousand German women, that nursing should

1 Die Berufsorganisation der Krankenpflegerin^en Deutschlands: in
Die Krankenpfiege, vol. ii., part 5, 1902-3, p. 461.

Sister Agnes Karll
Founder and President, German Nurses' Association

The German Free Sisters 9

be looked upon as a skilled pursuit for women who
desired industrial freedom, in contradistinction to the
conservative view that it must either be monopolised
by religious or charitable bodies or be left to ignorant
persons.

Agnes Karll defended energetically the new order
of free nurses, and said:

Undeveloped and timid women will do better to re-
main in the deaconess or Red Cross orders, where they
never have to think for themselves, but it is useless to
blind one's self to the rapidly changing conditions of
to-day ; . . . numberless women who are eager to devote
themselves to some kind of service to their fellow men
find the limitations of the deaconess and Red Cross
sisterhoods too narrow. . . . Above all things we
wish in our organisation to preserve personal freedom and
self-government on a rational basis.

In this article she made clear the nurses' wish for
three years of training. When the quinquennial
meeting of the International Council of Women, to
which the British and American nurses were then
affiliated, took place in Berlin, in the summer of
1904, English, Irish, and American nurses assembled
in that city and there for the first time met Sister
Agnes Karll, who had been working out her problems
unaided. Until the winter of 1903, she had not even
known of the nursing affairs of England or America,
nor had she been aware that the German movement
was already being sympathetically watched in those
countries. To find that fellow- workers of other lands
were ready and waiting to draw her into an inter-
national circle whose members all, with interests and

io A History of Nursing

aims alike, strengthened one another by moral sup-
port, sympathy, and encouragement, was a great joy
and a most unexpected source of help to her. The
visitors, in their turn, were impressed and stirred
by the whole -heart edness with which she had dedi-
cated all her powers to the upbuilding undertaken as
her life-work. Trained in one of the best Red Cross
hospitals, with an inheritance that made leadership
natural, possessed of a far-seeing intellect and keen
judgment, and with a real passion for bringing help
to the individual, Sister Agnes lived modestly on a
small private income and devoted time, strength, and
brains freely to the service of nurses.

What she has done so far shall be told in her own
words:

The opening of the new century was a turning-point
in our profession. Numerous occurrences of a painful
nature, I regret to say, had brought it sharply home to
the general public that a complete transition from the
older charitable and religious systems of sick-nursing, to a
new and secular form, had taken place unnoticed. In
the course of this silent transition, abuses had been
permitted to develop which, if not checked, would soon
drag the noblest and most womanly of all occupations
in the mire, and yet the new form was the only one which
could possibly promise to fill the great deficit in the
numbers of nurses. Two events of the summer of 1901
had caused especial consternation. One was an actual
strike declared by nurses: — "Nursing Sisters on Strike,"
said the headlines in the papers; and these, moreover,
were not the "wild nurses" at all, but deaconesses and
Sisters of St. John. The daily papers teemed with the
news, but presently the powerful association of deacon-
ess Motherhouses found a way to stop the publicity of

The German Free Sisters n

details in which the despotism of Matrons had played an
unlovely part. The other incident was a conflict between
medical men, when, the victory being to the strong, the
Sisters, having been arrayed on the weaker side, were
driven off the field.

At the moment when the feeling aroused by these
events was running high, there appeared a pamphlet by
Sister Elizabeth Storp, called The Social Status of the
Nurse, which excited keen interest. The numerous ar-
ticles in the daily press had naturally been characterised
by complete lack of knowledge of the theme under dis-
cussion. Much had been written of the motives with
which nurses took up their work, but little of the actual
conditions of their lives, and still less of remedies for
the great hardships they endured. It was, therefore,
most timely for one of our own number to come forward
to point out the real difficulties with which nurses had
to struggle in their calling, such as extreme overwork,
insufficient pay, and an entire absence of all security
for the future when old age or ill-health should overtake
them. It was well, too, for the declaration now to be
made that these hardships could only be abated by
"state regulation of training; the general employment
of trained nurses in institutions and in the municipal
service; the creation of a free employment bureau for
them; the establishment of recreation and convalescent
homes, and above all, the elevation of the status of the
nurse and her attainment of a higher standard of living. "
Frau Marie Stritt, then president of the National Council
of Women of Germany, brought this pamphlet to the
notice of Augusta Schmidt, of the Allgemeine Deutsche
Frauen- Verein, the veteran of the Woman Movement in
Germany, when she came, in the early autumn, to the
general annual meeting of 1901, and it was then decided
that the subject of nursing and the state of the nursing
body should be taken up for consideration at the next

12 A History of Nursing

year's Council. To Frau Professor Krukenberg, as the
widow of a physician, was assigned the responsibility of
the preliminary work of inquiry into the subject, for the
dense ignorance of all those present as to the conditions
of nursing was clearly evident in the discussions.

Public attention was still further stirred toward the
end of 1 90 1 and the beginning of 1902, by the publication
of a pamphlet bringing scandalous accusations against
the Hamburg hospital, and in the resultant lawsuit un-
savoury details were aired involving the private nursing
institutions. Nurses, however, though the ones most
concerned, took the smallest share in the general dis-
cussions and showed the least interest, owing, obviously,
to the shut-in character of their lives and their incessant
strain under exhausting work. However, in 1902, they
were stimulated to protest against oppressive conditions
at the time when the act for the legal protection of the
Red Cross insignia took effect. Sorely as this act was
needed to put a stop to the growing misuse by commercial
establishments of the Red Cross symbol, it yet caused
real distress to many of the best nurses in independent
private practice, who had worn the badge in good faith
for years, believing that they were entitled to it because of
their training in Red Cross hospitals, their honourable
reasons for leaving the Motherhouse (often the necessity
of supporting relatives), and their standing contract to
serve in time of war.

A little group of nurses who had come into relation
with one another through Sister Storp's pamphlet, met
one day in Berlin to talk over all these things. There were
Sister Elizabeth Storp, Sister Helene Meyer, Sister Marie
Cauer, who had written much and admirably in profes-
sional journals on the conditions of nursing, and I. We
discussed with great earnestness the coming meeting of
the Council of Women in October, in Wiesbaden, the at-
titude they would take in nursing matters, and the de-

The German Free Sisters 13

mands they contemplated making upon the government
for nursing reforms, details in all of which we had been
asked to give our counsel. The women's suggestions for
legislation seemed to us not quite desirable, and to me,
especially, with my ten year's experience of private duty,
their ideas of state control of private nurses seemed im-
practicable. My colleagues, whose lives had been spent
in hospital work, laid the chief emphasis upon hospital
reform, and one and all planned to go to Wiesbaden to
take part in the proceedings.

I alone was not satisfied, for the prospect of future
reforms in hospitals gave no promise of help for the
hundreds of nurses who were now and had been for years
making the hard struggle for existence in the lonely
isolation of private duty. It was clear to me that they
must unite ; clear, too, that this union must be outside of
the hospitals ; yet to form independent associations was a
thing unheard of for German nurses. While I hesitated,
the correspondence over the proposed resolutions went
on, and at last Frau Krukenberg wrote : — ' ' The only prac-
tical remedy for all abuses is self-organisation." This
declaration made me also decide to go to Wiesbaden.

I had long hung all my hopes for improvement in nurs-
ing conditions on the Woman Movement. Like all nurses
in private practice, I had had little time to form new re-
lationships, but through friends I had been kept supplied
with the literature of the movement, and during my ten
years of private duty, and before that in several years of
varied experience with hospital work, I had given my
spare time to a thorough study of all that the Woman
Movement implied and included. Then a fortunate acci-
dent, or let us say a dispensation, had put me in the way
of discovering the only road then leading to a provision
for the future of our nurses: namely, the annuity and in-
validity pension arrangement of the German Anchor Life
Insurance Society. When my long overtaxed strength

14 A History of Nursing

finally failed so far as to compel me, in 1901, to give up
nursing, I had devoted myself to a careful study of the
possibilities of private and government insurance, gaining
also, in the course of this inquiry, a personal knowledge of
the nurses' homes in Berlin. Thes 3 homes, while rapidly
increasing in numbers, were fast acquiring a very unde-
sirable reputation, and it was the experiences of this
year that gave me courage and perseverance to take the
helm when the time came.

The meeting took place. It was a glorious autumn
day as we four entered Wiesbaden. How I wish that
every Sister might have been there with us for just
that one session, when, for the first time, a vast throng
of women, the representatives of 80,000 members of
the federated women's societies, took up the conditions
of the nursing profession for discussion! Hitherto the
public and the press had held it to be a desecration
to practice nursing as a means of livelihood. Here, on
the contrary, it was regarded as self-evident that this
was one of the most natural of self-supporting occupa-
tions for women, and that, without need of a religious
background, it might be built up on solid founda-
tions with thorough training and sensible conditions of
living. Augusta Schmidt was dead, but many other
veterans of the Woman's Movement greeted us with the
warmest kindliness, and I felt certain that this was the
only direction in which we might look for energetic help ;
equally certain that we must unite among ourselves at the
earliest possible moment. Fraulein von Wallmenich,
from the Red Cross hospital in Munich, was on the
programme, and, naturally, took the position — " Nursing,
uncontrolled by Motherhouses, is impossible. " Motions
were made by Frau Krukenberg and Frau Eichholz, and
were supported, but were finally withdrawn in favour of
one framed by our group, in some parts of which we had
had the collaboration of Professor Zimmer.

The German Free Sisters 15

It was as follows: — "The Council of Women shall
present a memorial to the proper officers of the govern-
ment, containing a petition covering the following points :
It should be the duty of the State : —

" (1) To define a three years' training for nurses that
shall be recognised by the state; to admit nurses having
passed through such a course to a state examination,
and to bestow upon all successful applicants a state
certificate and a legally protected badge which may be
removed by the proper authorities for sufficient cause.

"(2) Only those hospitals shall be recognised as can
show a proper care for their nurses through the limitation
of working hours to eleven daily, and through a sufficient
provision for their staff in old age and invalidity, the
state to set an example of a model nursing organisation
which shall give due balance to the administrative,
medical, and nursing spheres, and secure the moral and
material interests of the nursing staff. "

After Fraulein von Wallmenich, Sister Marie Cauer
and Professor Zimmer spoke, and the resolution was then
unanimously adopted without amendment. To-day a
small part of our demand has been realised, and we need
not despair of gaining the rest in the course of time, if we
do our duty.

Many precious relationships are woven in with those
days in Wiesbaden, and many good friends were gained
for our cause : I need only mention Frau Poensgen, Frau
Krukenberg, Frau Cauer, and Oberst Galli.

Only Berlin would do, of course, as the centre of our
new organisation, for besides being the seat of govern-
ment it was the home of by far the largest number of
nurses. Immediately upon my return I began taking
steps to carry out our plans. It seemed to me impossible
to undertake such a responsible business venture without
the advice of men, and so I tried to secure Herr Geh.
Sanitats Rath Aschenborn and Herr Oberst Galli as

16 A History of Nursing

president and treasurer. Already warmly interested
in our cause through Sister Helene Meyer, Herr Geh.
Rath Aschenborn helped me willingly to frame the by-
laws which, with a few additions, are in force to-day, but
he advised me emphatically to have no one but nurses
upon the governing board; for, he said, "The members
of a profession are the only ones who can judge correctly
in the affairs of their profession." And Oberst Galli,
on grounds of health, could offer us no fixed services, but
gave us the first hundred marks for our treasury. We
soon succeeded in finding the women needed as organising
members for the new society. Sister Clara Weidemann,
Sister Anna Wundsch, Frau Dr. Metzger, and Fraulein
Heydel promised to help me, and on January II, 1903, we
called a meeting in the Emmaus Sisters' Home to found
the German Nurses' Association. To our delight and
surprise thirty-seven Sisters, all of whom showed intense
and ready interest, answered the call. Yet doubts as to
the possibility of success were inevitable, and another
meeting was proposed. I objected — "Now or never!"
and carried the day. The by-laws were read a second
time and adopted by twenty-eight of those present.
The next day two more nurses entered, so that we had a
membership list of thirty to take to the chief of police
with our announcement.

To send the necessary notification of our organisation
to the proper department of the government was our
first public step. To-day none of our many members
dreams of the trembling fear, the anxious deliberation,
with which we few women ventured into this, to us, so
absolutely unknown a region. Limited means, no assist-
ants, no experience. The by-laws had to be sent in
duplicate with the notification. Who wrote the clearest
hand? Sister Fanny Kraft met this demand successfully.
Next came the notification to the Amtsgericht, the
local bureau. The first attempt was vain. All five

The German Free Sisters 17

members of the executive committee and officers of the
association must appear before the court at a certain
hour in the morning. After a thorough scrutiny of our
by-laws, it appeared that we could not obtain a simple
association charter, as in our contemplated office and
registry we were regarded as conducting a business. We
were advised to seek a corporation charter, and this was
even more satisfactory to us, as it gave us more important
standing. That it took longer did not matter, but it did
much matter that we should be released from the neces-
sity of having all the officers appear at a particular time
and place in the huge city, every time there was a change
of officers or an amendment to the by-laws. This detail,
hard enough for business men to meet, would have been
simply impossible for us.

Our first bow in public having been thus successfully
made, we hastened to increase our membership. The
friendly precincts of "Emmaus" still, as at first, gave us
a meeting place. The presidency was entrusted to me;
Fraulein Heydel undertook the secretaryship and vice-
presidency, for none of us had ever kept minutes, far less
conducted a meeting. Sister Clara Weidemann, Frau
Metzger, and Sister Anna Wundsch filled the rest of the
offices. No one had time to work outside of the hours
of meetings. All that I could not do myself I must find
volunteer help for. A temporary office with registry was
developed in the tiny flat where I lived with four nurses.
Sister Marie Stangen, whose health did not permit any
longer of private duty, and who kept house for us, was
always ready to help. Several Sisters offered to help
when off duty. Then there was a lively coming and
going, telephoning and general activity. Writing could
only be done after ten o'clock at night. A group of
nurses in other places had already become linked with
our little home through the years of past work. Here
was the nucleus for our employment agency. Lists of

VOL. IV. — 2

18 A History of Nursing

addresses were put up, invitations sent broadcast to
interested friends, hectographing, enveloping, addressing*
stamping was to be done by the hundred. The work was
arduous, but what delight we took in this first co-opera-
tive work for a great end !

On January 29th we held our first public meeting in
the assembly room of the Girls' High School in Burg-
grafen Street. It was most kindly placed at our disposal
by the Principal, and we only had to rent the chairs. Our
audience had been invited by cards and notices in the
daily papers. The president of a woman teachers'
association remarked after this meeting that ' ' one could
easily distinguish the Sisters from the rest of the audience
by their expressions. A veil of weariness seemed to
cloud their faces. One could see that they had no time
to adjust their minds to new ideas." I cannot describe
the embarrassment with which I began my first public
address on nursing conditions and our aspirations. Only
two doctors came — Professor Salzwedel and Dr. Jacob-
sohn. The former was instructor at Charity, where
a three months' course in nursing was conducted. At
that time, it was the only public course under govern-
mental auspices for training in nursing. It was open to
everyone, men and women alike, upon payment of a
moderate fee, and was terminated by a state examination
Dr. Jacobsohn was the editor of the Deutsche Kranken-
pflege Zeitung. In the discussion he, supported by Pro-
fessor Salzwedel, took the position that if we regarded
our calling as a profession, we should give up the title of
Sister, as to retain it was only going half-way. Though
none of us agreed with him, we were not prepared to
refute his argument, but Fraulein Hey del deftly came to
the rescue, declaring that the professional nurse was now
forming a sisterhood, and would do wisely in retaining
this name, so intimately interwoven with the life of the
people. The president then laid emphasis on the point

The German Free Sisters 19

that only through sisterly union could our aims be
reached. Thus the professional idea and that of sister-
hood were united in the outset of our career, even if
not as firmly as they must be in the future.

This meeting brought us many new members, as did
also our next on February 28th in the Victoria Ly-
ceum, when Frau Krukenberg spoke on "Professional
Organisation for Nurses." Work also increased, as
testimonials and endorsements had to be verified, and
Sister Eugenia von Raussendorfl offered her services.
Now also came the first one of the many official journeys
of the president, and the membership list grew so fast
that it was no longer possible to carry on the registry
work in our little dwelling, where nurses on private cases
for night duty often came home to sleep. So after
careful deliberation we made the plunge and rented the
first office in the garden house at Bayreuther Street,
Sister Eugenia having promised to rent two of the rooms
and to act as registrar. It was a serious question to be
responsible for the rent, the telephone, salaries, and
furnishings. Many were the knotty points to be decided.
Our by-laws with a letter were sent to all the 2400 physi-
cians in Berlin, and Sister Kathe Angermeyer and Sister
Elf ride Bettenstaedt helped with the ever greater task of
addressing and mailing. Such an extraordinary amount
of mail matter fell into the division post-office that they
looked darkly at us there, and we divided our mail be-
tween several districts.

In March, at the annual meeting a sort of court of
appeals was chosen, and two Sisters who had taken
business training were appointed as auditors. Many
other things were dealt with at that meeting. It was
moved to attempt some approach to the Red Cross
Society, and we applied to them for the use of their
emblem for our badge; then there was the eligibility
for war service to work for, especially with a view to

20 A History of Nursing

the claim for post-graduate courses in hospitals, which
we wished to press energetically, knowing well how
many gaps there were in our training; the question of
reduced railroad rates for the Sisters and the granting
of a charter had also to be considered, countless visits
made, and preparatory work done for all these various
memorials. What we would have done without our
most loyal of all friends, Herr Rittmeister Praetorius and
his wife, it is impossible to imagine. He, as member of
the Reichstag and the Prussian Diet, could always advise,
drill us unsophisticated Sisters in the forms, ceremonies,
and proper use of titles in addressing the various official
bodies, and show us how to go about managing our affairs.
But all our memorials were at first fruitless, with the
exception of the reduced railroad rates. In 1903, after a
searching and favourable scrutiny of our nurses' district
work with the poor, this, to our great satisfaction, was
granted.

The correspondence had now assumed such dimensions
that a second Sister was installed in the office in August,
1903. Shall we ever again feel such fascination and
exhilaration as in those early days? Shall we ever greet
even the greatest success, attained with difficulty, as all
must be, with such rejoicing as we felt then over the
smallest steps forward? In that little circle it was
possible to come into close contact with each; the cor-
respondence with the distant Sisters could be personally
and intimately carried on; one could share the needs and
the cares, great and small, of each one in a way that now
with the many hundreds, is impossible, greatly as one
longs to do it, for the day has only so many hours and
strength has its limitations; and that some feel grieved
when they return, remembering the old times, now to
find new faces and a great pressure of business absorbing
every one, we who went through the first days under-
stand very well. But patience! The individual will

The German Free Sisters 21

come to her own again when we have our local groups
built up in every part of Germany, each with a nurse at
its head who will be indeed a warm-hearted sister to every
member. In July, 1903, our first local affiliated group,
under the leadership of Sister Christine Esser, joined us.
It was a private institution of Frankfort. So well has it
thriven that in March, 1908, its members owned their
headquarters. Next the founder of a group in Stuttgart
desired to get into touch with us, and I made the first
visit to Frankfort and Stuttgart at the same time to get
acquainted with the nurses, among them Sister Martha
Oesterlen who, we had learned at Wiesbaden, was in
sympathy with us. . . . As it means much personal
sacrifice to develop such centres, it is not to be wondered
at that they have not multiplied more rapidly. First
the Sisters in a locality must be gathered together, then
some one who must necessarily be a nurse must be found
who will stimulate wider growth and assume the leader-
ship. Although it is essential that the governing board
of the central organisation shall be limited strictly to
nurses by the necessity of keeping the general manage-
ment in the hands of members of the profession, the local
branches may be differently managed. There, I have
been desirous of gaining the co-operation of women who
were interested in the progress of women from the broad
standpoint. In the local groups we shall welcome the
co-operation of physicians and lay women on our boards
of officers, provided always, of course, that they sympa-
thise intelligently with our ideals of professional develop-
ment. But the many ' ' bad examples ' ' both at home and
abroad must ever prevent us from falling back into that
indifference which tends to let the control of our work
drop out of our hands because it is easier not to take
responsibility.

There is no such thing as independence without re-
sponsibility. We must never forget this; and every

22 A History of Nursing

member must realise her duty of responsibility to our
own association, which we ourselves have called into
being. Only the harmonious working of all parts in
unity can ensure its fullest usefulness for the benefit of all
its members. Again, though every organisation has the
right and even the duty of refusing the membership of
the unworthy or the undesirable, yet its aim should not
be to limit itself solely to a small select circle, but to
include the greatest possible number of the average
people, giving them that support which they, even more
than others, need, not only in business and in professional
interests, but still more in human brotherhood.

In every other profession than ours a standard of
efficiency has been developed, whilst in nursing, so long
as this was monopolised by religious and charitable
bodies, the importance of professional knowledge was
often quite overlooked and religious motives and duties
were given front place, naturally resulting in collisions
with the claims of science and hygiene. As necessity,
during the last few decades, gradually imprinted upon
nursing the stamp of a self-supporting occupation for
women, it was inevitable that in the absence of an
accepted professional standard improprieties of the most
deplorable kind should occur, such as the incidents which
first called our association into being and, next, compelled
the government to take precautionary measures.

Above all must we strive for this — that with the im-
proved technical education we shall never, in time to
come, lose that which is most needful in our calling and
which can only be imperfectly defined by law, namely,
an enriched ethical ideal. This we need everywhere, but
most urgently upon the battlefield of the social misery
of our times. This gives the trumpet-call to all noble
natures, men or women, among our people, and we, who
by virtue of our calling should be first to respond, are the
most poorly armed for the fight, because, in our hospitals-

The German Free Sisters 23

we have been drilled simply in the technical side of
nursing without being given sufficient comprehension of
the claims of humanity. This is the reason why, for
such positions as that of Sister in the women's venereal
wards of a large city hospital, one seeks almost in vain
for suitably prepared women who are ready to assume the
most difficult, yet most sacred tasks of our calling. For
there it is not only a question of caring for the body, but
of finding the lost soul; there it is a question of taking
the sins of the whole world upon our shoulders; such
work calls not only for special qualities, but also special
training and preparation, as not everyone can be an
original genius and succeed in creating professional
standards.

Only the hospitals can lay the foundations for our
calling. It was therefore naturally of the greatest
importance that we should cultivate relations with them.
The increasing shortage in the numbers of nurses was
the usual starting-point of negotiations between us, which
were often broken off by mistrust of our form of organisa-
tion. The City hospital in Frankfort- a- M. took our
probationers willingly from 1904 until 1907, when it
suddenly forbade its accepted pupils to remain members
of our society. Their reasons for this step are hardly
clear, for no hospital needs to fear our self-government,
or to suspect that we shall remove probationers or Sisters
from its service, a thing we would not do even if we could.
We are at all times the best champions of the hospitals,
as their interests are identical with ours. We did oppose
the custom of binding probationers by a money deposit,
for this custom is either useless or harmful. However, in
the matter of the two- or three- years' contract, we agree
with the hospitals only if they extend their plain duty of
teaching over the entire time of the nurses' service.
This would be, moreover, the best solution of one of the
greatest difficulties, namely, the overburdening of both

24 A History of Nursing

hospital and pupil in the attempt to give the whole
training in one year's time. x

The rapid growth and pressing activities of the
young society soon brought the need of a professional
organ to the front. Sister Agnes wrote:

In the summer of 1905, we decided on the bold step
of starting our own paper in January, 1906, and as early
as October, 1905, we found it necessary to begin with a
small printed pamphlet, Mitteilungen an unsere Schwes-
tern, which may really be regarded as our beginning.
Only those who have themselves founded a paper know
what a progressive step it is for a society to have its own
organ, but they also alone can know what work, anxiety,
and responsibility it means for the editor. One thing is
certain, such a paper can only be of real use to nurses and
can only develop on true lines when controlled by mem-
bers of the profession. Now nursing in Germany is not
a good school for public work. Owing to the religious
origin of her work, a nurse still seems, and in many cases
is encouraged to be, a person apart from daily social
interests! How much there is for her to learn, if in
connection with all her other duties she decides to run a
paper! . . .

We exchange journals with all professional and women's
papers, we also send it gratis to all women's clubs at
home, to some abroad, and to all Information Bureaus, in
all sixty-one. These are only small numbers as yet, but
we are beginners and have had so short a time to develop
that we have but little to offer when we compare ourselve?
to our "Sister-press" in other countries. Still, we began
with nothing; what we have succeeded in doing has been
done with our own means and by our own strength in the

1 Unterm Lazaruskreuz, January 15, 1908, and succeeding numbers;
articles on "The History of the Association," by Sister Agnes Karll.

The German Free Sisters 25

struggle for independence and progress, and we can only
say that we are content with the results. Even now, in
our second year, we are able to print a double number
when necessary, and numberless copies find their way
from time to time to distant lands, winning for us new
friends. . . .x

The official nursing journal, of course, needed a
name, and a symbol. The name Unterm Lazarus-
kreuz was chosen, as, in 1904, after consultation with
artists and antiquarians, a badge of the extinct Order
of St. Lazarus had been adopted as the society's
emblem. Sister Agnes explained the reason for this
selection as based upon the social service of the
combatants of leprosy, and said:

Perhaps it may seem strange to many that in spite of
our calling ourselves "interconfessional" we have chosen
a cross for the badge of our journal and association. It is
an historical fact that owing to nursing being, so to say,
the offspring of the Church, the cross is her natural coat-
of-arms. Not the so-called "Red Cross" — that of the
Geneva Convention, which, out of gratitude for the initia-
tive given by Switzerland, adopted its coat-of-arms in re-
versed colours for army nursing — but a much older cross,
as displayed by the Order of St. John and the Knights of
Malta. Such an old historical cross is the one we have
chosen, a relic of the Crusades, worn by a knightly order,
now extinct, in their fearful social struggle against leprosy.
And as we also are at war with social abuse, sickness,
and sorrow, we consider we may claim the right to follow
the advice of an artist and reanimate this symbol of olden
times as the seal and badge of our earnest endeavours.

1 Reports of the Paris Conference, IQ07. Papers on "The Nursing
Press."

26 A History of Nursing

It is our earnest wish that our badge be thus worn, that
each issue of our journal shall carry into the world the
true meaning of our efforts. Our motto needs no explan-
ation. Ich dien speaks for itself, and when one thinks
of the many difficulties we have surmounted and of the
still greater number before us, the encouraging words of
our second motto, per aspera ad astra, will not be con-
sidered out of place.

Before the association had finally adopted this
badge, their use of it was contested by the Red Cross
societies upon the ground that it resembled the
Geneva Cross. It is, however, quite different.

Young as we were, it seemed to us of the most far-
reaching importance that, in January, 1905, the city of
Dusseldorf made overtures to our society to staff its new
hospital when finished. It was expected it would be
opened in October, 1906. Professor Witzel of Bonn was
chosen as Director, and my first interview with him, his
medical chief, and the city officials concerned, was held
in Dusseldorf in 1905. . . . The course of training was to
last for two years, instead of the one recognised by the
law. [The two years' course was later abandoned for
one year.] The four weeks' service required of the
Sisters who were to take posts at Dusseldorf, given at the
Friedrich Wilhelm Stift in Bonn, was a valuable service
for our members and gave gratifying evidence that it
was entirely possible for them to work in complete har-
mony with the Kaiserswerth deaconesses there. . . .
That all did not come to be realised as we had hoped in re-
gard to Dusseldorf is well known to all our Sisters. Nor
would it be easy to say where the fault lay. We are in
a transition period which is characterised by special
difficulties in all our hospitals. There is hardly any
German hospital where the conditions to-day are satis-

The German Free Sisters 27

factory or promising, and things are naturally at the
worst in the vast city hospitals, with their complex
management. As the same theme with variations is
found everywhere, it is clear that the root of the trouble
lies in the system — in the mode of organisation of hos-
pital work. To trace it to the point of clear demonstra-
tion of where the trouble lay, why general discontent
and continuous change are the rule, would be the first
step toward improvement. To us, it is of first import-
ance to know in how far the Sisters are at fault. . . .

We should not only be nurses for the sick, doing simply
what is necessary for the physical care of our patients, as,
in the mad race of work in a big hospital, with its under-
staffing, is often unavoidable, but we must be apostles of
hygiene of social progress, if we wish to fill a place in the
life of the people. We are only useful for a few years in
hospital or private duty, while we are in the prime of our
strength. And then? Then our future is in social work,
whose full possibilities are only now beginning to be
recognised. True, we have not been prepared for it . . .
we must see to it that we are prepared. r

The year 1907 brought many important events:
The corporation charter was granted; the suit
brought by the Red Cross against the organisation
to prevent its adoption of the Lazarus-Kreuz as a
badge, on the plea that it might be mistaken for
the Geneva Cross, was decided in favour of the
German Nurses' Association. Then came June 1st,
when the Imperial Registration Act for Germany,
first demanded by the nurses at the Wiesbaden

e ■ Unterm Lazaruskreuz, articles on "The History of the Associa-
tion," by Sister Agnes Karll, in January 15, 1908, and succeeding
numbers.

28 A History of Nursing

meeting of the Council of Women, in 1902, went
into effect.

In March, 1905, the Federal Council had ac-
cepted the draft of an act regulating the practice
of nursing for the German Empire. On March
23» I9°7» a conference of nursing associations with
the Minister of Education, von Studt, was called
together, and on June 1st, of the same year, the act
went into effect in Prussia. The law, as adopted,
did not fully meet the nurses* wishes, but they re-
garded it as a step in the right direction. For
one thing, the state formally recognised nursing
as a professional career, and thus a weapon was af-
forded against the worst of those abuses which had
grown up under unrestricted competition. There
would now be a line of distinction drawn between
nurses who had passed a state examination and those
who had simply been "examined by a physician."
If the public had realised what was implied in this
latter ceremony it would have been less easy for people
to be deceived as to the respective merits of nurses.
Such examinations might even be based upon a six
weeks' lecture-course given in an office, upon pay-
ment of a five-dollar fee, and certificates signed by the
physician-lecturer gave the holder the right to nurse
the sick ! No wonder that the public sometimes saw
the resorts of such persons closed by the police! The
German registration act requires one year of study
and hospital training, and though this is too short,
it will act in a salutary way upon the present six
months' courses. Examinations are held twice a
year in hospitals, and comprise oral and written
tests, with practical work under observation in the

The German Free Sisters 29

wards. The examining board is composed of three
physicians. Eleven subjects are specified for ex-
amination. The examination is not compulsory, but
calls for one year's work and study in a public
hospital or in one recognised by the state.1
Sister Agnes wrote of the passage of the act :

That will remain for all time one of the most memorable
days in German nursing, because on that day the nurses'
calling was stamped and sealed as a secular profession.
Much as there still remains to do, nevertheless this first
legislative act in protection of our work, incomplete as we
hold it to be, has erected a new foundation upon which we
may and must build to completion.2

The conference called by the Minister of Education
to discuss the scope and details of the law, and held
on March 23d, was a noteworthy occasion. All the
nursing bodies of Germany sent their representatives.
Catholic orders and deaconess Motherhouses, Red
Cross societies and the Diakonie Verein, city hos-
pitals and the German Nurses' Association, — all were
there, but out of thirty-one such delegates only six
were women. Sister Agnes said: "The conference
was a step of the greatest importance. It was char-
acteristic that, while all the other nursing associa-
tions present were represented entirely, or largely,
by men, we alone, an independent body of women,
were distinguished by having our elected president
there to act for us." [Sister Agnes herself.]

1 Abstract of paper read by Sister Charlotte von Cammerer at
the Paris Conference, 1907, on " The German State Registration
Act for Nurses."

3 Unterm Lazaruskreuz, April 1, 1908.

30 A History of Nursing

The act, it will be remembered, is not compulsory,
and the deaconess and Red Cross Motherhouses were
extremely reluctant to accept it. The Catholic nurs-
ing orders received it with the best grace, and, whether
they liked it better or not, were among the first to
agree to conform to its requirements for professional
instruction.

From now on the friendly alliance with the army
of the Woman Movement became continually a closer
one.

Sister Agnes wrote: "Our connection with the
Woman Movement has developed in a gratifying
way, and has been fruitful in its broad relationships."
That summer she spoke on organisation among nurses
at meetings of the Council of Bavarian Women, and
on proper training at the public evening meeting of
the National Council of Women in Jena. In the
autumn and winter came invitations to speak on
nursing and its problems in many parts of Germany.
Into those years of strenuous labour we will now look
for a moment through the medium of Sister Agnes's
letters :

1906.
. . . But I am not well — always ailing, and have to
be very careful ... In our office they are working like
slaves; it is too bad and I do not know how it is to end.

Sister often looks so ill, I am afraid she will break

down. . . . We now have a very nice new Sister for the
telephone and office work. . . . But we need one more
and have not the money or the right person to do it. . . .

Not long ago I went to see for the first time since

January. It is amusing to see how evident it is that we
are gaining ground. He was always nice, but this time

The German Free Sisters 31

he was as proud as a peacock, because he had always
known that we would make our way. He told me that
the German registration act was really our work, and
that we were his best hope. . . .

Life is rather hard sometimes, but nothing of all the
worry can be everlasting, and so it is not worth while
to take it too hard. I am very glad of the few drops
of old wendischem Fiirstenblut in my veins which never
let me lose my courage. . . .

My tour through west and south Germany was
dreadfully fatiguing but inspiring, and those five weeks
seem like years. Is it not nice that the Munich doctors
asked me to speak before them? And they took my
reproofs so well : I do not think doctors quite as hopeless
as I did.

Saturday I have to go to a little town one hour distant
to look after one of our Sisters, who tried to take her life,
because she feels that she will not be able to work much
longer. It is heartrending, but the doctor wrote me
some splendid letters — he feared we would expel her —
every Motherhouse would do so. . . .

A young doctor came to see me a week ago — a fine
fellow ; he is a member of our association, and I asked him
if he would take the poor girl for his little eye-clinic and
he promised at once that he would. But first she must
go for treatment — God may help us to save her. I am
so sure we will find the means to make the way easier for
all these poor overworked girls, and in time we will find
them a convalescent home. Life is a dreadful thing,
but it is fine to grapple with it and get the better of it.
I sometimes feel like little David with the giant Goliath,
but I think in this battle a warm heart is the only stone
to throw. . . .

32 A History of Nursing

I am in bed for a little rest, so I have a quiet hour after
sending some notices to the papers about our battles won.

Geh. Rath in the Department of Education told me

to send them, and I think it is a good thing to do. Some
of them always take our slips, and I hope to find a million-
aire for another legacy.

In April I have to speak at the Bavarian Women's
meeting about nursing ; in May I must go to a committee
meeting of the National Council of Women to which I
belong ; in June, Paris — so you see my life is full to the
brim. I had a good fight one evening not long ago with
all my dear enemies in the Society of Social Medicine,
Hygiene, and Medical Statistics — a discussion of Dr.
Eugen Israels' paper on our registration act. . . . The
fight will really only begin in the next few years. This
was only a little taste of it.

The comedy about our badge before the Schoffcnge-
richt is just finished.

1908.

How I would like you to see our offices now, with
ten salaried Sisters in them, and so many new inventions
and things!

My tour of lecturing was full of interest and pain. I
saw heaps of authorities, and so many nurses. I think
I never before realised as I did this time how sorely
they need us. We can do a good deal for them, but
alas! never enough. And how they die; that is sim-
ply heartrending! So many suicides! And so many
dreadfully ill, and most of them die too young! . . . L
had a strenuous time, four weeks in eleven places; — not
more than five or six hours' sleep and working hard all
the rest of the time — lectures and visits.

By 191 1 the association had federated branches

o 5

The German Free Sisters 33

in Hamburg, Bremen, Baden, Wurttemberg, Saxony,
a group centre in Riga, Russia, including German
nurses all over Russia who are members of the
German Nurses' Association, and in Frankfort.
The groups are largely self-governing, and form
nuclei for the furthering of local interests and
the study of local needs. So steadily grow the
affiliated societies that detail must not here be
attempted.

The modern era is in full swing in Germany. The
rush to great cities is steady, industrialism has
marshalled its problems, and the free Sisters are
responding to the call for the many specialised forms
of social service. District nursing, in its older form,
is still in the hands of the Church, but the newer
lines of preventive visiting nursing are being directed
by the municipalities, and nurses are being appointed
to give instructive care to the families of tuberculosis
cases, especially of those sent to the sanatoria main-
tained by the government insurance; to follow up
alcoholic cases and their families, and to watch over
the well-being of infants. By 19 10, fifteen German
cities had appointed women, many of whom are
trained nurses, as police-assistants. Their duties
call for the finest combination of womanly initiative
and professional tact and skill. In the vast need for
many such assistants is a suggestion of the new paths
opening before the modern German nurse. School
nursing, first established in Chariot tenburg, was still,
in 191 1, in its very early stage of development. In
two h gh schools for girls in Chariot tenburg, nurses
were teaching hygiene, simple nursing, and the care
of infants. Many district nurses, epecially those of

"OU IV. — 3

34 A History of Nursing

the Diakonie Verein, gave similar courses. Nurses
were giving talks and demonstrations on nursing in
the home in girls' boarding schools, to classes of
wives and mothers of well-to-do families, and to
groups of factory girls. There were a few employed
in factories and department stores to guard the health
of employ es, and a few in the employ of hotels and
ocean steamers. On the whole, Germany had not,
at the time this was written, utilised nurses in pre-
ventive work as fully as she might have done.

Among the nurses who have entered actively into
fields of social reform none has stirred up more active
controversy than Sister Henriette Arendt, who is
known as the first woman in Germany to hold the
position of Polizeiassistentin. A woman of rare sym-
pathy, fearlessness, and energy, she has been described
as one of the most striking figures of the modern wo-
man movement. For a number of years at her post in
Stuttgart, her vigorous altruism flew far beyond her
prescribed duties, and voluntarily, in her free time,
she followed trails which unearthed obscure forms of
cruelty to and mistreatment of children. The socie-
ties existing for the protection of children took offence
at her revelations, and when she made public her
proofs that there was a genuine slave trade in children
for immoral purposes which yearly swallowed up
hundreds of little girls (usually illegitimate waifs),
and that police departments and charitable societies
were alike silent in its midst, bureaucratic dignity
was outraged. She was officially ordered to cease
her extra-official work. This was impossible to a
woman of her temperament and impatience with slow,
moderate ways of dealing with wrong, and her criti-

The German Free Sisters 35

cisms provoked counter personal criticism and
recrimination. In the resulting clash of dispute,
Sister Henriette resigned in order to devote herself
wholly to the salvation of the children in whose cause
she had enlisted, and undertook to support herself
by lecturing and writing on her subject, making her-
self, meantime, responsible for several hundred
rescued children. (By 19 12, over 1200.)

A striking and picturesque accompaniment of the
new movement in nursing is the wonderful growth
of hospitals. Like magic, new hospitals of the most
remarkable beauty are springing up in or near Ger-
man cities, built like village colonies in parks and
gardens, of immense extent, able to care for thousands
of patients, of the most highly perfected details of
architectural charm and fitness, meeting scientific
demands for treatment, speaking the last word in
inventions, apparatus, and labour-saving machinery,
and, withal, showing a captivating attractiveness of
ward interiors, bringing the whole force of combined
beauty and usefulness to bear on the problem of
treatment. These new hospitals will require hun-
dreds of women, trained to the highest standards of
the nursing art, to staff them properly. Great
changes are already going on in them. An item in
one of the daily papers for 1906 said of the Charite,
which has been largely remodeled :

A number of the Kaiserswerth deaconesses were re-
called last year, and this year the rest have gone. The
Sisters from the Clementina House in Hanover were the
next to go. All the posts are now filled with Charite*
Sisters. The nursing is now unified [but with no nurs-
ing head!], and is directly under the control of the direc-

36 A History of Nursing

tors of the hospital, instead of being, as before, carried
on by nurses from different institutions, each group
being under the control of its own school.

So moves the world ; but one must offer the tribute
of a feeling of sadness to see the Kaiserswerth deacon-
esses leaving old Charite, where Mother Fliedner
brought them long ago on her wedding trip. The
hospital directors first tried an entire permanent
staff; then, with ward Sisters, opened a training
school. The educational standard complies with the
registration act, but the school is not a model. Charite
is distinct among German hospitals by its refusal to
have a woman superintendent of nursing.

The most pressing problem to be worked out in
these splendid new institutions is that of the proper
organisation of the department of nursing. At
present there is, in some quarters, chiefly among the
authorities and their subordinate officials, a distinct
unwillingness to give this department its proportion-
ate share of importance and administrative power.
Though, with the exception of Charite, the hospitals
appoint Matrons, they do not give them their right-
ful position, nor do they secure for them a training
and experience which will enable them always to
handle and develop their work as Sister Helene
Meyer has been able, at Dortmund, to do.

The most serious individual problem facing the
German nurse is, without a doubt, that of overwork.
The saying sometimes heard, whose origin no one
knows, that a nurse's working life is ten years, must
have originated in central Europe. In 1903, Alfred
von Lindheim, a member of the Austrian Parliament,
published a book called Saluti JEgrorum: Aufgabe

The German Free Sisters 37

und Bedeutung der Krankenpflege im modernen Staat.
In this he studies statistically the morbidity and
mortality of nurses, finding the death-rate among
them to be twice as high in Germany and Austria as
that among other women of corresponding ages.
Analysing his figures, he finds the highest mortality
among the Catholic Sisters of Mercy. Some of these
orders have from seventy to one hundred per cent,
of deaths from tuberculosis. Taking all the Catholic
nursing orders in the German-speaking countries
together, he finds their average death-rate from tu-
berculosis to be sixty-three per cent. As youth is
susceptible to overwork and infection, the mortality
is so much greater in proportion as the Sisters are
younger, and he states that nearly all the Catholic
Sisters included in his inquiry died before they were
fifty years of age (p. 165). He found the tables of
sickness and disability astounding. For every one
hundred Catholic Sisters the time lost through illness
in one year amounted to something over 585 days
(p. 178). He found the morbidity and mortality
among deaconesses, Red Cross, and other secular
nurses to be considerably less, yet, as many such
women leave their orders, he considered that they
were lost to statistical research and that, if they
could be found, the actual percentage might be
greater than his results. He gives four explanations
of the high morbidity and mortality figures of the
religious orders:

(1) Probationers are taken too young, and physical
examinations are not rigid enough; they are often
admitted with inherited disease or delicate physiques.
His conclusion is that, solely on physiological

38 A History of Nursing

grounds, as a hygienic rule, women should not be
admitted to hospital training before twenty-one or
twenty-two years of age at the least. Below this,
the danger to health increases in a ratio directly
proportioned to the greater youthfulness. [This is a
point that might well be noted by American law-
makers, who almost invariably dislike the age limit
set for state examination and have in many instances
reduced it by from one to three years from that orig-
inally set by nurses.] (2) Unhygienic conditions of
living. (3) Stooped or cramped attitude and un-
hygienic dress. (4) Overwork and exhaustion.
But, if German-speaking nurses, or the Sisters them-
selves, were to arrange these four points, they might
properly alter their order and place overwork at the
head of the list.

Von Lindheim's statistics have been followed by
those begun under the auspices of the German Nurses*
Association, which are the only recent ones extant.
In the imperial insurance of Germany, nurses, as a
whole, are not among those workers for whom it is
compulsory. If they were, full statistics of morbid-
ity and mortality would be kept by the state, but
they are in the voluntary classes — those who may
insure if they wish. (As a detail, most of the members
of the German Nurses' Association do enter the state
insurance.)

From the first, one of Sister Agnes's strongest
wishes was to compile a census of health conditions
among the nurses. This she finally accomplished
after strenuous exertions. From her reports, which
we cannot give in full, the following significant ex«
tracts are taken:

The German Free Sisters 39

Those who, for a decade or more, have lived the life
of the German trained nurse, and have worked with and
for nurses, need no figures to tell them how it stands with
the health of these women. The tragedies met in the
day's experience, the letters received with their heart-
rending stories, speak a language that moves and con-
vinces, but that is spoken to us alone and is not meant
for the public. In order to prove what we have often
enough declared, and to bring about, for the reforms
that we need, measures far more energetic than any we
have had hitherto, statistical evidence is essential, and
this has long been lacking.

Soon after our foundation, we began noting in the
annual reports the state of health as well as the working
efficiency of our members. It was a difficult task, as we
early encountered the obstacle common to all statistical
inquiry, namely, that many blanks remained unfilled.
This has now been rectified in great measure by our by-
law making failure to answer our questionnaires a reason
for loss of membership in the association, and by the
exercise of endless patience and manifold warnings. But
these annual reports gave only a picture of the serious
illnesses at the time being, not a general survey of the
complete status of the Sisters' health. To show the
latter in a really valuable form a longer period of time
was needed, in order that greater numbers might be at
our disposal. With the rapid growth of our membership,
this has with corresponding rapidity become possible.

In January, 1909, we began an inquiry, and by the
end of the year 2500 replies were in our hands, so that our
statistical analysis could be begun. On account of the
great mass of questionnaires to be worked over, we could
not attempt sending back those that were incompletely
filled out. For the future they shall be filled out by
every new member upon admission, and so any gaps in
answers be avoided. But will even such records give

40 A History of Nursing

the whole truth? There lies a second serious obstacle
to the statistical demonstration of this, the weightiest
problem of our professional life. The Sisters will fear
imperiling their acceptance into the association and their
appointment to positions, and try to protect themselves
by their answers. Nor can one always say with confidence
how much of inaccuracy in reply is intentional. One
must have lived with nurses for some time before realis-
ing that, while there are always those who complain
readily of every little ailment, there are far more who will
not yield even to serious illness until the last endurance of
the will has been exhausted — who never think of their
own health until it is too late, and who ignore or overlook
in themselves symptoms whose seriousness they would
instantly recognise in their patients.

There may be those who, after reading the following
statistics, may assume that only in our association are
things so bad, and who may accuse us of not caring prop-
erly for our members, in not providing work for them.
However, as our association is only eight years old, and
as its aim has been to gather together the self-dependent
women in the nursing profession, rather than to bring
new elements into it, it has been a nucleus for the union
of all those women who, entering the work of nursing
from the most different directions, have found themselves
compelled sooner or later to stand upon their own feet.
A number of the 2500 members, whose classified health
records follow, had indeed been attached to several other
institutions, as many of them had been in the profession
for some years before joining us: 1535 have belonged to
one other institution; 761 to two, and 204 to several
others before entering our organisation. To specify
more closely: 383 had been in deaconess houses, 653
under the Red Cross, 207 in the Diakonie Verein, 200 in
the Victoria House, 706 in city hospitals, 142 in the
Hamburg-Eppendorf Hospital, 748 in other institutions

The German Free Sisters 41

and associations, 122 in university hospitals, and 543
in nursing homes [for private duty]. (Many of our
members still belong to one or another of these institu-
tions, as a professional organisation is simply supple-
mentary to them all.)

The conditions of health of the 2500 Sisters, then,
with their different ages and varying length of time in
the service, may be accepted as a fairly typical picture
of the health conditions of all German nurses, here bet-
ter, there worse, according to local conditions and the
degree of care taken of them, the greater or less shortage
of Sisters, and the sufficient or insufficient numbers of the
working staffs.

When our organisation was founded it was well and
clearly known to those who had been some years at
work, that the health of German nurses was such as to
give extraordinary cause for concern. For this reason
our membership requirements have only called for " abil-
ity to work" instead of the "perfect health" that is
always rightly required of probationers. It is greatly to
be desired that, while the practice of nursing continues
to be as dangerous to health as it now is, this require-
ment for probation should be more firmly enforced and
maintained than is actually the case. Our first dealings
were with those already in the work, and even though,
since our foundation, we have directed an increasing
number of applicants to various hospitals for training,
nevertheless the responsibility of deciding the physical
fitness of candidates rests not with us, but with the
hospitals. The following report, in many places, calls
for special attention to this point. Certainly the results
it shows in this connection are astonishing.

Of the 2500 Sisters, 2423 state that at the time of
their entrance into the nursing profession they were
in the enjoyment of health and working energy to
the full; 32 did not answer; 20 described their con-

42 A History of Nursing

dition as "pretty good"; 4 had pulmonary weakness,
12 had weak hearts, 3 were neurotic, 6 had various
serious ailments. Thus, among 2500 Sisters there
were only 20 whose health was not quite perfect,
and only 25 who were positively unhealthy, when
they took up the calling. These, then, should have
been withheld from entering it. It is possible that
among the 32 who gave no answer some may have
feared injuring their prospects by answering this ques-
tion, and their number would increase the figures given.
But it is by no means in accordance with facts that,
among 2500 nurses, only 45 should have been unable to
claim perfect health upon their entrance to nursing.
The number of women of extremely defective health who,
in spite of medical examination, are admitted to the
profession is very much greater than this. Between the
time of entrance into hospital and that of joining a
professional association this number diminishes, so that
the census of our members would give too favourable a
picture of conditions, if the original conditions were not
also considered in forming judgment. A considerable
number of the least strong and well would naturally be
dropped out during probation, but far too many would be
retained because of the hospital's need of numbers, and
would be taken along from year to year until they were
entirely worn out. We had supposed heretofore that the
share of this element, which had been unpromising from
the outset, had been a larger one in weighting our burden.
The figures that follow thus take on an added significance.
Hereditary tendency to disease is another point of
much gravity. We inquired only as to tuberculosis
and nervous disorders: 254 admitted the former,
and 76 the latter, in their family history. However,
among these only 46 cases of tuberculosis and 8 of ner-
vous trouble have developed. 859 of our Sisters had had
another occupation previous to nursing. To specify

The German Free Sisters 43

more closely, 62 had been married, while 627 had worked
at one, and 116 at two other occupations. As, however,
none of their other pursuits could be regarded as inimical
to health, it seems unnecessary to consider them in
further detail. The clearest light upon conditions of
health is given by the table of the age of entrance into
nursing. The admission of eighteen-year-old girls is
not unusual, even though twenty is supposed to be the
usual age. In our inquiry we found 3 who were ad-
mitted at 15 years; 13 at 16; 49 at 17; 563 between 18
and 20; and 940 between 21 and 25 years.

The age of 25 has been pronounced the most desirable
by various authorities. In foreign countries, where good
conditions are found, 22 and 23 are usual for admission.
Therefore, when 1568 of 2500 Sisters began nursing
before the 25th year, what follows need not surprise us.
The query as to working efficiency is, to our regret, left
unanswered by 125 Sisters. Of the remaining 2375,
1944, or 77.8 per cent., state that their working efficiency
is unimpaired; 290, or 11.6 per cent., that it is impaired.
Unfit to work are 141, or 5.6 per cent.; of these, 47 are
absolutely unable to work, and in the case of 25 of them
this will be a permanent condition; 94 are unable to
work at times, and 3 have died since the questions were
answered. Our table, x showing the age and the number

1 How long
nursing

No. of
Sisters

Working

efficiency

unimpaired

Impaired

Fully

incapable

of work

Can work
at times

1-5 yrs.

875

798

6-10

743

608

n-15

462

347

16-20

191

124

21-25

26-30

31-35

36-40

41-45

(125 made no answer to this question.)

44 A History of Nursing

of years at work, with the present degree of working
efficiency, sets forth the condition of things most clearly.

From the statistical tables, which space does not
permit giving in full, we find that overstrain has a
bad pre-eminence — 1050 nurses answered the ques-
tion as to the exact time of its appearance. Among
them, 277 were overstrained after one year; 180, after
two years; 163, after three; 106, after four; 88, after
five; 64, after six; 29, after seven; 30, after eight; 18,
after nine; and 31, after ten. Then followed tables
showing the relation of age to impaired efficiency,
and the proportion of those fully unable to work,
and those able to work at times.

So by the end of ten years' nursing 986 Sisters out of
1050 were overstrained, and upon reaching the age of
thirty years 739 out of 1050 were overstrained. Rarely
was the first overstrain repaired. Only too often did it
constitute the starting-point of manifold ailments which
were frequently scarcely noticed until they suddenly
declared themselves in their full, perhaps fatal, might.
Or, again, the constant effort to pull one's self together
under chronic breakdowns means chains of painful
suffering usually borne heroically in silence — for who
wants a nurse who is not so strong that she may be
leaned on wholly without thought? And yet nurses
must not only support themselves, but even assist in, or
assume outright, the support of relatives. The whole
gamut of women's heroism is sounded in this, the noblest
and most inspiring, but — in Germany — most cruel
calling.

The Sisters describe their present state of health as:
good, 1891; satisfactory, 161; poor, 149; variable, 20;
not satisfactory, 43; bad, 16.

Others describe themselves as follows:

The German Free Sisters 45

Worked-out and fatigued, 42; overstrained, 14; need
vacation, 16; nervous, 28; ill, 27. From 93 no answer
has come to this question.

That the Sisters do not estimate their health quite
according to their working efficiency is evident from the
fact that 1944 reported themselves fully equal to the
performance of work, while only 1891 called their health
good.

We attached special importance to the statement as to
physical condition during the first year of work. This
was unanswered by 141, or 6 per cent.; of the others,
1544, or 61.6 per cent., answered that they retained full
working efficiency during the first year; 504, or 20 per
cent, were temporarily overstrained; and 311, or 12.4
per cent., had illnesses. We inquired into attacks of
illness with the following result: 959, or 38.4 per cent.,
had always been well; 741, or 29.6 per cent., had been
ill once; 800, or 32 per cent., had been ill frequently.

After reading the foregoing one cannot be surprised
that 280 of the Sisters admit having been refused by the
private life-insurance companies. This number would
be even greater, were it not that many have not applied,
because of straitened circumstances or the high premi-
ums required in late entrance. The number of accidents
is surprisingly small and it is probable that only the
serious ones were reported. It is also evident to those
having intimate knowledge that mild forms of many
other troubles have not been mentioned — as, for instance,
slight cardiac neuroses, for otherwise our figure "80" for
cardiac defects would not be nearly right. Cardiac
disturbance is the rule among the elder Sisters.

While 161 8 have not exceeded the tenth year of nursing
service, there are 755 who have worked longer than that,
some even up to the thirty-fifth year, and two have nursed
for forty, though one of these two is now wholly incap-
able of work. The other still claims working efficiency,

46 A History of Nursing

though no one else would agree with her. We were
especially struck by the prevalent optimism, as we col-
lected the reports of the physical condition of those who
had entered hospitals before eighteen. Only ten of the
sixty-five admitted unsatisfactory health. The others
designated their health as "good, " although we happened
to know personally in the case of seven that they had
serious troubles which threatened them menacingly. . . .

The very saddest chapter of our theme is our death-
roll. ... In all, thirty-five of our members have died,
ten between the ages of twenty and thirty, after from
one to five years of service ; nine between thirty and forty,
after from six to ten years; and eleven between forty
and fifty, after from eleven to fifteen years of nursing.
Among the causes of death were nine suicides. . . .

Of the mournfully high total of suicides it must be
especially emphasised, that in no single instance did any
love affair or recklessness enter as a complication, and in
only one instance were there any domestic troubles other
than illness. In some cases the cause was unmistakably
acute insanity; in others, physical wreckage of one or
another form, sometimes traceable to heredity, some-
times to physical exhaustion or illness. That we should
continually find cases of alcoholism and morphinism
among Sisters is not surprising. Those who, exhausted,
must still keep on working, grasp at every straw of
support, and pain, sleeplessness, or mental depression
accounts often enough for the first step toward
habit.

In regard to the considerable list of tuberculosis cases,
it must be plainly stated that, taking into consideration
the fact that nurses are so frequently undernourished
and overworked, there is by no means enough care given
to seeing that nurses placed in tuberculosis wards are
not predisposed to this infection. An insufficient number
of nurses is usually the cause of this criminal neglect.

The German Free Sisters 47

How many of our 160 tuberculous Sisters must yet
expiate it with their lives?

Remembering that an old medical chief in a Mother-
house who, for thirty years, had held a leading position
once declared that fully one-third of the Sisters had car-
diac disorders as the result of over-exertion, but that
he was helpless to prevent :t under the circumstances,
we need not wonder at our six cases of heart disease.

Our association originally expected to reach not so
much the younger generation as those of longer activity, to
whom such an association would mean much as a support
in the struggle for existence. But, although individual
instances of prolonged nursing service occur, the number
of those who remain long in the profession is so dispro-
portionately low that the average working period for the
2500 Sisters is only eight years and six-tenths!

In our few years of existence we have gathered small
sums for assistance in sickness and convalescence, but
we need hundreds of thousands, yes, millions, in order to
relieve adequately the distress hidden behind these
figures. May the Sisters learn from what we have here
set down; may the eyes of the public, the directors, the
physicians be opened, that all of us together may help to
make things right, but, above all, for the future, to

PREVENT.1

Besides the burden of invalidism, German nurses
are exposed to the menace of poverty, more, perhaps,
than any other class of workers in the empire, because,
so far, they have been left out of the elaborate social
legislation which Germany has enacted to protect her
people from want. This neglect is readily explained
by the swiftness of the change in the nurse's position
from a supported member of the Motherhouse family

5 Unterm Lazaruskreuz, May 15, 1910, gives the full report.

48 A History of Nursing

to a solitary worker. Its sharp lines and contrast
to the state care expended for other workers, though
keenly realised by nursing leaders, were only recently
brought home squarely to the public by a very im-
portant contribution to social literature, a book1
setting forth the whole present relation of German
laws of all kinds — laws of contract, of hours of work,
of insurance, of misdemeanours, etc. — to the nurse
as a citizen, woman, and worker, and showing that
she is now tied in a sort of legislative patchwork not
framed with reference to her, and in which she has
been caught, as it were, unintentionally.

The story of this book's writing is especially in-
teresting. Fraulein Reichel, while taking the course
in a Handels-Hochschule, was required to prepare a
thesis on "The Legal Status of the Nurse." She
knew nothing whatever about it, but began visiting
hospitals and nursing institutions to inform herself.
However, she found an immediate obstacle in the
Schweigepflicht rigidly imposed upon nurses in in-
stitutions, never to speak of any of the details of their
work or training. This reticence, indeed, was so
thoroughly impressed upon them that many suffered
actual legal injustice on points as to which no law
would compel them to silence. As the "free nurses"
also were generally quite in the dark as to their legal
status, Fraulein Reichel entered a training school as
probationer, and worked through several institu-
tions until she had acquainted herself with every de-
tail of the information she was seeking. As she did
not feel nursing to be her career, she did not finally

1 Der Dienstvertrag der Krankenpflegerinnen, by Charlotte Reichel,
Jena, 19 10.

The German Free Sisters 49

enter the profession, but wrote her thesis in a style
which makes it most valuable to nurses. "Except
in the penal code," she says, "nurses have been for-
gotten by the lawmakers." And Sister Agnes asks:
"How many of us knew, before this, that we too, as
well as the midwives, stand, as a famous midwife
has said, with regard to certain penalties, 'with one
foot in the grave, and the other in prison'? "

The absence of systematic provision for chronic
invalidism is clearly shown. Fraulein Reichel found
the general belief, that nurses belonging to Mother-
houses were cared for under all circumstances, to be
erroneous. At a notable meeting of women in Berlin,
in February, 191 1, she spoke on the findings of her
investigations, emphasising the nurses' unprotected
condition, the urgent need of a minimum standard
of payment, and the extreme overwork — a fourteen-,
fifteen-, even seventeen-hour day being frequent.
Sister Agnes Karll followed with her story of the
revelations of ill-health among nurses. She urged
raising the age of admission to twenty-one, a more
thorough physical examination, good and nutritious
food in institutions, sufficient time for rest, a well-
regulated night duty, and timely oversight of nurses
to avert their physical and mental ills. She also
pointed out an unanswerable proof of overwork in
the excessive number of patients given to one nurse
in hospital duty, usually from ten to twenty, * — rarely
as low as five. Besides breaking down the nurse,
such numbers make the best care of patients impos-
sible. The audience of women listened in deepest

1 In the best London hospitals the average is one nurse to two or
three patients.
VOL. iv. — 4

50 A History of Nursing

sympathy. In the discussion, Fraulein Luders
spoke of nurses as "the pioneers of professional
women workers," and as thus having special claim
to aid and encouragement in their reforms. The
meeting closed by passing a resolution offered by
Fraulein Lischnewska, calling upon the state and
federal governments to legislate for the protection
of nurses according to modern ideas, and upon city
governments to examine and so regulate the work of
nurses in institutions as to secure their efficiency,
their good health being a part of public hygiene.
As a basis for such regulation, the resolution asked
for an official investigation into the conditions of
nursing. !

This public meeting made some impression in high
places, for, soon afterward, there appeared incident-
ally in a ministerial paper an order from the Regier-
ungsprasident of Potsdam, von der Schulenburg, to
the effect that in all hospitals belonging to his dis-
trict, the work of female nurses shall be regulated so as
not to exceed ten or ten and a half hours daily. This
shows that the criticisms reached a mark. However,
the comment added to this order, namely, "that the
complaints of overwork uttered by nurses probably
originate with those who are either physically unfit
for their work, or who lack the spirit of renunciation,"
shows how little accurate knowledge exists as to the
real state of affairs.

Sister Agnes believes that the next ten years will
see the real development of German nursing. Offi-
cial figures show a great increase in numbers. In
1895 the Imperial Register set the number of female

1 Unterm Lazaruskreuz, March 1, iqii.

The German Free Sisters 51

nurses at 43,946; in 1907, at 74,986. As the growth
of religious orders is not rapid, this signifies an active
trend toward secular professional nursing. The
total probably includes the attendants in asylums,
indicating a high proportion of ill-educated and
poorly-trained women. About twenty-six thousand
in this total were Catholic Sisters; about twelve
thousand were deaconesses; the Red Cross counted
between three and four thousand; the German
Nurses' Association three thousand, with numbers
rising yearly.

The National Council of Women of Germany, in
191 1, numbered two hundred thousand, and they
have set the nursing question on their calendar to
receive unremitting attention and interest until the
strengthening and upbuilding of the associations so
sorely needed by the army of professional nurses
shall have been completed, and the politico-economic
emancipation, which they so urgently need and to-
ward which they are bravely pressing, shall have
been attained. In 1912 the International Council
of Nurses' meeting in Cologne gave to view in high
relief the strong womanhood, earnestness, and noble
aims of the German Sisters, and here Herr Regierungs
u. Medizinalrath Dr. H. Hecker, of Strassburg, read
a paper on Overstrain among Nurses so weighty in
its conclusions that its influence must prove epoch-
making for reforms.

BOSTON UNIVERSITY

SCHOOL OF NURSING
LIBRARY

^ yt

CHAPTER II

OUTLINES OF PIONEER WORK IN SWITZERLAND, HOL*
LAND, AND BELGIUM

Switzerland. — The first training school on the con-
tinent founded on "free" principles was that of La
Source in 1859 at Lausanne, Switzerland. It was
the creation of Mme. de Gasparin — who bequeathed
a large sum for its maintenance — and he: husband,
and by its charter was named "The Normal Evangel-
ical School for Free Nurses." Though it was not
strictly secular, springing, as it did, fr m deeply de-
vout motives, it was intended to offer serious-minded
women an alternative to the religious orders, with
which the ardent protestantism of Mme. de Gasparin
was not in sympathy. Its founders refused to exact
celibacy from the candidates, to impose a religious
dress, or to use the title "Sister," while they em-
phasised their advanced economic views by making
the nurses individually free as soon as they had
taken their course, and by insisting on the honourable
quality of work done for wages, and on the nurse's
right to enjoy her whole earnings and direct her
own career. This unusually free and bold attitude
made this school to the continent of Europe what
Mrs. Fry's was to England,1 but it long remained

1 History of Nursing, Vol. II., p. 73.

Switzerland 53

even more elementary on the professional side, as
for a number of years it had no hospital training,
but taught its pupils in out-patient work and in
private duty. In 1891, under the direction of a
physician, Dr. M. Krafft, some hospital service began
to develop in a small way, and will doubtless grow.
Good theoretical instruction is given, but "training"
as understood in professional schools does not exi t,
nor are the pupils well prepared for executive posts.

La Source may justly pride itself on the number of
women of exceptional distinction of character and
ability who have come to it, and they, in turn, cherish
closely the high ethical ideal upon which the school
was founded, and believe in its free constitution. Its
pupils are carefully chosen, about two-thirds being
well educated, whereas in some Swiss training schools
uneducated women seem to be preferred. A visitor,
meeting the pupils in training at La Source in 19 10,
was impressed with the admirable personalities and
superior types of the women she saw there. If
the school is meant to live up to the traditions of
its origin it will develop on the lines of the Bordeaux
nursing movement; amplify the Matron's position,
give up undergraduate private duty, and grade the
practical work.

There is a training school in Berne, under the Red
Cross, founded in 1899, and one in Zurich, managed
by the Society of Swiss Women, founded in 1901,
the former giving two years' and the latter three
years' training. These institutions have formed an
association of nurses, but it is wholly under medical
control, and organisation in Switzerland may be said
to be in a state of rigid formalism, the nurses not yet

54 A History of Nursing

showing initiative or leadership among themselves.
There are also deaconess Motherhouses, whose
members are found in many hospitals, hardworking
as always, and doing beautiful work, finished, con-
scientious, and thorough.

There is another secular training school attached
to an institute of many interesting characteristics,
namely, that of a Catholic order of nuns at Ingen-
bohl. This order is young, founded about sixty years
ago, and is presided over at Ingenbohl by a Mother
Superior of a splendid type, cordial and frank, in-
tensely alive and keen. Both teaching and nursing
are well established, the latter in a good hospital of
eighty beds, and the teaching Sisters all take the
nurses' course so that they may continue to hold
the theoretical work in their hands. The nursing
methods are modern and excellent, and the secular
pupils are not overworked. Both nuns and nurses
carry on their studies and prayers as much as possible
in the beautiful garden of the institute. The Ingen-
bohl nuns first opened, in Switzerland, the question
of state registration, as many of their Sisters worked
in Germany and felt the influence of the German act.
They are cordial and responsive to the international
idea, and may be rightly regarded as a centre of
ardent and zealous progressiveness in nursing
education.

Switzerland has many fine hospitals, well managed,
and, in the main, well nursed, though it is obvious
that, in some of them, overwork is the rule for the
nursing staff.

The example and influence of the German Nurses'
Association seem likely to guide or colour, uncon-

Holland 55

sciously, the future of at least the German-speaking
Swiss nurses, while on their French and Italian
borders, too, the tide is rising which will some day-
reach them, within the high walls of the mountains
of their country, and bring them into closer relations
with the world outside. Perhaps already, in their
deaconess orders, they have felt the influence of that
country which gave pastor Fliedner his first glimpse
of women working as in the primitive church, tc
which we next turn.

Holland. — About fifty years ago [wrote one of the
honoured pioneers of the elder and more conservative
i?roup of educated nurses of Holland, Mej. C. A. La
Sastide Baarslag], sick nursing in Holland was chiefly the
task of religious corporations, especially of Roman Catho-
lic orders. The Brothers of St. Johannes de Deo have
for more than four centuries devoted themselves to the
care of their suffering fellow-members, and a great num-
ber of nursing sisterhoods are also of very ancient date.
Not until the year 1830, did there arise in Protestant
hearts the ardent desire to bring aid and comfort to their
sick fellow-men, and the Protestant deaconesses took up
this work of charity. In 1843, the first house of deacon-
esses in Holland, that at Utrecht, was opened, being in
the course of time followed by many other institutions of
that kind throughout our whole country. Some of these
deaconess houses are affiliated with the Kaiserswerth
Association, such as the Arnhem Home, founded in 1884,
and at present supervised by our well-known Mother Van
Ness. In all these institutions patients are nursed, pay-
ing different fees according to their financial condition.
Besides the care of such patients, the Sisters devote them-
selves to district nursing.

In recent years we have also developed several private

56 A History of Nursing

societies for district nursing, free from any religious bias,
but founded on the broad principle of human solidarity.
Of these I will mention two, especially : that at Rotterdam
originally established by the Dutch Protestant Society,
but at present on a distinct basis ; the Amsterdam Society
for District Nursing, and that at The Hague, both societies
sending out visiting nurses . The patients , who are divided
into different classes according to their social state, pay
for every visit at a fixed rate. The poor are aided and
comforted by the Sisters and are free from any expense at
all. The nurses have a fixed salary.

A number of institutions send out nurses for private
duty ; such are the section for nursing of the Association
of the White Cross, the Haarlem Nursing Association,
and others. Nurses belonging to these institutions
receive a fixed salary (the patients' fees going to the
association), but nurses preferring to work independently
(the largest number do so) receive their own full fees.
Nearly every town in our country has its own communal
hospital, and the care of the sick is becoming an ever
greater subject of public interest. Besides these city
hospitals, where the poor are nursed, there are a great
many private and special hospitals.

Devotion and love are indispensable qualities in a
nurse, but they are not all. A really good nurse cannot
dispense with knowledge; she must be trained in the art
of nursing the sick. And in this regard we have made
great progress in Holland during the last twenty-five
years and more. The standard of nursing has been
raised, and the nurse of now-a-days is quite another being
from the one of a quarter of a century ago. The nurse
of that time — if we may call her such — was a perfect
specimen of the Sairey Gamp type, so wonderfully im-
mortalised by Dickens. To Miss Reynvaan, late Matron
of the Wilhelmina Hospital, and honorary member of the
Matrons' Council of Great Britain and Ireland, belongs

Holland 57

the honour of having first brought about a thorough
reorganisation in the nursing world. It was she who felt
the urgent need of efficient nursing by well-bred women,
and she herself set the example. Belonging to a patrician
Amsterdam family, she devoted herself to nursing work.
Her task of matron in the Buiten-Gasthuis (now the
Wilhelmina), one of the two public hospitals of that city,
was a difficult one, but she did not despair, and with
the aid of Dr. Van Deventer, at that time medical
superintendent, she attained her noble aim. The male
and female Sairey Gamps were superseded by a more
competent nursing staff. Inspired by her words and
deeds a great number of well-bred and intellectually
developed women took up nursing work and gradually
there came a blessed change in the condition of things.
She has been a noble pioneer on the path leading to the
elevation of nursing. The need of a special training in
nursing was more and more clearly realised, and also the
truth, that theoretical knowledge without practical
experience was not enough. For this reason certain
hospitals offered the opportunity for a thorough training,
the passing of an examination, and the attainment of a
certificate. The first certificate for nursing was given in
1879 by the Society of the White Cross. Since that time
the number of hospitals and societies that grant certifi-
cates has largely increased.

We urgently want state registration and fervently hope
that the new century will fulfil this righteous desire in a
not too far-off future. In the meantime, the Dutch
Association for Sick-nursing (de Nederlandsche Bond voor
Ziekenverpleging), founded in 1892, whose rules and by-
laws have recently been revised, proposes to evolve some
order out of the present chaos, and to introduce more
uniformity and co-operation with regard to training and
examinations. The different hospitals and associations
for nursing make different demands upon the candidates

58 A History of Nursing

who are desirous of passing examination; a three years*
training in one of our large hospitals is generally required,
though some of our institutions still think that two years
are sufficient. The curriculum, though not quite the
same everywhere, contains generally the following
branches: Some study of anatomy and physiology; the
nursing of internal, infectious, and neurological diseases;
the nursing of surgical cases, including some knowledge
of the treatment of wounds and of first aid; the care of
lying-in- women and the new-born ; some study of hygiene,
ventilation, feeding, disinfection, bathing, sick-room
comfort, etc. Special certificates are given by certain
associations for obstetrical nursing and the nursing of the
insane. The probationers in the hospitals do not pay for
their training but, as a return for the duties performed by
them in the wards, they receive a small salary and their
living expenses. In most hospitals we find, next to the
medical superintendent, a Matron, who is especially
charged with the control of the Sisters. [In small hos-
pitals one person sometimes combines the duties of
superintendent and matron, as in the United States.]
The following conclusions were accepted as principles by
the medical superintendents and Matrons of our principal
hospitals, as the result of an inquiry made in 1898. " Pa-
tients should not be left to the care of untrained women
either by day or night; day duty for the nurses shall not
exceed twelve hours after deducting the time needed for
meals ; day nurses should have an undisturbed night's rest
of at least seven hours; night nurses shall perform no day
work; every nurse shall have one holiday every fortnight
and one evening off duty; half an hour should be allowed
for breakfast and supper, and one hour for dinner ; nurses
should have at least two weeks' holiday and head nurses
three weeks' holiday each year; hospitals should pay the
nurses' insurance fees for sickness and accident."1
1 Trans. Int. Cong, of Nurses, Buffalo, 1901.

Holland 59

The Bond, whose resolutions are thus set forth,
has a mixed membership. Only a small number of
its members are nurses, the large majority being
physicians, directors of hospitals, and Matrons. It
has also some membership among laymen, philan-
thropic societies, etc., and it publishes a journal called
the Maandblad voor Ziekenverpleging. Excellent as
are, without doubt, the motives and aims of the
nurses and Matrons on the Bond, it has not, from the
point of view of the working nurses, been an actively
useful body. In 19 10, most of the points covered in
the resolutions just quoted are still but imperfectly
attained. Those who know how to read between
the lines of these resolutions can readily see that they
pointed to an existing order of things that was full
of abuses. It is quite clear from them that patients
were being nursed at night by untrained women:
that day duty exceeded twelve hours, not including
meal-times; that many nurses were not having as
much as seven hours' sleep; that night nurses were
working by day ; that nurses had practically no time
off, no half-days, no holidays, nor sufficient time to
eat their meals. Were these things not so, there
would have been no reason for the resolutions. But
even yet many hospitals place six- weeks' probationers
on night duty; hours are still too long, even though
some improvements have been made.

Especially is it to be noted that the Matrons, part
of whose duty it is to look after the Sisters, do not
do so. The reason they do not, is because no real
authority is given them ; such as they have, is merely
delegated by the directors, subject to immediate
withdrawal unless they observe a submissive and sub-

60 A History of Nursing

ordinate attitude in all things. The mixed member-
ship of the Bond, though it may have been planned to
give full play and interplay to the various elements
there represented, does not in the very least voice
the needs and aspirations of the nurses, but only
acts as a buffer against free expression and progress
on their part. The influence of the hospital authori-
ties predominates in the association, and even the
Matrons have only the passive role assigned them
of seeming to share in discussions and motions which
are, in reality, settled as the financial or commercial
or professional aspects of hospital industrialism
dictate.

The Bond has so completely dominated the situa-
tion that, even though there is in Holland an asso-
ciation of nursing directresses or matrons, this body
has been singularly uninfluential in nursing matters.
In this respect it is in striking contrast to the British
and American societies of heads of training schools,
which have consistently assumed a foremost place in
voicing the professional needs of nurses and in up-
holding their human rights. It may be said that in
Great Britain and America the organised Matrons
have always led, followed and trusted by the nurses;
in Holland the nurses have led, while the Matrons
have remained in the background, afraid to assert
themselves against the hospital directors. The Bond
is really a clearing-house where compromises made
necessary by the business circumstances of the various
hospitals and institutions are agreed upon; it is not
at all a truly educational or professional body, nor is
it a highly ethical one. It is a characteristic example
of that form of organisation that is commended and

Holland 61

encouraged by employers who are secretly unwilling
to permit independent self-governing organisation
to arise among workers, especially when the latter
are women, The estimate of the Bond held by thought-
ful and altruistic women in the nursing profession
of Holland is indicated in the following quotation.

The Bond was founded with the purpose of elevating
nursing — it tried to do this by bringing into the hospitals
young women who wished to have some useful profession,
and putting them into the places of the former attendants
who had been of the lowest orders of society. Full of
ambition, this new element of well-bred young women
went to work, but for a great many the task soon proved
too heavy, for the directors of the hospitals, nearly all of
whom are members of the Bond, did not realise that it was
impossible to let those nurses perform the same heavy
manual labour that had formerly been done by the attend-
ants. Some theoretical lessons were indeed given, for
it was admitted that nursing meant something more than
devotion and deftness, but those lessons, given at the
end of a long, exhausting working day, were of little prac-
tical use. The directors did not perceive that the nurses
needed more comfort, a better training, more spare time,
and less exhausting manual labour. They did not
understand that their pupils wanted to learn nursing
in the true sense of the word, that they wanted to have
time to solace their patients and make them comfortable,
to give them all those small cares that sick persons ap-
preciate so much. As matters stood then the best nurse
was the one who did her manual work best. The direct-
ors trained good hospital attendants, but not nurses.

The results were that after some years the numbers of
desirable young women applying diminished, and such
women sought other, less exhausting, occupations. They

62 A History of Nursing

saw too many nurses being quite broken down after a few
years of hospital work or private duty. Some recovered
their health after a long rest; others still surfer from the
overstrain. There were then some among the nurses,
women who sincerely loved their profession, who per-
ceived that this tendency must be checked and the state
of things altered, if nursing was to be prevented from
falling back again into the hands of uneducated and
vulgar women, It was seen that it was high time to
found an association to combat and reform many existing
abuses, and it was felt that it must publish its own paper
in which to discuss ways and means of obtaining those
desirable and necessary reforms. For, before 1900, the
editors of the Maandblad were not inclined to allow nurses
who had an opinion of their own to have their say in that
paper. Nowadays, through the force of circumstances,
matters have changed, but being in the minority in the
meetings of the Bond, nurses have not much influence and
dare not speak openly there.

In May, 1900, a first meeting was held by some liberal-
minded nurses and physicians, when the outlines and
form of an association were decided upon. This associa-
tion, now established under the name of Nosokomos,
takes only nurses (men as well as women) into full
membership. Only nurses have a right to vote, or sit
on the governing board. The physicians who at first
assisted with the work of editing our journal withdrew
when it was well under way, and it is now edited by
nurses.

Nosokomos owes its inception and the marked in-
fluence it has exerted in the nursing world to the
splendid woman who was, until 1909, its leader.
Miss E. J. van Stockum began her nursing career
in 1893, in the Hospital for Children in Rotterdam:

Holland 63

It was during her training that she first realised how in-
complete was the system of nursing education, how many
abuses called for reform, what an absolute want of soli-
darity there was among nurses. She felt that, as much
in the interests of the patients as in that of the nurses, the
latter's servile attitude toward the directors of the hospital
should change, that they should protest openly against
the long working hours, and excessive rough work, and,
above all, that they should be protected against the
unfair competition of those who were badly trained, or
even in some cases without any training at all. In 1896,
she married Dr. Aletrino, who, equally with herself, was
a warm champion of justice and progress. The original
plan of uniting the nurses together in one association was
theirs.

At the first meeting on the 30th of May, 1900, nearly
thirty responded to the summons of Mrs. Aletrino and
two of her co-workers, Miss B. van Mems and Mrs. van
Regteren Altena. It was Mrs. Aletrino's aim to arouse
in the nurses a feeling of self-reliance and pride, to make
them see that they themselves, bound closely together,
had to make a stand for their own interests — that they
should not leave that to others. She was particularly
well fitted for the task she set herself. Her fine intellect,
broad views, warm sympathies, her willingness to help,
but especially the confidence she inspired, marked her
out as a born leader and wise counsellor for all who came
to her for consolation and help in their troubles. Until
1909, her husband being her ever faithful co-adjutor,
Mrs. Aletrino devoted all her time and strength to the
association, which, in June, 19 10, numbered some 700
members. Together (she first as secretary, afterwards
as president, and he as editor-in-chief of the Journal)
they built up a powerful self-governing nurses' organisa-
tion. Together they conducted the campaign to obtain
better conditions, so that it may be possible for well-

64 A History of Nursing

educated women to choose nursing as a profession,
without fearing to have their health, if not irreparably
injured, at least perhaps seriously impaired after a few
years' service. It is mainly owing to their intelligent
leadership and immense working power that many
abuses have now disappeared, and that great questions,
such as uniform training, preparatory teaching, state
examination, etc., are being considered, not only in the
small nursing world, but also in the wider one of the
general public.1

Another woman of unusual gifts of discernment
and devotion gave herself to the cause of advancing
the educational and ethical status of nurses, namely,
Miss J. C. Van Lanschot Hubrecht, for a long time
the secretary of the association. She had begun her
nursing career in 1890, in the Hospital for Children in
Amsterdam. After some three years there, she had
a serious breakdown, and afterwards was only able to
do private duty for short periods at a time. Coming
back to Amsterdam to live, in 1904, she was elected
a member of the executive board of Nosokomos, and
became secretary in 1905. She soon formed a warm
friendship with Mrs. Aletrino and her husband, and
under their stimulating influence gave herself wholly,
with deep enthusiasm, to the work of the association,
seeing in it a part of the great cause of human pro-
gress through uplift of the workers and especially of
women. They met the usual obstacles.

During the existence of Nosokomos [wrote Miss Hub-
recht], we have had many difficulties and encountered
much opposition from physicians and hospital directors,
some of whom have forbidden the nurses on their staffs to

1 British Journal of Nursing, Oct. 26, 1907, and other sources.

Holland 65

become members of the association. They do not allow
their nurses independent action or the right to take
care of their own interests. Every improvement must
be a favour from the director, to be obtained by a very
humble request. Although improvements in the physical
conditions of hospitals took place, the deficiencies in
careful training persisted, and were the more evident as
medicine by no means stood still, but advanced with a
rapidity unequalled at any former time of the present
civilisation.

Miss Hubrecht points out the strange inconsist-
ency of hospital directors in the following description :

The probationer is not considered as a student to be
taught . . . she only learns how to do the hospital work —
she is not taught the full extent of her calling : . . . yet
the diploma certifies her as capable of nursing all cases
and affirms her competency as a good nurse. But, when
she seeks a permanent position, she meets a strange and
unexpected rebuff; the same authorities who graduated
her may now answer inquiries about her by statements
quite at variance with the text of her certificate, and she
may learn that she has not the knowledge necessary for
the work which she solicits. The explanation of this
riddle is simple. . . . These diplomas, which should be
testimonials of capacity, are distributed with incredible
carelessness. Every hospital may arrogate to itself the
right to give diplomas and badges. Women, badly
trained or not at all, take advantage of this confusion.
. . . Some months ago, the Bond passed a deplorably
reactionary measure providing that it need no longer be
necessary to spend three years in a general hospital of
not less than forty beds, but that a committee appointed
by the Bond shall be competent to decide whether this
or that special hospital, or such and such a small one,

66 A History of Nursing

may be regarded as a training school, the decision to be
arrived at by the whole number of days spent by patients
in the little place, and the variety of diseases admitted.
Thus at one stroke the whole principle of a general hos-
pital training is swept away. The reason of this deplor-
able decision is not far to seek. It is simply that one
must defer to the managers of the small hospitals, who by
this arrangement are able to secure the necessary per-
sonnel most cheaply. . . -1

I have spoken of our lack of systematic instruction;
whose fault is this? Primarily it is that of the Matrons,
and next that of the nurses themselves, who, too often
indifferent and apathetic, lacking in social sentiment and
solidarity, submit to this state of things, . . . Our
Holland Matrons have an association, but it is not
active, nor does it take part in the solution of burning
questions ; its members do not seem to realise that it is
their part to put themselves at the head of the reform
movement and by their words and acts point out the
way to elevate and advance the profession.

Yet the demands made by Nosokomos were and are
very reasonable. It wants a better and more thorough
training ; a more practical distribution of the hours for
work and study; shorter hours of work; state regulation
of training schools, with examination. Nosokomos wants
the nurses to be independent of all philanthropic aid;
to make it possible for them to take care of themselves
in illness, accident, and old age; it wants nurses to be
really fitted for their work by improving their conditions
of life and by giving them a thorough preparation for it.

The strife the young association had to carry on from
trie outset did not harm it. It made it strong and self-
reliant, so that those progressive physicians who, in the
beginning, had helped with its affairs have now with-
drawn. This struggle has also brought to light many

« Reports, International Conference of Nurses, Paris, 1907.

Holland 67

abuses, which have been rectified after being published
and discussed. Now that it has attained a secure
position, its aim is to work more faithfully than ever for
the attainment of our ideals. We wish to make the
nurse, by her knowledge and experience, her devotion
and tact, a real help to the physician; one to whom he
can entrust his patient with the fullest feeling of security.
We wish to develop in nurses those qualities which will
make them real nurses — welcome at the bedside not only
because of their sympathy, but because of the broad and
thorough training which makes them a real support to
patient and family. We wish to have special courses for
superintendents, matrons, district and private nurses,
to perfect them in the careers they may desire to follow
after their three years of training. We wish the training
and examination to be regulated by law, with the view of
obtaining more uniformity. Now every hospital can
give its nurses what training it chooses. We wish also
to have opportunities for experience in all the lines of
social and preventive work which will soon be as much
the nurses' sphere as actual nursing is at present. The
great merit of Nosokomos lies in the influence it has had
on all matters relative to the education of nurses and the
conditions under which they work. Through its exer-
tions, its bold and open discussion of all abuses, and
pointing to the way of reformation, much improvement
has come about.

Nosokomos was indeed a militant publication.
For years, it fearlessly attacked every stronghold
of power and privilege as related to the world
and work of nursing. It stood with the British
Journal of Nursing and La Garde-Malade Hos-
pitalise in its self-imposed mission of combat
against the mercenary and undemocratic order

68 A History of Nursing

which retarded the advance of women workers. It
never allowed an issue to pass ; it never overlooked
a detail ; week by week local and national issues were
held up for scrutiny and criticism. It sometimes
seemed, to foreign observers, as if its pugnacity must
antagonise those who might otherwise be friends,
but this surmise was baseless, for no amount of soft
speaking would have been of use, as Dr. and Mrs.
Aletrino well knew.

The steps taken by the Holland association toward
state registration have been recorded for us in
chronological order by Miss Hubrecht.

In September, 1907, the executive committee of
Nosokomos sent in a petition to the government asking
for state registration. Our reasons were set forth in full,
as published in the British Journal of Nursing, March 14
and 28, 1908. In December, 1907, a second petition was
sent, this time addressed to the second chamber of the
House of Parliament, with the view of explaining still
more fully, and with many illustrations, why state regis-
tration is urgently needed. The government sent out
documents to the Central Health Department asking
for advice. This board resolved to institute an inquiry
as to the training of nurses in hospitals and asylums. A
very extensive questionnaire was made up, bearing upon
preliminary training, the number of probationers and
certified nurses in every hospital and asylum, the working
hours, etc.

Mrs. Aletrino was called upon for information in
this inquiry, but, up to the end of 1910, the De-
partment of Health neither published the results of
its investigation nor gave its opinion upon state
registration.

" a3

Holland 69

In February, 1909, Nosokomos published in pamphlet
form the two addresses which it had made in 1907 to the
government, and sent a copy to every physician in
Holland, enclosing a post-card and asking for an expres-
sion of opinion as to the desirability of state registration
for nurses. The result was on the whole very gratifying ;
one-fourth of all the medical men of Holland declared
themselves in favour of it. Only ninety-one went on
record as opposed, while the others did not answer at all.
In April, 1909, the Association of Medical Superintend-
ents of Hospitals and Asylums sent an address to the
government protesting against state registration, on
the plea that it was not necessary, and was not even
desired. The arguments were the same as everywhere
else : that nursing is a work of love and devotion for which
no fixed rules can be made; that character cannot be
registered ; that the present state of affairs is satisfactory
and matters constantly improving under private initia-
tive, etc. This association had, in 1901, declared state
registration to be urgently needed; but now, for some
unknown reason, they had changed their minds. In
September, 1909, three petitions were sent in, all in
favour of state registration: one by the Roman Cath-
olic Association for the Promotion of Nursing, one by
Nosokomos, and one by the League of Male Nurses.

During this campaign a number of pamphlets
were written, and Miss Hubrecht published a book
dealing with the whole subject.

The outlook at time of writing was not very hope-
ful. The conservative, calvinistic ministry of 191 1
was not favourable to state registration. The boards
of the deaconess associations and other groups of
religious nursing orders, whose influence with the
present government is strong,were absolutely opposed

70 A History of Nursing

to it. With them the idea prevails that nurses should
not be economically independent women, controlling
their own lives, but must live together as one flock
with a shepherd. Though trained, they receive no
certificates, being thus kept in more complete
dependence upon their Motherhouses.

Another group in opposition has been spoken of,
namely, the hospital and asylum superintendents.
They do not relish the idea of state control and state
intervention in their ways of managing their insti-
tutions and the training of their nurses.

Another difficulty in the realisation of our wishes is the
fact that nursing is, as yet, hardly held to be a profession.
The individual nurse will, in most cases, meet with con-
sideration and a courteous demeanour from the physician,
but as a group of persons, as a class, they are still largely
regarded and given much the same place as the servant-
attendants of former times. The doctors see in the
nurses not their assistants and equals, but their inferiors.
I am of the opinion that for this reason many physicians
oppose state registration. We say it will elevate the
profession; many of them do not wish it to be elevated.

I am convinced that there is a deep-lying connection
between the economic dependence of women and the
lack of consideration that nursing, as a profession,
receives, — the unsatisfactory conditions under which we,
as nurses, are living. Our nurses, even more than other
women, are, by reason of their isolated lives, inclined to
submissiveness, and to an apathetic acceptance of bad
conditions. They are not conscious of solidarity; they
do not understand the meaning of that word. They do
not realise the great social strength of unity ; they do not
seek in co-operation the means to alter present conditions.
They still harbour the mistaken and unwholesome idea

Holland 71

that a good nurse should sacrifice her life, as do the nuns
and deaconesses, forgetting that the nuns and deaconesses
are taken care of throughout their whole lives, and that
their doctrine of work done from motives of love only is
a sham, since they get their payment in the form of
lodging, clothing, food, and care in sickness and old age :
— forgetting, too, that the woman whose life is well
poised, who gives freely of her love and strength to her
fellow-creatures — to society — but without squandering
her vigour, is more useful than the woman who exhausts
her forces in a few years, only to become a burden for the
rest of her life. ... In conclusion, we want to point
out that, whereas the nursing profession is not, as the
medical profession, under state control, many persons,
especially in the large towns, often use the nurses' uni-
form for immoral purposes. They are alternately nurse
and prostitute, hence the terrible risk of infecting their
patients with their own infectious diseases, to say nothing
of the damage done to the good name of the profession.

For the nurses who do not belong to any religious
association, the working hours are also very long; they
live out of the world; nothing is done to awaken their
interest beyond nursing; no provision is made for them
in time of illness or old age.

The nurses' question is inherent in the whole woman's
question, but as long as they hold aloof on the pretence
that the very character of their work forbids them to act
as other women and obliges them to sacrifice all rightful
claims, it will be difficult to obtain any improvements.
Only political and economic enfranchisement can be the
lever to arouse them; — to make them realise how much
broader and nobler their life can be, once out of the
narrow groove in which it is at present running. x

At last, in 191 1, the special committee appointed

1 Letter from Miss Hubrecht to the editor.

72 A History of Nursing

by the Board of Health from its members, in response
to the request of Nosokomos, made its report. Three
and a half years had gone by, and the nurses suspected
that the task had been an uncongenial one. The
report was negative and lukewarm.

The committee began its work by instituting an
inquiry as to the conditions in the hospitals and training
schools in regard to working hours, preliminary teaching,
training and examinations, sending out a long question-
naire to . . . all hospitals, asylums, and nursing homes
in the country.

In this way much valuable information was gathered.
In the report the committee first gives its opinion on the
most important questions pertaining to nursing educa-
tion, and concludes with expressing some advice as to
necessary reforms. But this advice is very disappoint-
ing. It is true that the desirability of some control of
the examinations is advised, that certain gaps in the
training are admitted, and that the wish to remedy these
is expressed, but all is done in such a hesitating way, and
is interspersed with so much flattery for the Neder-
landsche Bond voor Ziekenverpleging, that ... it is
most difficult to know the real opinion of the committee,
for every time it points out some fault, or proposes some
improvement, it recedes quickly, as if saying, "tout est
pour le mieux dans le meilleur des mondes." . . .

It was a great disappointment to perceive that the
committee took sides with the medical superintendents
and Matrons, and considered the matter from the point
of view of what kind of training is necessary for hospital
service, instead of taking the broader view. The inquiry
proved: (i) That a preliminary training is given hardly
anywhere; (2) that there is no uniformity in the condi-
tions of admission of probationers to the training schools;

Holland 73

(3) that there is no uniformity in training; (4) that there
is no uniformity in the examinations.

Of course, all hospitals insist on good health and good
morals as the first condition for admission to their train-
ing schools. As to previous education, some hospitals
desire the certificate of a higher school; most think the
instruction given at a primary school sufficient, and a
few do not even ask as much as that. To anyone
knowing that in Holland children leave the primary
school in their twelfth year, it is evident that the com-
mittee has made a great mistake in declaring that the
primary standard of education is sufficient for a nurse.
It shows so clearly in what a low estimate nursing is held
by the authorities — how it is in their eyes no more than
an industry which any uneducated person can exercise.

The inquiry brought to light the sad lack of uniformity
in the practical training; every hospital has its own views
upon the matter and acts accordingly, no matter whether
that training is sufficient to fit the nurse for her future
career or not.

. . . The committee is of the opinion that the present
training is sufficient; that there is no need of a state
certificate to protect the profession ... it thinks that
the presence of a deputy of the government at examina-
tions will mend all matters.

The committee suggests a few improvements in regard
to nurses' homes, salaries, and long working hours. But,
in all these matters, the fact that any improvement will
cost much money is put forward so strongly that we
shall not be surprised if the Minister receives the impres-
sion that the matter is too unimportant to spend money
on. . . . "Shorter working hours" is at this moment a
burning question in our nursing world. One of our
university professors made a speech on the subject
which roused much indignation among the nurses. The
jgist of it was that hours are not too long. Probationers

74 A History of Nursing

must realise that they can only learn their profession
by working for long hours, which is synonymous with
long days in which to learn. They can only show their
love of and devotion to nursing by working long and
hard. It is true that many of them are overtired and
look ill; but there the parents who allowed them to
become probationers are at fault. Is not that excellent
logic?

Our Matrons' Council adopted some resolutions at its
general meeting last spring, where the same things were
said.

And then seeing those young women who are the
victims of such narrow reasoning, one feels sad. All
nursing work seems so useless when, in nursing patients
back to health, the nurses become patients in their turn.
What profit is that to society?1

As we write, nursing education in Holland seems
to be stationary, but the nurses are strengthening
their organisation. Miss Hubrecht, president of
Nosokomos for 19 12, has succeeded in bringing the
society to open headquarters and unite all its work
under an office secretary, and has further founded
a large and active Society for State Registration,
composed of laymen and professionals. Finally,
the leading nurses are supporting the woman suf-
frage movement as fundamental to changed condi-
tions of education or of work for women.

Belgium. — In 1909, for the first time, a general out-
line of modern nursing conditions in Belgium was
heard by nurses from other countries, to whom the
Belgian nursing field had been, before, almost un-
known territory. It was read by Miss Cavell, who

1 British Journal of Nursing, Sept. 2, 191 1, p. 195.

Belgium 75

was herself the English Matron she mentions, and
ran as follows:

Nursing in Belgium, though still much behind that of
England, Holland, and other countries, has made some
progress in the last two or three years. A desire is evi-
dent in many quarters to supersede the present ignorant
and blundering methods by enlightened and up-to-date
work. The first attempt to alter the existing state of
things was made by Dr. Depolpe, who instituted lectures
for lay nurses twenty years ago. They were given twice
a week, and included a few practical demonstrations.
The pupils were not attached to a hospital, and they had,
and have, no actual practical work. The school is still
carried on under the same conditions, directed by Mme.
Doequia.

The hospitals in Belgium are staffed by nuns or by lay
nurses, the greater part of whom are peasants taken
directly from the fields, without any training or instruc-
tion. Where the nuns are in charge, much of the rough
and unpleasant work is done by lay nurses, who are no
better than low-class servants. An attempt has been
made at the Hopital St. Jean to form a regular training
school. At first the few probationers recruited were
instructed entirely by doctors. After a time the need
of a trained Matron was felt, and one was placed at the
head. Unfortunately, the difficulties put in her way
were many, and I believe the school is at present almost
non-existent.

A mental hospital exists near Brussels, at the Fort
Jaco at Uccle, where about forty pupils, mostly Dutch
women, are trained under the able direction of Dr. Ley
and a Dutch Sister. The probationers receive lectures
in the usual subjects, and also some general instruction
in other branches bearing on their work. They pass

76 A History of Nursing

examinations and receive certificates, including one for
mental work. All the pupils are resident within the
school, a condition unfortunately not general in the
country.

The only school which exactly answers to the condi-
tions of training in England is the Ecole Beige d'lnfirm-
ieres Diplomees, generally known as the School of the
Rue de la Culture. This school has been open since
October i, 1907, and has now [1909] thirteen pupils.
It was founded by a committee of doctors and others
anxious to improve nursing, to open a new career to
Belgian girls of good education, and to train new aids
in the cause of science. An English Matron was engaged
to open it, and four pupils formed the first recruits. After
two months' trial, the probationers sign a contract for
five years. The first year is passed in a clinic attached
to the school, where medical cases are received and
lectures given; the second in a surgical clinic, where the
lectures are continued; in the third we hope to give the
pupils experience in infectious work or in the nursing of
children. A great point is made of discipline and
character, and the pupils have given proof of much
devotion and loyalty.

At Antwerp a certain number of pupils are received
at the hospital under the direction of Dr. Sano. They
are not obliged to live in the hospital, and they have no
Matron. Lectures are given each evening, and examina-
tions are held for the diploma. Liege, Gand, and Ander-
leche are also anxious to establish training schools, and
there is one at Mons which at present is not definitely
organised.

In 1908, state registration was inaugurated, and a
certificate is now given to all men and women who pass
the government examination. This certificate can be
gained by following certain lectures during one year —
practical work is not obligatory. An examination is also

Belgium 77

held for a diploma in mental nursing. The state cer-
tificate shows the erroneous ideas of nursing held in our
country. The conditions for obtaining it will have to be
much altered as the work advances. r

The government examination, which, elementary
as it is, demonstrates the modern tendency in nursing,
was brought about by royal edict, this, in turn, being
the result of agitation and resolutions of the medical
societies. Nurses seem to have had little or no
share in obtaining their legal status. The standards
recognised are: (a) a two years' course in public or
private hospital; (b) one year's theoretical and
practical work given by physicians on the subjects
specified for examination, viz. : anatomy and physi-
ology, asepsis and antisepsis, medical nursing, record
keeping, and emergencies. Applicants must be eight-
een years old and of good moral character. The
examinations are conducted by physicians. Yet,
elementary though it be, the Belgian state registra-
tion has already had a salutary effect in stimulating
training efforts. The religious nursing orders have
accepted it, and not only that, have criticised its
inadequacy in not emphasising practical hospital
drill, while a central school to provide a uniform
standard of teaching for the Sisters of the religious
nursing orders was begun very soon after the pro-
mulgation of the edict, with results that are very
gratifying to the friends of the movement.

The training school spoken of by Miss Cavell as
being undertaken at the Hopital St. Jean struggled
through its difficulties so far as to have an official

1 International Congress of Nurses, London, 1909, Reports.

78 A History of Nursing

ceremonial of inauguration in 191 1, in the beautiful
Hotel de Ville. The school is under the control of the
city administration, and bright hopes for its future
now seem justified. The Nurses' Home is in the
Rue Pacheco, and accommodates twenty or more
pupils, who receive their practical training in the
historic and picturesque hospital of St. John, or in
certain of its divisions.

The school directed by Miss Cavell is well past
the experimental stage. In 191 2 it had thirty-two
pupils, who were in training in four different hos-
pitals, in each one of which the school placed a
trained Directrice, on the English system, while
every ward has a trained head nurse.

Belgium shows a great awakening in nursing in-
terests, and progress is under way. Many physicians
hold liberal opinions, even upon that crux of dis-
cussion, the Matron's position. Antwerp has a
municipal school, and there is a Belgian Society to
Develop Training Schools for Nurses.

CHAPTER III

MODERN NURSING IN AN ANCIENT SETTING

Italy. — Nowhere on the continent, except in
France, are there such old and interesting hos-
pitals as in Italy. Judged by their architectural
and artistic charms, and by the atmosphere of
antiquity and story in which they are enveloped,
they are fascinating, but in the light of modern ideas
fall far into the background. In 1903, an American
nurse, seeing them for the first time, thus described
her impressions:

In going through these hospitals one cannot but feel
everywhere the entire absence of real nursing, no matter
how charming the picturesque side may be. So long as
the patients are not seriously ill, it is not so bad, but
when one sees typhoid, pneumonia, and other acute
cases then all the inadequacy of the care strikes one.
From the nursing standpoint, the worst were the great
General Hospital at Milan and three of the largest in
Rome. Everything looked ... as if there were moun-
tains of work piled ahead which would never be caught
up with. The nuns in these gigantic hospitals are worn
and haggard, and one cannot doubt that they are all
overtaxed, even though nothing is properly done.

80 A History of Nursing

The system of nursing that had developed during
the Middle Ages, producing saints and humble, self-
sacrificing workers whose names and very memories
are now lost, has come down to the present day un-
changed in general outline, but altered for the
worse in certain details, namely, the diminished
numbers of nuns and the introduction of secular
untrained attendants under the authority of the civil
administration.

In a word, the transition stage that marked the
last century in French hospitals had been entered
upon, somewhat later, by those of Italy. Through
the pressure of economic conditions the numbers
of oblates, lay Sisters, and other unpaid workers
were shrinking, and those of self-supporting though
ever so poorly paid women, increasing. This eco-
nomic transformation; political changes, bringing
the civil government more to the front in hospital
management and displacing the purely clerical con-
trol; scientific advance, revolutionising the study
and practice of medicine and profoundly altering the
relation of the nuns to hospital work, were the three
deep-lying factors preparing the way for the indi-
vidual workers whose careers we are about to follow.
But before beginning with the doings of the new gen-
eration, we shall quote from an article written by a
nurse in Italy, which gives an authoritative state-
ment of the internal conditions of the hospitals, and
sets the stage, as it were, for our characters.

The writer, Anna Celli, has been briefly referred
to in an earlier chapter. l She was of German birth
and had been trained as a nurse in the large hospital

1 A History of Nursing, Vol. I., p. 513.

Italy 8 1

at Eppendorf. As Sister Anna Fraentzel she was
well known in Germany. Her marriage to Professor
Angelo Celli, famous among physicians for his re-
search work into, and practical experiments with, ma-
laria, gave a new direction to, but did not abate, her
professional ardour. Beautiful and accomplished,
she threw herself with intensity of temperament
into the problems about her. She and Professor
Celli are both Socialists, and engrossed in social up-
lift. As Socialist member of the Italian Parliament,
Professor Celli helped to bring about the government
control of quinine, while Signora Celli visited the
peasants of large regions, making control experiments,
taking blood specimens, and in every way assisting
her husband. She opened and was responsible for
a dispensary for children in one of the poorest parts
of Rome. She worked there part of every day, and
maintained cots for children who needed to remain
for some little time. She made strenuous efforts to
initiate the training of nurses, and succeeded in de-
veloping certain lines of teaching, though without
founding a regular school. Her greatest contribu-
tion to nursing reform in Italy was, undoubtedly,
her strong, accurate published presentation of careful,
thorough investigations into conditions, and her
bold statement of facts. Her writings are charac-
terised by high professional ideals and warm human
sympathies.

The servant nurses are the only ones who really attend
to the sick. Few indeed are the hospitals where this is
done by the Sisters, as, for example, to a certain extent
in Rome at the San Giovanni, at the Cottolengo

VOL. IV. — 6

82 A History of Nursing

in Turin, the civil hospital at Udine, etc. Still fewer
are the examples, as at Pavia and in S. Maria Nuova in
Florence, where semi-religious orders of women who have
taken no regular vows are in charge of the wards and
perform all the most delicate and important duties for
the sick. . . . The discipline of the religious orders is
certainly vastly superior to that of the lay nurses, and this
is of the greatest importance for those attending upon
the sick. But the admirable discipline of the Catholic
Church has this one defect : instead of first recognising the
medical, it puts first the religious authority. This is a
stumbling block. The service of the sick is looked upon
as a labour rewarded in heaven, and it is not considered
necessary to teach it as a profession. It is regarded as a
religious function. It has happened that Sisters have
declined to carry out medical orders for children, saying
that "it was better they should become angels. " In one
instance, a patient having hemorrhage, instead of calling
the physician the Sister went for the priest. Another
allowed a patient with pneumonia to get up on a winter
night to pray on the cold floor, where, half-dying, he
was found by the doctor.

This is not said in a critical spirit, for I am the first
to recognise the great merits of the Sisters. But
science is to-day too far advanced for this to be de-
sirable, and to be a competent nurse it is absolutely
necessary that the nurse be thoroughly taught, and
not limited to the religious service. She should oc-
cupy herself solely with the sick and leave all else to
others. She should be exclusively subordinate to the
medical officers and follow rigorously all their orders.
She should be put through a practical and theoretical
course, and be capable not only of recognising grave
symptoms, but also, in times of emergency, of applying
the remedy. And before practising she should be well
instructed, partly by the physicians and surgeons, and

Italy 83

partly by the trained and qualified head of nurses. She
should not, from reasons of false modesty, leave the most
important parts of the care of the sick to attendants, but
it should be her highest duty and honour to have no
ignorant person touch her patient. She should not wear
a dark habit and immense headdress which impedes
work and becomes a vehicle for micro-organisms, but
choose a light, washable dress. Until such reforms can
be made the religious Sister can never be a model nurse
in the modern sense of the word. . . .

To-day, the care of the sick in Italy is largely in the
hands of illiterate lay persons, engaged as servants. In
general they are admitted from the age of eighteen to
that of forty years, in one hospital at fifteen, * in another
at sixteen. In another there is no rule. Usually only
unmarried women are accepted, because the work
requires that they should live in the hospital. However,
in a number of institutions this rule is not in force. In
two the applicant must spend six months in the laundry
before being engaged as a nurse. In others she is
engaged without condition. In five she must give some
unpaid time — in one, two months, in another, three, in
another, two years, before being definitely accepted.
In one it is compulsory to attend lectures, in another it is
voluntary. In some hospitals practical instruction is
given, in others, both practical and theoretical, with an
examination at the end. At Pavia a physician gives a
course of two months' teaching after the nurses demon-
strate that they can read, write, and do simple arith-
metic. At Ferrara a similar course lasts four months,
with one lesson a week, and comprises medical and surgi-
cal work. At Siena physicians give a theoretical course
of six months. If the applicants, men or women, cannot
then pass a satisfactory examination, they are not

1 In the original article, Signora Celli gives the names of all hospi-
tals in full.

84 A History of Nursing

accepted. In Florence, every year, the physicians and
surgeons give a practical and theoretical course of six
months, and this, as at Rome, may be attended by
applicants.

These courses appear well on paper (and they do indeed
represent a step in advance) , but in reality they often do
more harm than good. Instead of being of practical
benefit, they only serve to confuse the minds of the pupils.
The instructor should be able to descend to the level of
his hearers, so as to explain things in a way they can
understand. It is most difficult for young persons who
have hardly gone through the elementary schools to
understand any part of so complicated an organism as
the human body. Instead of being made to memorise
the skeleton and its parts, would it not be better for the
nurse to understand the daily functions of the body?
So it happens that, whether the course is taken or not»
the ignorance of the pupils remains the same. Especially,
even when the course is taken, they have no idea of
asepsis and antisepsis, of diet for various maladies, of
how to apply treatment, and so on. Who ever teaches
them their duties toward the sick? Who shows them
how to make a patient comfortable? Who drills them
in the cleanliness so essential in a ward or sick-room?
Who teaches many other necessary little points? The
physician cannot do so ; often he does not know how him-
self. No one can do this but a woman, and therefore the
pupils must have head nurses who can teach them.

After having passed the requirements of the different
hospitals, they are taken into service under varying
conditions. . . . Few hospitals make any provision for
the old age of their employees; in others they are dis-
missed when no longer capable. As a result of insuf-
ficient pay the nurses demand fees, and have a marvellous
art in extracting something, even from the poorest. The
relatives of the sick ones, hoping to secure better treat-

Italy 85

ment for them, often give beyond their means. I do not
know whether any hospitals forbid taking fees, but there
are certainly some where the authorities count upon them
in paying smaller wages. Then, too, this meagre payment
often drives the nurses into immoral or illicit ways of
making money. In general, nurses have the daily care
of from eight to fifteen patients, and twice as many by
night, but there are hospitals where one nurse may have
thirty and more to attend to.

Tuscany is undoubtedly the most advanced part of
Italy in regard to hospital service. Siena and Florence
especially have excellent rules. The work of the nurses
there is well regulated and their future is provided for.
On the other hand, in such centres as Turin, Milan, Rome,
Naples, the service leaves much to be desired. Shameful
conditions are found in one of the Neapolitan hospitals,
where the patients nurse one another. When will these
necessary reforms in the service be made? It is a ques-
tion of the highest importance for the whole people.
The service in private duty is even worse than in hospi-
tals and calls insistently for improvement. *

Signora Celli concluded her paper by presenting a
table of figures which she had personally obtained,
showing the hours of work, amount of wages, and
standards of food and housing of the nurses. For
reasons of space we omit this table. The data as to
hours of work have been summarised in an earlier
volume. 2 It is enough, now, to say that they ranged
from twelve to forty-eight hours of continuous work.
The obstacles, then, to a modern system of nursing
for Italy were weighty. With mediaeval standards of

1 "La Donna Infermiera," by Anna Celli; Unione Femminile, Nos.
2 and 3, 4, 7, and 8, Milan, 1901.

2 A History of Nursing, Vol. I., p. 514.

86 A History of Nursing

technique and nursing, hospitals were staffed by
cheap labour, for even the nuns belonged in this class,
since they were supported by their orders, which were
paid most meagrely by the administration for their
services. The more technical and responsible parts
of nursing care were performed by medical students
and young physicians, who, in the hospitals, took
the places of our senior nurses, and, in private duty,
were usually called to be on hand in the houses of the
wealthy while a nun watched the patient. z Religious
sentiment, administrative conservatism, professional
caution, social usage, rigid conventions, medical
jealousy, and economic bondage offered formid-
able barriers to a modern invasion of the antiquated
nursing service of Italy.

Twenty-five years ago no influence from without
had ruffled the order of the internal management of
the Italian hospitals. But it was meant to be the
prerogative of Old England here, as in many other
countries, to bring a new element into these massive
buildings. The love of English people for Italy is
proverbial. The Italian cities have always held colo-
nies of Britons, and it so happened that in Florence,
in 189 — , there lived a Scotch-English lady with her
family. A born altruist is Miss Amy Turton, pos-
sessing extraordinary optimism and energy, with a

1 For private duty there were the Daughters of St. Anna, with its
house in Siena. Each Sister takes the name of Anna. For district
nursing there were the Sisters of the Sacred Hearts of Jesus and
Mary, a new order. An English private duty order working in
Rome was the Little Company of Mary. These Sisters, though
doing private duty entirely, do not make any charge, but leave it to
the patients to give what they will. They are very efficient nurses,
and do not practise fasts or austerities, regarding the difficulties of
the calling as their equivalent.

Amy Turton, the Pioneer of Modern Nursing in Italy

Italy 87

gift for setting things in motion that has had notable
results in many directions. No one else could so well
as she describe her long, plucky, undiscouraged
quest during the years when, like Columbus, she
never remitted the determination to reach her goal,
and so we begin with her story of the first small
beginnings in Italian hospitals.

The idea that something practical should be attempted
to improve the nursing in our hospitals came to me in
1890 or '91 in Florence. I used often to visit Santa
Maria Nuova, and we had a little society — composed
chiefly of rich friends of mine — for taking food and
garments to the sick, so that each ward was visited at
least weekly, and fruit, biscuits, eggs, wine, tobacco,
snuff, books, clothes, and little pious pictures were given
to the patients. It was not exactly satisfactory — they
needed so much, and there were so many of them — but
we redressed a few serious evils, as I remember, one
Italian friend especially having wide influence and great
energy. But the feeling grew: they need some one with
them all the time who is conscientiously good to them
and an intelligent aid to the doctors — they need nurses,
not visitors.

We heard stories of neglect, of extortionate tips, on all
sides; we heard the staff quarrelling and saw how
roughly they moved the patients, and wondered what
they did or did not do when no one was there, as they did
so badly when we were present. So the belief grew
steadily that I must either do more, or give up the little
I was doing. . . I was free — not too young — with
sufficient influence to get admission; — a stranger, I
could do what an Italian could not (for an Italian
lady could not live in hospitals or even work there
seriously; her family would object), anon-Catholic, I

88 A History of Nursing

could try to help the nuns indirectly, as others could
not do. . . .

I believed, and I believe now, that some of us atoms
of humanity are meant to do one or another bit of work,
and, despite ourselves, we shall do it. The bit of work
meant for me was that of the thin edge of the wedge in
our Italian hospitals — to open their closed doors, that
others more competent should enter and reform the
nursing. . . . The thought I held with blind faith was
— the thing should be done; ... no one else seemed able
to set the example, so I must begin.

The difficulties were not slight ; at first it was thought
best to go to England for a brief training, but we found
that only by offering to learn could I ask to enter an
Italian hospital. If it was to teach, there were already
plenty of trained nurses, but Italy would not admit
them, except as outsiders, in ambulatoria (dispensaries),
therefore it was clear that I must find a hospital which
would take me as a pupil. The next difficulty was that
there were only nuns and servant-nurses in our hospitals
— I could enter neither group. My friends tried to get
me admission as a lay boarder with the Suore at Pisa and
Cremona, but in vain.

After some six months Prof. G in Lucca accepted

the idea of teaching me, that I in turn could teach Italian
pupils. He admired German hospitals, and wished to
get a better class of nurses for his wards. I tried to
board in a convent at Lucca, but the hours were not
possible, not leaving me free to be in hospital ; — then, too,
there were children in the house being educated, and I
might bring infection in to them. Finally, through a
friend's servant, a family was found, ladies of slender
means who were willing to take me to board, and I
stayed with them, without causing any gossip, for six

months, from January to July, 1893. Prof. G and

Prof. B ■ were kindness personified. I spent days,

Italy

and occasionally nights, in their wards, theatre, and
medication rooms, and got a good insight into things as
they were. The surgical technique taught was excellent,
but nursing? Who could teach me that? ... A St.
Thomas's friend now visited me, ascertained that I was
only learning to be a "surgical or medical assistant,"
and told me I must go to England to see what nursing
was. She advised my writing to Miss Nightingale,
simply stating where I was in my scheme. I received
one of our priestess's inspiring letters, then another, and
another, the third securing me admittance to the Royal
Edinburgh Infirmary as paying probationer for at least
six months, or, if possible, a year.

The professors were doubtful as to the wisdom of this ;
they could not understand why a nurse should need long
training; — an intelligent woman could surely get an
insight into organisation and technique in a few months.
"In six months," they said, "you can return and then
we will begin the school." It was useless to try to
explain to them; I promised only to return as soon as
possible, and they were to prepare the way for taking
pupils. I stayed one year, from October, 1893, to 1894,
at that delightful and beautiful hospital, the late Miss
Spencer giving me every possible facility. The Lucca
professors meantime endeavoured to get the hospital
administration to vote in favour of admitting a better
class of lay pupils, but politics as usual intervened — the
plan was "freemasonic and atheistic." The majority
voted against it, and the professors' attempts ended in a
definite defeat. This was a blow, but the way closing on
one side meant trying another.

Rome came to me through friends who were determined
that my small efforts should not be so easily ended.
Professor Rossoni, temporarily medical clinician whilst
Baccelli was Minister of Instruction, was a friend of
friends of mine, and he was induced to admit me to work

90 A History of Nursing

in his clinic at Santo Spirito, giving permission for two
or three Italian girls to come also and begin to train.
This did not succeed; the right girls were not found;
and after a few months my friends formed a small com-
mittee to gain admission to S. Giovanni, the Direttore
Tosti (who is now Director of the new school in Rome
and one of its warmest supporters) coming on the com-
mittee with the surgeon Mazzani. The ladies interviewed
the Mother Superior, and enlisted her sympathies; she
promised to instruct the Suore to teach all they could to
the pupils, who were to be prepared for private duty, and
it was agreed that after six months I should be admitted
to give the finishing touches to their education regarding
the specialties of private nursing.

At this juncture one of Queen Margherita's ladies-in-
waiting, the Princess Strongoli, heard from a mutual
friend of the strange English lady who wished to start a
training school. Nursing had always been on the
Princess's list of feminine professions, as proposed for the
girls' college which she was evolving out of the Suor
Orsola Benincasa Convent in Naples. I was taken at
eight one morning to talk to her at the Quirinal, and
convinced her that nursing could not be taught by
lectures in a school, but required hospital wards. She
undertook to gain entrance to a hospital in Naples by
September (it was then June), and offered me hospitality
at her girls' school. I went as arranged; negotiations
were in process, and by November I was working in the
Gesu e Maria and reflecting upon how matters could be
carried on when I left, for, as I was due in Rome in
January, I had only the intervening time to give to
Naples. A nurse who knew Italian was essential; we
made one or two unsuccessful attempts to find one
close at hand; finally I appealed to Miss Grace Baxter,
then in the United States in charge of a ward in the
Johns Hopkins Hospital.

Italy 91

It was one of the inspirations which have attended
me at the worst moments. She "burnt her ships behind
her," considering that "Italy's need was greatest, and
it was the land of her adoption." In January, 1896, she
joined me, and, after a brief time together, I returned
to Rome. I took her place that summer for a month,
and then left Naples to her; — being truly a missionary
spirit, she has never reproached me, though from the
worldly standpoint I was undoubtedly the instrument
which prevented her making a brilliant professional
career in the States.

Before taking up the account of Miss Baxter's
work, our readers shall have a peep into Miss
Turton' s diaries covering the period just outlined in
her story; — these daily memoranda give a faithful
picture of the slow uphill work carried on so
patiently.

November 4, 1894.
I went to ask Signora X. about pupils; she was
very amiable. I brought her a letter from Marchesa
XX., one of the patrons of her big professional school.
She said she would find me exactly what I wanted;
only I must be prepared to put aside many of my
"English ideas " ; I told her I was quite willing to do so —
in fact, I should not wish to retain any ideas that were
not non-national or founded on the universally accepted
ethics of nursing ; also that I had begun my own training
in an Italian hospital. She then explained that educated
girls cannot be expected to perform ' ' the menial serv-
ices" for the sick — there must always be servants for
that part of the work. I tried without success to con-
vince her that this was against all rules of nursing. But
I did not venture to tell her that this was the very reason
why the girls whom she had had taught in Profes-

92 A History of Nursing

sor 's courses were not thought capable nurses by pri-
vate patients, — "nice girls, intelligent and sympathetic,
but useless." On one point, however, I found her very
enlightened: she allowed that in time, and with tact, I
might get girls to nurse in men's wards; it would not do
to mention the matter at first, — she had not told her
girls even of the possibility, but, after a few months, one
of the most intelligent and enthusiastic pupils had
volunteered to nurse some particularly serious male
cases after operation, and since then there had been no
difficulty in getting them to nurse men as well as women.

November ioth.
I went back to Signora X. this afternoon; she has
found two young women whom she thinks eminently
suited for nurses. One I saw, a bright, intelligent
girl, a chemist's daughter. She informed me that she
was not afraid of illness, and that she liked making up
prescriptions. ... I went to see the other: "Does the
Signorina wish me to accompany young ladies to the
Clinica?" Signora X. had not quite explained, but she
understood it was about young ladies and the hospital ; —
perhaps her knowledge of French would be useful if they
were foreigners. ... I explained that it was pupils I
was looking for and added a little about the work.
She replied: "Ah Signorina, is it not a life very hard to
support? I could never venture, and you, also, look far
too tender-hearted, but even if I had the courage to assist
the sick, I am all alone in the world, and so would have
no one to fetch me in the evenings. You see, therefore,
it is quite impossible for me." ... I see there will be
the difficulty of chaperonage; only servants have no
traditions to prevent their walking the streets alone.

November 23d.
I am making inquiries elsewhere for pupils; the

Italy

chemist's daughter has accepted another engagement.
It is natural enough that Signora X. should keep

the most promising girls for Professor as he is

beginning a new course of lectures, and admitting a new-
set of pupils to his clinic to be taught by himself and
his assistant; there is no directress living with them;
Signora X. is nominally such, but she is not a nurse, and
only gives the moral support of her presence at lect-
ures. . . .

December 12th.
A promising probationer, Signorina Bianca, has come ;
she is quiet and nice-mannered — shy of the patients, of
course; she has never been in a hospital ward be-
fore. I tried to make her feel at home — no attempt
at any nursing. ... As we left at seven, Sis-
ter M accompanying us through the wards, I felt the

girl was getting frightened ; we talked to her as she walked
between us, but unfortunately one of the big doors was
pushed open just as we came to it and the porters
entered carrying a coffin. I saw Bianca grow quite
white but said nothing; I put her in the tram and said,
"good-bye until to-morrow, " but my landlady is certain
she will not come again. Poor me . . .

December 16th.
Signorina Bianca did not appear. Later on came her
father with a note — she was too badly frightened — she
returned the muslin and the aprons; this is the end of
pupil number one.

December 19th.
Signorina Antoinette, a promising probationer, has
been accepted; she has a good manner with the
patients, is not afraid of them, and is generally self-
possessed. . . .

94 A History of Nursing

December 21st.
I had to talk seriously with Signorina Antoinette this
morning, as I found she was calling the servant for what
Signora X. termed "the menial services," and on my
refusing to allow her to do this, she frankly expressed her
objections to performing these offices. I told her the
nurse's code was to do everything in connection with the
patient herself, and nothing was "low" if looked at from
this standpoint, as the simplest things often ministered
most to his comfort. Her answer was that the educated
nurse should supervise, but that servants should do the
rough and unpleasant work. As this was precisely what
was taught at Professor 's clinic, I found it diffi-
cult to convince her that the theory was wrong. In
fact, I see that it will be all but impossible to prevent
the servants from doing these things, which, from the
Sisters never doing them, have earned the reputa-
tion of being low . . . but which evoke the patient's
gratitude (and tips).

December 30th.
Signorina Antoinette told me to-day that she would
never dream of nursing, if she were not compelled to seek
the most paying profession open to her, and she was told
that it would be far more profitable than mending old
lace; — this was depressing, but her truthfulness pleased
me. She is genuinely good, doing whatever she does so
conscientiously; still, after this wet-blanket on my hopes
for a disciple, I was quite moved by an English girl
telling me, coming out of church, that she envied me
profoundly, as nursing was the one thing she had always
longed to do. This comradeship in feeling was very
consoling; no one else, so far, quite understands my
caring to nurse, and I fear that most people find me very
tiresome for asking their help in inducing others to share
the strange privilege of doing so.

Italy 95

December 31st.
Signorina Antoinette took fright this morning at a
suspicious throat case . . . and came to me after rounds,
saying she could not conscientiously stay. . . .

February 17th, 1895.
Donna M. and I have prepared an article on the nurs-
ing question for the March number of U Ora Presente;
we treat of the need of more intelligent nurses, and of
opening a new profession to educated girls, who, at
present, clog the teachers' market.

April 25.
We had a meeting to discuss rules for the Scuola
Infermiera. The whole matter is extraordinarily com-
plicated. I am feeling the keenest sympathy for the
man in the fable who spent his life in getting on and off
his donkey, in his attempts to satisfy the moral scruples
of his friends!

April 30th.
One of our committee ladies has been to see Signora
X., and came back quite depressed over the nursing
question. The danger of contact with the doctors is
what troubles them. It seems that in the Bologna
secularised hospital there have been very unpleasant
scandals. ... I, of course, listen to these disasters as to
signals, showing the need of avoidance of any semblance
of lightness in our pupils . . . and also as proving the ne-
cessity of the power of dismissal being in our own hands.
... I always feel that the sense of proportion needful in
guiding others consists in drawing the line justly between
the "not leading into temptation," and the "trusting
men, that they may show themselves true. "

May 7th.
Our rules are made out at last. The pupils have still

96 A History of Nursing

to be found, but we have had the following notice put in
the papers: "School for Nurses: A committee has been

formed of the ladies aided by Senator and

Professor with the object of founding a school for

nurses for private cases. With the kind permission of
the Director-General of the hospitals, the instruction will
be given in one of the Roman hospitals under the super-
vision of the sanitary authorities and the Sisters, accord-
ing to the rules of the institution. The course of
instruction will be theoretical and practical and will last
two years" (the usual requirements and regulations
followed) . As we cannot offer the pupils either board or
lodging, or salary whilst training, . . . and as we have
had to settle that the pupils should work only half the
day so as to leave the other half for home duties or
whatever way of earning they are accustomed to, we
consider the two years the lowest possible minimum.

August 31st.

I am spending a night in Rome so as to have a visit

to our rive pupils. ... I went to the hospital at ten . . .

they seemed happy, and told me they liked nursing, and

were fond of the nuns and the patients. ... It was

satisfactory to hear from Professor that all had gone

well . . . that they were good girls and the nuns found
them intelligent and willing, while the patients were
always singing their praises.

January 21, 1896.
I shall now keep the pupils with me, teaching them
how to bathe under blankets, change, move, etc., without
exposing the patient. At present I am to have a room for
these demonstrations; later I trust there will be no diffi-
culty about my showing the pupils in the wards what to
do and making them responsible for doing it with special
cases. The wards are huge and often overflowing; the

Italy

Suore and servants overworked, so that we can really be
of use and comfort, if only the oft-prophesied feelings of
distrust and jealously can be avoided.

January 26th.
At 8 a.m. the professor and house doctor went the
rounds with the Suore and two of our pupils. Sister M.
Cristina, the head of this ward, is such a sweet woman;
I am thankful we are to work first in her ward. The pro-
fessor told her he would like her to put beds in my hands
for teaching the pupils, and she was quite pleased and
anxious to give us the worst cases, saying, "then they
would have more constant attention. " That is the true
nurse spirit . . . We have two pneumonias, one obscure
fever case, and one obscure, without fever. The ward is
very heavy, and one can't help seeing, after English
wards, that want of system in several respects makes it
heavier. It is painful, too, that backs are not rubbed or
hair combed except once a week, and consequently bed-
sores and lice are more or less taken for granted. What
is well done here is the administration of medicine. The
patients do not take it themselves, as in many hospitals,
but it is kept on a neat little tray and carried around and
given by a Sister at the proper hours.

February 10th.
It is rather serious lecturing to pupils who have no
sense of humour. In telling them the other day of the
nurse's need of persuasiveness and tact, I mentioned the
very disastrous habit of allowing a large number of
persons to be in the patient's room . . . adding at the
end of my remarks that, if doctors were in question, the
nurse could not make any suggestion but could only pray
they would go away. One of my pupil's notes, handed to
me for correction, read: "It is very harmful to have too
many persons in the room, but if they are doctors, the

98 A History of Nursing

nurse shall not make any observation to them, but shall
pray to God that they may leave !" Regarding a matter
I have most at heart, they all seem to understand: I
mean the sacredness of what nurses see and hear when
people are in trouble. . . .

March 226..
We have got leave to wash our patients. ... I spoke
first to the chief, who was delighted, then to the inspec-
tor, who was also quite in sympathy, and told Sister M.
Cecilia to provide basins, rubbers, and soap. This she
smilingly did, and we began this morning — cautiously,
lest some be alarmed and object. But no one made
difficulties, and most were touchingly grateful. One
poor old man did at first refuse, but when asked for the
reason he explained that he was ashamed, as he had been
ill for many months and his feet had never been washed.
. . . Those who were up helped to change and fetch water,
and the whole scene was most cheery and friendly. We
gave only two real "bed-baths, " as there were a hundred
patients, but we washed the feet of the bed-patients of
one-quarter of the ward.

April 25.
The first year's examination is over . . . the aptitude
and trustworthiness of our pupils make us quite happy
and hopeful of their ultimate success.

The time had now come for Grace Baxter to enter
upon the scene. The harmony of the sequence of
events in her career, by which she was unconsciously
prepared for her life-work at the very moment when
it was ready and awaiting her, has been reflected in
the unwavering fidelity and efficiency that she
brought to it. Miss Baxter was born in Italy, and
had lived her life there up to the time when she came

Italy 99

to America for training; she was, therefore, in one
sense, an Italian. Her parents were both English,
scholarly, literary, and idealistic ; x loving Italy as the
English of their type do, their home was in Florence,
where Miss Baxter grew up. The writer knew her
well in the Johns Hopkins Hospital during her train-
ing : a serious, lofty-minded, most simple and direct
nature, completely averse to all sham and pretence,
very quiet as to her opinions, but of great independ-
ence of mind, holding views on the great funda-
mental questions of life that were untrammelled in
their natural strength and freedom. Hers were high
standards of daily living, based upon truth, justice,
and a great compassion for humanity. Immediately
upon her graduation she left the Johns Hopkins and
sailed for Naples, where her work lay in the large
public hospital called the Gesu e Maria, a beautiful
old pink and yellow stucco building, with large
cloisters and gardens. The wards are old-fashioned
but pleasant. Her residence was in a little house on
the domain of the school for girls already referred to,
which had been established in wonderfully beautiful,
picturesque old convent property, built upon a
series of terraces with bewildering gardens, corridors,
cloisters, and salons that lent themselves perfectly
to their new uses.

This girls' school, the most complete and progres-
sive educational institution in Italy, had been called
into being by the Princess Adelaide di Strongoli, lady-
in-waiting to her Majesty Queen Margherita, and
one of the really great educationalists of her day. A
fearless woman and untiring, far-sighted worker, her

1 Miss Baxter's mother wrote under the name " Leader Scott."

ioo A History of Nursing

devotion to the cause of practical education led hel
to become the first patroness of trained nursing in
Italy, and it is certain that without her firm support
and steady financial backing the Blue Cross Society
(the name given to Miss Baxter's nursing school and
its graduates) could not have existed. In personal
service, too, the princess has won her laurels, for in
1884 she received the gold medal for active assist-
ance in the great cholera epidemic.

Miss Baxter's entrance into the routine of the
hospital was effected very quietly. There were local
reasons why the nuns had given up the management
of certain divisions, and in these she began the new
order. Probably no one with a less complete arma-
ment of weapons in her perfect knowledge of Italian
characteristics and customs, and her own heredity
and training, could have maintained this position.
It was so unusual to see a woman who was not a nun
in a public hospital, that even some of the medical
staff mistook her motives, and had to be assured that
she had come there for work and not for frivolity.
In the director, however, she had from the outset a
chivalrous, old-school, fastidiously honourable chief
and ally, whose support meant everything to her.

Miss Baxter's letters to America told some of the
incidents of her hospital work and the often amusing
obstacles to progress:

OSPEDALE CLIN1CO, NAPLES,

January, 190 1.

Have I told you how I started my school with three

nurses, one of whom soon left, while the other two were

so well satisfied with themselves that they sailed through

their ward work superciliously and listened to my

■^

Grace Baxter

Superintendent, Blue Cross Nurses in Naples

Italy 101

theoretical lessons with a scarcely veiled smile of pity at
the idea of my taking so seriously what appeared to them
elementary knowledge? I had not at that time an official
position, which made my humiliations all the harder
to bear. The revolution took place during my summer
holiday ... a new set of doctors were elected, who
knew me and upheld my authority. I was now officially
accepted as head nurse of — nobody knew exactly what.
My position grew of itself, and I have crept up by slow
degrees, gaining or losing ground according as I have won
or lost the innumerable little battles which I fight every
day. . . . My subordinates are the cross of my life, although
we are excellent friends, because they do not and never
will understand so much as the elements of discipline.
When I returned to Naples in September, I found that the
Princess of Strongoli had been busy all the summer pub-
lishing articles and getting up new subscriptions: the
result was that there were fourteen new pupils waiting
for me besides the three who had begun in June. Of all
these, ten have just passed their junior examinations. . . .
Lest I be accused of deliberately departing in my sys-
tem from the time-honoured methods of alma mater,
let me protest that to make any way at all I must insert
the thin edge of the wedge and not the thick one. Any
other course would most assuredly end in my offending
irrevocably the customs and prejudices of the country.
After much discussion among themselves, my suggestions
being waved aside, the staff made out a programme of
theoretical work. It was decided that there should be
an hour's lecture given daily to the nurses by the phy-
sicians, the first-year subjects being anatomy, physiology,
hygiene, surgical and medical pathology; the second year
gynecology and obstetrics, diseases of children, first aid
to the injured, diseases of the eye and ear, and dietetics.
On discussing the position of my pupils, the Blue Cross
Nurses, as their official title runs, I could not obtain the

102 A History ol Nursing

dismissal of a single one of the existing "servant- nurses. *
The result is that my pupils' ward work has never been
anything but voluntary, for, if they do not perform the
duties required by the patients, there is someone else
there to do them. . . . My pupils come on duty at
eight A.M., coming in from their homes, wherever they are.
They do ward work and make rounds with the staff until
eleven, when the lecture is due. When this is over I go
over the lecture of the day before with them, explaining
the difficult passages. We then return to the wards, and
between two and three p.m. the pupils leave the hospital
and return to their homes. . .

Perhaps you will realise what is required of me when
I tell you that no nurse is allowed to remain in the four
wards unless I am walking the hospital and making
myself as ubiquitous as possible. If I go upstairs to
lunch or to rest for more than a few minutes, I must
collect my flock, no matter what they are doing, and
take them with me. After the pupils have gone home,
I spend the afternoon and evening in writing up the
notes of the lecture for them to copy. Though they are
fully up to the standard of the average English girl in
social status and refinement, they are too inexperienced
to take down correctly the scientific and technical lect-
ures, and this is better than revising all their written
notes. At the beginning of the year, I wrote out a
programme of the subjects I considered indispensable for
nurses, copied from my hospital notes. The chief, whose
ideas on nursing matters do not differ greatly from those
prevalent in English hospitals, agreed with me. The
lecturers, however, enlarged a good deal on theory and
technicality. In the course of the year they have
realised that we need simple facts.

I put my nurses into uniform in February. The
material is rough gingham, striped blue and white, with
turn-down collars, high white aprons, and hemstitched

Italy 103

half-sleeves. Caps would have been against the ideas of
propriety here, and I did not suggest them.

With regard to ward work : during the first few months,
not having any graduate nurses to help me, I was obliged
to leave three out of the four wards to the servants, and
give my practical lessons in the fourth. After six
months' training I was able to place the pupils in charge
of the wards, always of course under my direct surveil-
lance, and the results have been such that the ward
physicians are fully persuaded of the value of our school.
The nurses take temperature, pulse, and respiration, do
up the bed patients, and wash and comb the others,
catheterise and give douches, prepare for surgical rounds
and medical emergencies, assist at operations, distribute
medicines, and give hypodermics. What they do not do
I will try to explain. They are not allowed to make
temperature charts, lest they should presently usurp
others of the doctors' functions, but I have taught them
unofficially to keep special charts of interesting cases.
They may not make beds in the morning except for regu-
lar bed patients, bed-making time being four p.m., and
not every day of the week either. In the men's wards
the servants are forbidden to turn the mattresses except
on Thursdays and Sundays, though the sheets may be
changed several times a day. There are two reasons for
this extraordinary regulation : first, the floors are washed
daily at five a.m. by the servants and any subsequent
bed-making would nullify their work, sweeping being also
prohibited ; second, there is so much phthisis in the ward
that it is inadvisable to make much dust; for the same
reason sheets may not be shaken out in the ward.

Bed baths are permitted in theory, but merely tol-
erated in practice. For this reason I have to get them
done in the early morning, before the director and the
ward doctors appear, lest on some inauspicious day they
be prohibited altogether, and this in the women's wards.

104 A History of Nursing

In the men's wards, although I myself might bathe any
patient, the permission is not extended to my nurses,
who may only wash the men's faces and hands. The
general ablutions are entrusted to the servants, who take
advantage of the loophole of escape and bathe none.
Nor can I insist. Diets are entirely out of the province
of the nurses except in the matter of feeding helpless
patients, and under no circumstance would they be
allowed to enter the kitchen. Before the training is
finished they will go through a course of cooking, but it
will be outside the hospital. . . . The ward cleaning is
done by the servants, of whom there are three to each
ward. Their business is to keep the place dusted,
washed, and burnished, and I must say for them that,
with due allowance for circumstances, they do their work
well. The director does not wish the nurses to interfere
with this part of the work as a rule, so that they only do
so in exceptional cases. I feel the less troubled about
this, as all my nurses are taught at home to do housework.
The disinfection of utensils, linen, etc., and the sterilisa-
tion of nozzles, instruments, etc., is entrusted to the
nurses.

Medical rounds are carried on in a very delicate man-
ner when we are present, a feature due to the refining
influence of the chief. Even in the men's wards there is
nothing which could shock the most puritanical mind, so
that the pupils' parents, who at first stipulated that their
daughters should nurse only women, now prefer these
wards to the others. The only difference in the system
of rounds here from that familiar to other nurses is that
the ward doctor's assistant, instead of the head nurse,
takes down the orders. T . . .

To illustrate further the difference in social customs
in Italy and America, and the influence which they exert
on hospital life, I will mention that during the year I have

1 Foreign Department, A. J. N., March-July, 1901.

Italy

105

had to deal with two love-affairs between nurses and
doctors. Now this may seem of no great importance to
Americans, but in our case the incidents nearly wrecked
our fragile bark. It is significant of the opinion in which
love-affairs are held, when not carried on under the direct
aegis of the parents, that the director, when he heard of
them, behaved as though the affairs had brought dis-
honour on the whole institution. It was with the very
greatest difficulty that I persuaded him not to discharge
the entire staff of medical assistants, twelve in number,
for the offences committed by two only. My pupils
being very young, I honestly believe them not to have
been so much in the wrong as the doctors who had dared
to admire them from afar, but I could only save them by
keeping them out of the way for days after, and as it is,
they must take the lowest rank for months to come. You
will have realised by now that since the feasibility of a
"lady nurse" remaining unchaperoned in the wards is
denied to us in the first place, there are greater difficul-
ties in the way of conducting the work of the hospital
with trained nurses of the educated class than at first
appear. I confess that I do not yet see my way through
it. A few love-affairs of the kind mentioned, though
innocent enough in Anglo-Saxon countries, would in
Italy ruin a serious undertaking such as ours, to its very
foundation. . . .

Our school is growing slowly but surely, and has come
to be looked upon as one of the institutions of the city,
so that only last week we were asked if we could under-
take the nursing of the big hospital for incurables. Un-
fortunately our number is too small for such a colossal
undertaking and we have had to give up the idea for
the present. . . . Now that our position is assured, we are
able to choose our nurses from respectable middle-class
families, but owing to our exclusiveness we cannot for the
present get as many as we need. ... In the hospital

106 A History of Nursing

where we were once despised and ridiculed we are now
appreciated and sought after. When two new wards
were opened last month the chief, Professor d'Antona,
requested me officially to let him have enough nurses to
run them, and his assistants were even heard to say that
they could not be opened without us. We have now
one hundred and ten beds. Another very satisfactory
incident was the request of Professor Bianchi, one of the
greatest neurologists of this country, for two nurses to
take charge of the clinic for nervous diseases just opened
at S. Andrea della Dame. They were duly installed and
are working satisfactorily. Seven of our graduate nurses
are in positions as head nurses in this and other hospitals.
Many more could be so placed, but the salaries offered
are ridiculously low. The nurses have more work
offered them than they can do."1

Only a few years later the Blue Cross nurses were
firmly established. They spent the full day in hospital
instead of a few hours ; were in charge of seven instead
of four wards, and in the children's took the entire
service both day and night; wore uniform and cap
and were no longer expected to be chaperoned, but in-
stead held head-nurse posts in a number of hospitals.
One went to Rome to the new school as head nurse
of the operating rooms, and for a long time they had
carried on the work of a small dispensary for anaemic
and rachitic children in Naples that was supported
by voluntary contributions. Among those who first
stood alone must be mentioned Signorina Tonino,
who pioneered in Rome before the new school was
opened, helping Miss Turton with her little group
of pupils in San Giovanni. Her work there was aided

*A.J. N., June, 1903.

Italy 107

and watched over by the Princess Doria, in the very
wards where an elder princess of that name, several
generations earlier, had founded the hardworking
and practical order called the Sisters of Mercy. Nor
would the sketch of Miss Baxter's surroundings be
complete without a line for Signora Adelaide Pagli-
ara, the secretary and registrar of the Blue Cross
Society, the strong, practical, gifted friend and ally
of the school and its pupils, whose encouragement
often revived hope and chased away depression.

The growing interest in skilled nursing undoubt-
edly received a great impetus from the meeting of the
First National Congress of Italian Women which
took place in Rome, in April, 1908. This was a
stirring and most important gathering, attended by
over a thousand women from all classes and parties,
where every detail of the modern social structure in
its special relation to women, and every aspect of the
status of women as related to the progress of the race,
were discussed with earnestness, brilliancy, and learn-
ing. The nursing question was taken up at one
session, but, regrettably enough, the organisers of
the congress did not secure the presence of nurses
themselves upon the programme. It is a pity that
Miss Turton, Miss Baxter, and Signora Celli had not
been persuaded to report upon the work of nursing
in Italy.

Nevertheless the papers read were of great in-
terest and value. Signora Sciamanna, of Rome,
an enthusiastic amateur who had worked in the
Roman hospitals as a volunteer, read the leading
paper stating the nursing case for Italy ; she described
the low plane of the injermiere and their defective

108 A History of Nursing

education, long hours, low wages, immoral ten-
dencies, and absence of discipline. She described from
life an incident she had seen, where the nurse, sup-
posedly remaining beside a dying patient to adminis-
ter oxygen, was in reality so absorbed in a trashy
novel that she did not notice when the patient ceased
to breathe. She advocated schools for refined women
to be annexed to hospitals, but showed her limitation
of ideas of a future for nursing, by contending that
nurses should be prohibited from joining leagues or
federations controlled by themselves. She had ar-
rived at this opinion by the fact that the oppressed
attendants had formed unions and resorted to strikes
in order to better their wretched economic con-
ditions. z

Professor Mengarini, a woman, spoke also on the
nursing question; she had little direct knowledge,
but took a larger view of human liberty and pro-
tested against its curtailment by the prevention of
self-governing associations.

A resolution presented by Signora Dacher closed
the discussion. It ran, in effect, as follows:

The Woman's Congress asks that there may be one
educational programme for all Italian nurses, to be ap-
proved by competent authorities, and that no one be
allowed to exercise the profession who does not possess
the diploma. The admission of candidates should be

xThe infermiere, long unorganised and defenceless, had finally
formed leagues for mutual support in the different Italian cities, and
by 1903 there were 29 such leagues united in an Italian federation,
having a journal called V Infermiere. In 1904 this body was strong
enough to hold a national congress in Rome. Through its efforts and
influence many improvements in the economic status of the attend-
ants had been brought about.

Italy

109

regulated by the same formalities as are in use in other
professional schools. The principle of equal pay for
men and women should be recognised.

We shall now continue Miss Turton's narrative,
which traces the steps finally leading up to the open-
ing of a model training school in connection with the
Polyclinic Hospital in Rome.

The following years held attempts in Rome and in
Florence which bore fruit very incommensurate with the
efforts made by friends and patrons, but which brought
Princess Doria always more and more with heart and
soul into the crusade. Few girls were found to risk the
chances of success, when we had no home and no pay and
only insufficient training to offer them. But enough did
come forward to prove their aptitude and keep the ball
rolling, and the Casadi Cura1 episode in Florence, where
six or seven Italian nurses cared for private patients with
some help from English nurses and from the Blue Nuns
(the most sought-after private nursing order), leaves
memories of many happy hours. But the hospital reform
was still in abeyance and time was going. A friend offered
money to start a training school in some hospital, and
Bologna nearly accepted, but a tragedy in the Pro-
fessor's family closed that door. A scheme to run a

1 The Casa di Cura, a private nursing home, was one of the
creations of Miss Turton's executive energy, and a notable success.
In the midst of her other undertakings, she also found time to pro-
ject, plan, and build a sanatorium for incipient tuberculosis cases,
the first in Italy. It is near Florence and accommodates eight girls
or women. She began raising money for it in 1902 and it was opened,
with a nurse in charge, in 1904, turned over later to a society founded
to aid incipient cases, and is now nursed by nuns. It was described
for the International Tuberculosis Congress in Washington in 1908.
See Transactions; also American Journal of Nursing, November,
1908, p. 124.

no A History of Nursing

private hospital in Rome was next brought forward, and
a shareholding company formed, but the speculative
spirit swamped the original plan of balancing paying and
free patients, a school being impossible with only the
former. It was fated that this door also be closed, and
the building was sold before completion.

New elements had now come into the campaign.
Signora Maraini Guerriere Gonzaga, wife of a member
of Parliament, absorbed the fundamental principles of
pioneer reform, and became the Voice which we had all
along needed. Italian, she knew the standpoint of her
compatriots ; in sympathy with the Princess Doria, Miss
Baxter, and myself, she gradually became the handle of
the wedge, inserting it with such enlightened intelligence
that the Polyclinic doors were finally opened to a real
training school. But this did not come about directly .
There was first an attempt, after the Women's Congress
and Signora Sciamanna's speech on nursing, to start a
school in connection with the Cliniques, the Matron and
pupils living in a house near-by. The project was neve?
a satisfactory one, as the Matron would not have had the
nursing organisation nor oversight of the wards entrusted
to her, but only the teaching of the pupils within the
school.

[In the medical Clinique Signora Celli is head and
in the surgical there was, before her remarriage,
Signora Sciamanna, each having her own paid staff
of nurses.]

Pupils living outside with a third Matron would
thus have been too literally outsiders, with insufficient
responsibility. Difficulties closed this doorway also,
then a sudden inspiration seized Princess Doria and Mme.
Maraini: "Let us make a desperate effort to get a real
hospital block to nurse, — Professor Bastianelli's, — and

Italy in

get a nurses' home somehow in the Polyclinic. " It was
only one year ago that this plan came into being. Talked
of in March, when the earthquake excitement had sub-
sided a little, pushed, guided, lifted, dragged, — it was
finally accepted by Queen, Government, and hospital
authorities, the ground chosen, the plans drawn, and work
begun by the end of June. During the summer the little
Home was hurried forward, and on the 28th of February
Miss Dorothy Snell, Miss Reece, and I entered it. Per-
haps the most remarkable feat accomplished by our
committee was in securing the acceptance of a foreign
staff as teacher nurses. As soon as Italians can be
trained to replace the English contingent they shall
assume the posts. The staff, however, does include one
Italian, Signorina Sciarrino, who was trained in Buffalo,
New York State, and took post-graduate work in Bor-
deaux with Dr. Hamilton. The nuns remain in charge
of household administration.

The English Matron, Miss Dorothy Snell, has been
described as "a woman of great power, intuition,
and intelligence; very spirituelle and diaphanous in
appearance, but with an iron will — a born leader."
She and her assistants made a success of their work
from the first. Miss Turton lives in the school as
one of the faculty — a sort of fairy godmother whose
wand will ward off harm. In a letter to England,
she described the auspicious opening of the new
regime.

Roma, April 17, 19 10.

Fourteen days ago the little band of pioneer nurses,

with their first ten Italian probationers, took over the

nursing of the first surgical pavilion here — a small

beginning, seemingly, but one which we believe will have

ii2 A History of Nursing

wide-spreading results, and is consequently worth what-
ever it may cost in effort. The fourteen days and nights
have been strenuous, physically and mentally. Five to
eight operations on alternate days, dressings of the ma-
jority of the seventy-five patients and " specialing" opera-
tions and hopeless cases have proved the need of an
ampler staff, and Miss Conway has come on from Bor-
dighera (kindly spared by Miss Bryant),1 and Miss Beau-
foy is starting from London, to aid with hands, minds, and
tongues (they speak Italian) in the "great endeavour."

It is difficult to give details of the work — of what is
being reformed, for we are, in a way, guests in a foreign
land. We want to help, not to criticise. Years ago
Miss Nightingale wrote me, when I returned to Italy
after my year at the Royal Infirmary, Edinburgh:
"Patience and prudence, as, e.g., not extolling English
things to Italians, or saying, 'I do so and so in Great
Britain.'" Theoretically speaking, this standard is the
only one compatible with courtesy; but reformers cannot
always wear velvet gloves. Much must be wrestled
with, much uprooted, only we should always aim at
doing silently. And consequently it is not an easy
matter to write anything that is really true all round.
Another saying of Miss Nightingale's often comes back
to me. A year later, when I was going to Naples, leaving
our first Roman pupils to the nuns at S. Giovanni, she
wrote to me: "I am sure you will remember it is only
personal work that can do things. Stand your ground
and kiss your enemy's nose is one of the secrets of life.
... A large Tom cat of mine came into the room and
ran at my two little kittens. The larger and handsomer
kitten ran away. The smaller stood her ground till the

1 Miss Bryant, a young English woman, had been trained in
Bordeaux at the Protestant Hospital and did much to aid the
Italian movement. She also gave Dr. Hamilton an endowment
for her training school.

Dorothy Snell

Superintendent of Nurses, Queen Helen's Training School in Rome

Italy

113

big Tom cat came quite close, and then she kissed his
nose and made peace. Now take up your ground, my
dear Miss Turton, and stick to it. . . . Go on persever-
ingly and prosper." For all of us these are words of
really inspired wisdom. If even half of us really succeed
in living them, success will be a certainty, nay, since our
leader does live them, even one- third of us, by following
her, will ensure victory. "Hold your ground, but kiss
your enemy's nose." A smiling insistence of attitude,
in other words, whenever certain that the point to be
gained is undisputably right.

The first point thus gained, I think, was — screens.
In our hospitals here such "luxuries" are obtainable
only (and not always) for the dying. But the first pavil-
ion now possesses scarlet twill screens, a vivid note in the
colourless wards, and one which, with the really charming
green and white frocks of the probationers makes up the
red, white, and green of the Italian flag. The first
corollary of screens, systematic washing, is an innovation
which is almost invariably appreciated. The routine
evening, "face, hands, and back washing" cause grati-
tude and surprise. The first night drew forth the remark
from the Suora in charge, "How quiet the wards were!
no one seemed to ring. " And the cure amorose of the new
nurses seem to make even deeper impression on the
patients than their skill. The real nurse touch, voice,
and manners are a revelation, even when the words are
limited by being in an unknown tongue.

Already patients are leaving off calling perpetually
for attention; they have learnt that everything will be
done for them in due time — that ought to be done — and
without ' ' the hateful tip ! " x

In 1908, Signora Celli contributed another valuable
study of hospital conditions and schools for nurses,

xThe British Journal of Nursing, April 30, 1910.
vol. iv. — 8

ii4 A History of Nursing

called "Per le Scuole delle Infermiere" to the Nuova
Antologia for October. The year of her inquiry
was 1902. Of 1 24 1 hospitals, 429 were staffed solely
by secular (untrained) attendants; 112 were nursed
solely by nuns, while 696 had a mixed staff. [The
other four were in charge of monks.] The number of
nurses to this list of hospitals was: secular 8380
(4613 men and 3767 women), and religious 4313.
Of these, some seventy were monks and all the rest
nuns. Signora Celli showed that forty per cent, of
the personnel in question were in religious orders,
this percentage having risen by ten per cent, in fifteen
years. As only ninety-three of these hospitals were
bound by bequests or conditions, it was clear that
they preferred the nuns. Their discipline was best;
they were a superior class of women, and they cost
the hospital least; even the secular servants cost
more, while nurses of course were the most expen-
sive to the administration.1 She found admirable
exceptions to the usual low standard of nursing in
the work of the Sisters of Mercy and the Suore delta
Sapienza, but emphasised the absolutely unhygienic
conditions of the Sisters' lives. She referred to a cir-
cular written by Pope Pius X. in 1906, in which he
invited nuns to come in turn to a school of instruc-
tion founded under his auspices in Rome, and coun-
selled them to lay aside artificial modesty and learn
to be efficient nurses. Some orders could not, be-
cause of their rules, follow his counsel, but others
were doing so, and were taking instruction from the
professors of the university. Signora Celli showed a

1 According to an official inquiry of the Minister of the Interior, a
nurse costs the hospital 505 lire, a servant-nurse 463, a nun 446.

Italy and Spain 115

marked reform in the hours of hospital work — her
earlier statistics had been useful. She advised a
complete separation of nurses from servants, inde-
pendence of the ward staff from religious rules, and
urged the abolition of the male officials who now
supervise the nurses, and the appointment of trained
directresses and head nurses, leaving the nuns in full
charge of the general administration and household
economy.

Miss Amy Turton has also treated the question of
organisation in an open-minded paper, in which she
said:

Such facts [the figures cited by Signora Celli] seem to
prove the folly of even contemplating a general laicisation
of Italian hospitals, whilst my experience of some fifteen
years convinces me that, should it be possible, it would
be the greatest of disasters. For, without going into
psychological and racial considerations, it cannot be
denied that hitherto a large proportion of altruism has
been absorbed by the religious orders, and in consequence
it would need a generation or two to produce in sufficient
numbers women who would devote themselves, their
strength, intelligence, and feeling, to the service of the
sick, without any impulse given by religious belief.

Should, therefore, the seemingly impossible happen,
and Italy exact the suppression of religious nursing orders
in public hospitals, we should undoubtedly find ourselves
deprived of the very element we most desire for pupil
nurses, since the odium attaching to those who replaced
the Sisters would cause even the most liberal Catholics
to hesitate before casting their lot in a camp which
would be designated "atheistic" and "freemasonic."
The question would inevitably fall into the domain of
politico-religious conflict, and the cause of nursing

n6 A History of Nursing

would be grievously damaged or delayed. We would,
therefore, proclaim from the beginning our desire that
the nursing question should remain entirely outside all
political or religious parties. That our object is solely
that of helping to provide what modern science recognises
as needful in nursing patients, either in or out of hospital
— in other words, the formation of the competent trained
nurse. Whether she be nun or secular should be a ques-
tion of individual choice with private patients, and of
the majority in public hospitals. Briefly, nursing, like
medicine, should be recognised as a non-confessional
profession. . . .

The conclusion to which I come is, that hospitals in
those towns desirous of bringing nursing up to date
should start training schools on one of the following
lines: (a) Hospitals which open training schools to lay
and religious pupils, (b) Hospitals which confine the
nursing entirely to a lay staff, retaining the Sisters only
for economic and spiritual departments. In each type of
hospital the standard of nursing to be identical, and
eventually to receive government recognition. In those
of type (a) the nuns and lay pupils would frequent the
same two years' courses of lectures, adopt the same
modern systematisation of ward work, and pass the same
examination to obtain the same diploma. After two
years from the opening of these training schools only
those nurses who gained the diploma, whether nuns or
lay, would be eligible for the posts of head nurses. In
both types of hospital the present staff of servant-nurses
would cease to exist. Those who possessed sufficient
education and aptitude for the higher training would
enter as pupil-nurses of the new school. The others
would compete for places as ward-maids.1

The year or more that has elapsed since the auspi-

x Reports, International Congress of Nurses, London, 1909, p. 53.

. ' *■ ■

Italy and Spain 117

cious opening of the new school in Rome has brought
only added encouragement. Its roots seem to be
well set ; the day is probably ripe for the permanent
success of a new era in the beautiful hospitals of Italy.
Already there are intimations that Florence may
follow the example, and two charming Florentine
nuns have appeared in the wards cared for by the
nurses of the Scuola Convitto Regina Elena.

Spain. — Spain must be numbered among those
countries where the idea of modern nursing is least
comprehended, as evidenced by the story of a travel-
ling American nurse, who was obliged to introduce
herself as a "doctress" when visiting Spanish hospi-
tals, as no one knew what a nurse was. Yet there,
too, the first ground has been broken, and in the
"Rubio Institute" near Madrid a school for nurses
was first opened and for a time throve under the
care of a German Sister, a member of the German
Nurses' Association.

The Institute was the creation of Dr. Rubio, who
was a many-sided genius, far-sighted, benevolent
and genial, besides being the most progressive and
scientific surgeon in Spain. He effected a revolution
in Spanish surgery, and was the first to perform there
many well-known and important operations. The
Institute, for which he obtained funds by a public
appeal, is a unique establishment, being actually a
small republic in its government. All the beds are free,
and the patients' friends and relatives have the stand-
ing of guests. While the Institute beds are largely
surgical, a circle of "polyclinics" attached to it give
general training as well as study of varied specialties.

n8 A History of Nursing

In 1896, Dr. Rubio first undertook developing a
school for nurses, and named it after St. Elizabeth
of Thuringia. Genius though he was, the rules and
organisation of this school were as extraordinary as
could be imagined. The pupils first taken were
from a lowly and uneducated element, and, as there
was no compulsory free schooling to be had, they
were positively illiterate. Undismayed by this,
however, his intention, buoyed by enthusiasm, was
to give them a thorough professional training in two
years' time. Perhaps to banish all coquetry from
their minds, perhaps also from motives of convenience
and cleanliness, the nurses were made as hideous as
possible. Their hair was shaved off, and dark purple
woollen hoods, made with earflaps and trimmed with
yellow frills, were set upon their heads. The uniform
was a dark blue striped cotton of shapeless cut, and
on the breast was worn a large cross in yellow linen
with the name of the school on it in purple letters.
A white apron was worn with it, and winter and
summer the nurses had no stockings, only sandals
on their feet.

The rules at the outset were exceedingly strict.
The pupils were neither allowed to make nor receive
visits, and the plan was to keep them so busy that
they should have no time for relaxation, which might
permit of gossip, or even of thought. Besides the
nursing, they performed all the work of the place,
cooking, laundering, and scrubbing. In order that
they should not become familiar with the patients,
their work was changed every eight days in a fixed
routine: kitchen, laundry, housework, women's
ward, men's ward, eye clinic, ear clinic, general

Italy and Spain 119

clinic, operating rooms, and then beginning again
with the kitchen. Even the directress, who, at first,
was selected from among the staff, was changed in
the same way every eight days for some time, but,
the impossibility of this arrangement doubtless be-
coming apparent, she was left for one month, then
for three, and later for a whole year, in her post.

The first directress to receive a salary was Donna
Socorro Galan, who brought about considerable im-
provement in the domestic management. To her it
was due that cooks and laundresses were installed
and the nurses relieved of so much of the labour.
She remained for about six years in her position, and
during the latter part of her administration the train-
ing period was lengthened to three years and a sum
of money awarded to pupils in the final year if their
conduct had been meritorious. The hours, however,
retained their mediaeval and inhuman stamp. The
nurses were on duty from 5 a.m. until 9, 10, or 1 1 p.m.
with scarcely time enough even to eat their meals
in peace, while night duty, falling every third or
fourth night, gave a stretch of from thirty-eight to
forty hours' continuous service. In addition to this,
if it was thought necessary to discipline or punish a
nurse, it was customary to extend this service even
further, or send her to bed without food. In all this
grotesque arrangement there was no intention at all
of cruelty, but, on the contrary, the most benevolent
disposition. It was simply believed to be the proper
thing. How the nurses survived is a miracle, and
that the patients did is even more remarkable, for
the wards were always full of fresh operation cases.

In 1 910, the Director of the Institute was Dr. Gu-

120 A History of Nursing

tierrez, physician to the Queen of Spain, and under
his rule (through the Queen's influence one can hardly
doubt, though there is no evidence) the harsh regime
was mitigated and an attempt made to introduce
modern methods. Dr. Gutierrez now called to the
position of Directress a German lady resident in
Spain, who had taught in Madrid for a number
of years and had also taken the Victoria House
training in her native city, Berlin, — Sister Marie
Zomak. Before entering upon the difficult work
of reorganisation, Sister Marie went to Bordeaux
to stay with Dr. Hamilton and Miss Elston and learn
of their experience and methods in an environment
similar, in some respects, to that she was about to
enter. She wrought great changes in the Institute
Rubio. The. hours of duty were remodelled, night
duty set for two weeks at once, with eight hours'
sleep for night nurses, and a day off at its termination.
The purple hoods were thrown away, and the pupils'
hair allowed to grow, white linen caps set on it, and
stockings put on their cold bare legs. A certain
amount of freedom under proper chaperonage was
provided, and visits from relatives allowed.

Of great importance was the perfected instruction.
Heretofore the training had all been practical, but
now theoretical teaching was given by Dr. Mut, who
not only devoted himself with unselfish energy and
without remuneration to his class work, but was also
an excellent and successful teacher.

Such changes could hardly take place in a conserv-
ative country without exciting intense disapproval,
and so it was in the Institute Rubio. All the more
conventional elements, including ladies who had taken

Italy and Spain 121

a philanthropic interest in the work, believed that
destruction was at hand, and Sister Marie passed
through a difficult time There was one episode,
indeed, which left her without any nurses except
two who remained loyal, but at that critical moment
the whole medical staff rallied to her side, and offered
their services to take any necessary part of the care
of patients. Sister Marie was on duty day and night
for some weeks, and not a patient suffered, nor were
operations delayed. A truce then followed for the
summer months, and there we leave her, knowing
that progress is an uphill path, leading through thorns
and over pitfalls.

CHAPTER IV

NURSING IN NEW CONTINENTS

Collaborators: M. Louise Lyman, Canada; Alice R»
Macdonald and Ellen Julia Gould, Australia;
Hester Maclean, New Zealand; Margaret
Breay, Africa.

Canada. — In making a study of hospital and nurs-
ing conditions throughout Canada, we are confronted
with a great difficulty — the lack of a general scheme of
vital statistics and reports. Statistics are provincial
records only, and are mostly recent and incomplete.
We have, to refer to, the decennial census which
takes us back to 1901 There is no Bureau of Public
Health, and the health agencies of the Federal
Government are scattered in the various departments
so that information relative to hospital or nursing
matter can be obtained only from individual sources
and research.

In the earliest days of her history and throughout
the French regime (1 535-1 759) , Canada was indebted
wholly to the religious orders which came out from
France for the establishment of hospitals and the
care of the sick in their homes. Some record of the
heroic and perilous lives of the hospitalises has
already been made in our first volume.

122

In New Continents 123

The early French hospitals of which we find au-
thentic records are, in chronological order, as follows:

St. Jean de Dieu, founded in 1629, or shortly after,
at Port Royal in Acadia (now Annapolis) ; no longer
in existence. L'Hdtel Dieu du Precieux Sang, at
Quebec, founded in 1637 by the Jesuits and taken
charge of later by the Augustinian nuns from Dieppe,
as related,1 is still in existence on its original site.
L' Hotel Dieu de Saint- Joseph of Montreal, founded
by Mile. Mance in 1642 and completed in 1644; still
in existence. The Hospital for Hurons, founded in
Sault Ste. Marie in 1642 by the Jesuits and nursed
by them until it was burned by the Iroquois in 1644.
L'Hopital General in Montreal, dating from 1688,
founded by the Sulpiciens and nursed by lay
brothers until 1745, when a new order, called the
Grey Nuns, founded by Mme. d'Youville, took
charge of the nursing; still in existence. L'Hopital
General of Quebec, built in 1621 by the Recollets
as a monastery and purchased from them by Mon-
seigneur St. Vallier for a hospital; given into charge
of Sisters from the Hotel Dieu of Quebec in 1692;
figured in the siege of the city in 1759, and still in
existence. Two that have ceased to exist are the
Hotel Dieu at Three Rivers, founded in 1697, by
St. Vallier and given to the Ursulines, and a hospital
at the Fort of Louisburg, founded in 17 16 or soon
after by five lay-brothers of Charite de St. Jean de
Dieu, who filled the offices of Superior, surgeon,
dispenser, nurse, and chaplain, respectively. The
annals of all of them are replete with accounts of
conflagrations, epidemics, and sieges. The Hotel

1 A History of Nursing, Vol. I., p. 369.

124 A History of Nursing

Dieu at Quebec was twice burned, the last time in
1755, when nearly all its original documents were
destroyed. The Montreal Hotel Dieu was destroyed
by fire in 1695, 1721, and 1734. The General Hos-
pital of the Grey Nuns in Montreal was burned in
1745 and 1765, and the Hotel Dieu at Three Rivers
in 1806.

Throughout the ravages of the Indians, the con-
stant warfare between the French and British, and
the many epidemics and plagues to which Canada
fell heir, these hospitals sheltered and cared for
the wounded and sick. Later, when, in 1775, the
Americans invaded Canada they figured as military
hospitals and barracks.

The hospitals under religious orders in the Domin-
ion now number about eighty-four, of which forty-
four are in Quebec Province, For the most part,
they continue along the lines of their original, con-
servative policies, yet the influence of the modern
spirit has not quite passed them by, for, within the
past decade, training schools for nurses have been
started in many of the Sisters' institutions and ex-
cellent nurses are sent forth from under their aus-
pices. The religious orders have greatly increased in
numbers in Canada, and their monasteries and
hospitals multiply as the population and opportu-
nities for them increase. It is, therefore, hardly
possible to obtain complete statements as to these
institutions and schools, but we shall presently make
some record of the most important.

With the settlement by the British, hospitals were
established under civil or military control, in the
more thickly populated districts, at shipping ports

In New Continents 125

and in towns along the waterways. Gradually the
hospital idea grew until now there are found hospitals
from coast to coast, not only in the cities and towns,
but throughout the country and sparsely populated
districts, along lines of railway construction and
in remote mining camps far north. Some three
hundred or more, exclusive of military, private, and
special institutions, exist in Canada, at our writing
in 191 1 , while the estimated total number of hospital
beds is fifty thousand. They are supported by
public and private subscriptions, aided by provincial
or municipal or county grants. Some are entirely
maintained by the province or the municipality.
Comparatively few have endowments.

A brief account of the more prominent hospitals
and training schools is all that we may attempt.

The first hospital, under lay management, was
founded in Halifax, in 1750. It stood back of the
present site of Government House, and, in 1766,
was granted to the city as an almshouse and used
as such until 1800, when it was torn down.

The first training school in Canada, that of St.
Catharine's, has been briefly described.1 It was
later given the name of its founder and called the
Mack Training School. This, the oldest school for
nurses in Canada, and one of the first on the conti-
nent, has been in existence continuously for thirty-
seven years, and is to-day one of the best known
of the smaller training schools. It has an atmosphere
of distinction and charm and is in every way a place
of dignified traditions. The early graduates were

1 A History of Nursing, Vol. II., pp. 354~355-

126 A History of Nursing

called "Sister'* and wore an outdoor uniform, but
both customs were discarded some years ago. From
the beginning the nurses had a separate home, and
were never housed in the hospital itself.

The first attempt to introduce trained nursing
into a large civil hospital was made in Montreal.
Quebec Province boasts in the Montreal General Hos-
pital the most important, historically, in Canada.
After the war of 1812-1814, and after disbandment
of the armies in 181 5, when Waterloo broke the power
of Napoleon and settled the peace of Europe, there
was a great influx of emigrants into Canada from
Great Britain and Ireland. The winter closing of
the great waterways prevented new arrivals from
going far west. Quebec, Montreal, and Kingston
were crowded with emigrants, starving, sick, and with
no means of support. To cope with the distress, the
Montreal Female Benevolent Society was founded
in 1 8 16. Through its efforts, in that year, a four-
room house was taken on Chaboillez Square and was
called "The House of Recovery.' ' The first phy-
sician in charge was Dr. T. P. Blackwood, a retired
army surgeon. In 18 18, a large house, capable of
accommodating twenty-four patients, was hired on
the north side of Craig Street, near Bleury, and was
called the "Montreal General Hospital." In 1820,
the land on which the front of the present hospital
stands was bought. (It was then called Marshall's
Nursery.) The corner-stone was laid June 6, 1821,
with Masonic honours, and the following year the
hospital was ready for use with accommodation
for seventy patients. In January, 1823, His
Majesty George IV. granted a Royal Charter. In

In New Continents 127

1866, the land opposite the hospital was bought and
the old buildings on it were removed.1

In 1822, a school of medicine was organised in
connection with the hospital and called the Montreal
Medical Institution. In 1828, this became the
Faculty of Medicine of McGill University. This was
the beginning of the university, and for some time
the medical faculty was the only faculty, was, in fact,
McGill University. The General Hospital, there-
fore, is intimately connected with and is virtually
responsible for the establishment of the university.

In 1 83 1, Montreal had thirty thousand inhabitants.
That year cholera carried off, in three months, one-
tenth of the population, and it was a busy time for
the hospital. In 1869, 160 cases of smallpox were
treated there.

In an address delivered to the Montreal General
Hospital Nurses' Club, December 6, 1905, Dr. F.
T. Sheppard, dean of the medical faculty of McGill
University, described thus the wards and nursing as
they were in 1867:

The wards were small and rather untidy, the nurses
were Sarah Gamps. Good creatures and motherly souls,
some, — all uneducated. Many looked upon the wine
(or brandy) when it was red. ... In those days, it was
with the greatest difficulty patients could be induced to
go into a hospital. It was the popular belief that if they
went they would never come out alive. . . . No records
were kept. The clinical thermometer had not come
into use; the patients had to look after themselves; fresh
air was not thought necessary. Armies of rats disported

1 The Canadian Nurse, March, 1906. "Montreal General Hospital
A Short Historical Retrospect." F. T. Sheppard, M.D.

128 A History of Nursing

themselves about the wards. . . . Instruments were
looked after by a man who assisted in the operating room
and at post-mortems in the dead-house. Nothing was
known of sepsis or antisepsis. Surgeons operated with
dirty instruments and septic hands and wore coats which
had for years been baptised with the blood of victims.

In 1875, the Committee of Management decided
to make a change for the better, and in the autumn
of that year Miss Nightingale, who was, of course,
consulted, and who entered most warmly into the
project, arranged for a lady superintendent, Miss
Machen ( a Canadian), one Sister, and four trained
nurses from the Nightingale school to go to Canada,
and they entered upon their duties with the good
wishes of the public and the hospital authorities.
The results attending this enterprise were at first
satisfactory, not only in the superior quality of the
scientific nursing, but in the influence and example
exercised by gentlewomen. Their moral influence
and 'dignified presence in such an undesirable com-
munity were not the least of the benefits conferred.
But, unfortunately, this advanced innovation was
doomed to failure, and, after difficulties, jealousies,
restraint, and much unjust public criticism, the hope
of establishing a training school was abandoned,
and, to the regret of their friends, the Nightingale
nurses returned to England. Possibly, had they
lived down the jarring notes and shown a little more
tact in dealing with a difficult problem, the result
of their advent might have spelled success instead of
failure.

Naturally, nursing affairs then took a retrograde
movement. After this attempt a matron who was

In New Continents 129

not a nurse was appointed to take charge of the
hospital, and Miss Anna Maxwell (later of the Pres-
byterian Hospital, New York) was placed in charge
of the nursing department. However, this arrange-
ment, never satisfactory, broke down. Miss Max-
well, finding herself thwarted in her work, returned
to the States, and the matron took entire charge for
a period of fully ten years, when, in 1889, she retired
because of ill health.

Under pressure from various sources the Commit-
tee of Management realised that they had reached a
momentous period in the history of the hospital,
and that, in order to keep in line with modern pro-
gress, it was necessary that the nursing be taken out
of the hands of the ignorant and uneducated and
given over to intelligent and trained women. Ap-
plications were called for from both England and the
United States for a lady superintendent — a graduate
from a training school in good standing. Many
experienced applicants for the position declined to
accept it when they fully understood the overwhelm-
ing difficulties to be combated, but it was finally
undertaken in January, 1890, by Miss Norah Living-
ston, an American, who had recently graduated from
the training school of the New York Hospital and
who brought with her two assistants, graduates from
her own school.

In December of that year the school was formally
opened by His Excellency, Lord Stanley of Preston.
The nursing department was soon in good running
order and the public recognised and supported the
nursing reform. In 1 891 , a class of five nurses gradu-
ated. Their names were Ellen Chapman, Georgina

VOL. IV. — 0

130 A History of Nursing

Carroll, Jean Preston, Julia English, and Christine
Mackay. In 1906, a preliminary course for pro-
bationers was established, one of the graduates
holding the diploma of Teachers College, Columbia
University, New York, being appointed instructor.

The next large hospital to reform its nursing was
in another and neighbouring province, Ontario. The
largest hospital in Canada is the Toronto General,
containing four hundred beds. Its history briefly
is as follows: In 18 19 certain lands in York (which in
1834 became Toronto) were granted by the Crown,
in trust to four persons for hospital and park pur-
poses. In that year appeared in the Upper Canada
Gazette the following notice :

Proposals for building by contract a Brick Hospital
in the town of York will be received at the Post Office, by
William Allan, Esq., where a Plan, Elevation and par-
ticular description of the intended Building may be seen
and any information respecting it obtained. Proposals
to be given in within one month from this date.

York, November 24, 18 19.

The original York hospital was built on King, near
John Street. In 1832, it was described as "in success-
ful operation and affording to the students daily
opportunities of observing diseases and their treat-
ment." In 1 847, an Act was passed incorporating the
Trustees of the Toronto General Hospital. Shortly
after 1847, the present main building on Gerrard
Street was erected. To it have subsequently been
added several additions. A magnificent new build-
ing being erected in the centre of the city, (191 2)
is to supersede the present building

In New Continents 131

The training school that it was proposed to es-
tablish had, like that of the Montreal General, an
initial period of distress. In the Canada Lancet,
July 31, 1877, we read:

It is proposed to establish a training school for nurses
in connection with the General Hospital, Toronto. Miss
Goldie, Lady Superintendent of the hospital, will assume
the management. She has had considerable experience
in the Franco- Prussian War and in British and Conti-
nental hospitals, and is, therefore, eminently qualified for
such an undertaking. It is proposed to take in about
twenty young women, and distribute them about the
wards of the hospital, where they will have to discharge
the duties of the nurses already in the place. The period
of residence will be about six months, and the fees will be
about fifty dollars for the period, including board and
lodging. Appropriate lectures will be given by medical
gentlemen of the city. Those wishing to enter should
apply at once to Miss Goldie.

It was not, however, until four years later, that
the training school in connection with this hospital
was really established. The nurses employed were
women of the type found in hospitals everywhere
prior to the establishment of training schools. They
received nine dollars a month with board, lodging,
and a daily allowance of beer. They occupied bed-
rooms opening into the wards of which they had
charge, and each nurse carried her knife, fork, and
spoon in her pocket.

The successful changes which had been introduced
into Bellevue, and into the Massachusetts General,
encouraged the Toronto authorities in deciding

132 A History of Nursing

to organise a school for nurses, and in April, 1881,
the entire nursing staff, then consisting of seven-
teen women, was invited to be present at a meet-
ing held in the amphitheatre. Addresses were
delivered, and the nurses were told that a training
school was to be opened. They were offered the
privilege of being enrolled as pupils in training upon
the following conditions: They were expected to
agree to remain two full years in the hospital and at
the expiration of that time to pass an oral examina-
tion before a board of examiners. Those who ful-
filled this condition were promised a certificate of
qualification in nursing, signed by the authorities
and by the examiners, and a silver badge. Only
five of those present agreed to accept the new state
of things, and at the expiration of two years (1883)
these pioneers received the certificate and badge of
the new school.

After eight years in the hospital, Miss Goldie re-
tired and was succeeded by Mrs. Fulford (nee Starry),
a graduate of an English hospital. This lady was
succeeded in six months by Miss Lucy Pickett, a
graduate of the Massachusetts General, who in her
turn resigned after eight months' incumbency. To
the initiated these brief, quickly relinquished efforts
to guide the helm are significant of troublous times,
of authority helpless and defied, and of insubordina-
tion where discipline should be. The organisation
of the training school was still most incomplete.
The nurses occupied rooms situated in various parts
of the hospital; slept on straw beds; their dining-room
was in the basement, and they not only served the
meals in the wards, but washed the dishes. As yet

In New Continents 133

they were little advanced beyond the servant class,
and their instruction was elementary. At this point
the real organisation of nursing was taken up and
with undeviating and unremitting patience carried
on until fully and roundly developed.

In 1882, Miss Mary A. Snively, a Canadian woman
with teacher's training, went to Bellevue Hospital
from the little town of St. Catherine's. Miss Perkins
was then at the head of the Bellevue school, and
when, in 1884, the Toronto hospital trustees applied
to her for a superintendent of nurses, she, with that
consummate skill in character-reading, and in select-
ing the right woman for a post which was her most
valuable asset, at once sent them Miss Snively, who
had just finished her course. For twenty-five years
of unbroken service Miss Snively presided over the
hospital nursing and the training school. At once
dignified and genial, with patience enough to wait a
quarter century for the full fruition of her labours,
diplomatic and astute in maintaining her position
against difficulties, she, little by little, reorganised
the school on modern lines.

In 1910, after twenty-six years of service, Miss
Snively retired full of honours. She was succeeded
by Miss Stewart, a graduate of the Johns Hopkins.

The history of these two women, Miss Snively
and Miss Livingston (the latter at the end of 191 1
still in her post) , is the history of nursing in Canada.
Their graduates have gone forth from their hands into
every corner of the Dominion, bui ding, developing,
reforming, carrying the traditions and atmosphere of
the schools in which they were trained. To Miss
Livingston is due not only the efficiency of the

134 A History of Nursing

nursing department of the Montreal General, but
the high tone and standard of nursing to-day in many-
parts of Canada. Miss Snively, strongly social by
nature, has been foremost always in public move-
ments, in nursing organisation, in the superintend-
ents' conventions, in committee work, and in educa-
tional propaganda. Hers is the credit of having led
Canadian nurses in national and international rela-
tions and of having cherished the international spirit.
She rightly regarded the national associations of
Canadian nurses, and their affiliation with those of
other countries, as the crowning work of her nursing
career.

Having followed the leading figures in the early
transformation of Canadian nursing, we return to a
brief summary of the conditions in the various pro-
vinces, taken serially, and beginning with Nova
Scotia. What is now the Victoria General in Halifax
was formerly a military hospital founded by the
Imperial Government. In 1880, the buildings were
taken over by the local authorities and changed into
a general hospital under the name of "Provincial
and City Hospital" for the Province of Nova Scotia
and Cape Breton. In 1896 and later, large wings
and buildings were added. Its present name was
adopted in honour of Queen Victoria's Jubilee. It
is supported by the government of Nova Scotia and
accommodates two hundred patients. Its training
school for nurses was established by the Executive
Council of Nova Scotia in 1892. Only natives of
Nova Scotia, men as well as women, are admitted
as pupils. The men take the same course as the
women, with the exception of two specialties, and

In New Continents 135

some of them have remained for years in the same
position. The training of men is regarded here as
successful. The school had, in 191 1, a roll of forty-
five students, seven of whom were men.

The Aberdeen Hospital in New Glasgow has its
nurses' school; Charlottetown has a training school
in the Prince Edward Island General Hospital; St.
John's, New Brunswick, has one organised in 1888.
Fredericton was one year earlier with its school

At Kingston, in 1812, a few citizens banded them-
selves together under the name of the Kingston Com-
passionate Society with the object of relieving the
distress and sufferings of emigrants. The society's
work increased, and in 182 1 was taken over by the
Female Benevolent Association, which, in 1833, ap-
pealed to the Legislature of Upper Canada and ob-
tained a grant toward the erection of a hospital.
The building was completed in 1834, Dut owing
to lack of means the interior was unfinished until
1837 when a further grant was received from the
government.

During the rebellion of 1837-8, on the advice of
Colonel Bonnycastle the recently completed build-
ing was used for military purposes from May, 1838,
to June, 1839. In 1841 the building was changed
to some extent and the United Legislature of Canada
met there until 1844. In that year the Female
Benevolent Association received permission to send
their sick poor to the hospital, and a small grant was
made by the legislature for maintenance. In 1888, a
training school was organised by the late Dr. Fen wick
in connection with the hospital. Four nurses com-
posed the first staff, three of whom graduated.

136 A History of Nursing

The horrors of 1847, caused by the failure of the
potato crop, frightful famine, and the ensuing typhus
which made Ireland desolate, can never be forgotten.
Hundreds of thousands fled for refuge to America,
many died on shipboard, whole others landed on the
shores of Canada only to succumb to the pestilence.
Thousands died at Grosse Isle, at Quebec, and at
every port along the waterways. The hospitals were
over-filled and temporary sheds were erected to
shelter the victims. In Quebec a private hospital was
opened by Drs. Douglas and Racey, who had an-
ticipated the outbreak. It was on the Beauport
Beach and accommodated masters of vessels and
cabin passengers who objected to going into crowded
public hospitals.

During the outbreak this place became over-
crowded and consequently the "dwelling house and
premises of the old breweries" at Beauport were
leased. One hundred and sixty-five cases of typhus
were cared for in these buildings.

On June 17th, at Point St. Charles, near Montreal,
hundreds were dying unaided. Three sheds two
hundred feet long and fifty feet wide were built, and
the Grey Nuns went to aid the sufferers. In the
open space between the sheds lay the inanimate
forms of men, women, and children. More arrived
day by day. Death was there in its most appalling
form. On June 24, two young nuns were stricken
with ship-fever and more followed hourly until thirty
of them lay at the point of death. Seven died, while
those remaining, overwhelmed with exhaustion,
were obliged to withdraw. Then the Sisters of St.
Joseph from the Hotel Dieu tcok their places. In

In New Continents 137

September the Grey Nuns resumed their heroic task
at the sheds and continued their charitable labours
not only during 1847-48, but also later, when, in
1849, cholera replaced the typhus fever.

At this time the only route for the transportation
of immigrants to the Canadian West was by Ottawa
through the Rideau Canal, which had been opened
in 1832. Over three thousand emigrants reached
Bytown (now Ottawa), and with them the typhus.
The first patients were taken to the Grey Nuns'
hospital. Later, the government built sheds for
their reception. The nuns continued to care for the
fever-stricken, and, before the erection of the special
sheds, any improvised shelter such as upturned
boats was utilised. The County of Carleton General
Protestant Hospital was the outcome of the fever
epidemic. Many desired a hospital under the con-
trol of the public, to be supported by public sub-
scription. This resulted in the formation of a
board, whose efforts were rewarded in 1850 by the
erection of the stone building on the lot at the north-
west corner of Rideau and Wurtemberg streets. In
1854, Bytown became Ottawa. The original build-
ing, until 1875, served as the General Hospital
and was then used for contagious cases, until 1903,
when the city opened a new Isolation Hospital. In
1907, the old building was torn down.

In 1898, the Grey Nuns established a training
school for lay nurses in the Ottawa General Hospital.
The superintendent of nurses for some years was
Sister Mary Alice, trained in Lowell, Massachusetts,
at St. John's. Ten graduate nurses were placed
in charge of wards, and affiliation has now been

138 A History of Nursing

effected with the Maternity and Isolation hospitals,
thus securing the pupils in their three years' course,
a full variety of services. This was the first of a
number of training schools now managed by the
Grey Nuns, of which they are justly proud.

In Montreal an institution of the first importance
from a medical and nursing standpoint is the Royal
Victoria, a general hospital beautifully situated on the
slope of Mount Royal, overlooking the city. It was
established through the munificence of two Canadian
peers, Lord Mount Stephen and Lord Strathcona,
each of whom gave in all a round million of dollars
toward it. The building was opened in 1894, when
the training school was also started. To open and
develop it on the most highly advanced plane pos-
sible, Miss Edith Draper, of a Canadian family dis-
tinguished for intellectual eminence, a Bellevue
graduate and old friend of Miss Snively and Miss
Hampton, was called from the position she was then
filling as superintendent of the Illinois training
school. The Royal Victoria school for nurses soon
came to rank among the best in America. In 1906,
a modified preliminary course was started which
includes a domestic science course. The residence
for nurses was opened in 1907.

Montreal has a splendid modern Maternity Hos-
pital, affiliated with McGill University, where pupils
of the Royal Victoria and the General schools obtain
their obstetric training.

The Sisters of St. Joseph, who have served the
H6tel-Dieu of Montreal since 1659, have seen a won-
derful growth in their hospital, whose early days were
so dramatic. In 1859 it removed from the original

In New Continents 139

site in St. Paul Street to Pine Avenue, and the Sisters
now preside over a fine modern building with a front-
age of 650 feet, covering two city squares, and con-
taining nearly three hundred beds. The wards are
spacious and airy, with modern equipment. The
beds are surrounded by white linen curtains. The
private wards are large and perfectly equipped for
therapeutic bath treatment. Operating rooms and
fittings leave nothing to be desired. The dispensing
is performed entirely by the nuns. In the large and
beautifully arranged pharmacy a Sister is in charge
who teaches her skill to the others, while every ward
has a nun in charge of medicines and drugs, whose
duty it is to compound, in the pharmacy, all the pre-
scriptions and disinfectants needed in her ward, and
to see to their administration and use. The electrical
department of the hospital is celebrated for its com-
pleteness, and was the gift of Dr. Desloges, the
Sisters supplying the rooms and assistance. A
training school for lay nurses was opened in 1902,
at the instance of Dr. St. Jacques. Beginning with
five pupils, there were, in 191 1 , twenty taking a three
years' course. The lectures and demonstrations are
given by the visiting physicians; the nuns, as staff
and supervising nurses, giving the practical teaching.
The Sisters, with their novices, are nearly all on duty
in the wards. They do no regular outside nursing,
but are frequently accorded permission to leave the
hospital to perform works of mercy. As these
Sisters are strictly cloistered, they never leave the
grounds without the consent of the Archbishop. In
Montreal there are also several smaller training
schools. In the old city of Quebec is Jeffrey Hale's

140 A History of Nursing

Hospital, dating from 1864. It is a large and well«
equipped modern building,with a good training school.

Excellent schools for nurses exist in connection
with general hospitals in Ottawa, Hamilton, London,
Guelph, and many other Ontario towns, of which,
did space permit, interesting details might be given.
In Toronto, the Sisters of St. Joseph have had train-
ing work in hand longer than those in Montreal
(for it is not clear that the orders are the same,
though with the same name), as, at St. Michael's,
it was begun at the opening of the hospital in 1892.
The course is three years' medical and surgical work,
with a three months' preliminary course. The Sisters
supervise in wards and operating rooms.

Manitoba has at least thirty hospitals and eight
training schools. The pioneer hospital of the West
is the St. Boniface General. On April, 25, 1844,
three Grey Nuns left Montreal in canoes for the far-
off Red River settlement. They arrived at St.
Boniface, opposite Winnipeg, on the 21st of June
and there immediately established the first hospital
in the West, which has grown to accommodate four
hundred inmates. A training school was established
in 1890, with a course of two and a half years.

The most important Western hospital, however,
is the Winnipeg General. In 1871, after the collapse
of the rebellion, the little colony of Fort Garry en-
joyed a considerable boom, and many volunteers
who had come up from the East beat their swords
into ploughshares and remained as colonists. Other
immigrants came in over the Dawson route, or by
river and cart from St. Paul. Houses were few and
over-crowded, and, when sickness broke out, condi-

In New Continents 141

tions were such as to render immediate action neces-
sary. A meeting was called, a board of health
formed, and steps taken to begin hospital work im-
mediately. A one-story frame house was the best
place that could be secured, and this became the first
general hospital of Winnipeg. It was not destined to
become a settled institution without its full share of
the vicissitudes of the pioneer. For ten years it
moved from place to place, doing the best possible
work under the worst possible conditions. The
present location, reached in 1883, was the eighth
occupied. By this time the construction of the
Canadian Pacific Railway was well under way, and a
large up-to-date hospital was necessary. This was
erected and on March 13, 1884, was opened. In
1899, a large Jubilee wing was added to the hospi-
tal. In 1909, the hospital accommodated three
hundred and fifty patients.1

The training school was organised in 1887, and has
set the standard of nursing west of the Great Lakes.
A nurses' home was built in 1888. Here the nurses
also enjoy a summer cottage on the lake, the gift of
friends in the hospital administration. We believe
this is the only instance in Canada where provision
for nurses during vacation is made by an institution.
The hospital retains a large staff of permanent head-
nurses and employs a nurse as social worker.

Alberta and Saskatchewan, together, have about
forty hospitals, some of which have between fifty and
one hundred beds. Twelve of these institutions have
training schools. In the Yukon, with its frontier

'"The Winnipeg General Hospital," by Ethel Johns; The Cana-
dian Nurse, June, 1909, p. 298 et sea.

142 A History of Nursing

life, nursing may be seen in some of its most pictur-
esque aspects. There are five hospitals in the
territory, some of which are nursed by Sisters.

British Columbia has fifty-seven hospitals with six
training schools, of which the oldest and best known
is the Royal Jubilee in Victoria, with one hundred
beds, founded in 1890. Its school was established
when the hospital was built. The Vancouver Gen-
eral is the largest and most important in the province,
with two hundred and fifty beds. In all these hos-
pitals the nursing staff is ample, numbering, on an
average, one nurse to three patients. In lumbering
and mining districts are hospitals controlled by mills
or mining interests. Here and there, nurses are
found in tents and shacks caring for the sick, while
awaiting the erection of more permanent quarters.
British Columbia is so new that the population far
exceeds the housing accommodation.

The Columbia Coast Mission, established in 1905
by the Rev. John Antle, has three hospitals for min-
ing and logging camps, of which there are thirty scat-
tered along one hundred miles of island- studded
coast. Patients are brought by the hospital steam-
boat Columbia, and sometimes in small open boats.
At each hospital are a resident surgeon, a head
nurse, an assistant nurse, and a " kitchen-helper,"
usually a Japanese. Here a medical officer may be
found hauling baggage up-stairs, fetching hot water,
or even helping to cook. Strict discipline, however,
prevails. Space fails to permit of a fuller account of
the simple though arduous life led by cultured
workers in this mission, to which we owe so much in
helping to develop the resources of the country.

In New Continents H3

Hospitals for Children. — Halifax and Montreal
have institutions for children ; the former, founded
in 1909, with Miss Fraser from the Sick Children's
Hospital of Toronto. The Children's Memorial, in
Montreal, is a good example of affiliation, for its
nurses pass through other hospitals for obstetrics
and gynecology. The Foundling and Baby Hospital
in this city carries on a milk depot, opened in 1901.

The most important Canadian hospital for child-
ren, and one of the most perfect of its kind in the
world, is in Toronto. Established in 1875, its training
school was opened in 1886 and has become one of
the most thorough and progressive on the continent.
Its ratio of one hundred and sixty little patients
and sixty pupil nurses, as well as a supervising staff,
shows that it is well cared for. In 1897, Miss Louise
C. Brent, a Canadian graduate of the Brooklyn
City, was placed at the head of the hospital and
all its departments, and under her rule both school
and wards have become models. The hospital owes
much to the devotion of Mr. J. Ross Robertson, presi-
dent of the board of governors, through whose gener-
osity a magnificent residence for nurses was built in
1906. A preliminary course for the probationers was
then established, with trained teachers and lecturers.
Especial emphasis is given to domestic science. The
course is four months long and is included in the
three years' term. During training the pupils are
sent to affiliated hospitals for obstetrics and gyne-
cology. Some two hundred and fifty nurses have
gone forth from this school, many to take posi-
tions as the heads of hospitals. Mr. Robertson,
whose benevolence extends to the whole nursing

144 A History of Nursing

profession, has made it one of his amusements to
collect a complete library of nursing literature in the
nurses' home. He may truly be called the father of
Canadian nursing affairs.

During the summer months, all cases of surgical
tuberculosis, and as many others as possible, are
transferred to the Lakeside Home of one hundred and
twenty -five beds, a beautiful spot on an island in the
lake.

The Nurses Alumnae Association, organised in
1903, formed in 1909 the Heather Club, with the
aim of giving voluntary care to tuberculous children.
Mr. Robertson gave the club a pavilion on the
grounds of the Lakeside Home, and during the first
year over thirty children were cared for by the vol-
untary work of the members, each nurse giving two
weeks of time. The pavilion then grew to accom-
modate fifty, and two permanent nurses were taken
on, who accept a purely nominal salary as a contri-
bution to the cause, while the voluntary work
continues as before.

In the great West, Winnipeg has the only hospital
for children, founded first in temporary quarters,
with twenty-two beds, in 1909, then given a new
building of three times that capacity by popular
subscription. To organise its training school in
191 1 came a nurse from Guy's, in London, Miss
Elsie Fraser.

State Hospitals. — I. There is a system of marine
hospitals maintained by the Federal Government,
including all seaports. It consists either of small
special hospitals, or of arrangements made with
general hospitals in seaports to care for sick mari-

In New Continents 145

ners. The government also maintains hospitals in
connection with immigration and Indians.

II. Two Norwegian sailors from a barque called
The Florida landed in 1815 at Caraquette, Glouces-
ter County, N. B. Later two women, living at
Tracadie and Neguaak respectively, who had washed
their linen, became lepers. The disease then became
endemic among the French settlements on the river
Miramichi, the shores of the Baie des Chaleurs, and
in parts of Cape Breton. In 1844, a hospital was
built for these lepers on Sheldrake Island, near the
mouth of the Miramichi River. In 1849, the insti-
tution was transferred to Tracadie, N. B., and in
1 868 placed in charge of the Sisters of St. Joseph from
Montreal. The lazaretto was at first provincial,
but after confederation became the property of the
Federal Government.

III. From 1800 to 1832 various epidemics affected
localities, but none during that time seem to have
invaded the whole country. Early in the nineteenth
century cholera broke out in the Orient; by 1832 it
had reached London, and, with every vessel, the pesti-
lence was expected in Canada. The government
took the precaution of opening a quarantine station
at Grosse Isle, thirty miles below the port of Quebec.
Temporary buildings were erected there, the station
was under military control with military medical
officers, two companies of regulars to do police work,
and artillery with three mounted cannons to prevent
ships from passing. On the 8th of June the cholera
reached Grosse Isle, and went by leaps and bounds
throughout Canada. Within three months, four
thousand persons died in Quebec alone. Since then

VOL. IV. — 10

146 A History of Nursing

there have been four outbreaks in Quebec Province
(1834, l849> l852> and 1854). At Grosse Isle, as
matters passed from imperial to colonial government,
military medical officers and men were replaced by-
civilians, until finally the station came under the
control of the Federal Government. Stations were
also opened in 1832 at Halifax and St. John, N. B.
Later on quarantine stations were opened at Sydney
and Louisburg, C. B., Char lottet own, P. E. I., and
Chatham, N. B., Vancouver and Victoria, B. C.

IV. A series of Immigration Detention hospitals
was begun in 1904. They are found in Halifax, N. S.,
Sydney, C. B., St. John, N. B., Quebec and Montreal,
P. Q., and Victoria, B. C. Graduate nurses are em-
ployed in them as occasion demands during the ship-
ping season. The Detention Hospital in Quebec,
which accommodates five hundred inmates (civically
and physically unfit) is a particularly interesting
post for a nurse.

V. The energies of the State in relation to the
Indians are chiefly displayed in reference to tuber-
culosis. A tent hospital of fifteen beds was founded
in 1908 on the Six Nations Reserve near Brantford,
Ontario. There is another at Birtle Indian Agency,
Man. At Morley, in Alberta, is a wooden hospital,

as well as tents, and in British Columbia there are
provincial hospitals in which are medical superin-
tendents.

VI. Hospitals for the Insane. Little is known of
the condition of the insane during the French regime,
and for seventy-five years after the establishment of
British rule they were cared for in almshouses and
jails. The present system is in process of evolution

In New Continents 147

to a more scientific foundation. The training of
nurses for hospitals for the insane has begun, the
first example being that established at Reckwood
Asylum, at Kingston, Ontario, in 1888, under Dr.
C. R. Clarke, then medical superintendent. The
course, as everywhere at that time, was for two years,
while the curriculum of study was arranged like that
in the general hospitals. This departure worked won-
ders in the hospital. Its graduates took post-graduate
courses in general nursing, and succeeded admirably.
Dr. Clarke later took charge of the Toronto Asylum
and established a training school there also.

In Nova Scotia a school was opened in 1894, in
connection with the state hospital at Dartmouth,
with a two years' course for men as well as women.
Trained head nurses are placed in the wards. Many
of these nurses have taken supplementary training
and are filling important posts in Canada and the
United States, chiefly in hospitals for the insane.
The Prince Edward Island institution for the insane
at Falcon wood opened a school for nurses in 1900.
It is a thoroughly well managed and fully equipped
hospital.

Though New Brunswick was the first of the prov-
inces to make provision for its insane, by converting
an old cholera hospital in St. John into an asylum in
1835, it has, as yet, no regular school for nurses in
the Provincial Hospital at Fairfield, into which the
original plant was merged in 1848. The Protestant
hospital for the insane at Verdun gives its nurses
practical training in the care of mental cases, and
teaches them general nursing in the infirmary, but
has not developed a regular training school.

148 A History of Nursing

Of recent times, the question of nursing the insane
has been given consideration by Mr. Hanna, Provin-
cial Secretary, with the result that Ontario established
a Provincial Board, and all the hospitals for the insane
in Ontario (which, as the wealthiest province, has the
best provision for these unfortunates) , were required
to develop schools for nurses. The board appointed
an examining staff of medical men, and uniform ex-
aminations were held for the first time in 19 10 in
London, Toronto, and Kingston. A third year was
next added to the training, which is thrown open to
former graduates, if they desire to take it. Many
have availed themselves of this opportunity. In
Toronto and Kingston the lecturers are members of
the university staff, and exceptional advantages are
thus afforded the pupils. The board also discussed
affiliation between schools in general hospitals re-
ceiving government grants, and those in the service
of the insane, as a desirable possibility.

During 19 10, in Ontario, male wards for the insane
were placed in charge of women nurses, with marked
improvement in the management and well-being of
patients.

Quebec is the only province in which there are no
state institutions for the insane. Its several asylums
are owned by private corporations, though the prov-
ince contributes to their support and has supervision
of them. The largest ones are cared for by the Sisters,
the Grey Nuns taking charge of 1200 patients in the
Quebec Lunatic Asylum, which is their private pro-
perty, and the Sisters of Providence in the asylum at
Longue Pointe near Montreal, with its 2500 cases.

An immense work is yet to be done in raising the

In New Continents 149

status and efficiency of the great numbers of nurses
needed to care for these sufferers, and in perfecting
their education and training.

VII. Military Hospitals. — Information regarding
early military hospitals is vague and fragmentary.
There are documents extant, however, relative to
such an institution at Kingston prior to 1790. The
earliest hospitals for soldiers were, of course, the es-
tablished institutions at the various towns and posts.
At Annapolis and Louisburg there were hospitals
established shortly after the garrisons, and they
served not only the garrisons but any sick in those
places. Between the years 1 759-1 814 temporary
field shelter must have been erected wherever the
wounded were not near enough to the established
hospitals to be taken to them. At Quebec in 1759,
the British took possession of the city hospitals and
convents and erected field shelter outside the city,
as well as on the Isle of Orleans. Shortly after the
occupation of the British, garrisons were established
throughout the country, and, in 1793, military hos-
pitals existed in Sorel, Montreal, Kingston, York,
Fort George at Fort Niagara, Amherstburg, and
probably elsewhere. The present military hospitals
of Canada are located at Halifax, Fredericton,
Quebec, St. John's, Kingston, Petawawa, London,
Winnipeg, and Esquimalt, B. C.

In 1904, a very important addition was made to
the militia of Canada, when a regulation added to
the establishment of the militia a certain number
of nursing Sisters. The Canadian nurses who had
gone to South Africa had in every way upheld the
honour and credit of the militia, and it was felt right

150 A History of Nursing

that they should be recognised as part of that or-
ganisation.1 The establishment authorised was
twenty-five Sisters, who were given the relative rank
of lieutenant in the army medical corps, with a pay
of $2.25 a day when on duty, and the allowance of
that rank. When the Dominion Government as-
sumed charge of the large garrison at Halifax, with
its military hospital of 120 beds, the want of nurs-
ing was at once felt, and two nursing Sisters were
added to the establishment of the Permanent Army
Medical Corps. Miss Georgina Pope, Royal Red
Cross (trained in Bellevue), and Miss B. Macdonald,
both of whom had served with distinction in South
Africa, were appointed to the positions. The Sisters
of the Permanent Army have been augmented to the
number of five or six and are stationed at other
hospitals. The Sisters on the reserve list are required
to take a course at Halifax under the nursing Matron.
Army nursing in Canada is carried out by the whole
of the personnel of the army medical service in the
various military hospitals and during annual training
at the several camps. The personnel is composed
of officers, nursing Sisters, warrant officers, non-
commissioned officers, and men of the permanent
medical corps and the army medical corps. The
men are trained by the officers and nursing Sisters.
If at any time the services of the Canadian forces
should be needed for the defence of the empire, nurs-
ing Sisters would form an important part of these
forces. Preference for employment would, of course,

1 The Canadian Nurse, March, 1907, p. 129. Article by G. C.
Jones, Chief Military Medical Officer to the Dominion.

In New Continents 151

be given to those already holding commissions in
the army medical corps.

Anti-Tuberculosis Work. — Slowly the people of
Canada are awakening to the need for an active cam-
paign against tuberculosis. To wage effective war-
fare, concerted action of Provincial and Federal
Government is needed, and the difficulties hitherto
found in the way of such action must be overcome.
The Federal Government's activities on this line now
appear in its relations to its wards, the Indians, and
to immigrants. With the former a beginning has
been made by removing affected Indians from their
homes to tent hospitals on the Reserves. A num-
ber of such outdoor colonies have been provided, each
one in charge of a nurse, who also acts as district
sanitary inspector. Nurses are being employed in
ever larger numbers to carry out the preventive and
educational work of the various local, provincial,
and national associations. In Toronto, there are
municipal visiting nurses for the tuberculous poor.
It is scarcely possible to indicate the extent to which
nurses are active in such work, as it grows too rapidly
for figures to be followed. Of the hospitals for tuber-
culosis, most have at least a trained nurse as super-
intendent, while others have an entire staff of
graduates, and still others have training schools
affiliated with general hospitals. In this class is
the Lady Grey Hospital at Ottawa, which sends its
pupils for part of their three years' course to Bellevue
and Allied Hospitals in New York.

The Victorian Order. — The Victorian Order of
Nurses is the national district nursing association of
Canada, founded in 1897 by Lady Aberdeen to do

152 A History of Nursing

for Canada what the Queen's Jubilee Nurses had done
for Great Britain; but with this difference, that not
only are the indigent poor cared for in their own
homes, but also the people of moderate means. Up
to 1897, two large classes had been practically un-
cared for in time of illness — the indigent poor and
the hard-working, self-respecting class who could pay
something, but not the fee of a private nurse. In
many districts, hospitals did not exist, and where
they did, it was often impossible for the patient to
leave home. The objects of the Order as set forth in
the Royal Charter are stated as follows: (1) To sup-
ply nurses thoroughly trained in hospital and district
nursing and subject to one central authority, to care
for the sick in their own homes, in town and country
districts. (2) To bring local associations into affilia-
tion with the Order and to afford pecuniary and
other assistance to such local associations. (3) To
maintain a high standard for all district nursing. (4)
To assist in the building of small cottage hospitals
and homes.

The chief object was district nursing, and at first
the activities of the Order were directed solely toward
that end. During the first three years, local associa-
tions for supplying district nurses were organised
in the large cities and towns. In the year 1900,
during a tour through the North and West, Lady
Minto, then Honorary President of the Order, real-
ising that the people in remote regions needed more
adequate nursing care, started a fund known as
"The Lady Minto Cottage Hospital Fund," from
the interest of which grants are made from time to
time by the V. 0. towards the building of small

In New Continents 153

hospitals in out-of-the-way places where they are
most needed. So from 1900 on, the work of the Or-
der has been twofold — district nursing and hospital
building and nursing. In 1909, nursing in country
districts was developed. In all parts of the Domin-
ion, especially in the West and North, the cry had
come to meet the needs of the women on the ranches,
homesteads, and farms. This new development is
known as "Lady Grey's Country District Nurs-
ing Scheme." The plan is to organise local associa-
tions in large country districts varying from one to
ten miles in radius, within which the nurses work.
Continuous and visiting nurses are combined.

The problem of nursing the people in isolated
districts can be solved only by an association of
people bound together for that purpose. The indi-
vidual nurse cannot solve the problem herself, nor
is it her responsibility to do so.

There is to-day no provision made for the training,
licensing, and inspection of midwives in Canada.
There are a number of midwives from England and
foreign countries who practise, for the most part,
among immigrants of their own nationality. Some
have been trained in their own countries and many
have picked up what knowledge they have as they
went about. At present it does not seem advisable
to do anything in Canada to encourage the establish-
ment of a training for midwives; but probably the
time will come when our foreign population shall have
grown very large, when it will be imperative, as it
is now in Great Britain and in the United States,
to deal with this knotty question. In Canada, at
the present time, old country midwives will not

154 A History of Nursing

solve the nursing problem of the West. Fully
trained nurses, nothing less, will solve this problem,
and the Order has a complete organisation for doing
the work; funds only are lacking.

The structure of the Order is simple. There is
the central authority, the Board of Governors, con-
sisting of five appointees of the Governor- General,
who is a patron of the Order ; of representatives from
each local association, and from each medical asso-
ciation, both Provincial and Dominion. This man-
aging board is very representative; each local as-
sociation is closely tied with the central authority.
The unity and strength of the Order are due to this
centralised system. Nurses who join the Victorian Or-
der must be graduates in good standing of recognised
training schools connected with general hospitals.
They must have a thorough training in obstetrics
and must have taken, besides, a post-graduate course
in district nursing. The work is spreading into other
branches of philanthropic effort. In some parts,
nurses are employed by the Associated Charities
with satisfactory results. In some of our cities the
V. O. nurses are working as tuberculosis nurses,
often in connection with dispensaries or local bodies.
In several cities the nurses employed in the public
schools are members of the Order.

The McDonald College of Domestic Science at
St. Anne de Belle vue employs a V. O. nurse to give
lectures to the pupils and teachers.

There is a nurse on the reservation of the Six
Nations Indians near Brantford who works under
the New England Missionary Society of England,
founded in 1661. She also looks after the social and

In New Continents 155

hygienic conditions on the reservation; for this pur-
pose a horse and trap are provided. In many cities
the V. O. nurses work in connection with the Milk
Commission, taking charge of the depots and also
instructing the mothers in the feeding and care of
infants. At Harrington Harbour, Labrador, are
V. 0. nurses in connection with Dr. Grenf ell's hos-
pital. The V. O. has undertaken the nursing of the
policy-holders of the Metropolitan Life Insurance
Company, which has 200,000 industrial policy-
holders in Canada. The total number of nurses
working for the Order in 1 910 was one hundred and
sixty, distributed as follows : In hospitals, thirty-two ;
in districts,1 sixty-four; taking post-graduate course,
thirty-seven; nurses in training in hospital training
schools, twenty-seven. There are four training
centres: Montreal, Ottawa, Toronto, and Winnipeg.

New districts are constantly opening up, and as
the number of branches increases, more fields of
usefulness will be taken possession of and tilled by
the workers of the Order.

There are several societies and missions employing
district visiting nurses in cities, and in many places
are parish nurses, all doing good work in their
own way. Welfare work, or nursing among factory
hands, as an instructive visiting nurse, has been
introduced into Canada, and more than one large

1 Districts: Sydney, Baddeck, Canso, Halifax, Yarmouth, St.
John, Truro, Montreal, Lachine, Sherbrooke, Grand'Mere, Ottawa,
Cobalt, Stratford, Gait, Gravenhurst, Fort William, Winnipeg,
Lundreck, Fernie, Vancouver, and Victoria. Hospitals: Harrington
Harbour, Almonte, North Bay, New Liskeard, Copper Cliff, Swan
River, Minnedosa, Shoal Lake, Yorkton, Melfort, Indian Head,
Kasco, Chase, Quesnel, Rock Bay, Revelstoke, Arrow Head.

156 A History of Nursing

factory in Ontario has its welfare nurse. Some
of the large departmental stores employ a nurse to
care for customers in emergency and to teach hygiene
among the staff.

Settlements. — The oldest settlement in Canada is
in Montreal, in connection with the University Club.
It has been in existence about twelve years and em-
ploys at least one trained nurse. The second in age
is the Evangelica Settlement, Toronto, opened in
March, 1902. A trained nurse works in connection
with this settlement, and effective work has been
done in modifying and distributing milk to infants
from a depot managed by the nurse, as well as in
instructing mothers in the feeding of infants, care of
bottles, etc. A third settlement was established in
Ottawa, 1909. So far the work has been chiefly vol-
untary, carried on by lay workers. It is hoped to
acquire funds for a nurse in the near future.

Milk Commission. — Chiefly through the efforts
of the Women's Council in the larger cities, Mon-
treal, Ottawa, Toronto, Hamilton, Winnipeg, and
others, there are depots where milk is prepared ac-
cording to formulas and distributed to infants.
Usually a nurse is in charge of the depot and a visit-
ing nurse is employed to instruct the parents. Fre-
quently this instruction is given by V. O. nurses, or
in connection with settlement or parish nurses' work.

School Nursing. — According to the terms of con-
federation (B. N. A. Act), education is in the hands
of the Provincial Parliaments. Efforts have been
made to secure recognition of the fact that sanitary
and medical inspection of schools is a state duty.
Up to the present time, however, school inspection

In New Continents 157

and the employment of school nurses are dependent
upon individual or municipal school boards.

In Montreal, through the efforts of a committee
of the Montreal Women's Club, medical inspection
of schools was inaugurated in 1906. In January,
1908, two trained nurses, one of whom was on the
Victorian Order staff, were engaged by the Board of
Health. In March of the same year, the Protestant
Board of School Commissioners also appointed two
nurses of the V. O. at their own expense, and have
since added another to their staff.

Toronto was peculiarly fortunate in securing as
superintendent of school nurses "the first public
school nurse in America," Miss Lina L. Rogers, whose
experience in school work in New York has been
outlined in the chapter on the United States. After
six years service there, she was called to Pueblo,
Colorado, in 1909, to organise school nursing, and re-
signed this position in response to urgent calls from
the Board of Education to go to Toronto in February,

19 10. Five assistants were appointed in May and two
more in November of the same year. In February,

191 1, thirteen additional nurses (making a total of
seventeen) were appointed. The nurses inspect the
children in the classrooms, referring all cases to the
medical inspector for diagnosis. They treat minor
contagious skin or eye conditions according to pre-
scribed orders, visit the homes, instruct the parents,
explain conditions, and advise. The appointment
of Miss Rogers and the excellent organisation of the
Toronto school work were largely due to the disinter-
ested labours of Mr. J. Ross Robertson.

The school nurses in Toronto recently considered

158 A History of Nursing

the question of uniting the public school nurses of
Canada for mutual help and co-operation, and, to
this end, organised the Canadian Public School
Nursing Association. The Toronto public school
board offers a one-month post-graduate course, under
Miss Rogers's direction. Within one year thirteen
nurses took this course with a view to filling similar
positions in other cities. In 191 1, school nurses were
employed in Montreal, Toronto, Hamilton, London,
Brantford, Kingston, Stratford, Winnipeg, Regina,
and Vancouver.

Education and Organisation. — In considering
standards of training and the professional education
of nurses, we find lack of uniformity in all respects.
There is no standard other than that imposed by
custom, which varies in localities. Certain schools
there are which rank among the foremost in the
world ; they have held their own, some by virtue of
the hospital with which they are connected, some
through the influence of interested hospital boards,
but usually through the persistent efforts of individ-
ual superintendents of training schools. The large
hospitals, as a rule, are graduating capable, well-
equipped nurses. On the other hand, there are
numerous small and special institutions issuing
worthless diplomas in return for two or three years
of hard work and inadequate training. This con-
dition prevails, not only in the youthful West, with
its sparse population, but, with much less excuse, in
the East as well.

The first Canadian schools, with few exceptions,
were organised and supervised by women who had
been trained in the pioneer institutions of the United

In New Continents 159

States, and who modelled their work along the same
lines, laying down a course of training, at first of two
years, with a curriculum corresponding exactly with
that of the American schools. As changes in methods
of work and training were introduced, often by
Canadian-born women, into the United States, they
were also introduced into Canada. Many superin-
tendents of Canadian schools were members of the
American Society of Superintendents of Training
Schools for Nurses, organised in 1894, a society
which has exerted a marked influence in Canadian
as well as American hospitals. As early as 1896
the matter of a uniform curriculum was brought for-
ward by Miss Snively, then Lady Superintendent of
the General Hospital in Toronto, and a paper upon
the subject, read by her at the second convention of
the society, with the subsequent discussion, had a
definite effect in Canada.

The large city hospitals have long lists of appli-
cants from which to choose their probationers, but
in proportion as hospitals are remote from attractive
centres and environment, the difficulty in securing
suitable candidates increases. Schools which are
independent as to choice of candidates require a
high school education or its equivalent. Those
less fortunate are often obliged to accept such can-
didates as may offer, irrespective of educational
qualifications.

Preliminary courses for probationers have been
established at the Hospital for Sick Children, To-
ronto, in 1906; at the Montreal General in the same
year, and subsequently at the Victoria, in London,
and at the Winnipeg General. The Royal Victoria,

160 A History of Nursing

Montreal, has adopted a class system which has many
advantages. This plan, combined with a modified
preliminary course, has been found feasible in many
institutions. Two or three schools require a tech-
nical course or domestic science training previous to
entrance. While nearly all school authorities ac-
knowledge the advantage of the preliminary course,
the financing of such a course has proved the ob-
stacle to its establishment generally. The proba-
tionary term varies from two to six months. With
few exceptions the length of training is three years,
while hours of work average seventy weekly during
the entire time.

The custom of affiliating special or small institu-
tions so as to give a general training is increasing.
We find many instances of small schools affiliated
with maternity and contagious hospitals and vis-
iting nurse organisations, by this method giving
the pupils the advantages of a thorough general
training. For the establishment of this system we
are largely indebted to the registration law of New
York State, which, while it has no jurisdiction in
Canada, admits the registration of such Canadian
schools as meet its requirements and accepts their
graduates as candidates for registration.

Most schools still adhere to the old system of
granting an allowance of a few dollars monthly
throughout training. Some supply books and uni-
forms with no allowance. Comparatively few have
paid lecturers, most of them being dependent upon
voluntary tuition or lectures by members of the staff.
A few schools offer scholarships and many give
prizes in competitive examinations. Uniforms con-

In New Continents 161

sist of the regulation print dresses, white aprons, and
caps. Graduates usually wear white linen uniforms.
In short, the rules and conditions prevailing in
American hospitals obtain also in Canada, — nursing
traditions, customs, variations of climate, and social
conditions being almost identical, as well as the popu-
lation, which consists of the original Anglo-Saxon
and French, with an increasing proportion of peoples
from European countries, Orientals, and an occa-
sional African or North American Indian.

Fields of activity for graduate nurses are ever in-
creasing. We find graduates in permanent posts
in the hospitals, acting as instructors and dietitians
in institutions, doing office, district, visiting, and
settlement work; school nursing, welfare work in
factories or with the Milk Commission, inspecting,
reporting, and instructing under boards of education
and health and with Charity Organisation Societies
here and there; also doing literary work, while one
at least, in Canada, is the editor of a magazine. Priv-
ate nursing still absorbs the majority, and for the
tactful, thoroughly trained nurse, this demand al-
ways exists. Work is obtained through registers,
some of which are managed for private gain and
others by nurses themselves co-operatively. Gradu-
ates usually reside, when off duty, in Homes or in
graduate nurses' clubs. The position accorded to
nurses in society or in the homes of patients depends
entirely upon themselves.

Post-graduate courses are rarely taken advantage
of in Canada. The Toronto General Hospital offers
a post-graduate summer course. The Hospital for
Sick Children in the same city has offered a course

162 A History of Nursing

in its baby ward. In Toronto, the school board gives
a month's course in school nursing, and the Victor-
ian Order gives courses in district nursing at each of
its four training homes. If our nurses wished for
special or post-graduate training, the hospitals of
Canada would gladly arrange for it, to the mutual
benefit of all concerned.

At the time this is written we know of two hospitals
only employing nurses as social service workers — the
Children's, Toronto, and the Winnipeg General.
Several have instructive visiting nurses in connection
with their tuberculosis dispensaries.

In almost every Canadian city are to be found
private hospitals corresponding to the "Nursing
Homes" in Great Britain. They are the private
property of physicians, nurses, or stock companies.
They are sometimes supervised by competent super-
intendents and nursed by graduates, but too often
by young women, who vainly imagine that they are
receiving an equivalent in professional education for
their time and energies. These inadequate small
schools and correspondence schools, together with
the unrestricted influx into the Canadian West of
disqualified nurses and midwives from the United
States and Great Britain, are an increasing menace,
not only to the nursing sisterhood, but to Canadian
society at large, a menace which can be checked only
by the passage of a uniform registration bill in each
province.

Activity has been exhibited during the last decade
in the formation of alumnae associations and local
clubs and societies. In the different provinces, or-
ganisations are forming with intent to obtain state

In New Continents 163

registration. Because of our political structure each
province must have its own act. In the past, there
has been lack of organised concerted action by the
nurses of the various provinces, easily explained by
distance and by the early stage of co-operative
effort.

Provincial associations, in 191 1, are found in Nova
Scotia, Quebec, Ontario, Manitoba, and Saskatche-
wan. That in Quebec is the oldest, having been
founded in 1895 in Montreal, as the Canadian
Nursing Association. It is affiliated with the Na-
tional Council of Women of Canada. That in
Ontario, named the Graduate Nursing Association
of Ontario, founded in 1904, had in the subsequent
nine years made three praiseworthy but fruitless
attempts to carry a registration act through the
legislature.

Local associations of nurses are numerous, all fully
self-governing, and every year they are becoming
more influential and useful.

The Canadian Society of Superintendents of Train-
ing Schools for Nurses was established in March,
1907. Miss Snively, whose efforts in its behalf had
been largely responsib e for its creation, became its
first president, and immediately threw all her energies
and prestige into the work of bringing a national
society for nurses into being.

During all the later years of her work as super-
intendent this had been her plan, signified long ago
by her standing in the International Council of
Nurses as a Councillor and Honorary Vice-President
for Canada, for the purpose of the International is to
unite national bodies for mutual aims and services.

164 A History of Nursing

Miss Snively's good offices were successful at the
second meeting of the Canadian Superintendents
in 1908, as a national society was then inaugurated
and a provisional association formed, called The
Canadian National Association of Trained Nurses.
The well-merited honour of the president's place
was offered to her, and under her leadership Canada
entered the international group in London, 1909, at
one of the most picturesque and stirring functions in
which nurses have ever taken part.1

At the fifth annual meeting of the Canadian
Society of Superintendents, the work lying to hand
for the nurses of the Dominion was graphically
summarised in Miss Snively's opening words:

And now let me enumerate the objects of our associa-
tion: "To consider all questions relating to nursing
education ; to define and maintain in schools of nursing
throughout the country minimum standards for admis-
sion and graduation; to assist in furthering all matters
pertaining to public health; to aid in all measures for
public good by co-operation with other educational
bodies, philanthropic and social ; to promote by meetings,
papers, and discussions cordial relations and fellowship;
and in all ways to develop and maintain the highest
ideals in the nursing profession." Every clause there
means work. The question of registration is one of
supreme importance at this very time, and it is from this
society, composed largely of the older and more experi-
enced women in the profession, that help should be
expected. . . . Then, too, the influence we may exert
on all questions of public health and its allied depart-
ments, all those matters which we roughly sum up as

1 Second Quinquennial Meeting of the International Council of
Nurses, Mrs. Bedford Fen wick, President.

In New Continents 165

social service problems, is very great. We are demand-
ing more and more in our profession that our members
be women of broad sympathies and culture, and, if such
are to be encouraged, we must look to our superintend-
ents of nurses to see to it that such qualities are fostered
in their pupils. And, too, the social side of our society's
work is of great importance. We are all bound together
by one bond at least of sympathy and we must try to
know one another and work together. . . . Following a
suggestion, an effort has been made to arrange for talks
to college women on nursing, with a view to attracting
the college trained woman, especially for social service
work. . . . This society is affiliated with the National
Council of Women, and a report will be heard of its
work. . . .

In Canada, as in the United States, there is a
society, founded in 1907, of hospital superintendents
(who may be either physicians or laymen or nurses) ,
many of whose members are nurses, holding positions
at the head of institutions. It had been proposed
that the society of training school superintendents
should form a subsection of this society, and meet
with it. The report brought in by the committee
in regard to this proposal was a frank and fearless
one, and merits careful reading for its dignified self-
assertion. It ran :

This committee begs to recommend that this society
do not amalgamate with the Canadian Hospital Asso-
ciation— and for the following reasons: (i) There is
enough work to be done in connection with training
schools to keep one society busy, and the Canadian
Society of Superintendents of Training Schools for
Nurses can do that work better, more effectively, and

166 A History of Nursing

more sanely when it preserves its identity. There are
many problems for this society to solve, for with its
members really rests what the nursing profession is to be.
(2) This society in its membership is strictly professional
and educational. (3) It has been claimed that the union
would make for economy — bargains are very doubtful
blessings ; that all would reap the benefits of the papers,
discussions, etc. But that may be obtained by arranging
meetings as they are arranged during this convention;
they are held at the same place and programmes are so
worked out that members from both societies may
attend all sessions, and union meetings and conferences
may be arranged for as desired. (4) This society would
gain nothing by the union, for the members of the Hos-
pital Association know necessarily very little about the
training of nurses, whereas the superintendents of train-
ing schools know a great deal about the management of
hospitals. The object of this association is to study out
all the phases of training school work, so that its members
may be mistresses of that branch — authorities — to whom
all such matters should be referred.

By all means, let us have sympathetic co-operation,
friendly, helpful interest in each other's welfare, but —
and this should be the watchword of our profession to-day
— let us hold fast to this : We are specialists in training
school matters ; we are mistresses in that part of the work,
and nothing should make us give up that place. Let us
hold fast to that, take nothing less. It is in this
society, composed, as it is, of professional women of the
highest type, that such truths will be fostered, that we
shall, by careful study, build up our ideals, know what an
influence we may be, and so be able to take our stand
where it is intended we should.

The report was presented by Miss Mary A. Mac-
kenzie, Chief Lady Superintendent of the Victorian

In New Continents 167

Order of Nurses, and was adopted, thus securing
the society an untrammelled existence.

With a view to assisting the various provincial
and alumnae associations, the Society of Superin-
tendents of Training Schools appointed, in 19 10, a
committee to consider standards of nursing education
and registration and to confer with the provincial
societies as to the drafting of a bill to meet the needs
of nurses in all the provinces and, later on, lead to
interprovincial registration. This committee con-
sisted at first of Miss Mackenzie, Convener; Miss
Louise Brent, and Mrs. Fournier, who were de-
signed to be the nucleus of a large committee consist-
ing of representatives from the national and from
each provincial association. The work of this com-
mittee was to prepare a model bill to be presented
before each provincial legislature, the result hoped
for being — Dominion Registration.

The general scheme included affiliation with central
technical schools, universities, or groups of hospitals,
so as to make thorough preliminary and didactic
instruction possible without increased financial effort
on the part of individual hospitals.

The Canadian Nurse is the official organ of all the
organisations among nurses in Canada. It appeared
first in 1905 as a quarterly, under the management
of a publication committee composed of members
of the alumnae association of the Toronto General
Hospital. In another year all the alumnae societies
in Toronto were on this committee, and in 1907 this
local publication committee was replaced by a
broadly representative editorial board, with a
member from every province in the Dominion.

168 A History of Nursing

Miss Bella Crosby told the story of its growth, in
Paris.

It is to an impulse from the great Canadian West that
we owe the founding of our national nurses' magazine.

Miss Lennox, the president of the Alumnae Association
of the Toronto General Hospital in 1904-05, had resided
for some time in Alberta and had an opportunity to
realise the need of such a magazine, not only in the cities
but on the prairies.

Also it is to be remembered that the Association of
Graduate Nurses of Calgary, Alberta, wrote to the
Toronto Medical Society about the founding of a nurses'
journal almost at the same time.

In the presidential address of Miss Lennox, delivered
in November, 1904, she said: "The work I most desire to
accomplish this year is the institution of an alumnae
journal. ..."

At the regular monthly meeting of the Alumnae Asso-
ciation of the training school of the Toronto General
Hospital for December 13, 1904, Miss Hodgson gave a
paper on the advisability of publishing a periodical.

A committee was then formed, composed entirely
of alumnae members, to promote the enterprise.
The greatest difficulty was to find an editor, and
finally the nurses persuaded Dr. Helen MacMurchy,
an old friend of Miss Snively, and well known for
her public work of many kinds, to fill the position
until a nurse as editor could be secured.

Already the magazine was assuming a national charac-
ter. ... It enlarged rapidly; Montreal, Winnipeg, and
other cities lent aid, and before the end of a year, the
Canadian Nurse was the official organ of eight societies

In New Continents 169

. . . The first year closed with a well-established journal,
free of debt and with a small balance to its credit. Both
editor and business manager were paid a modest sum
for time and work generously given. . . . Great services
were rendered by Miss Hargrave, who proved herself,
from the beginning, an ideal editor of one of the most
important departments of the magazine, and endeared
herself to the committee and to the subscribers by her
unfailing loyalty, interest, and enthusiasm. The same
may be said of Miss Mitchell, the convener, Miss Hodg-
son, the assistant editor, and also of Miss Christie, the
business manager, whose work in that department was
admirable. x

In 19 10, Miss Bella Crosby, a graduate of the To-
ronto General, was made editor, and an editorial
board was formed to represent every province and
every nurses' association in the Dominion. Yukon,
Labrador, and Newfoundland have their representa-
tives, and even the Canadian nurses in the United
States have one, upon this board. The Canadian
Nurse has a future of importance before it, in welding
the nurses of the broad provinces into one united
body.

Between Canada and the United States there has
always been a lively reciprocity in nursing affairs.
Because avenues of self-support for cultured women
are fewer in the former, more conservative, country,
the career of nursing has attracted there a pro-
portionately large number of exceptional women,
many of whom, in the United States, have found
abounding opportunities, and, in return, have con-
tributed notably to professional progress. Across

xThe Canadian Nurse "Reports," Paris Conference, 1907.

170 A History of Nursing

the border, freedom to develop initiative is greater
and more room for experiment is allowed. To a
certain extent, British conservatism checks the Cana-
dian spirit at home, and medical guardianship of
nurses is, in some centres, fairly strong, while the
fell influence of the London group of reactionaries
is occasionally perceived in the hospital atmosphere.
But nurses realise more clearly every day that they
must work out their own salvation. To-day is the
dawn of organisation and progress.

If you will only multiply the smallest force by time
enough, it will equal the greatest; so it is with the slow
intellectual movement of the masses. It can scarcely
be seen, but it is a constant movement. It is the shadow
on the dial — never still, though never seen to move. It
is the tide — it is the ocean, gaining on the proudest bul-
warks that human art or strength can build. It may be
defied for a moment, but in the end it always triumphs.

Newfoundland, the independent little British col-
ony, conservative, and cherishing its individuality
has given the profession of nursing some of its best
members. Its first hospital was a military one in
St. Johns, first in use during the middle of last
century. About 1870 that series of enlargements
began which now make it a general hospital main-
tained by the government, and having a capacity
of something under 150 beds. Only ten years ago
training was unknown in Newfoundland nursing.
To celebrate Queen Victoria's Jubilee, the women of
the island gave the general hospital two wards for
women, and in 1903 a training school was organised
there by Miss M. Southcott, who came from England

In New Continents 171

with the certificates of the London Hospital, the Lon-
don Obstetrical Society, and the Plaistow midwifery
course. This school, still small, has an excellent
three years' course covering all branches of work.
Near the General is a government hospital for con-
tagious diseases, and a convalescent home founded
by the " Ladies of the Cowan Mission" in memory
of the hospital's first Matron, Miss Cowan. The
government also controls the hospital for the insane.
Anti- tuberculosis work, well under way, is partly
under private and partly under governmental direc-
tion. At the camp started by the Daughters of the
Empire, a St. Johns General graduate, Miss Camp-
bell, was the first nurse to take charge, and the same
hospital supplied the trained women who initiated
visiting work in the city and outposts, and who, in
the summer, make the tour of the whole coast. Nurs-
ing organisation, spoken of but, up to 191 1, not
brought about, must soon come.

Labrador. — Upon the coasts of Newfoundland and
Labrador is carried on one of the famous missions
of the world, known widely and well as Dr. Grenfell's
work among the deep-sea fisherfolk of the Northern
coasts. Wilfred Thomason Grenfell, whose spirit
imbues the whole, was born in England in 1865 and
engaged as a medical missionary in the work of the
Royal National Mission to Deep-Sea Fishermen, in
1889. He fitted out the first hospital ship for
British fisheries in the North Sea, and in 1892 went
to Labrador, where he devotes himself to the religious
and industrial improvement and the medical and
nursing care of the people. A man of keen practical

172 A History of Nursing

sagacity and much magnetism, he has enlisted nurses
to help him, whose lives and duties are among the
most picturesque in all the annals of district nursing.
A Canadian graduate of the Illinois training school,
Miss Edith Mayou, became his chief head nurse,
and the alumnae of the Johns Hopkins school under-
took a sort of sisterly responsibility to keep his staff
filled, and have sent several of their Canadian mem-
bers to posts in Labrador. The Mission has five hos-
pitals, four on the Newfoundland and one on the
Labrador coast, while other stations are opened up
yearly, where the boats call to treat and transport
patients. Original articles by nurses in the Ameri-
can Journal of Nursing and that of the Johns Hop-
kins Alumnae Association give graphic accounts of
their life among the simple seafaring people and well
merit a transcription, for which our pages are too
short.

Australia. — A hundred years ago, in October of
1811, the first hospital erected on Australian soil was
opened for the reception of patients. With the
Sydney Infirmary (now Hospital) the history of
nursing in Australia begins. Were it possible to
obtain a faithful picture of hospital life in the early
days, we should, no doubt, be surprised at the rapid
strides made by the nursing profession in the last
fifty or sixty years. For although some of the hos-
pitals date back to the earlier decades of the last
century, the nursing practised within their walls
was very primitive. The early Matrons were house-
keepers, who attended to the feeding of the inmates,
and the care and cleansing of the house. It is re-

< m

In New Continents 173

corded of most of them that their institutions were
models of cleanliness, which is, considering the dis-
advantages under which they worked, a record of
no mean attainment.

As early as 1868, however, a training school was
established by Miss Lucy Osburn, Lady Superin-
tendent of the Sydney Hospital. Miss Osburn was
one of five Nightingale nurses who came from
England in March of that year. The Australasian
Nurses' Journal1 says that she and her companions
were specially selected by Miss Nightingale herself as
suited for work in the colony, at the request of Sir
Henry Parkes, who had corresponded with Miss
Nightingale about his desire to alter the nursing
system in the Sydney — then the only large hospital
in the city. That the early Nightingale nurses were
a remarkable group of women is emphasised afresh
by every recollection of them. In 191 1 , two Austra-
lian nurses were still living who had been trained
under Miss Osburn, and one of them said of her:
"She was an exceptional woman, well-read, having
an absolute fascination of manner and an indomit-
able will. She looked upon nursing as the highest
employment a woman could take up. . . . To her
it was a holy mission, and should be entered into in a
spirit of devotion, ..."

Within four years the five nursing missioners were
scattered over Australia, doing pioneer work in new
hospitals in other colonies.

Five more Nightingale nurses were brought out
by the Tasmanian government a little later, and set
to work in Hobart and Launceston, where training

1 A Pioneer of Trained Nurses, p. 364, November, 191 1.

174 A History of Nursing

schools were, in time, established. Few of these
nurses kept long to their original centre, their services
being requisitioned by the new hospitals springing
up all over the continent. It was, therefore, the per-
sonal work and influence of the Nightingale nurses
that began organised nursing, and subsequently
organised training schools in Australia.

In October, 191 1, the Sydney Hospital celebrated
its centenary with suitable ceremonials and events,
of which the one of most significance to nurses was
the endowment of a bed by nurses past and present,
for sick members of their guild.

In 1871, Miss Haldane Turriff, one of the first
Sisters of the Sydney Hospital, and a Nightingale
nurse, was asked to take the matronship of the then
new Alfred Hospital in Melbourne. This was one
of two built to commemorate the visit of the Duke
of Edinburgh to Australia, the other, the Prince
Alfred, being in Sydney. Both have become im-
portant and valuable training schools for nurses.
The former enlarged and improved its training in
the eighties, under the administration of the medi-
cal superintendent, Dr. Backhouse, the nurses' course
being lengthened to two years in 1887. Under
the matronship of Miss M. D. Farquharson, an
English nurse who was at the head of the school
from 1890 to 1895, it was lengthened to three years.
Miss Farquharson stood on the Council of the In-
ternational Council of Nurses from its inception,
representing the Commonwealth of Australia.

The Prince Alfred Hospital in Sydney, which is an
especially well-equipped and up-to-date institution,
owes much of its prestige to the long service of Miss

In New Continents 175

S. B. McGahey, as Lady Superintendent, there.
During the time she was connected with it she made
a tour of the world, coming on the way to the Con-
gress of Nurses in Buffalo, U. S., and taking back
all the best ideas then available as to hospital con-
struction and fittings.

The Melbourne Hospital, which underwent re-
building sixty-odd years after its foundation, opened
its doors in 1848, its sole resident staff being an
apothecary and a Matron. For many years the
Matrons of this institution were only housekeepers,
and, when the increasing number of inmates called
for more attention, the staff was purely domestic.
As in all Australian hospitals of that day, nurses'
duties consisted in feeding the patients and keep-
ing them and the wards clean. Almost all, even the
most elementary details of nursing, such as taking
temperatures and giving medicines, were carried out
by the medical staff. The founder of the training
school in the Melbourne was Miss I. J. Rathie, an
Edinburgh Royal Infirmary nurse, who came from
Hobart to the Melbourne in 1890. She brought
with her two certificated Sisters, who assisted her
in organisation. Miss Rathie was followed after
five years by Miss Farquharson, who was the first
here, as she had been in the Alfred Hospital, to give
the nurses theoretical as well as practical instruction.
They appreciated it intensely, and Miss Farquhar-
son's ten years' service in these two hospitals did
much to set the high standard of professional in-
struction demanded by Australian nurses to-day.

Miss Weedon from the Charing Cross in London
was the first trained Matron of the Brisbane Hos-

176 A History of Nursing

pital. She established the training school in 1885,
and the first certificates were given in 1 888 . Previous
to 1885, nursing in Queensland was very primitive.
There were few nurses, if any, who had had the
advantage of regular training.

In Adelaide, the General Hospital was, until the
year 1886, under the management of a housekeeper.
In that year, two ladies trained in the London
were appointed as day and night superintendents,
and a training school was opened there. About 1886-
f88, regular organised training of nurses was estab-
lished in most of the metropolitan hospitals, and
certificates given. At first there was considerable
difficulty in obtaining sufficient numbers of suitable
probationers, and in some places it was even found
necessary to advertise for them. There was a strong
feeling against the name of the trained nurse, and
of course the necessary changes in hospital adminis-
tration met with much criticism. There are stories
still told of medical men who were openly opposed
to such a dangerous practice as the training of nurses.
There were many difficulties to be faced and much
hostility to be put up with, but the courage and en-
terprise of the promoters of the movement were not
to be quenched by any amount of wet-blanketing.

Each town of any size has several hospitals, includ-
ing those for children, for infectious diseases, and for
midwifery. There are also hospitals for eye and ear
treatment and for the treatment of mental diseases.

Hospital training has naturally changed in many
ways since the training school movement began.
Originally nurses' bedrooms and board were of the
plainest and roughest description, and their hours

In New Continents 177

were very long. The duties required of them in-
cluded a vast amount of housework, which exhausted
their strength and devoured their time in a most need-
less way. By degrees ward maids and housemaids
were introduced, thus relieving the nurses of much
purely domestic work; more men were employed
as porters, and nurses were no longer subjected to
the harmful strain of carrying heavy patients and
moving furniture. The older hospitals have been
either remodelled or rebuilt, and modern labour-
saving contrivances, lifts, etc., have been used. All
this, with the increased comforts in nurses' homes,
has made the life of the pupil nurse much less trying.
She has now more time to devote to mastering the
intricacies of her profession. New duties and fresh
responsibilities have been laid upon her, and she is
a much more highly trained woman than her sister
of the eighties and early nineties.

The general management of nursing education
and public affairs concerning nurses is in the hands
of two governing bodies, one, the Australasian Trained
Nurses' Association, having its headquarters in
Sydney, while the state of Victoria has its Royal
Victorian Trained Nurses' Association. There is,
besides these, a branch of the Royal British Nurses'
Association in South Australia, which is in close
touch with general nursing affairs. The Councils
of the Australasian and Victorian associations are
composed of medical men and members of the nurs-
ing profession. There are representatives of the
Matrons of hospitals, of the nurses themselves, and
special representatives of the special training schools
and the subcentres.

VOL. IV. — 12

178 A History of Nursing

Of the beginnings of the Australasian Trained
Nurses' Association, Miss McGahey reported, at the
Buffalo Congress, that, as early as 1892, a meeting of
medical men and nurses had been held in Sydney
to consider what steps could be taken to form an
association in that city, but so great was the diversity
of opinion as to what constituted a "trained nurse"
that no agreement could be arrived at. We next
find that, in 1894, the Matron of the Launceston
Hospital in Tasmania, Miss Milne, came over to New
South Wales to confer with the Sydney Matrons upon
the possibility of starting a nurses' association. On
her return to Tasmania she tried to bring about the
plan discussed, but soon found the time was not
opportune. Miss Milne's keen interest in the social
and educational progress of nurses induced her to
consent to act as honorary Vice-President of the
International Council of Nurses representing Tas-
mania, in which position she stood for international
relationships and professional union. A few years
more brought success, for the small band of leaders
was not to be daunted, and in 1899 another meeting
was held in Sydney, New South Wales, and that
association was founded which, at first, was named
after the colony in which it arose, but a few months
later, because of its membership from all colonies,
was given the comprehensive name of The Austral-
asian Trained Nurses' Association. Among the
objects agreed upon at its inception was this one:
"To establish a system of registration for trained
nurses." The late Dr. Norton Manning was chosen
as its first president, and Miss McGahey and Dr. Mills
were made honorary secretaries. They worked most

In New Continents 179

enthusiastically at the general arrangements, and
Very soon evolved regulations so broad and so suit-
able that to-day, twelve years later, there are very
few alterations, and these same rules govern the
training and registration of nurses throughout the
length and breadth of the continent.

The Royal Victorian Trained Nurses' Association
was inaugurated in June, 1901, with Dr. J. W.
Springthorpe as its first president. The association
was fortunate enough to remain under his guidance
until 191 1, when he retired, and Miss Ayres, Matron
of the Alfred Hospital in Melbourne, was elected pre-
sident. This was the first time in the history of either
of the Australian associations that a nurse was
elected as presiding officer, and the event was com-
mented on in the nursing journals with general ap-
probation. The British Journal of Nursing said of it :

The selection of Miss Ayres may be looked upon as a
very happy augury for the future status of nursing in
Victoria. Of Miss Ayres's professional work it may be
said that no one has done more to raise nursing to a high
standard than this lady, who, as the senior Matron in
Melbourne, is beloved and respected throughout the
state. Miss Ayres was one of the original founders of the
Royal Victorian Trained Nurses' Association, and has
worked loyally and effectively for its success.

The two associations entered into a reciprocal
agreement in March, 1902, and local councils of the
Australasian Association were gradually established
in Queensland, South Australia, Western Australia,
and Tasmania. Each council is practically a self-
governing body, only certain points, mostly inter-

180 A History of Nursing

pre tat ion of rules, being referred to the Central
Council. The various councils all work with the
same rules, and alterations to existing rules are
referred to all states before final decision.

The purposes and methods of the two ruling Aus-
tralian associations are exceedingly interesting and
worthy of careful study, while the results they at-
tained are unique, for in no other country has a
voluntary association of nurses — or of physicians
and nurses — succeeded in imposing an educational
standard on hospitals to the extent and degree
witnessed in Australia, without state registration
and simply by the force of its membership regu-
lations and oversight of the whole nursing field.
Through the two associations, working reciprocally,
the training schools throughout the continent have
been brought into line, and by means of a central
examination for membership, held every six months,
a high uniform standard has been attained. The
minimum length of training has been fixed at three
years in hospitals with a daily average of over forty
occupied beds; four years for those of over twenty
beds, and five for those of over ten. Each hospital
recognised by the associations as a training school
agrees to abide by the schedule of training laid down
by the associations, and sends in to them annual
reports of the progress of each pupil or nurse in train-
ing. In this way the Council keeps in touch with
its future members from the day they send in their
papers to the Educational Committee; for every
candidate for hospital training has to produce evid-
ence that she has attained to a certain standard of
education, and, failing such evidence, has to pass an

c
o

C/2

In New Continents 181

examination to prove that she is sufficiently equipped
as far as English and arithmetic are concerned.

In much the same manner the training, preliminary
educational test, and final central examination of
obstetric nurses seeking membership is controlled
by the association. Throughout Australia the time
of hospital training in this specialty is twelve months,
except in the case of general-trained nurses, who may
qualify for an obstetric certificate by six months'
training in a recognised obstetrical training school.

In 191 1, the Australasian associations added an-
other branch of nursing under similar rules, namely,
that of mental nursing. For this specialty, a three
years' training in a recognised government hospital
for mental cases of not less than one hundred beds
is required. Should registered mental nurses wish
afterwards to train in general nursing, their mental
certificate enables them to start in the second year
of a three years' training school, the theoretical and
practical tuition being on the same lines in both
classes of hospitals during the first year. The as-
sociations provide for the registration of nurses hold-
ing general hospital certificates, also for those who
hold, in addition, certificates of special training.
Instruction in invalid cookery is an essential part of
the general training. Nearly five thousand members
belonged on the rolls of the two associations in
1910-11, these numbers showing what a power they
have made themselves.

Nevertheless, in spite of the unusual power and
influence gained over hospitals in specific points of
educational requirements by the associations of
nurses, and despite the results gained by voluntary

182 A History of Nursing

registration, far surpassing those achieved under
voluntary auspices in any other country, the nurses
and medical men of Australia came gradually to the
conclusion that they must have the interference of
the state in order to cope successfully with those
institutions whose own standard as to education,
or convictions of self-interest, clashed with the public
good, as such centres could not be reached by the
means available to a private society. For some years
the growing evidence in this field occupied the minds
and meetings of nurses. In April, 1906, a conference
between delegates of the two associations was held
in Melbourne, where many matters of common in-
terest were discussed. Again, in July, 1909, a second
conference took place in Sydney, and was attended
by delegates from all the states of the Commonwealth
working under the Australasian Trained Nurses*
Association. One important subject discussed was
the necessity for state registration, which was un-
animously recognised as pressing.

To provide for this reform, a bill was prepared and
introduced by Dr. Mackellar, to whose unselfish
labours in its behalf the gratitude of the nursing pro-
fession is due. Among the deputation which waited
upon the Minister of Public Instruction in the New
South Wales Government were Miss Kendal Davies,
Miss Gould, Miss Newill, Mrs. Ashburton Thompson,
and Miss Sanders, as well as a number of physicians.
Of the outlook for success the Australasian Nurses'
Journal said in May, 191 1: "There seems every
probability of having state registration of nurses in
New South Wales by the end of the present year,
judging by the favourable reception accorded by a

In New Continents 183

minister of the Crown to the deputation of the
Australasian Trained Nurses' Association." This
bill was passed in the Upper House, but before it
went farther Queensland came to the front. In
191 1 its government amended the Health Act, and
nurses were taken by surprise to find that some in-
sufficient clauses were being added, providing for
registration. The Queensland Council at once called
a special meeting, and the wishes of this professional
body were submitted to the ministers, with the result
that all their amendments, except two, were accepted.
On January 1, 191 2, the act went into effect. It is
considered by the nurses fairly satisfactory, and they
will keep a close watch upon its administration. Of
this event Miss Garran, secretary of the A. T. N. A.,
said:

Under Australian conditions there are certain great
advantages in the work of registration being done by the
government, but there are also very great advantages
in the present system of an independent body, which,
though it receives government support and approval, is
yet free from political influence. With our uniform sys-
tem of training, examination, and registration, we are not
so urgently in need of state registration as in a country
like England where every hospital is a law unto itself.
Here there is one system of registration and one standard
from end to end of the continent. State registration will
to a great extent break up this uniformity, as each state
will have its own law on the subject. The aim of the
A. T. N. A. is to bring pressure to bear in any state where
a bill is introduced, so that any proposed legislation may
be brought into harmony with our methods and stand-
ards, but there are bound to be many and great differ-

184 A History of Nursing

ences in the laws passed by the various parliaments and
in the regulations and by-laws passed by the local govern-
ment boards. . . .

The tendency in Australia — a tendency which has
increased during the years that women have had the
suffrage — is for men and women in all political, social,
and professional associations to labour side by side at
the work in which they are mutually interested and not
to separate into opposite camps. This is especially the
case with nursing, where, whether in hospital or in private
work, the one cannot do without the other; and, indeed,
from all I can gather from Australian nurses who return
from their travels abroad, it seems that doctor and nurse
work together on much more equal terms here than is
the case in most countries. Certainly the medical men
in Australia have worked hand in hand with the nurses
to raise their professional training and status.

Two professional journals are published monthly
in Australia, the Australasian Nurses' Journal be-
ing the organ of the older society, while Una is the
periodical of the Victorian nurses. They are keenly
alive on educational matters, giving much space to
reports and discussions relative to the enforcement
of their standards upon hospital training schools,
and publishing fully the status of the various institu-
tions from this point of view. They follow the eco-
nomic circumstances of nursing with close scrutiny
and clear vision, never losing sight of the need for
keeping a good standard here as well as in education.

Private nursing is the branch which accounts for
the largest number of nurses on the register. There
is abundance of work during the greater part of the
year the demand for nurses at times exceeding the

In New Continents 185

supply. Private nurses are usually attached to a
nurses' home. These homes charge a small weekly
fee, and act as agents for the nurses, providing them
in turn with cases. When they are in residence in
the home, moderate board is also charged. Nurses
belonging to the various homes are under the direct
protection and guidance of the lady superintendent.

Private hospitals which are registered by the as-
sociations are pledged to employ only certificated
nurses on their staffs. It is, therefore, now impossible
for patients who pay for skilled attendance to be
left to the uncertain ministrations of the partially
trained nurse.

It has long been evident that a considerable portion
of the community was unable to face the ordinary
nursing or private hospital expense, and yet not
prepared to ask for treatment at the public hospitals.
In consequence of this fact, much attention has been
given of late to the question of the nursing of the less
well-to-do. At the time when this is being written,
some scheme for providing an intermediate hospital
is being discussed in connection with the Friendly
and Provident Societies.1

The nurses themselves have, to some extent,
grappled with the problem, and have instituted
visiting or hourly nursing. Much good work is
being done, many sick folk being thus enabled to
receive skilled attention in their homes, who otherwise
would go to swell the hospital lists. It has been
found possible also to overtake a number of cases

1 These intermediate hospitals would probably receive patients
who could pay a small reasonable sum per week, as is so widely cus-
tomary in American hospitals. — Ed.

186 A History of Nursing

where some attention was required, but where
the members of the family were quite capable of
attending to the patient, once the important details
were seen to by the nurse. The visiting nurse is a
boon to the tired nurse with a heavy case, to give
assistance with especially difficult procedures, or to
relieve the nurse, in times of stress, for exercise or
sleep. She has been well worth her small fee, and
has, in some cases, saved the patient the expense of
a second nurse. District nursing does very similar
work in poorer circles, and it would be impossible to
over-estimate its worth.

"Bush nursing" is in its infancy, but it shows
signs of lusty health and rapid development. Bush
nursing means, in Australia, what rural nursing means
in other countries: It is intended that no settler
however remote, no little home, in however distant
and lonely a part of "the bush" it may be found,
shall be isolated beyond the possibility of skilled
nursing care in time of need. Bush nursing is a big
scheme and calls for much forethought and careful
administration. Enthusiastic women, old enough to
be experienced, yet young enough to be adaptable, are
needed to fill positions as bush nurses; above all is
it of the first importance that nurses undertaking such
work should have had the fullest, most thorough, most
well-rounded training that their country is able to
give them, both general and special, for such women
must be, in the widest sense, missioners of health as
well as nurses of the sick, and they should be the
very flower of their profession. This principle has
been recognised in the high standard of qualifications
demanded for nurses entering this service in Australia^

In New Continents 187

and it may be concluded from the history of current
events that the power of the professional associations
of the country was successfully exerted to secure a
model pattern for the equipment of the bush nurse.

The Countess of Dudley has placed the Common-
wealth in her lasting obligation by the splendid
work she performed, in spite of much difficulty, in
organising bush nursing. Others have helped, some
with generous gifts of money — among these Madame
Melba — but it was Lady Dudley's keen interest and
untiring, enthusiastic work that began bush nursing
in Australia. It had been her hope to establish it on
a federal scale, covering the whole country in one har-
monious network, and in the planning with this aim
in view, Miss Amy Hughes, General Superintendent of
the Queen's Institute in the mother country, had been
called to Australia to confer and counsel. The large
federal system, however, was not destined to spring
full-fledged, and bush nursing began under state
auspices, the first nurse being installed at Beech
Forest early in 191 1. From this beginning it will,
without doubt, spread from state to state. Tasmania
has been making efforts to provide bush nurses for
the many islands grouped about her. These islands
have been for months in the year unable to obtain
either medical or nursing assistance.

Medical inspection of school children is enforced
throughout Australia. In Hobart a nurse has been
appointed to assist in such work, which will doubtless
become more highly perfected and demand nurses
in large numbers, providing a new opening for capable
women as well as ensuring the well-being of schook
children.

188 A History of Nursing

Lady Talbot has also left Australia a memento of
her work for the sick and afflicted in the Talbot Milk
Institute which she inaugurated during her husband's
term of office as State Governor of Victoria. By
means of this charity pure milk and ice are supplied
to delicate babies. Two nurses are employed in
connection with this institute, and their oversight
and educational work, aided by the sufficient supply
of pure food, has meant health and strength to many
a puny, delicate child of the stifling back streets.
Numbers of little lives must have been saved by
the Talbot Milk Institute.

In some centres nurses are employed as sanitary
inspectors; while at least one insurance company
is using a nurse in investigating and caring for
" sick-pay* ' cases.

Nurses' clubs are being talked of everywhere.
Though few have as yet come into existence, the need
is felt, and very soon every centre will follow the
example of Sydney and have its own club. This
will do great good, for the social side of nursing life
might with advantage be improved and developed.

Australian cities are said to be too lavishly sup-
plied with institutions for the relief of the sick poor.
It is claimed by some that the work could be done
more conveniently and at much less expense of time
and money, were the many merged in the two or three.
While there is much difference of opinion on this
point, it would undoubtedly be of advantage to the
student of nursing to be able to take her special
courses in her original training school, instead of, as
at present, waiting admission to another hospital.
There are registered training schools in all the

In New Continents 189

larger towns of the states, while in the small country
towns there are cottage hospitals which are often very
well built and up-to-date as to their equipment.

With regard to the untrained nurse, she is with us
in large numbers, continually exemplifying the truth
of the saying — "A little knowledge is a dangerous
thing." In midwifery practice especially she may be
described as a danger to the community. But the
day is at hand when all midwifery nurses working in
Australia will be required to pass a state examination
and be registered by the state.

Much has been done in every way, during the past
twelve years, by the two leading associations, but
no record can give the true value of the work done
by many individual women in the early days. To
the Matrons and Sisters of our hospitals in the various
states is due the advance from that time when igno-
rant and uneducated women, many of whom could
not even read and write, staffed our hospitals, to the
present satisfactory state of nursing progress. The
true history of Australian nursing is the story of the
life-work of many honourable women.

New Zealand. New Zealand is one of the young-
est of Great Britain's daughters; discovered in 1769
by Captain Cook, she was not settled for many years
later. The history of the care of her sick in early
days is fragmentary, and few records are reliable
until the times when, population becoming more con-
centrated in some centres, the different provincial
governments found it necessary to provide hospital
accommodation for the people. There was no settled
system of nursing, nor were there trained nurses.

190 A History of Nursing

The Auckland was the first hospital established,
the city of Auckland being the seat of government
for the North Island. A site was set aside in 1850,
and the patients now partaking of the benefits of
the hospital have to thank the officials concerned
for their choice of a most beautiful spot. The large
area of land chosen is on a rise commanding an ex-
tensive and most lovely view of the harbour. Here
a small building was erected in 1850 or 185 1, no part
of which now remains. It was designed by the Rev.
Mr. Thatcher, private secretary to Sir George Grey,
and had about ten beds for each sex, with living rooms
for the Master and Matron, but no room for a resi-
dent physician. There were no female nurses other
than the Matron. Dr. Mackellar was the first medical
officer. The hospital was managed by the provincial
government until the abolition of provinces in 1875.
At that time a stone building was put up which forms
the nucleus of the present large hospital. Up to
1883 it was under government control, when it was
placed under a committee in part nominated by the
governor and in part elected by the subscribers.
A government inspector was then appointed to super-
vise all hospitals. This was Dr. Grabham. His
first report describes the nursing in this institution
in 1883:

The female nursing (which is confined to the large
ward for females and to the female fever ward) is per-
formed by the Matron, an assistant nurse, and a night
nurse. The Matron takes her meals in an adjoining
room, but sleeps at home, as also does the night nurse.
In this division of the hospital the patients appeared to

In New Continents 191

be well and kindly treated. Everything was, moreover,
orderly and very clean. I cannot, however, approve of
the arrangement whereby at present the same nurses
attend upon the ordinary patients and those suffering
from fever. The same thing is done when scarlet fever
is present. The male fever ward has nine beds; eight
of these are occupied by typhoid fever cases, and the
other by an old patient, who does the whole of the
nursing. At present he has some assistance from a con-
valescent patient, and he certainly does everything in
his power for the good of those under his charge. The
ward he keeps beautifully clean also; but the arrange-
ment is a very bad one, and may end in disaster. The
nursing — if I may call it by that name — in the other
male wards is of the most wretched description. In No.
I there is an old man who is paid to take charge of it.
No. 3 is under the care of another old man, brought from
the Refuge for that purpose. . . .

The committee then appointed a trained nurse as
superintendent and made Dr. E. D. Mackellar
resident house surgeon with quarters in the building.
In the inspector's next report, written in 1884, ^e
dwells on the improvements made since his former
visit, and his satisfaction with the manner in which
the committee and medical officers of the Auckland
and other hospitals had received and carried out his
suggestions. He then said: "We have now many
establishments which, in their arrangements, order,
and comfort, will bear favourable comparison with
any of the European hospitals with which I am ac-
quainted, and a spirit of emulation has sprung up in
the Colony which cannot fail to have a wholesome
effect." He goes on to say that a very excellent

192 A History of Nursing

system of nursing is in full operation at the Welling-
ton and Christchurch hospitals, where well-educated
ladies may be seen serving their apprenticeship with
other "probationers." There were, however, ap-
parently no regular training schools yet initiated.
Miss Crisp is specially mentioned as possessing
"in an eminent degree the qualifications which
are desirable for her present position, and is ably
seconded by her assistants."

Miss Annie Alice Crisp, the new Lady Superin-
tendent, was a certificated nurse, trained at Netley,
and had been in active service in Egypt. On her
appointment Dr. Mackellar recommended a staff of
women nurses for the men as well as women patients.
At this time the number of beds was — male, seventy-
three; female, twenty-seven; no children's beds.
Miss Crisp had as staff twelve nurses, two house-
maids, three porters, cook and assistant. Five years
later the training school for nurses was established.
Dr. Mackellar took the greatest interest in this work,
and even now he is looked up to by Auckland Hospi-
tal nurses as the father of their school. Long after
retiring from the position of medical superintendent
he was an active member of the honorary medical
staff, and still carried on the lecturing and teaching
of nurses which he inaugurated.

The modern Auckland Hospital is a fine and up-to-
date institution of 340 beds. Attached to it and in
the same grounds is a well- designed infectious annex,
comprising two observation wards for suspicious
cases, a building for scarlet fever, with two wards,
nurses' quarters, and offices, and a similar one for
diphtheria. There are a fine laboratory and a mor-

In New Continents 193

tuary in one building, and the hospital proper is
built in blocks erected at different dates. Every
ward has wide balconies to which the patients are
wheeled to enjoy the beautiful view of the harbour.
The new wards are known as the "Costley Block"
from the name of the wealthy citizen who gave the
funds to build a theatre and surgical wards for
children. A large addition to the nurses' home is
also new. The nursing staff is under the control of
a lady superintendent, who has under her an assist-
ant in charge of the home, where eighty nurses are
in training. The course is for three years, and
a very complete set of lectures is given by members
of the staff, resident medical officers, and superin-
tendent. The ward Sisters give the practical
teaching.

Under the control of the same board are the Costley
Home for old people, with a trained nurse in charge
of the women, and a convalescent home, to which the
hospital nurses are sent for short terms.

There was at one time a ward for maternity
patients at the Auckland Hospital, and a good
many nurses learnt maternity nursing there, but this
was discontinued some years ago. The nurses have
a good opportunity of experience in different branches
of nursing. The probationers are given their turn
in the infectious diseases' wards as juniors and again
as seniors. The special children's ward takes in
quite small babies and affords good experience in the
diseases of children. One hundred and forty nurses
have been trained and registered in the Auckland
Hospital since "The Nurses' Registration Act " was
passed. The Matrons who succeeded Miss Crisp

VOL. IV. — 13

194 A History of Nursing

(afterwards married to Dr. Mackellar) were Miss
Squire, trained at the Edinburgh Infirmary, who was
appointed in 1895, and resigned after three years;
Mrs. Wooten, trained in the Alfred of Melbourne,
who remained till 1910, when she was succeeded by
Miss Peiper, trained in Invercargill Hospital and
Matron for some years of the St. Helen's in Auck-
land. Miss Peiper was one of the nurses who went
to South Africa to nurse in the Boer War, and she
obtained her midwifery certificate in London.

The Wellington Hospital has the honour of being
the first training school for probationers. In Dr.
Grabham's report of his visit of inspection in July,
1883, he mentions that "Dr. Hammond has been ap-
pointed Medical Officer and Mrs. Moore, Lady Su-
perintendent. The ' nurses' have been supplanted by
probationers drawn from a higher order of society."
He speaks of the need for better accommodation for
the nursing staff:

The lady superintendent should have apartments in
such a position that, while within call, she would at
times be free from the noises, bad smells, and other con-
comitants of a residence close to the door of a large ward.
The very successful introduction of the probationer sys-
tem will also necessitate some structural additions of an
inexpensive character. These nurses take the greatest
possible interest in their calling, which they have chosen
from other than pecuniary motives only; and I have no
hesitation in stating that a foundation is here being laid
for a considerable permanent benefit to the Colony.

Later reports by Dr. MacGregor refer to the im-
provement in the nursing staff of the hospital, and

In New Continents 195

especially mention Dr. Ewart (who was for about
twenty years medical superintendent, retiring from
the position only in 1908), and Miss Godfrey, who,
trained under Mrs. Moore, became Matron in 1890,
and retired in 1898, being succeeded by Miss
Payne, who had been trained in the hospital under
Miss Godfrey, and was afterwards for a short time
Matron of the Christchurch Hospital. Miss Payne re-
mained in office until 1903, when she left to take
charge of the Rotorua Sanatorium, and was succeeded
by Miss Pettit, but afterwards returned to her
former post. In 1905, great improvements took place
at this hospital, in the opening of a fine nurses' home,
and special chronic wards. The Victoria wards,
accommodating forty patients, are detached, and are
a complete hospital in themselves. There are shel-
ters for consumptives, and a new fever hospital with
its own complete nurses' home under the same man-
agement as the Wellington, though some distance
away.

Several of the Matrons of the most successful
training schools, as Miss Thurston of the Christ-
church Hospital, Miss McKenny of Wanganui,
Miss Berry of Napier, Miss Todd of Timaru, Miss
Gosling of Nelson, and Miss McGregor of Waihi, are
Wellington nurses.

The Christchurch Hospital was first built in 1862.
There had been a small hospital previously at Lyttel-
ton, but little is known of it. Dr. Dalgleish was the
first medical officer, but there is no mention of a
nursing staff. For about twenty years the old
Christchurch was carried on under a house steward
and housekeeper. There were then some women

196 A History of Nursing

nurses, not trained, but who were probably of a higher
class than the servants, as it is mentioned that they
took their meals in their own rooms and that the
patients were kindly and carefully treated. A part
of the building erected for twenty-five patients in
1862 still stands, and in it are the dispensary and out-
patients' department. The wards above were used
as lumber rooms for many years, when, after a fire
that destroyed two wards, they were again put into
use for the patients thus turned out. The modern
nurses thus learnt something of the disadvantages
their predecessors had to labour under. In 1885,
the first trained Matron was appointed. She was a
Miss Paton, who had been for six months in a
London hospital. Nothing more is known of her.
The number of beds was then eighty. No attempt
at training probationers was made until 1887. The
chairman then offered a gold medal to the first nurse
who trained there, but there is no record as to who
received it.

Two years later, we read that "the nursing system,
one of the most essential features of hospital manage-
ment, is well organised." Later the reports are not
quite so satisfactory, as the house surgeon needs to
insist that all vacancies shall be filled with well-
educated young women, capable of profiting by such
special training as every modern hospital of this
size ought to impart to its nurses. In 189 1, the need
of a home for the nurses is dwelt on, and it is pointed
out that, until this is provided, the staff cannot be
put on a proper footing of efficiency. It is recom-
mended that one be built and the whole nursing
staff reorganised. In 1894, came a period of trouble.

In New Continents 197

Miss Maude, a nurse trained in the Middlesex
Hospital, had been appointed Matron, and had given
splendid service in reorganising the nursing of the
institution, but, unable to combat the prejudices
engendered by the past system, resigned. She was
followed by Miss Ewart, then a Sister in the wards,
and trained in Belfast. After fourteen years' sway
Miss Ewart was succeeded by Miss Thurston, trained
at the Wellington Hospital, who, as the head of nurs-
ing in all the institutions under the control of the
board, supervises, besides the main hospital, the
sanatorium for consumptives on the Cashmere Hills,
the chronic wards for women at the Jubilee Memorial
Home, a mile or two away; those for men at Ash-
burton, and the hospital for fevers. Trained nurses
belonging to the hospital staff are in charge of these
outlying wards, and probationers are sent to them
during training. A cottage hospital at Akaroa, a
lovely seaside place, is also under the board and is
staffed from the hospital.

A new children's ward and one for gynecological
patients enable Christchurch to boast of possessing
the model wards of the Dominion. The children's
ward is tiled throughout in pale blue and adorned
with beautiful nursery pictures in tiles. The
verandahs are wide, that cases may be treated in the
open air. Convalescent children have a garden
playground, and the women's ward a roof -garden.

The Dunedin Hospital is the medical school of
the Dominion, and its history has been of special
interest on this account. Only sixty- two years ago
was the Otago settlement founded and, two years
afterwards, the first Dunedin Hospital erected. The

198 A History of Nursing

Memorials of John A . Torrance describe its earliest

days:

Like the gaol it was in advance of its time. . . . For
over two years not one of its beds was occupied, and
then also like the gaol, it was turned to a use never
dreamed of. The insane persons had to be cared for,
and so the first hospital became the first asylum, and for
a time it served the double purpose . . . those physic-
ally sick of course ultimately preponderating. But not
until the discovery of the gold-fields in 1861, when im-
migrants were poured into Dunedin by shiploads, was
there any large demand for hospital accommodation.

The hospital is now a large and handsome insti-
tution, with well-equipped schools both for medical
students and nurses. The training of nurses was first
started in 1888, when lectures were given by the
honor ary staff and an examination was held at the end
of twelve months. At this time the Matron, Miss
Burton, an estimable elderly dame still [in 191 1] liv-
ing near the hospital and sometimes attending as an
out-patient, was quite untrained. How her eyes
must open at the appointments of the new out-patient
department and the nurses on duty there ! When the
question of giving lectures to the nurses arose, she
said: "What do they want with lectures? I'll
lecture them!"

The time of training was first fixed at one year,
and nurses were only placed in the women's wards.
The first Matron with full training was Miss Edith
Maw, who came from England in 1892, but was only
in office for one year. In 1893, Miss Isabella Fraser
trained in the Edinburgh Infirmary, came from Mel-,

In New Continents 199

bourne to succeed Miss Maw, and remained in her
post for twenty years. She instituted a three years'
course and placed nurses in all the wards. Large
additions have been made to the hospital in all its
departments, and it has also several dependent in-
stitutions for infectious cases, chronic and consump-
tive patients, all of which are under the one medical
superintendent and lady superintendent, and are
staffed from the main hospital. There are also
several cottage hospitals or receiving wards in
different parts of the district, with trained nurses
from the general staff in charge. The Maternity
of the Medical School is a well-equipped small
special hospital where the Dunedin nurses receive
midwifery training. This, however, is a dis-
tinct post-graduate course of six months under the
same rules as the state maternity hospitals.

In addition to the four chief hospitals just de-
scribed, there are over fifty others in New Zealand,
with beds running from one hundred to ten. Some
of these were established in districts which once pro-
mised rapid growth and prosperity because of the
existence of gold mines long since abandoned. They
are now little more than homes for old people and
refuges for disabled miners.

The hospitals which train nurses are thirty, in
all. Some of the medium sized ones, as Wanganui,
Palmerston North, Waikato, Timaru, Napier, and
Invercargill, are fine institutions, well equipped and
staffed, and send out excellent nurses. With state
registration, their training has come into line with
the larger hospitals, and it is often a nurse from one
of these schools who tops the list of examination

200 A History of Nursing

candidates. The history of the Masterton Hospital
is interesting from the fact that its first Matron was
a Nightingale nurse. The original building, put up
in 1878, was paid for with funds collected by Miss
Selina Sutherland, aided by a government grant.
Miss Sutherland was a personality well-known for
many years in Melbourne, Victoria, in connection
with charitable work and the care of destitute
children. In the early days before the existence of
the hospital, because of her energetic efforts to get it
for the district, and her care of the sick and afflicted,
she was called the Florence Nightingale of the Waira-
rapa. The first Matron, who had had some training
under Miss Nightingale, was Miss Lyons, but she
only stayed a few months, and then until 1897 the
hospital was in the care of an untrained Master and
Matron. In that year Miss Heath, a Wellington
graduate, was appointed with two trained nurses as
assistants. The new building was opened in 1907,
and is a good specimen of a modern country hospital,
as the old one is of the cottage hospitals of twenty
years ago.

The Nelson Hospital is fairly old. The present
building was put up in 1867, but a still older one
had been built before that by the provincial govern-
ment. Its first trained nurse was Miss Dalton, an
Englishwoman. A photograph shows her a com-
fortable looking dame of eighteen stone, and it was
once remarked of her that she did all the work that,
in later times, fifteen nurses were needed for. Before
retiring for the night she would put her head in at
the ward door and call out : "Now ; any of you chaps
want a drink? Because I 'm going to bed." Miss

In New Continents 201

M. Jones was appointed in 1893, and under her and
Dr. Talbot a course of training for probationers was
first started in 1897.

These brief sketches of the principal hospitals
and their gradual evolution as training schools show
how primitive for some years were the arrangements
for nursing the sick. The people in various districts
built hospitals, recognising the need. In many
country places it was indispensable to have some
provision of the kind, as the men in this new country
were mostly homeless, living in tents, and generally
roughing it. The difficulty of taking proper care of
them when in the hospitals was greatly accentuated
by the scarcity of women, and owing greatly to that
cause the systematic training of nurses was not pro-
perly begun until about twenty-five years ago, and
men were mostly nursed by men. In fact, in one
hospital it was found that the only nurse at night was
an old man, who attended on men and women alike!

The appointment of an inspector of hospitals for
the government undoubtedly aided greatly in bring-
ing about a more correct method of administration.
On his visits of inspection he could observe the needs
of each institution, advise as to means of bettering
each and every part of the organisation, and, being
a medical man experienced in the management of
hospitals in the old country, the nursing department
was one in which he took great interest and was
qualified to advise and suggest. The first inspector
(Dr. Grabham) remained in office only about three
and a half years, and was succeeded by Dr. Mac-
Gregor, who carried on the work for twenty years.
In 1895, a great step in the interests of nurses and for

202 A History of Nursing

the betterment of their training was taken in the
appointment of Mrs. Grace Neill to the position of
assistant inspector of hospitals and asylums, Dr.
MacGregor having recognised that the numerous and
delicate questions affecting women which had to be
dealt with in connection with the system of charitable
aid, and the administration of hospitals and asylums,
ought to be handled in the first place by a woman.
Dr. MacGregor considered that Mrs. Neill com-
bined in a very high degree the ability, knowledge,
and sympathy required for this position. She was a
trained nurse, having undergone training in London,
as Grace Campbell, at the King's Cross and Charing
Cross hospitals. She held a St. John's House cer-
tificate for midwifery, and, until her marriage, had
been lady superintendent at the Children's Hospital
in Pendlebury. She had, therefore, special qualifi-
cations for the post to which she was appointed.

After coming into office, and becoming thoroughly
acquainted with the varying conditions under which
the patients in the different hospitals were nursed,
and the very unequal standards of the nurses sent
out from them, both Dr. MacGregor and his assist-
ant recognised the advisability of establishing some
means by which the training of nurses could be
regulated.

At first it was proposed to establish a branch of the
Royal British Nurses' Association, and negotiations
were opened with that body, proposing affiliation,
but these came to nothing, as the parent association
would not agree to self-government for the colonial
branch, and, though it was to be self-supporting, all
subscriptions were to be sent home. Mrs. Neil]

In New Continents 203

was in England in 1899, and had an interview with
some of the officers of the association, but reported
that she saw no reason to expect the slightest ad-
vantage to New Zealand, or help in establishing a
standard of efficiency. In fact, it was found that
no such guarantee of efficiency was even then estab-
lished by that association, and the founders of it had
already, disappointed, withdrawn from its ranks and
were devoting themselves to strenuous efforts to
obtain state registration. It was thus decided that
only the power of laying down laws for the proper
training and examination of nurses under state
auspices would remedy the existing evils. Dr. Mac-
Gregor made the statement: "Nothing short of this
will ever secure efficient and trustworthy nurses for
any country."

Early in 1901, the government authorised Dr.
MacGregor to prepare a bill for the state registration
of nurses. No interference was contemplated with
the right of every person to employ whatever nursing
he desired — the state limiting itself to giving a reli-
able list of nurses properly trained and tested by
state examinations. The bill passed, but was some-
what altered during its passage through the house.
Members representing districts where the smaller
hospitals were established would not agree to the
minimum number of beds for training schools pro-
posed at first, viz., 40, and though some limit and
minimum should have been settled, this was not
done, and any general hospital which complied with
the terms of training and gave, to the best of its
ability, the instruction laid down in the syllabus,
was able to send its probationers up for examination.

204 A History of Nursing

While in older and more closely settled countries,
no doubt, it would have been more easily possible to
limit training schools to those possessing a certain
number of beds, it is certain that, had it been done
here, and with so high a minimum as 40, many ex-
cellent nurses trained in some of the smaller hospitals
would have been lost to the profession As a matter
of fact, with very few exceptions, candidates for ex-
amination do not come from the very small hospitals,
or do not take it until they have had supplementary
training in the larger ones. When the act first came
into operation, nurses who had been previously
trained, or who had had four years' experience, were
registered, but after 1902, all New Zealand nurses
had to pass the state examination. Some of the
larger hospitals in which a systematic training had
been carried out before this still held their own final
examination, and gave a certificate independently
of that given by the government. This is the correct
thing, as nurses should value the certificate of their
alma mater ; but the smaller ones seemed content to
avoid the trouble of examinations and leave the work
to the government. The regulations as to examina-
tions, and the curriculum of training and syllabus of
lectures, were drawn up by Mrs. Neill, and continued
in use for several years without alteration. They
were, however, in 1907, revised and altered, though
it was not found necessary to make any very great
difference in the main points. It is hoped later to
amend the act in several details, especially with
regard to the recognition of hospitals as training
schools.

We have gone thus fully into the institution of

In New Continents 205

state registration for nurses in New Zealand, as this
Colony was the first of the British possessions to
pass a bill for that purpose.1 After two or three
years of operation, the inspector-general of hospitals
remarks in his annual report: "It is becoming daily
more apparent that by the silent pressure of this
law the nursing profession of New Zealand will be
effectively organised." In the last report (written
shortly before his death) of this able administrator
of the New Zealand Hospital and Charitable Aid
Department, he says :

New Zealand has proved by five years' experience the
advantage to medical men and the public, as well as to
the nursing profession, of having a recognised standard
of proficiency and consequent state registration. There
is no fault to be found with our system of state registra-
tion of nurses; it works well and maintains a standard
which acts as a stimulus to hospital authorities.

The nurses' registration act of New Zealand
uses no compulsion, except that of enlightened self-
interest on the part of the nurses themselves ; but it
is rare indeed for a nurse to spend the necessary
three years in a hospital, going through the routine
of training, and not present herself for the state
examination. No important hospital position can
be obtained by a nurse unless she is registered. The
number of nurses coming up for examination has
doubled in the four years of 1906-19 10. The pro-
vision for nurses coming from elsewhere to register

1 Cape Colony had the first registration, but under a medical
act. — Ed.

206 A History of Nursing

is perhaps rather lenient. Their certificate of train-
ing from a recognised training school for three years,
with a course of lectures and examination equivalent
to that of New Zealand, is accepted, and they are
not obliged to pass the examination. As a matter
of fact, the need of nurses in New Zealand, in spite
of (considering the size of the country) a fair
number being trained each year, is so great that it
was inadvisable to shut out desirable additions to the
number from abroad. It may in the future be pos-
sible to open the door less widely.

The next step of importance to the nursing pro-
fession in New Zealand was the passing of an act
for the registration of midwives. This was accom-
plished also by Dr. MacGregor and Mrs. Neill, and
took place in 1904. The act provided for the
registration of women with a certain amount of
experience (gained during a minimum of three 3'ears)
of the work of midwifery, and vouched for by medical
men as understanding their work and being of good
character. After 1906 women not so registered were
no longer allowed to undertake confinement cases
without a doctor, except in cases of emergency. In
administering this act it was found necessary in far
back country places to allow the word emergency
a wide meaning, as many even of the experienced
women did not avail themselves of this opportunity
given them to register, and the work had to be carried
on, while frequently the nearest doctor would be
many miles away. Having passed a midwives' act,
it was then necessary to provide means of training
nurses as midwives. It had been necessary for
women wishing to become properly qualified to go

In New Continents 207

to Australia or Great Britain for the necessary in-
struction. In connection with one or two hospitals
— the Auckland and the Dunedin, for instance — there
had been maternity wards, but these were not
organised training schools. The then Premier (Mr.
Seddon), in order to meet this difficulty, determined
to establish state maternity hospitals, and deputed
the task of finding suitable buildings and organising
hospitals in the four chief cities to Mrs. Neill.
They were to be for the reception of the wives of
working men, and a small fee was to be charged.
Pupil nurses were to be taken and fully trained nurses
with midwifery certificates were appointed Matrons,
with one qualified assistant. The first four Matrons
were Miss Wyatt, Miss Holford, Miss Peiper, and
Miss Inglis. The hospitals were all named for St.
Helen and a non-resident medical officer was ap-
pointed for each one. Dr. Perkins, of Wellington,
was the first appointee, followed by Dr. Agnes
Bennett. Dr. Emily Siedeberg was appointed to
the Dunedin, Dr. Alice Moorhouse to the Christ-
church, and Dr. Tracy Inglis to the Auckland
St. Helen's.

The primary idea was that while the houses were
to be comfortable for the patients, they should not
be equipped in such a way that the nurses on going
into ordinary homes would be at a loss to manage
without what they had been accustomed to. There-
fore, ordinary houses were selected and fitted up in
a simple and inexpensive fashion. In such houses
the work of the St. Helen's hospitals has been carried
on for over five years. But it has grown so much,
the people for whom the hospitals were intended

208 A History of Nursing

having appreciated the benefits of being nursed and
cared for so thoroughly, that the time has come when
more truly hospital-like places must be built and
equipped, and the first to be built on proper hospital
lines is to be erected in Wellington. During the
time these houses have been established, the number
of patients has more than doubled, and the pupil
nurses also have doubled, and in some centres trebled.

A regular curriculum of instruction and examina-
tion is laid down. The term of training is twelve
months for untrained women, but for registered
nurses it is six months. Each pupil must personally
deliver twenty women and nurse the same number
through the puerperium. Contrary to the usual
practice in home maternity hospitals, the nurses are
trained to be maternity nurses and midwives. In
the town, as a rule, they prefer to work under the
doctors, but in the country they — being qualified to
do so — must undertake the full delivery of cases,
calling for a doctor only under certain rules laid
down for their guidance. There are two hospital
training schools for midwifery nurses (besides the
four state St. Helen's hospitals), one established in
connection with the medical school in Dunedin,
and one built in Gisborne by a society of ladies.
More and more the trained nurses of the Dominion
are realising the value of midwifery training, and
entering for their six months' course, after completing
their general training. There are usually two or
three registered nurses in each term at each of the
hospitals.

Before the third of the St. Helen's hospitals— that
in Auckland — was established, their founder, Mr.

In New Continents 209

Seddon, died when on his way to declare it open.
Of all the great work which this man, so gifted with
the genius of statesmanship, accomplished for his
adopted country, perhaps none will have such lasting
effect and do so much for the coming race of New
Zealanders as this of founding the four state mater-
nity hospitals. They are a more enduring monument
to his memory than any statue or tombstone can be.
Mrs. Grace Neill, his helper in the work, resigned
her position shortly after this time, and handed on
the work of organising the fourth St. Helen's Hos-
pital to her successor. Miss Hester Maclean was
appointed to fill her place and commenced her duties
as Assistant Inspector of Hospitals, Deputy Reg-
istrar of Nurses and Midwives, and Officer in Charge
of the St. Helen's hospitals, on November 1, 1906.

Miss Maclean was trained in the Royal Prince
Alfred Hospital, Sydney, and held the certificate of
the London Obstetric Society, and the C. M. B.
She had had experience as Matron of cottage hospi-
tals and of the Women's Hospital, Melbourne, with
various other posts, which fitted her for the position.

Still another change was to take place in the gov-
ernment department which held control over the af-
fairs of nurses. Dr. MacGregor, who, with Mrs. Neill,
the nurses of New Zealand have to thank for their
state registration, died suddenly in November, 1906.
Dr. Valintine was appointed to succeed him , and
has carried on his work with the same regard for the
general improvement of all hospital matters. As
Registrar of Nurses he has the interests of the nursing
profession very much at heart. In 1909 a new act
for the management of hospitals and charitable aid

VOL. IV. — 14

210 A History of Nursing

was passed by Parliament. This act, by placing all
the institutions for the relief of the sick under one
general control in each district, has rendered possible
the training of nurses in a wider and more varied
way than was possible before. This has been referred
to in the accounts of the larger hospitals. Another
very important change under this act, and one which
opens out a wide field to trained nurses, is that the
hospital boards are empowered to expend money on
the nursing of the sick outside the walls of their in-
stitutions. Thus they may pay nurses to take charge
of distant parts of their districts, in this way bringing
the benefits of the hospital system to those who are
too far distant to avail themselves in illness of the
benefits of the hospital itself, and yet under the law
must contribute their share in rates.

Back-block district nursing is the scheme for the
relief of the sick nearest the heart of the inspector-
general of hospitals. He, having been for years a
country practitioner, working far out to the back
blocks, knew what it was to have no help from a
competent nurse, to have to ride away, after being
called a distance of fifty miles to a case, knowing
that his visit had been of little use owing to there
being no one able to carry out his instructions. In a
few years it is hoped there will be no country district
without its nurse. Nurses of the highest ideals,
unselfish, sympathetic, endowed with judgment and
decision, well trained and experienced in both general
and midwifery nursing, are needed for this work.
Great responsibility will rest in their hands. Far
away from a doctor, they will often have to act
promptly without advice; they will have to diagnose

In New Continents 211

disease, will have to decide whether a doctor must
come, whether a patient must be sent to hospital;
on their good judgment and observation many a
life will hang. Owing to an excellent telephone
service, there are few places quite cut off from a
doctor, but frequently it is impossible for him to get
to a place in time.

A recent case may serve as an example: One of
our district nurses was summoned in the night by
a lighthouse-keeper in the Sounds. His wife was in
labour. At once a nurse set off, and after a wild,
rough ride and scramble she arrived three hours
later, to find her patient almost pulseless from hemor-
rhage, the baby cold and almost lifeless. She set to
work, and her efforts were rewarded — both mother
and babe saved. Here it was an impossibility to get
the doctor — he was thirty-five miles away. Immedi-
ately after the arrival of the nurse, the tide came up
and the lighthouse was completely isolated. Here
is grand work for our nurses to do. The pioneers
in this service are Nurse Bilton (the first to start),
Nurse Warnock, and Nurse O'Callaghan.

In some of the towns there is a system of district
nursing organised by charitable bodies. Nurse
Maude, formerly Matron of the Christchurch
Hospital, started this work in Christchurch. In
Wellington it is worked under the St. John's Am-
bulance Association. Mrs. Rhodes, a philanthropic
woman of ample means, largely finances this part of
the work and was made by His Majesty King George
a Lady of Grace of St. John. In Dunedin also a
nurse connected with the St. John's Ambulance
Society works among the poor. In Wanganui and

212 A History of Nursing

Palmerston North there are district nurses. There
has not, however, been any very large extension of
this branch of nursing. There is not the poverty
among the people, the cities are not so crowded as
in the Old Country, and they are well supplied with
hospitals; therefore, the need has not been so
apparent.

We must not omit to mention a branch of nursing
which has been established during the last few years
in several of the cities by the Society for the Promo-
tion of the Health of Women and Children, started
under the auspices of Lady Plunket, wife of the late
governor, at the instigation of Dr. Truby King,
medical superintendent of one of the large mental
hospitals. Dr. King had observed great neglect of
proper infant feeding, and therefore, great loss of
infant life, and determined that something must be
done to educate the women of New Zealand in this
direction. A babies' hospital was established in
Dunedin, called the Karitane Home for Infants, and
babies suffering especially from malnutrition were
received there. A carefully worked out form of per-
centage feeding and preparation of humanised milk
was instituted under the direction of Dr. King, and
nurses were taken for a special course of post-graduate
training for three months. Branches of the society
were formed in different cities and nurses sent for
instruction, and then to take up "Plunket" nursing;
namely, the visiting and advising of mothers on the
proper care of their infants, teaching the preparation
of humanised milk when the babies were not breast-
fed, and general home hygiene. There are ten to
twelve nurses engaged in this work. A subsidy is

K K

In New Continents 213

given by the government to the Karitane Home and
£50 per annum to the maintenance of each nurse up
to the number of twelve.

The history of nursing in New Zealand would not
be complete without the mention of the efforts made
to train some of the Maori girls to care for the sick
of their own people. This training has been under-
taken by the government, with the aid of certain
hospitals. Schools for Maori girls have been estab-
lished and aided by the government, where their
general education is carried on, and as soon as this
is completed some few are kept for an extra year and
sent as day pupils to the main hospital in the town.
This means that they still live at their school, but
are given an insight ino nursing work. If they ap-
pear to promise well they are then found vacancies
as regular probationers in some hospital and go
through the ordinary training of a nurse, passing the
same examinations and receiving the same certificate
as the European nurses. So far not many have yet
completed this training, as it takes four years in all,
and if they go in for an obstetric course also, longer.

The two first nurses to obtain both their general
and midwifery certificates were Akenehi Hei and
Heni Whangapirita, about 1908. These nurses were
then given appointments in the Native Health De-
partment, and allotted districts in which to work.
They were sent to cope with outbreaks of illness
among the natives, and did splendid work. In an
outbreak of typhoid in a pa on the Wanganui River,
Nurse Akenehi made the natives bring their sick to
the meeting house, in which she established an ex-
tempore hospital, and also made them dig drains and

214 A History of Nursing

improve the sanitation of the pa. Nurse Heni was
sent to assist her, and together they brought fourteen
patients to recovery and prevented further spread of
the disease. It is sad to record that later, after
nursing some members of her own family suffering
from this illness, Nurse Hei contracted it herself,
and succumbed after a short illness. Her loss is an
almost irreparable one to the Maoris, as she was a
woman of fine character and with the highest ideals
of nursing and improving her people. The second
Maori, Nurse Heni Whangapirita, is unlikely to
continue her work. She recently had a severe at-
tack of typhoid and pneumonia, and has not fully
recovered. Those Maori girls who are now in train-
ing have a great example before them in Nurse
Akenehi Hei, whose work was appreciated alike by
Maori and European.

The nursing of infectious diseases has not been
made a specialty, all the infectious disease hospitals
being connected with the general hospitals and
treated as separate wards to which nurses are sent
for a term during their three years' course. The very
occasional cases of smallpox or plague are nursed
in the quarantine stations by private nurses and are
too few in number to afford any opportunity for
training probationers.

Outside of hospitals and public institutions the
nurses of New Zealand are largely employed in
private nursing, and in carrying on private hospitals.
Private nursing is mostly carried on from the prin-
cipal cities, from which the nurses travel to country
cases. In some of the country towns there are a
few private nurses, but this is the exception.

In New Continents 215

Until a few years ago there was no organisation
among nurses. The first attempt at anything of
the kind was started in Wellington by a small resi-
dential home being established and managed by Mrs.
Holgate, who at the same time conducted a private
hospital for women. An association of private
nurses was formed, and Mrs. Kendall, formerly a
nurse at St. Bartholomew's, and the possessor of the
Royal Red Cross for services under fire in India,
was elected president. Later, this private nurses' as-
sociation enlarged its aims, and became the Associa-
tion of Trained Nurses. At the same time a bureau
was maintained and a large residential club estab-
lished under the control of a council elected by the
members, and a Matron, appointed by the council,
carried on the home. In Dunedin an association
of hospital and private nurses was started and a
bureau also conducted. The example of the nurses
in these two cities was followed by those resident
in Auckland and Christchurch. Later still, the
four associations agreed to affiliate and become the
New Zealand Trained Nurses' Association, with
four branches — Wellington, Otago, Canterbury, and
Auckland ; all adopting similar rules and working for
the same objects. A central council for the whole
association was elected in 1909, composed of four
members from each centre, and Miss Maclean, the
Assistant Inspector of Hospitals and Deputy Regis-
trar of Nurses was elected President, with Miss
Bicknell, of the Hospitals' Department, Hon. Sec-
retary. The formation of these associations has
resulted in more unity among the nurses, and much
benefit has been derived from lectures delivered by

216 A History of Nursing

doctors on various subjects, and by the opportunities
given of meeting and discussing many subjects of
interest.

In January, 1908, the first publication of a nurses'
journal for New Zealand was issued. Kai Tiaki,
edited by Miss Maclean, is a quarterly, and the
official organ of the four branches of the Trained
Nurses' Association. It aims at keeping the nurses
of the Dominion in touch with each other by personal
news of hospital changes, and with the rest of the
nursing world by giving news of the great develop-
ments of nursing in other countries. It also aims at
improving knowledge of modern medical and surgical
treatment, by publishing lectures and articles by
medical contributors and by encouraging the reports
from nurses themselves of their experiences and
observations.

Private hospitals are legislated for in a part of
"The Hospitals and Charitable Institutions Act,
1909." This is not the first legislation in regard to
them, as they were first dealt with in an amendment
to "The Public Health Act" and again in a separate
act in 1906. But the whole spirit of the legislation
is the same — the protection of the public by inspec-
tion and control of these places by the government.
Every house in which more than one person is re-
ceived at a time for medical and surgical treatment
and in which obstetric treatment is intended, must
have a license to conduct a private hospital. A
heavy penalty is imposed for receiving patients
without a license. Except under special circum-
stances, a license is not granted to any one but a
registered medical practitioner, a registered nurse

In New Continents 217

or midwife. Testimonials as to good character are
also required. The premises to be used are inspected
and the number of patients one registered nurse can
be responsible for are specified. The licensed private
hospitals are visited periodically by trained nurses
appointed by the government for the purpose. The
licenses have to be renewed annually, and can be
cancelled for certain reasons. A record of the
patients treated and the work done has to be kept,
and submitted to the inspectors. The nurses ap-
pointed for this work first were Miss Bicknell and
Miss Bagley, both New Zealand trained nurses and
midwives. They visit the private hospitals and at
the same time see the registered midwives in the vari-
ous districts, and work specially under the superin-
tendence of the Assistant Inspector-General, Miss
Maclean.

Under an Act for the Protection of Infant Life,
which was passed in 1908, there is an opening for
the trained nurse which so far has not been taken
advantage of very fully. Nurses are required for
the inspection of the homes for infants licensed under
the act, and for advising the foster mothers on the
health and rearing of the infants committed to their
charge. At present all the inspectors under the
Infants' Act are not trained nurses, but as time goes
on it is hoped that more will be willing to come
forward and help in this important work.

Another branch of nursing is that of mental cases.
The prejudice against this nursing is only gradually
dying out, and as a general rule the women taking
it up are not of so high a class as the general hospital
nurse. Of late years a system of training in mental

2i 8 A History of Nursing

nursing with a three years' course of lectures and
examination, has been initiated, and a register of
mental trained nurses, male and female, has been
established. The mental hospitals of the Dominion
— some with 800 or 900 beds — are well equipped,
fine establishments, and afford a very fair training
in the care of the insane. Owing, however, to the
fact that there is very little illness among the patients,
the teaching of the various nursing methods is very
difficult, and is more theoretical than practical.
In the future the higher appointments in the mental
hospital service will be held by nurses who have had
general as well as mental training. A nurse inspector
visits the mental hospitals periodically, and especially
interviews the women patients and examines their
accommodation. This office is combined with ttoat
of the Assistant Inspector of Hospitals, and is carried
out under the Inspector-General of Mental Hospitals,
Dr. Hay, formerly assistant to Dr. MacGregor and
on his death placed in sole charge of the Mental
Hospital Department. Dr. Hay desires to improve
the status of the mental nurse and attendant, and
has instituted a course of lectures and examination on
the basis of the medico-psychological association.

The nursing of consumptives is carried out chiefly
in four sanatoria. Two are situated in the North
Island — one at Cambridge, which is entirely a govern-
ment establishment, and the other at Otaki, which
is connected with the Wellington Hospital. Two
are in the South Island — at Christchurch, on the
Cashmere Hills, and at Palmerston, South in Otago,
and connected with the Christchurch and Dunedin
hospitals respectively. These are for curable cases

In New Continents 219

only, and are nursed by a trained staff, in the case
of the three last by probationers drafted for a short
period from the main hospitals. In the near future
it is probable that a scheme for fighting this dread
disease will be set on foot, in which the assistance
of the trained nurse will be essential in wider fields
than in the sanatoria.

Nurses are nearly all eager to get out into the
world on completing their training — so much so that
it is difficult to keep a sufficient number of staff
nurses in the hospitals. Several of the larger ones
make their pupils sign an agreement to remain a
fourth year if required on the staff, after completing
their three years' training and becoming registered
nurses. This spirit of change and unrest is undoubt-
edly detrimental to the better training of nurses, the
Sisters frequently being too junior, or if they them-
selves have sufficient experience, not being aided by
charge nurses of full training.

The hours for nurses' work throughout the Do-
minion are, compared with other countries, fairly easy.
The eight hours' system has been established since
1898 in some of the hospitals, and by the Hospitals
and Charitable Institutions Act in 1909, was made
compulsory for all pupil nurses training in the larger
hospitals. It originated with Dr. Kenny, medical
superintendent of the Wellington Hospital, and or-
ganised by him on the lines of engineer hours on
board ship. Whether such hours — during which
owing to the smaller number of nurses on duty at a
time, the work must be rather strenuous — are of
benefit to the nurses, is a matter for doubt. To the
patients the stress and hurry must inevitably mean

220 A History of Nursing

less careful and thorough nursing, and therefore,
less thorough training of the probationer. Fortun-
ately the eight hours' system is not extended to the
trained staff nurses and Sisters of the hospitals. The
united protests of the Trained Nurses' Association
of New Zealand were called forth at the time this
law was passed, and with other representations against
a measure so hampering to the work of nursing,
succeeded in confining the law to the pupils in train-
ing. The benefit of organisation was thus illustrated
in a very practical way only a few months after the
formation of the association. T

The difficulty in this country of getting domestic
help renders it quite necessary that nurses who intend
to qualify for the charge of a country hospital must
be able to cook, scrub, and wash as well as nurse.
A matron may at any moment be deserted by her
cook or her laundress and have to take charge of
stove or wash-tub herself. Sometimes, too, the
nursing work in the very distant small hospitals is
not sufficient to justify a staff of even one additional
nurse, and the matron must depend chiefly on the
help of a wardsman whose special duty is the care of
the grounds. In spite of all, however, we find
those who stick to their work under all disadvant-
ages and love their little hospitals. They work hard
when necessity arises, and are on duty day and night
when any bad case is in, indeed welcoming a bad case
with delight. A typical hospital of this kind is the

1 As overwork in hospitals is a grave problem in many countries,
it seems a pity that this fortunate land should find its nurses criti-
cal of the eight-hour hospital day. It probably only needs some
modification as to change of shifts. — Ed.

In New Continents 221

Taumaranui, which is situated on the main line
between Wellington and Auckland, and in a sparsely
settled district. The Matron there has no trained
assistant, and the probationer nurses she can secure
remain only long enough to be of some use when,
if they are any good, they go on to a training school.
There is also a general servant and a man on the staff.
The hospital is administered by the government.
There are six beds and now and again eight or nine
patients, at other times only one. The patients are
all acute, sometimes bad accidents from the saw-
mills, needing careful and continuous nursing, and
in such case the matron is allowed extra assistance
from Auckland. A Christchurch graduate, Miss
Gill, who went there as Matron, wrote shortly
after arrival.

We were now ready to take patients, but none were
forthcoming. As the mills in the district were not work-
ing, and no one in the township was sick, our attendance
was not required, therefore nurse and I proceeded to make
a track for ourselves down the hill to the river. We went
forth armed with slasher and spade, and cut and dug a
winding path. We then set up numerous sticks with
rags tied to them, so that we should easily find the track
in the scrub. ... A new difficulty had arisen; who was
to look after the acetylene gas plant, and the oil engine
by means of which the water was pumped to the house?
Certainly the man about the place, and he did so when I
had one with sufficient intelligence to understand it.
But supposing the man should take it into his head (as
they sometimes do) to go off at a moment's notice, who
then should work the engine and gas plant? Nothing
for it but the Matron must learn how. This I promptly

222 A History of Nursing

did, and I am sure you would have laughed at my get-up,
when, the water getting low in the tanks, I had to go into
the engine-house and clean and start the engine. This
was no hardship as I am fond of engines. But it was
very dirty work, and later on when myself and a proba-
tioner had nine patients to nurse, three of whom were
typhoids, I really could not find time to do it . . . but I
was sorry to give up that engine.

Steps are now being taken to form a Nursing Re-
serve under the new Defence Scheme for N ew Zealand
as organised by Major-General Godley, an Imperial
officer, on lines recommended by Lord Kitchener,
after his visit to the Dominion, in 1910. The nursing
reserve will be under civil control and organised by
the Inspector-General of Hospitals. There was a
previous attempt to form a reserve, and a Matron-
in-Chief, Mrs. Janet Gillies, formerly Nursing Sister
Speed during the South African War, was appointed
to the position ; but the reserve was not formed and
she has now retired. A new Matron -in-Chief is to
be chosen immediately and the appointments of
Matrons, Sisters, and nurses will follow.

Africa.— Africa is known as the " Dark Continent,'*
but darkness is giving place to dawn, and dawn
with tropical rapidity to broad daylight. A powerful
factor in this development is the trained nurse, who,
following the flag, has found her way to the heart of
the continent, so that in Uganda, on the shores of the
Victoria Nyanza, there is now a hospital having a
three years' certificated nurse as Matron, and on the
island of Likoma, on Lake Nyassa, there is a well-
appointed hospital nursed by certificated British

In New Continents 223

nurses. The same may be said of Zomba, head-
quarters of the administration of British Central
Africa.

On the northern seaboard British nurses are doing
excellent work in hospitals at Port Said, Alexandria,
and Algiers, while at Cairo there is a large hospital,
the Kaisr-el-Aini, with an English Matron and nursing
staff, in which native nurses are trained. This is
the only recognised training school in Egypt for
nurses or midwives who are registered by the govern-
ment. On the west coast many lives have been
saved by the good offices of members of our profession
in the hospitals at Sierra Leone and Lagos, and
trained nurses have also gone inland to nurse mem-
bers of the West Frontier Force on expeditions into
the interior.

On the east coast there is at Mombasa a govern-
ment hospital, founded originally by the Imperial
British East African Company, which was nursed
first by religious Sisters, now by nurses sent out by
the Colonial Nursing Association. At Tanga is
another under the care of German deaconesses,
while the island of Zanzibar, the metropolis of the
east coast, has English, French, and native hospitals.
The former is interesting, inasmuch as in it some pro-
gress has been made in giving systematic instruction
to native men and women in nursing. The hospital
is maintained by the Universities ' Mission to Central
Africa, and has a nursing staff of a Matron and five
or six British certificated nurses, who take consider-
able pains to train the natives who work under them.
The value of this work is great, as the African thus
receives instruction in habits of order, method, and

224 A History of Nursing

discipline, and in an appreciation of the value of time,
which are foreign to him naturally. So far the men
have, on the whole, made better nurses than the
women, partly because the latter marry so early that
few of them stay in the hospital long enough to pass
through a full training; partly because in Zanzibar,
as in other Oriental countries, the men are in advance
of the women in educational development; partly
again because the male wards are more used and so
afford a better training ground than the female wards,
and it would outrage national feelings to place an
unmarried woman in charge of men's wards. Never-
theless some of the girls have proved themselves apt
and trustworthy pupils, and, given equal advantages,
would no doubt become as proficient as the men.
They have many of the characteristics essential in a
good nurse, being gentle, kind, sympathetic, dextrous
with their hands and quiet in their movements.
They are also, as a rule, devoted to children. On
the other hand they do not like performing parts of
the work which they consider menial, and they have
not much sense of responsibility; neither have they
much stamina.

Two reasons may be assigned for the dislike of
the natives to menial work: they have too recently
emerged from slavery and many have had personal
experience of the horrors of the slave caravan. They
have a profound dislike of doing slave work, and a
common objection is, "I am not a slave." Then,
too, as the right hand takes the place of a spoon
among the Swahilis they are very particular as to
its cleanliness. So far as practical work goes, both
native men and women in Zanzibar have learned

English Hospital, Zanzibar; Miss Breay and Miss Brewerton in the

background

In New Continents 225

enough to make them very useful. For instance,
they can polish instruments and prepare for an opera-
tion in a way which would be creditable in an up-to-
date London hospital. Their theoretical work has,
so far, lagged behind the practical, and there are at
present no nursing text-books in the Swahili language.
The influence of the training given in this hospital
is far-reaching, as many of those who receive it re-
turn to their tribes up-country, and thus carry their
nursing knowledge to villages where no European
is stationed.

No account of the hospital of the Universities'
Mission in Zanzibar would be complete without
mention of the gracious and cultured woman at
whose instance it was built. The mission had had
many devoted nurses, but their work was done under
difficult and unsuitable conditions. It was owing
to the initiative and the strong representations made
in 1890 by Miss Emily Campbell, a nurse possessed
of rare charm and professional skill of a high order,
combined with absolute devotion to the sick, — a saint
in the making, — that the mission owes its hospital,
in which her successors, notably Miss H. Brewerton,
for many years Matron, Miss S. A. Whitbread, now
gone to her rest, Miss M. Brown, Miss C. L. Saunders,
and many others have rendered the most devoted
service to patients of all colours and creeds. Miss
Campbell herself did not live long enough to see the
completion and opening of the hospital, and her
death, after two years' work in the mission, was an
added urgent proof of its need, for she died uof sheer
overwork, nursing single-handed a poisonous case
in a house eminently unsuited for such a purpose.

VOL. IV. — IS

226 A History of Nursing

. . . We could not but be influenced, every one of
us" said the Reverend Spencer Weigall at a meet-
ing of nurses in London, "by having a character of
such extraordinary beauty among us.

Another heroic pioneer worker for the sick in
Zanzibar was Mme. Chevalier, who gave devoted
service in connection with the French mission.
Mounted on her beautiful white donkey, she was a
well-known and notable personality on the island,
where she lived for over a quarter century without
returning to France, making the lepers her special
care. Mention must also be made of a midwife,
who is at work in the town of Zanzibar, under the
auspices of the Lady Dufferin Fund.

We must turn to South Africa, however, to find
nursing organisation in an advanced condition.
Nurses there were the first to secure legal status
and registration under state laws. This was con-
ferred upon them by a section of the Medical and
Pharmacy Act of 1891. The administration of the
act is carried on by the Cape Medical Council.

It was largely to Sister Henrietta of Kimberley,
an English nurse and daughter of a clergyman, the
Rev. Henry Stockdale, that nurses in South Africa
owe the honourable distinction of being the first to
be registered by Act of Parliament in any country.
Sister Henrietta attended the London Congress of
Women, in 1899, and there told the nurses, assembled
in their first international meeting, how, when the
new medical bill was before the Cape parliament,
the trained nurses of the country, — a little band of
some sixty-six women then, now quite an army, —
petitioned almost unanimously for a place on the

In New Continents 227

register and for state control of education. With
much care and forethought clauses were drawn up
providing for the registration of foreign trained nurses
and state examination and registration of the colo-
nial-trained. A section also deals with midwives.
The nurses gained their wish, and after this length
of time, the act has on the whole worked well. Sister
Henrietta continued her life of active usefulness for
many years; took a prominent part during the siege
of Kimberley and afterwards, in organising the care
of the wounded and sick, and died, full of good deeds
and honours in 19 10.

This first registration act gave a year of grace
during which time all nurses holding hospital cer-
tificates could register. One year's training was at
first accepted. In 1892 the minimum was set at two
years, and finally, in 1899, three years in a hospital
of not less than forty beds was fixed as the minimum,
and the medical council set a syllabus of subjects for
examination and fixed the lines of training at much
the same as in the best English hospitals. Medical
men delivered lectures preparatory to examination,
and conducted written and oral examinations in the
different centres.

South African nurses have found, however, that
there is a disadvantage in having no nurse sitting
upon the council, and liberal physicians have learned
the same thing. In 1904, a report on the act and its
workings was sent to the International Council of
Nurses by Dr. Moffat, then resident surgeon at the
Somerset Hospital in Cape Town, in which he said :

The legislation affecting nurses is gradually improving

228 A History of Nursing

the education of nurses and raising the standard of pro*
fessional knowledge.

I venture to suggest, even though I may tremble at
the thought of what our Council would say to such a
thing, that some at any rate of the members of the
Council should be trained nurses, who could discuss and
vote on nursing questions. Probably in time there will
be a Nursing Council; some of these should be trained
nurses. At present the members of our Council are all
men.

In the same way, I think the examination should be
conducted in part by trained nurses.

The great gain which would follow from the two latter
additions does not need to be pointed out.

In 1899 registration of trained nurses was enforced
by act of Parliament in Natal, and in 1906, in the
Transvaal under the Transvaal Medical Council.

Some of the South African hospitals are fine build-
ings, and in a number there are training schools of
excellent standing. Certificates are no longer granted
by individual schools, as the medical council now
issues its own by the authority taken from the
hospital authorities and vested in them. With the
development of the country and the advance of
nursing, we shall hope to see nurses placed on the
examining board, but this will perhaps not come
until women are enfranchised.

CHAPTER V

NURSING SISTERS OF THE ORIENT

India. Among Miss Nightingale's writings some
of the most remarkable evidence of her genius is to be
found in articles published in her later years on the
problems of life in India, as affected by government. z
In an earlier volume2 we have cited her plea for vil-
lage sanitation in that country, but had not then seen
those writings in which she analyses the whole social
order of India, tests every detail of land ownership,
taxation, social, and economic organisation in the
clear fire of her interpretative intelligence, exposes
every weak, wrong, or oppressive point with her
vivid, flashing gift of demonstration, and constructs
item by item, with a rare statesmanship and a prac-
tical force all her own, the programme by which
alone the real sources of famine, pestilence, and
misery could be reached. Papers of an intellectual
outlook and human insight so broad and deep should

1 "The People of India," Nineteenth Century, August, 1878; "The
Dumb shall Speak and the Deaf shall Hear, or the Ryot, the Zemindar,
and the Government," Journal of the East India Association, London,
1883; "Our Indian Stewardship," Nineteenth Century, August, 1883,
"Health Missioners for Rural India," in India, (a magazine),
London, 1896.

2 A History of Nursing, Vol. II.

229

230 A History of Nursing

never be allowed to fade in obscurity. They should
be in every public library. Had they been written
by some cabinet minister they would stand, richly
bound, on the shelves of every man in public life,
even if their recommendations were not followed or
even read. Her mastery of enormous official detail
and technical, statistical facts as shown in these
papers is amazing, and suggests that the greater part
of her later years must have been given to an intensive
and laborious study of Indian affairs. This was the
hard work which filled her time and left her in her
invalid's room no leisure, for she continually re-
ceived masses of official documents, such as few other
persons ever saw, and which were sent for her con-
fidential analysis and commentary. We do not know
exactly what results followed these labours. Here
she launched far forth from nursing subjects to deal
with Imperial policies, yet every flash of her mind
showed that her basic thought was of health — the
health of a nation and the happiness to a race that
could result from it.

The earliest efforts to transplant English nursing
into India came through the missions. To describe
their gradual advance is beyond our province and
our powers. The nurses who shared in it, pioneers
in the fullest sense, were sent ready trained from the
mother countries, and we must be content to begin
this record with the first work in training native
women.

Whether simple human service to others' needs
should be made the vehicle for controversial pro-
paganda is a question which must be answered by
each one as he sees the light, and in how far the

India 231

work of medical relief may be developed when allied
to any doctrine or dogma or to the tenets of any one
church is also debatable. Yet the mission spirit
has always led the way to service in the hardest, most
dangerous places long before any one else was ready
to go, and during two thousand years we have seen
medical missions breaking the ground for a new
civilisation by their heroic and devoted labours.
The Hindu papers complained that the most powerful
weapon used by the Christians to lay hold of the
hearts of the Hindu women was the Zenana hospital.
They perhaps felt that their people were being alien-
ated from sacred tradition. On the other hand, the
love and care expressed in mission work were always
lavished especially on those downtrodden and inferior
beings whose sex or caste gave them, under the old
dispensations, little to hope for in heaven or else-
where, so why should they remain bound by the
conventions of ancient historical religions which,
however beautiful in ideals, had become in practice
full of negations for workers and for women? The
missionaries entered, inspired by a purpose ever
fresh, pure, and strong, and consecrated all their
powers to the task of awakening soul and spirit.
The medical woman and the nurse were irresistible
to the neglected proletariat to whom they ministered,
and suspicion and aloofness melted away before
their skilled, tender handling of poor diseased bodies.
The first project for bringing medical care and
nursing on a national scale to the people of India,
and of providing a far-reaching and autonomous
system by which centres of teaching and training
might be multiplied, according to local needs, was

2^2 A History of Nursing

the work of the Countess of DufTerin, during her
stay in India as "first lady in the land." Her plan,
built upon large and comprehensive lines, was de-
veloped with wisdom and foresight, and shines
brightly in that tale of upbuilding and conservation
which goes to balance the long dull histories of de-
structive forces. How it came into being is best
told in her own words1:

When I was leaving England, Her Majesty the Queen-
Empress drew my attention to the subject [of supplying
medical aid] and said that she thought it was one in
which I might take a practical interest. From that time
I took pains to learn all that I could of the medical ques-
tion in India as regards women, and I found that, though
certain great efforts were being made in a few places to
provide female attendance in hospitals, training schools,
and dispensaries for women, and although missionary
effort had done much, and had indeed for years been
sending out pioneers into the field, yet taking India as
a whole, its women were undoubtedly without that med-
ical aid which their European sisters are accustomed to
consider as absolutely necessary. I found that even in
cases where nature, if left to herself, would be the best
doctor, the ignorant practice of the so-called midwife
led to infinite mischief, which might often be character-
ised as abominably cruel. It seemed to me, then, that
if only the people of India could be made to realise that
their women have to bear more than their necessary
share of human suffering, and that it rests with the men
of this country and with the women of other nationalities

1 See The National Association for Supplying Female Medical
Aid to the Women of India. By the Countess of DufTerin, reprinted
from the April Asiatic Quarterly Review. Calcutta, Thacker Spink
& Co., 1886.

India 233

to relieve them of that unnecessary burden, then surely
the men would put their shoulders to the wheel and would
determine that wives, mothers, sisters, and daughters de-
pendent upon them should, in times of sickness and pain,
have every relief that human skill and tender nursing
could afford them ; and we, women of other nationalities
... we surely too should feel a deep sympathy with
our less fortunate sisters and should, each one of us, en-
deavour to aid in the work of mitigating their sufferings.
I thought that if an association could be formed which
should set before itself this one single object, to bring
medical knowledge and medical relief to the women of
India, and which should carefully avoid compromising
the simplicity of its aim by keeping clear of all contro-
versial subjects and by working in a strictly unsectarian
spirit, then it might become national, and ought to com-
mand the support and sympathy of every one in the
country who has women dependent upon him.

With this idea, Lady DufTerin took her initial
steps and her plan was warmly received. A pro-
spectus was drawn up and published in various lan-
guages all over India. The association was named
the National Association for Supplying Medical Aid
to the Women of India; and as the money for it
was collected, it was credited to the "Countess of
DurTerin's Fund." The press and public were ready
for it. Few objections were heard. One, however,
put forward by conservatives was, that the women
of the country did see medical men professionally,
to which Lady Dufferin answered that this was only
in the last extremity, when the medical man admitted
to a Zenana entered with his head in a bag, or re-
mained outside the purdah, feeling his patient's pulse,

234 A History of Nursing

but unable to examine her. (A medical missionary
in India knew of a string being tied around the
patient's wrist in a critical case and the doctor, in
another room, given the string at its other end to
feel the pulse!) Said Lady Duflerin in discussing
the objections:

Others simply state that the women do not want
doctors at all, and that, therefore, any scheme for giving
them medical relief is unnecessary and quixotic. To
refute an argument properly one should understand it,
and I confess I do not understand this one. It seems to
me simply to point to the total abolition of doctors and
to the extinction of medical science altogether. ... But
it is true that in India, as elsewhere, men have all that
they require in the way of medical advice, while the
women here have not, and the object of this scheme is
to remedy an occasional injustice. If women do not
want doctors, then men can do without them. . . .

The criticism that the association was "official" was
also made, and to this Lady Duflerin, after pointing
out that it received no government aid, said :

We are honestly desirous that it should become un-
official and truly national, and we are making every effort
to place it upon a really popular basis. We are merely
birds of passage here, and if the work is to go on and
prosper it must be gradually taken out of our hands and
be undertaken by those who live in the country and for
the benefit of whose women it has been begun.

The affairs of the association were managed by a
central committee, of which the Countess, during
her stay in India, was president. Branches were

India 235

connected with the central body, and by this articu-
lated form continuous growth was made possible,
to include and cover the whole country. Each branch
association was, for all financial and executive pur-
poses, entirely independent, but was expected to
adhere to the principles of the national association,
and was asked to contribute a small percentage of
its receipts to the central fund. Public meetings
were held to explain the purpose of the fund and to
arouse interest. Existing institutions and organisa-
tions having the same medical work in view were
encouraged to affiliate with the association, their full
independence remaining unimpaired. This arrange-
ment was meant especially to affect mission societies.
Such affiliated groups, it was explained, might obtain
grants from the association for special purposes,
while all would benefit by having a common centre
of reference and information. The objects for which
the association was established were set forth in its
publications as being:

I. — Medical tuition, including the teaching and train-
ing in India of women as doctors, hospital assistants,
nurses, and mid wives.

II. — Medical relief, including the establishing under
female superintendence of dispensaries and cottage hos-
pitals for the treatment of women and children; the
opening of female wards under female superintendents in
existing hospitals and dispensaries; the provision of
female medical officers and attendants for existing female
wards; and the founding of hospitals for women where
special funds or endowments are forthcoming.

III. — The supply of trained female nurses and midwives
for women and children in hospitals and private houses.

236 A History of Nursing

The national association, as above outlined, was
organised in August, 1885. " Its one aim and aspira-
tion," wrote its foundress, "is to bring to the women
of India better health, freedom from unnecessary
pain, and all the comforts and alleviations which
science has discovered and which the ministering
hand of doctor or nurse can supply. ..."

In an article written upon the work, Lady Dufferin
recounted some of the difficulties met :

A last difficulty is that we start our medical work with
scarcely any supply of doctors, midwives, or nurses to
hand. There is not one single native female doctor
ready, though about forty are now being trained. [The
number of such students is rapidly increasing.] A few East
Indian ladies have been educated at Madras and have
all the necessary qualifications [to some of these, posts
were offered], but the country itself is, undoubtedly, un-
able to supply even the present demand for well-educa-
ted doctors, well- trained nurses, and efficient midwives.

In regard to the missions, she thus explained the
principles of the association :

The national association cannot employ missionaries,
nor can it provide hospital accommodation in which it
is intended to combine medical treatment with religious
teaching. It may, in certain cases, be glad to avail itself
of medical missions as training agencies, and may oc-
casionally attach an assistant to a mission dispensary.
[For further training.] But in such cases it would have
to be clearly understood that the assistant's duty would
be strictly confined to medical work. No officers in the
employ of the national association can be allowed to
exercise a missionary calling. . . . The national associa-

India 237

tion cannot undertake to provide funds for the travelling
expenses or establishment of medical missionaries.

While defining the purely humanitarian character
of the work in thus standing aside from doctrinal
teaching, the intention of its foundress was to unite
all bodies in the philanthropic work common to all,
and not to intervene where the mission already oc-
cupied the ground, except in towns so large that there
was room for a second medical establishment, or
when the demand came from the people of a locality.
She wrote:

The function of the central committee is to act as a
link between all branches, to collect information, give
advice, and assign grants-in-aid. It is in direct com-
munication with those parts of the country where no
branches have been formed, and with those Indian princes
who interest themselves in the movement and who are
endeavouring to promote its objects within their own
dominions. Its duty is to study the information re-
ceived, so that it may understand the wants of different
localities; to see in what direction it can best help each;
and to administer the funds at its disposal for the benefit
of the most useful institutions and the most needy
districts.

The central committee has also the responsibility of
directing the policy of the association ... to consolidate
and to improve the position of the society. x

Though in no way an arm of the government, it
being understood that the employees of the associa-

1 From A Record of Three Years1 Work of the National A ssocia-
tion for Medical Relief to the Women of India, August, 1885 to 1888,
by the Marchioness of Dufferin and Ava. Hatchard, London, 1889.

238 A History of Nursing

tion were not employees of the government, a certain
official recognition was granted to the medical women
and others employed by the association, and there
was also a certain amount of direct co-operation by
the Surgeon- General and the chief medical officers
of the provinces. The whole amount subscribed
to the fund, even in the first few years, was a princely
sum. From the subscriptions received, a certain
amount was set aside as an endowment fund, and
at the end of three years' work enough had also been
set aside from income to endow six medical, twelve
nursing, and two hospital assistant scholarships.
Besides this, annual grants were made to medical
staffs and nursing expenses in a number of cities,
as well as a great deal of current outlay of varied
kinds.

The impetus and definite help given by the fund
was general and varied, and to deal fully with its
extent would far overpass our bounds. In medical
relief in 1889, twelve hospitals for women and fifteen
dispensaries, most of which were officered by women,
were more or less closely connected with the associa-
tion. Many were the new enterprises, private and
provincial, that responded to the stimulus thus given,
and many were the localities that undertook the
maintenance of some branch of relief under the fund.
Ever watchful of the best development of her plan,
Lady Dufferin wrote in 1888:

I should like in this place to remind those who have
undertaken to benefit their state or their district by es-
tablishing one of these institutions, that they must think
of the future as well as of the present, and that they must,

India 239

year by year, send to one of the medical schools girls
from their own neighbourhood, to study medicine, to
become compounders, nurses, and dhais, so that the
hospitals they have started may never have to be closed
for want of female officers to direct them.

She wrote further:

I believe the teaching of midwifery to be the most im-
portant and the most urgent work we have to do, for
this science is grievously misunderstood by the ordinary
dhais of the country. Few people know the dreadful
cruelties perpetrated by these women under the guise
of professional aid, while those who suffer at their hands
are too ignorant of any better treatment to resent their
malpractices. . . . Part of the treatment, before the birth
of the child (as shown in official reports) consists in
kneading the patient with the foot and stamping upon
her hip joints, while in extreme cases a pole is placed
across her, the attendants resting their whole weight on
either end.

The details are often too painful to repeat, but,
as leading characteristics, common to most parts of
India,

there is the unhealthy room, remarkable for the unsani-
tary nature of its arrangements; there are the charcoal
fire, the absolute lack of ventilation, and the crowd of
spectators; there is the extreme and accumulating dirt,
and added to all this the further danger attending the
ministrations of the ignorant or the careless or the vicious
dhai. Nor can we, in the case of Indian women, comfort
ourselves, as we are apt to do, with the idea that they
lead a more natural life than Europeans and, therefore,
suffer little at childbirth. The very contrary is the case*

240 A History of Nursing

The lives led by all but the very poor are most unnatural,
and as they marry unnaturally young, they suffer more
at the time, and are much more liable than older women
would be to injuries causing lifelong suffering. l

The work of teaching midwives and nurses, most
arduous and difficult as it was, went on, at first slowly
— then with gratifying steadiness ; the Dufferin Hos-
pital at Nagpur was the first one for women and
children in the central provinces. It is impossible
for us to mention all the branches and work under-
taken, but the map of India in the reports of the
association, showing all the centres of work under
the fund in red, is a revelation, while from year to
year the beneficent results of its activities are more
widely extended. The yearly reports2 should be
studied for the most recent information.

In closing her report, Lady Dufferin said:

It is a sense of obligation . . . that I wish to instil into
the minds of men throughout this country. I want
them to look upon the provision of medical aid for their
mothers, wives, and daughters, as a positive duty, and to
give not only money, but time and talents and personal
labour to procure it for them. ... If relief is to be
brought not to tens, but to hundreds of thousands of
Indian homes, as it should be, then it is not one society,
or a certain number of single individuals, who can ac-
complish such a task. It is the determined attitude of
the men of this country which must do it. It lies with
them to give the women relief in suffering. . . .

1 From A Record of Three Years' Work of the National Associa-
tion for Medical Relief to the Women of India, August, 1885 to 1888.
by the Marchioness of Dufferin and Ava. Hatchard, London, 1889,

a Printed at the Bombay Gazette Electric Printing Works.

India 241

The first regular training school in India for the
systematic instruction of native pupils in medical
and surgical nursing, as well as midwifery, was es-
tablished in 1886 by the Bombay branch of the
Countess of Dufferin's Fund in connection with the
Cama Hospital in Bombay. It is a civil institution
under government management and is solely for
women and children of all castes and all denomina-
tions. Two English physicians and a staff of Eng-
lish nurses opened the work of the hospital, but the
training school dates from the appointment, a little
later in the same year, 1886, of Miss Edith Atkinson,
as lady superintendent. Trained at the York
Road Hospital in England, she had gone to India
in 1884 and had served in St. George's and other
centres. An exceptionally able and sympathetic
woman, she gave a whole-hearted devotion to her
work, and died in 1905 after nineteen years spent in
the training school. Two auxiliary institutions are
now allied to the Cama, both the gifts of wealthy
Indian gentlemen and named after them — one an
obstetrical hospital, the Allbless, and the other a dis-
pensary for women and children, the Iaffer Suleiman.
These are entirely in charge of women physicians.

The nurses' training, at first one year, was ex-
tended to one and a half, and in 1905 brought up to
the three-year standard. Though the staff nurses
and hospitals are supported by the government, the
training school is still kept up by the DufTerin Fund.
It was at first impossible to get native women to
leave their homes for more than a year, but they
learned to do so readily, and, between 1887 and 191 o,
220 pupils had been trained and seven had had six

VOL. IV. — 16

242 A History of Nursing

months midwifery as well. In the year last men-
tioned, Miss S. Grace Tindall, the lady superinten-
dent in charge, wrote:

Our pupils go into all parts of India and often return
to their old school in positions of trust. I have former
pupils as charge nurses in the civil hospitals of Maymyo,
Karachi, and Moulmein, and have placed native nurses
in charge of female wards in Amritsar and elsewhere. I
am asked to fill more vacancies than I can possibly
supply, showing that our nurses are appreciated.

Miss Tindall was trained in England, and had had
wide experience at home and in Egypt before coming
to India. Active in organisation, she was chosen
first president of the Trained Nurses Association of
India when it was formed in 191 1, and under her
guidance the school advanced in development;
teaching was thoroughly organised, and lectures
given in English and in the native "vernaculars."
The nurses wear white without distinction of class.
In the lecture-room of the school are tablets whereon
are placed the names of all who receive certificates.

One of the earliest pieces of pioneer nursing work
was that of the Zenana Bible Medical Mission, which
has aimed both at providing English trained nurses
for the needs of the medical service, and at training
the native women as nurses. Its nursing field was
taken up in 1882, when Miss Marston came with her
sister, Dr. A. Marston, to the hospital at Lucknow.
She, however, was transferred within the year to the
Zenana work. In 1883, two trained nurses, Miss
Gregory, who was trained in Manchester, and Miss

1 I

India 243

Roper, were sent out. The latter was placed at
Lucknow, then the only hospital of the mission,
while the former studied the vernaculars in prepara-
tion for the expected opening of a second hospital in
Benares. When this new hospital was opened in
1888, Miss Gregory began the training of native
women there. Hers was a varied and useful service,
for at the time this was written she was still connected
with the hospitals of the mission, sometimes directing,
sometimes helping with the nursing departments, and
always leading the way to new and improved methods.

Other nurses in the training work have been
three from the Manchester Royal Infirmary, Miss
Bowesman, Miss Riley, and Miss Grant; Miss
Creighton from the Illinois school in Chicago; Miss
Bostrop, a Dane; Miss Watson, trained in Liverpool,
Miss Wright, in Derbyshire, and Miss Pearse, in
the Edinburgh Royal Infirmary. Under these women,
the training was brought up to an organised three
years, study and examinations arranged, and text-
books translated into the Persian and Roman Urdu.
The mission has several hospitals. The first Indian
probationer to take the full course here was Hermina
Caleb, who graduated in 1897. Although she soon
married, she studied pharmacy and remained at
work in one of the hospitals as compounder until
1904. Of forty-odd nurses trained in ten or more
years, nineteen married almost at once, which does
not look as if India would be speedily overstocked
with nurses.

Miss Creighton has told of an incident of plague
nursing under this mission, which shows a high degree
of fortitude in our Indian sisters:

244 A History of Nursing

In 1902, when the plague was at its worst in Lucknow,
we built a plague camp. The huts, made of grass, were
large enough for two patients and, as it was intended for
Zenana women, we had an enclosure made of reeds around
it. I shall never forget the day when I asked for volun-
teers from among our Indian nurses for this camp. I
could only give them two days to think about it, and when
I gathered them all together and asked who was willing
to go, making it very plain to them that perhaps they
would never return, out of the twelve four spoke and said :
"We will take our lives in our hands and go." They
made all preparations in case they should not return,
and, taking their oldest clothes in bundles, we silently
walked to camp. For months they were in the camps,
cut off from every one, and what they went through
would have made many an English heart faint. It was
not only the being in a lonely place with the dead and
dying; many times robbers came their way, with their
strange custom of imitating the cries of wild animals.
A gang went through the field one night between eleven
o'clock and midnight, when I was in the camp. They
imitated jackals until the field seemed full of them. In
another camp, a native nurse, the only one on night duty,
was attacked by a robber. Although he seized her by
the throat, she succeeded in driving him off and stayed
at her post until the morning.

The Sisters of All Saints took an important part
in developing Indian nursing. In 1884, they took
charge of the European General Hospital, Bombay,
and a year later of St. George's, the intention of the
authorities being that their work should form a
centre from which well-trained nurses might be sup-
plied to other institutions. In 1907, St. George's
formed its own staff, but in the Jamsetjee Jejeebhoy

•^ £

India 245

Hospital in Bombay among others, the Sisters con-
tinued to train not only Europeans, but also numbers
of Parsee and Indian pupil nurses. St. George's
formed a Nursing Association, and chose Miss C. R.
Mill, from the Dundee Royal Infirmary, as lady
superintendent. Miss Mill, who joined the Inter-
national Council of Nurses at its formation, to re-
present India, had had five years' experience in plague
nursing in Poona, under the government, as well as
ordinary work in England. St. George's training
is for three years, while the nurses sign for four,
spending the last on the private staff.

The North India School of Medicine, founded at
Ludhiana in 1894 by Dr. Edith Brown (England),
has done yeoman's service in early training efforts.
Dr. Brown wrote:

Nineteen years ago when I came out to India, there
was nothing which could be called nursing in the Woman's
Hospital, and it was exceedingly difficult to get any woman
or girl of good family to enter a course of training. Sanit-
ary work was objected to as "sweeper's work" and per-
sonal care of the patients as "ayah's work," while there
was no appreciation of the necessity for accuracy or
method in the giving of medicines and food. Some of
the orphan girls were sent from the orphanage to learn
nursing, the reason for their coming being such as the
following:

"As she has only one eye and cannot be a teacher, "
or, "as she is so disobedient, I can do nothing with her"
or, "as she has such a bad temper that she cannot be
trusted in the school, because she beats the children."

Further, they were sent to us at sixteen years of age,
if at all, as it was "not worth while to keep them longer

246 A History of Nursing

in school, " and when they came they were physically
not strong enough for such work — were afraid of being
awake at night, and, if a patient were specially ill, were
actually afraid to go near her alone at night, so it may be
imagined our difficulties were great. After some time
we got some European girls and a few girls of good family
to take up the work, following the example of those at
home, and this gave a certain amount of prestige which
has made it easier. The presence of English nurses in
India, too, has had much influence in altering the general
attitude towards the profession. In 1900, we were
joined by Sister Winifred Thorpe, whose influence has
been great in India, and under her superintendence our
course of study was raised from two to three years, and
a higher standard of preliminary education was required.
Nurses who have gone from our school have had respons-
ible posts in government hospitals in Simla, Lahore, and
Amritsar, and in many mission hospitals in North India.

The Albert Edward Hospital of Kolhapur took its
first class of native women to be trained as nurses in
1890. They were hardly able to read, yet did excel-
lent work, and their example was not without influ-
ence among high-caste women. In 1905 another class
was formed and a better educated body of women
then came forward. Ten of them, superior women
in every way, completed the course of training.

The Canadian Presbyterian Mission built its first
women's hospital at Indore, Central India, in 1 891,
and worked slowly toward nursing efficiency. For
five years the nursing of all the patients had to be
done by their friends, but, in 1896, a graduate of the
Toronto General Hospital, Miss Harriet Thomson,
came into the mission, and, in 1898, the first class of

India 247

two probationers was started, with a native head
nurse trained in a mission hospital at Benares. One
of the two first probationers died. The other com-
pleted a three years' course, took her certificate, and
was appointed as head nurse in a native state hos-
pital. The uniform is a pink and white check with the
white draperies of the country. The mission has also
a hospital in Dhar. Canadian trained nurses have
done excellent work in these centres.

The American Evangelical Lutheran Mission
opened its hospital at Guntur, South India, in 1897.
Many obstacles had to be surmounted before native
prejudices to nursing duties were finally overcome.
Well-educated girls regarded such duties as very de-
grading, conflicting with ideas of caste, and it was
finally decided to open a training school for European
and Eurasian candidates as an example. After
laborious introductory work the school was started
in 1899 with three pupils. Beginning with two years,
the course was soon extended to three, and a care-
ful arrangement has been satisfactorily followed
for teaching anatomy and physiology, surgical and
medical nursing, materia medica, and midwifery in
class and lecture, with practical demonstrations and
classroom equipment. So well did all progress, that,
in April, 1 9 10, on the day after the annual commence-
ment, an alumnae association or league was organised,
members of five classes being present. Miss K.
Fahs, then the superintendent (University of Penn-
sylvania Hospital), to whose ability and earnestness
most of this result was due, wrote: "We have finally
overcome the native prejudice to nursing, and now
have more applicants than we can take. We have

248 A History of Nursing

conquered the unwillingness to sweep, and the op-
position to all those duties once considered degrading.
The nurses do everything for the patients, and we do
not allow a sweeper to enter the wards. It was up-
hill work, but we have succeeded, and feel proud of
our success."

The English Baptist Zenana Mission had its first
English nurse at the hospital at Palwal, but this
service was more or less tentative until the arrival
in February, 1905, of Sister Duff, who held London
Hospital and other certificates and had been for three
years in plague work in Bombay, Poona, and Ahmed-
nagar. She rounded out the course of instruction
and added class work in special practical nursing.
The next English nurses who came to the work con-
tinued to build up, and progress was marked and
encouraging. The course developed to three years,
and Indian girls were trained into excellent nurses,
yet when they first came, "beds, sheets, and clean-
liness were unheard-of luxuries and punctuality an
uncoveted virtue." In the various hospitals of the
Baptist mission trained nurses are paid as high
salaries as teachers, and this gives them standing in
Indian eyes.

From the United Free Church of Scotland Mission
with its Mure Memorial Hospital at Nagpur comes
the report:

The young girls over seventeen who are taken are ir-
responsible and require much supervision. As a rule,
they marry at or before the end of their training. The
uneducated women, if intelligent and suitable, make
good nurses, though to train them is a task needing much

India 249

time and patience. Our Matron and nurse-in-charge is
a girl of our own training, an exceptionally good nurse,
and quite capable of directing and superintending the
juniors. She has now been with us for several years and
is still, at twenty-five, unmarried, so is an exception to
the general rule. During the three years, the subjects
taught are elementary physiology, bandaging, surgical
instruments, sick-room cookery, simple compounding,
and midwifery. Examinations follow each course of
lectures and a certificate is given if merited. The un-
educated women have a longer training and less class
work than the others. Some of our nurses have taken
good posts in other hospitals.

The simple narratives of these pioneer efforts show
what an immense process of upbuilding is going on
in India under the faithful hands of nurses from many
countries. The constant aim and efforts of the nurs-
ing superintendents there tend toward a practical
working uniformity or standardising of training.
To this end there has been formed the Association
of Nursing Superintendents of India, first proposed
at a conference in 1905 and agreed upon in 1907, and
this body has called into being the Trained Nurses'
Association of India. A journal for self-expression
and as a carrier of professional communications,
called the Nursing Journal of India, was successfully
launched in 1910, and with this organ at command
and the quickened interest that results from co-
operative effort, great impetus forward is at hand.
The Journal was first edited by Mrs. Etha Butcher
Klosz, from the Johns Hopkins.

The question rife in hospital work all over the world
— of uniformity in training — was definitely taken up

250 A History of Nursing

in 1909, when, at a conference of the India Medical
Mission Association, a resolution was passed author-
ising Miss E. MacDonnell (superintendent of the
South Travancore Medical Mission of the London
Missionary Society and trained at the Edinburgh
Royal Infirmary) to inquire into and report upon this
subject. Miss MacDonnell' s work was arduous,
for the standard of training for native Indian nurses
was to be itemised and compared, and the proposition
of two levels — one for the hospitals under the govern-
ment and another for those under the missions — con-
sidered. Her committee sent out a questionnaire in
1 910 and, to focus replies, put forth a tentative pro-
posal for arriving at a uniform standard for the mis-
sion training schools. Briefly, this called for an
admission age not under eighteen, good vernacular
education (about seven years of schooling) with some
knowledge of English, regular entrance periods twice
yearly, a three years' course with the subjects laid
down for each year, and an agreement on text-books
for study. Miss MacDonnell further wrote : * ' It was
felt that it would very materially help in raising the
standard of nursing in mission hospitals throughout
India if a nursing diploma were granted, not by each
unit, but by the I. M. M. A. who, through its local
branch, would appoint examiners annually."

The direction of effort of nurses in India is further
shown by an editorial in the March Journal, 191 1,
closing with these words: "We are working towards
registration of nurses, i.e., government recognition
of the status of a trained nurse. ... To get registra-
tion, we must have a uniform standard of training."

The first definite example of incipient registration

Miss M. E. McDonnell and Nurses at Neyoor

India 251

is shown in the Presidency of Bombay, where a cen-
tral nursing board was formed in 1909-10 under the
Bombay Presidency Nursing Association, to stand-
ardise training, set examinations, and give one cer-
tificate to graduates from all the hospitals in its
territory. The first examination held under the
auspices of this body was described critically, by
Miss Tindall, in the Nursing Journal of India for
November, 191 1. Tentative though it may seem,
this must be regarded as an important event, mark-
ing a beginning of far-reaching changes.

Private nursing in India is largely confined to the
foreign colonies there, and is chiefly carried on
through associations, of which that called Lady
Minto's Indian Nursing Association is the largest,
most recent, and also the most comprehensive, in
that it recognised and made use of existing organisa-
tions, amplifying all, and extending their services.
It was projected in 1906. In the report for 1909,
Mrs. Jessie B. Davies, Lady Superintendent of a staff
comprising three assistant superintendents and forty-
eight Sisters, gave some details, as follows:

It may be interesting to note that, under special
conditions, nurses are supplied to Indian ladies and
gentlemen, the conditions being that the number of
nurses unemployed in the home is more than sufficient
for the needs of the registered subscribers, that the
applicants must be living in European fashion, and
able to provide suitable food and accommodation for
the nurse, that only those nurses who volunteer
should be sent, and that a special fee should be charged
in all such cases.

All nurses engaged for service in India are carefully

252 A History of Nursing

examined as to physical fitness. Inoculation against
enteric fever, which is now compulsory for all nurses
coming out, is done free of charge at the pathological
laboratory of the Royal Medical College at Mill-
bank, and the association is much indebted to the
Director- General of the Army Medical Service for
this privilege.

Association nurses are also permitted by the London
School of Tropical Medicine to attend the lectures de-
livered by Sir Patrick Manson and Dr. Sandwith. These
lectures include both the nursing of tropical diseases
and the preservation of health in the tropics and are of
very considerable importance to nurses going to India
for the first time.

In order to meet the criticism that nurses must of
necessity become old-fashioned in their methods after
five years' private nursing, it was agreed that, if desirous
to re-engage, they must consent to go through a course
of three months' training in some recognised hospital
approved by the central committee either at home or in
India, and, at the termination of such period, must
produce a certificate of efficiency.

There is also an association of Indian ladies who
are undertaking to do something in nursing education,
as shown by the following editorial from the Nursing
Journal:

The Seva Sadan, or Sisters of India Society, has just
closed its second year. It is an association of Indian
ladies who are trying to build up a sisterhood of women,
who, irrespective of caste or creed, shall devote themselves
to philanthropic work, much as Christian deaconesses do
in other lands. . . .

The Sadan has eight probationers in Bombay under a

India 253

Matron who gives her services free. One of these pro-
bationers is taking a nurse's training in the Sir Jamsetjee
Jejeebhoy Hospital. She is maintained by the Sadan
and will give her services to it, but the Sadan 's officers
desire to get a place where they can provide accommoda-
tion for in-patients and have at least one resident lady
doctor and train their own nurses.

One of the friends of the association collects Rs. ioo
a month to secure a nurse and midwife for work among
the poor. Two nurses are employed, who visit the sick
in all parts of the city and its suburbs. . . .

What chiefly interests us is the nursing part of their
work. We could wish that the Sadan would send all
its nurses to training schools in connection with large
Indian hospitals, thus ensuring a good general preparation
for their work, instead of opening a small hospital for
training them itself. The report reads: "We want the
public to realise that, to bring together women who have
the same ideal of service, and to place them amidst sur-
roundings, where, practically, nothing but service (seva)
occupies their minds, is to solve half the problem of de-
veloping a true missionary spirit. We are at present
making the best use of existing agencies. But there is
a difference between institutions teaching paying occu-
pations and turning out workers for pay, and institutions
which aim at giving to the country devoted women,
wedded to the ideal of loving, self-sacrificing service, and
bearing ' the torch of knowledge and the balm of physical
and spiritual comfort all over this ancient land, through
the all-embracing agency of sisterly love and good- will. ' "
We do not think the report is quite fair here. These
high motives of service are always kept in the foreground
in training schools at home, and they are found very
markedly in the superintendents of nurses out here.
They form the ideal which is set before all the Indian
girls who take up a training, even though they may have

254 A History of Nursing

to make nursing their means of livelihood, and if the
Sadan can send among them girls who already have
these high aims, there must be gain on both sides. ■

The outline here given may, it is hoped, bring an
impression of nursing in India before the mind, but
by no means does it indicate its extent. The lists
of membership in the national society show fifty or
more hospitals, many built and supported by the
government, others expressing the munificence of
wealthy Hindus or Parsees, as well as the mission
hospitals. The women holding executive posts in
these institutions are as yet preponderatingly English
or American ; one Indian nurse's name appears in the
column of 1910, that of Rosie Singh, trained in the
Memorial Hospital at Ludhiana and holding a post
in the Sarah Seaward Mission Hospital at Allahabad.
But in the future, Indian nurses should and doubtless
will come into membership in ever larger numbers.
At the Trained Nurses Association meeting in 1910,
the question was discussed whether or not there
should be a separate branch for the Indian women.
Miss S. M. Tippetts (Guy's Hospital), Miss Tindall
(Metropolitan and City of London), Miss Steen
(Royal Infirmary, Edinburgh), Mrs. Klosz (Johns
Hopkins), and others in the forefront of Indian nurs-
ing affairs took the just and right position that true
professional unity must be their aim, and the Indian
nurses be encouraged to develop into organisation
work, not by themselves, but all together. At the
same time, the superintendents' papers and discus-
sions dwelt upon the enormous difficulties surrounding

1 Nursing Journal of India, Oct., 19 10.

India 255

the training of native women and the indispensable
need of their being trained by nurses, not by doctors,
especially not by men, who could not — did not know
how to — train.

The story of nursing progress in India is woven
through with the influence of Sister Winifred Thorpe,
whose life of abounding gifts was ended by a dis-
tressing accident in 1909, and whose buoyant,
inspiring personality, now gone, is mourned as a per-
sonal grief by her co-workers. She was trained in
the Richmond Hospital, Dublin, and looked forward
even then to mission work in India. Miss Tippetts
spoke of her to the nurses' association in 1910, in the
following terms:

Almost entirely to her splendid zeal and enthusiasm
were due the formation and organisation of, first, the
Association of Nursing Superintendents of India and,
later, of the Trained Nurses Association.

She worked untiringly as secretary and treasurer of
these associations, when the work entailed must have
been a heavy tax in addition to her already heavy hospital
duties. She inspired all those with whom she came in
contact, and by organising these two associations, she has
left her mark on the nursing profession of India.

Her enthusiasm was unflagging, and her dearest hope
was to see nursing in India put on a thoroughly satisfact-
ory basis and brought up as nearly as possible to the
standard of nursing at home. She believed, as we all
hope, that the associations will set a very high standard
of work and character among the nurses of India, and
that they will^help and support them in the difficulties
that are well-nigh insurmountable alone.

We can never forget Miss Thorpe's splendid work,

256 A History of Nursing

and her name will ever call forth our admiration and
gratitude.

Japan. The recorded history of nursing in Japan
begins twelve hundred years ago with the legends of
the empress whose figure corresponds to that of the
holy Elizabeth and other nursing saints. A transla-
tion of her story was brought from Japan by Miss
Wald and Miss Waters of the New York Nurses'
Settlement, and runs thus:

Over twelve hundred years ago there lived an empress
whose name was Komio. She was the wife of the Emperor
Shyomu, who built many temples, and brought many
sacred objects from China and India. She was endowed
with a very merciful and charitable heart. She estab-
lished two charitable institutions: (1) Hidenin, a place
where orphans and aged people came to be taken care
of; (2) Seyaknin, a place where the poor were provided
with medicines and necessary things for the sick. [A
charity hospital.] With the permission of the Emperor
she built a house where people came to be bathed, and
sent word to the near-by towns that the Empress herself
would bathe the lepers. The number [to be bathed by
her own hands] was limited to one thousand. One after
the other the patients came, but when the number
reached 999, there was a sudden stop to their coming.
The Empress was greatly disappointed and wondered
why there was not one more to make up the number.
Finally there came a very ragged dirty man, whose whole
body was covered with ulcers, of which the odour was
enough to make those sick who were near by. He
stopped at the gate and asked those inside to let him in.
But he was so filthy that the custodian refused to let
him in. The ragged man still begged repeatedly to be

m
O

-1-5

Japan 257

admitted, and finally the word reached the Empress and
she sent out her orders that he be let in, and they were
obeyed immediately.

The leper was led to the bathroom by the Empress
herself, in reply to his plea that she should bathe him.
She was so abounding in mercy that she did not hesitate
a moment, and while she was washing the leper he was
suddenly transformed into a very perfect being. As-
tonished, she asked him who he was. Then in a loud
voice he answered: "I am the image of Ahiniyorai; I
came to see whether you were doing this work from your
heart or only to gain the praise of the people." Then he
rode on the purple cloud and vanished away. So bright
a light radiated from him as he disappeared that the
people named the place " Komio San Ashikaji." [Komio
— light or bright; San — mountain.]1

From the day of the merciful Empress we come to
modern times, convinced that her story is an emblem
of the ministrations of gentle, delicate Japanese
women to the sick and suffering, even though they
were not recorded or performed in public.

The Charity Hospital in Tokio, one of the best
charity hospitals in the country, was established in
1882. The first training school in Japan was that
started in September, 1885, by Miss Linda Richards,
who, early in that year, was sent by the American

1 Hospitals and asylums for lepers in modern times, we are told,
have been chiefly founded and carried on by foreign missionaries:
by a Catholic Father at Hakone; by Miss Youngman, an American
missionary, in 1894, at Tokio; by Miss Riddell and Miss Knott, two
English missionaries, at Kumamoto, in 1895, and others. See page
108, vol. ii., of Fifty Years of New Japan, in two volumes, compiled
by Count Shigenobu Okuma, English version edited by Marcus B.
Huish; London, Smith, Elder & Co., 1909. The story of the Empress
was written down for Miss Wald by a Japanese friend.

VOJ- IV. — **

258 A History of Nursing

Board of Missions to organise a school for the training
of women nurses in the Doshisha Hospital in Kyoto.
Beginning with the tiniest outfit and accommoda-
tions, but with a group of well-educated girls and
married women, the school graduated its first four
pupils in June, 1888, and its reputation had so grown
in the meantime that the second year opened with
thirty patients, new wards, and a home for nurses.
Miss Richards stayed for five years in Japan, and
after her departure the school came under Japanese
management.1 Her first printed mention of this
work was made in 1902, when she wrote:

So it came to pass that the first training school for
nurses in Japan was organised and, for a time, controlled
by Americans. At first, like all new movements, it was
carefully watched to see if it was really just what was
wanted to meet the demands . . . There are no people
more quick to recognise merit in any enterprise than the
Japanese, nor can a people be found who will more quickly
detect weak points. Notes of merit and demerit were
carefully made, and soon it was pronounced a good and
desirable thing. . . . Shortly a second and much more
important school was opened, having for its patroness the
Empress herself. It was organised in connection with
the Empress's Hospital, and, of course, received the
sanction and support of the government. . . . The
Japanese did not consider all methods in use in foreign
training schools perfect, and decided to improve upon
them. If training schools were to benefit women, it
was thought they should be educational institutions,
and pupils in them should have similar advantages to

1 Reminiscences of America's First Trained Nurse, by Linda
Richards, Whitcomb & Barrows, Boston, 1911.

Japan 259

those in other schools ; they must be treated as scholars,
and, therefore, an entrance examination was required.
The nurses were to be self-supporting, the hours of duty-
must be fixed, and those for study, lectures, and recita-
tion must be ample. Most of the applicants were gradu-
ates from good schools, young women of high purpose,
with a determination to succeed, and to such success is
assured. x

Miss Richards's work laid the foundations for a
friendly feeling between American and Japanese
nurses. Since that day many Japanese probationers
have come to America for training, and others,
trained at home, have come for post-graduate work.

A vivid description of the organisation and ideals
of modern Japanese nursing was brought by Miss
Hagiwara to the London Congress in 1909, and is here
repeated almost in full. It was prepared in the Red
Cross headquarters in Tokio under the direct aus-
pices of Prince M. Matsukata, president of the Red
Cross Society of Japan, to whose kindness and interest
in the International Congress of Nurses we owed the
friendly participation of Japan and the presence of
several Japanese nurses, one of whom came from Paris
as a delegate from her country. The war between
Japan and Russia had brought the brilliant achieve-
ments of Japanese nurses into world-wide renown,
attracting the interest and sympathy of those in all
other countries. When, therefore, these little ladies
came upon the platform beautifully dressed and cov-
ered with decorations for valour in three wars, the
stir and interest were lively and cordial. They
quickly won all hearts, and Miss Hagiwara, the

1 American Journal of Nursing, April, 1902, p. 491.

260 A History of Nursing

delegate, was one of the centres of attraction at the
reunions.

The work of nursing in Japan has no such old history
as in Christian countries. The association of Christian
Sisters is unknown in Japan, not because there was no
charity in the country, but because Buddhism — Japan's
chief religion for centuries — laid much greater stress upon
helping the poor than upon nursing the sick and wounded.
In addition to this fact, up to very recent years, social
rules as to the separation between the sexes were so strict
that, outside the sphere of family relationship, no idea
could be entertained of a woman taking care of a sick or
wounded man, unless for pay, and mercenary nursing
has not the same element of charity and self-sacrifice in it.

The art of nursing by women was first introduced with
the art of treating patients according to Western methods,
and nurses are now being employed in great numbers in
all the hospitals, public and private; and considering that
there are in the whole of Japan 102 institutions for their
training, besides those belonging to the Red Cross Society,
we may presume that their number is very rapidly in-
creasing. In this paper we shall not attempt to describe
other institutions than those of the Red Cross Society.
Several local governments have within recent years en-
forced regulations according to which only those qualified
for the work can make nursing a profession. But our
present purpose is to introduce to our Western sisters
the Red Cross nurses of Japan.

The 14,000 nurses of our Red Cross Society are in two
divisions, namely, voluntary nurses and relief nurses,
whose duties have been developed upon the following
lines.

The Japanese Red Cross Society collects contributions
from generous and patriotic people, and, with the capital
so realised, trains and exercises the relief personnel of

Japan 261

both sexes in time of peace, in order to assist the medical
service of the army and the navy in time of war. And in
order that the Red Cross Society may properly execute
its plans, it is necessary that everybody belonging to its
relief personnel should do his or her work, not for the sake
of personal gain, but with the idea of moral duty, an
idea which can be sought for only among the higher
classes of society. But, under the old regime, the women
of the higher classes were exactly those that were bound
most strictly by the rules concerning the separation of the
sexes, and it was almost hopeless to induce them to be-
come nurses whose part it was to take care of the sick
and wounded soldiers that were not their relatives, not
even friends. To overcome this difficulty a special plan
was adopted, and executed with lasting success, by the
founders of the Japanese Red Cross Society. It consisted
in inducing ladies in the highest class of our society to
show by personal example that nursing is a noble and
honourable work — noble enough even for the daughters
of kings and princes — if done, not for gain, but with the
elevated idea of a moral duty. Let all praise be due to
our most benevolent and loving Empress that she con-
curred in this plan, and caused the princesses of the Im-
perial family and the wives and daughters of the highest
dignitaries to take part in its execution.

Thus, in May, 1887, the year in which the Japanese Red
Cross Society joined the international association of her
sister societies, an association of about twenty ladies was
formed, with Princess Arisugawa for its president, and all
the other princesses of the Imperial family for its vice-
presidents. They came together once in every month to
receive instruction in nursing and dressing wounds,
and more ladies were invited to join the patriotic work.
This attracted such public attention that in a short time
its members increased a hundredfold, and had not only
the effect of dispersing all the idea of meanness connected

262 A History of Nursing

with nursing, but also that of breaking through the
custom of our ladies leading a life of seclusion and retire-
ment, and gave them the impulse to come out and take
part in the work of public utility. This is the origin of
the Volunteer Nursing Association in Japan. Its sub-
sequent development was remarkably rapid, and it
rendered great services in the Chinese war of 1894, the
Russian war of 1904, and the Boxer troubles of 1900.
It now forms an important auxiliary force, side by side
with the relief nurses to be next described. It has its
central committee in the headquarters of the Japanese
Red Cross Society in Tokio, and forty-four branches in
the different provinces of the Empire, and counts at
present over ten thousand two hundred members. Not
a few of the foreign residents in Japan take part in it,
and it is our great pride to count among its associates
Lady Macdonald, wife of the British Ambassador, and
Mrs. Richardson, now in London, widow of the late
Colonel Richardson, who had fought for his country in
South Africa.

Let us now pass on to the relief nurses of our society.
The name demands an explanation. All the persons that
the Japanese Red Cross Society specially trains in view
of service in time of war, according to the regulations
authorised by the army and navy, constitute the relief
personnel, and the nurses that form a part of this per-
sonnel are relief nurses (the volunteer nurses just de-
scribed form no part of relief nurses, because they are not
included in the relief personnel). The relief nurses are
taken from among general candidates upon examination,
and are subjected to special training, at the expense of
the society, either in its main hospital in Tokio or in the
hospitals belonging to its local sections, for the term of
three years, during which they are called the "proba-
tioners ' ' of the Japanese Red Cross Society. In provinces
where no Red Cross hospitals exist, arrangement is made

Japan 263

with other public or private hospitals for their training
in the way fixed by the society. They are also from time
to time sent to military and naval hospitals in order to
be instructed in matters connected with the medical or-
ganisation of the army and navy. The " probationers "
are between sixteen and thirty years of age, and un-
married. We have not yet been able to make inquiries
as to the position of women that volunteer to become Red
Cross nurses, but we are almost sure that the difficulty
of marriage is not the cause; for dowry, which makes
marriage such a difficult thing in Europe, is almost un-
known in Japan. As already said, the strongest motive
would be that of following the example set by the ladies
in the highest position devoting themselves to nursing
out of patriotic ideas; to which we might perhaps add
the motive of acquiring some art which can serve as a
means of leading an independent life, whenever compelled
by circumstances to do so. At all events, all the proba-
tioners belong to the middle and higher classes of society,
for only those with an adequate amount of education are
admitted. After graduation they are bound by a solemn
oath, written in documents, to remain faithful to the
principles and respond to the calls for service of the
society any time during the period of fifteen years, reck-
oned from the date of graduation. Travelling expenses
and salaries are paid to them whenever called on by the
society and during the time of their service.

The three years' course is divided into the first term
of one year and the second term of two years, the former
being devoted to theoretical instruction and the latter
to practical training. The theoretical instruction con-
sists of the outlines of anatomy and physiology, bandag-
ing, nursing, disinfection, obstetrics, diseases of women,
nursing of the first born, assisting surgical operations
and medical treatment, massage, manipulation of instru-
ments, improvised treatment of the wounded, hygiene,

264 A History of Nursing

outlines of pharmacology, and transport of patients.
Also, the "Instructions to relief personnel," ethics and
11 Moral counsel to nurses," " Rules of saluting and other
etiquette of the relief corps," grades and denominations
of military and naval officers and their uniforms, inter-
national treaties concerning the Red Cross work, a sketch
of the history and organisation of the Japanese Red Cross
Society, and the organisation of its relief work in time of
war, are taught as side studies. Lessons are also given
in the treatment and feeding of patients in military
hospitals at the front, the disposal of deceased patients
and of their wills, the service in the base hospitals and
the fortress hospitals of the army and in the hospitals of
the navy. Foreign language is optional. A glance at
the subjects taught will show that it is only the well-
educated daughters of the middle and the higher classes,
possessed of intelligence above mediocrity, that can aspire
to become relief nurses of our society.

Those that have shown themselves to be excellent both
in theoretical training and practical work are subjected
to a course of special training for another six months in
the Red Cross Hospital of Tokio, after which they are
once more examined, and, if successful, are granted the
diplomas qualifying them to be head nurses of the society.

During training the probationers are obliged to live
in the dormitories under the strict guidance and control
of their superiors. They are not permitted to discontinue
the study at their own will, unless it be on account of
illness or other disqualifying circumstances.

Since this system of training was begun in 1890, 4067
students were admitted, of which 3160 graduated, 486
died or had to give up the study before graduation, and
421 are still under training. The relief nurses of the
society are free to marry or to adopt any mode of life
thev choose, provided they remain faithful to the vow
and keep themselves ready to respond to the calls of the

Japan 265

society at any moment ; but, of course, a great majority
of them willingly continue their work in public and priv-
ate hospitals, or offer their services to private families,
where they are especially welcomed, and enjoy very good
reputation on account of their education and good dis-
cipline. For fear lest among such a great number there
may be some one or other that goes astray and does things
detrimental to the dignity of a Red Cross nurse, a home
for the graduated nurses is established in the Red Cross
Hospital in Tokio, under the name of "Department for
Services Outside the Hospital," and those that wish to
employ Red Cross nurses are made to apply and pay to
this department, which looks after the wants of the in-
mates and deducts a small portion of the fees received to
defray the expenses of their protection and control.
This arrangement also serves as a means for rapidly des-
patching the nurses in cases of public calamity.

Service in Time of Peace and of War.

The voluntary nurses have no fixed obligations in time
of peace beyond receiving instruction at the regular
meetings of the association and volunteering for relief
work or visiting patients when there is a sudden necessity,
in consequence of earthquakes, inundations, great fires,
and the like. In time of war they devote themselves to
works either resolved upon by the association or commis-
sioned by the military or naval authorities. In the
Chino- Japanese war of 1894, f°r instance, a great number
of them, including the princesses of the Imperial family,
assembled day after day in the hospital of the society
to make bandage-rolls in great quantities, partly as free
gifts to the army, but mostly in compliance with the de-
mand made to the association by the Army Medical Ser-
vice. Also, two of the oldest members of the association
repaired to Hiroshima, which was the base of operation

266 A History of Nursing

of the army fighting in China, and became directresses
of the relief nurses serving in the military hospital of
that place. Other members, all of them ladies in the
highest position, visited the military and naval hospitals
as representing the whole association. These visits to
hospitals are regarded as a matter of great importance in
Japan, for among the soldiers are men from the lowest
classes, such as labourers and coolies, who can never hope
to converse with ladies of the highest position in ordinary
times ; but when they are admitted into hospitals as sick
or wounded soldiers they are spoken to and consoled by
these ladies, and the feeling of honour done to them
certainly does them good.

In the Boxer troubles of 1900 the sick and wounded
were not numerous; but the ladies of the Voluntary
Nursing Association paid visits to patients, and also
tried in many ways to encourage the relief nurses working
in the hospitals and hospital ships.

But it is in the late Russian war that the Voluntary
Nursing Association, hitherto playing rather a decorative
part in the whole organisation of the Red Cross work in
Japan, showed a great activity and proved itself to be
an important factor in the real relieving force of the
society. In the seventeen provinces of the Empire, the
real work of nursing in the base hospitals of the army
and in their sections was actively assisted by the members
of the association living in the respective localities, and
in every landing-place and railway-station where the sick
and wounded soldiers returning from the front were made
to rest and take meals, rest-stations were established by
the local committees of the Red Cross Society and worked
by the members of the Voluntary Nursing Association,
some changing the bandages or washing the faces of the
soldiers, and others aiding them in taking meals. Others,
again, paid visits to hospitals, distributed presents to
patients, and even occasionally gave entertainments in

Japan

267

music and other amusements in order to make them
forget their sufferings.

Some of the members in Tokio devoted themselves
to the manufacture of bandage-rolls and caps for
patients; and her Majesty, the Empress, visited their
workroom to encourage the ladies, and contributed
to the fund of the undertaking. One thing to be es-
pecially noted is that all through this long war every
single packet of bandages carried by Japanese soldiers
in their pockets was manufactured by our voluntary
nurses. These being the very first bandages that are to
be placed by the soldiers themselves on their fresh wounds,
the medical authorities of the army wished to be abso-
lutely sure that they were properly disinfected and rolled,
so that their manufacture could not very well be trusted
to merchants. That is the reason why they asked the
Voluntary Nursing Association to undertake the task.
Two hundred and fifty members, including the Imperial
princesses, took part in the work and laboured hard
from nine in the morning till four in the afternoon,
through heat and cold, between the months of June, 1904,
and of February, 1905. Such a fact as this could not
fail to act as a great stimulus to the relief nurses render-
ing their services in other districts, and contributed not
a little to the encouragement of soldiers going out to
expose their life and limbs to enemies' fire and swords.
Again, all the sick and wounded soldiers brought home
from the front and transported to provinces east of Tokio
had to pass through that city, and every time announce-
ment was made of trains carrying such patients arriving
there, the Imperial princesses, with other members of the
association in their suite, repaired in turn to the railway-
station, personally consoled the soldiers, and distributed
to them patients' caps made by themselves and the ladies
of the Court. In this war, 281 1 members of the Volun-
tary Nursing Association assisted the real work of relief

268 A History of Nursing

in the different localities, 79 of them were decorated for
their services by the state, and 1399 received diplomas
of honour from the society.

The relief nurses especially trained by the society have
many duties, both in time of war and of peace. When-
ever a great public calamity takes place, and many cases
of wounded occur at once, the local section of the Japanese
Red Cross Society concerned calls together the relief
nurses under its jurisdiction and despatches them to the
scene of disaster. Again, when the Imperial army has
its manoeuvres, all the relief personnel of our society, and
with it the relief nurses, are also called out for purposes
of manoeuvring in combination with the troops. Besides
these extraordinary calls, there is a roll-call once in every
two years in order to ascertain that the nurses whose
names are on the list are ready and fit for service in cases
of national emergency. The occasion is also utilised
for giving necessary instructions to the nurses. All the
head nurses are called once during the fifteen years of
their engagement specially for the purpose of training
them in the work for which they are intended. The
writ of calls ought to be served to the persons addressed
at least twenty days before the date fixed as that of their
departure. Every time the relief nurses are called, be
it for roll-call, for manoeuvres, etc., they are subjected
to physical examination, and if found unfit for service
in time of war, their names are struck out from the list.
Should the nurses be behind time in responding to the
call, or not respond at all, they are guilty of a breach
of vow, and treated as such, unless a certificate of ill-
ness, signed by a physician, or a document establishing
inevitability of the delay, is produced.

Before September 30th of each year, the president of the
Japanese Red Cross Society has to draw up a report on
the preparation of the society for service in time of war,
covering the period of twelve months after April 1st of

Japan 269

the following year, and present it to the Ministers of War
and of the Navy, who utilise the personnel of the society
in their plan of preparation for the emergency of war.
Should war actually break out— which may God forbid !
— and orders are issued by the ministers to organise the
relief corps of the society in accordance with the plan
of preparation, the nurses required for the relief corps
mobilised are called, and every time a vacancy occurs
after the corps have once been formed, supplementary
calls are made. These two cases of call are to be carried
out with the greatest strictness. In each local section of
the society, forms of call-order are printed and stored
away in time of peace, ready to be filled in with the nec-
essary items before sending out, and, when sent out, the
nurses addressed to, or the persons responsible for, the
management of affairs during their absence are bound to
post the receipt within twelve hours from the moment
the order has reached them. In fact, everything is just
like the calling in of reserve forces of the army.

The nurses thus called are incorporated into relief de-
tachments and personnel of the hospital ships. These
are the two hospital ships owned and equipped by the
society, to be distinguished from the many ordinary
merchantmen temporarily used as hospital ships by the
army. The relief detachments, so-called, are the units
of the relief organisation of the society, usually composed
of two medical officers, one pharmaceutist, one clerk, two
head nurses, and twenty nurses. In some detachments,
attendants (men) are used instead of nurses. These
units the military and naval authorities are at liberty to
subdivide into smaller units, or combine to make greater
ones, and employ them in hospitals and hospital ships.
Usually the units formed of men attendants are sent to
the front; while those composed of nurses are employed
on board the hospital ships and in the hospitals at the
base. Neither the army nor the navy has nurses, and

270 A History of Nursing

for this indispensable element of good medical and surgi-
cal treatment, both depend entirely upon our society.
And the way in which our relief personnel is employed
as part of the medical organisation of the army or the
navy is special: they are never permitted to work inde-
pendently, but are placed under the direction and control
of medical officers of the army and the navy, and in many
cases our personnel work with the government personnel
in one and the same ward. In each hospital ship there
are only one directing medical officer and one or two non-
commissioned officers representing the army, and all the
rest of the medical staff is composed entirely of our relief
personnel.

Of the 152 relief corps the Japanese Red Cross Society
organised and used in the Russian war, 102 were relief
detachments formed of nurses, 14 those composed partly
of nurses and partly of men attendants, besides the
personnel for the two hospital ships of the society,
composed likewise of nurses and attendants. The de-
tachments were used by the army and the navy in the
following way: 77 detachments in twelve base hospitals
and one fortress hospital of the army, 4 detachments in
two hospitals of the navy, 35 detachments in twenty
hospital ships of the army. The number of nurses
employed was: 1 directress of nurses, 255 head nurses,
2526 nurses — total, 2782.

As the nurses belonging to the society were insufficient
after the battle of Liao-yang, 829 out of the above number
were recruited as a temporary measure from among the
nurses trained at the Tokio Charity Hospital, the Medical
College of Okayama, the Kumamoto branch of the
Japanese Sanitary Association, etc. ' We have also to
count the 99 relief nurses attached to the 20 rest-stations
at landing-places and railway-stations.

The total number of the sick and wounded soldiers
cared for by the eighty-one detachments serving in the

Japan 271

base hospitals of the army and the hospitals of the navy
was: 217,488 Japanese; 6743 Russian — total, 224,231.

Our detachments in the base hospitals were usually
entrusted with the treatment of the gravest cases and
infectious or contagious diseases, and where separate
wards were established for the sick and wounded Russian
soldiers, the Red Cross medical officers and nurses were
placed in charge of such wards, as a rule. A special
hospital having been established at Matsuyama for the
wounded Russian sailors, victims of the battle of Nin-
Sen (Chemulpo), the Minister of the Navy entrusted its
entire management to our medical officers and nurses,
who worked independently.

The work of the nurses in the two hospital ships of
the society and the twenty hospital ships of the army
during many consecutive months was the hardest for
women, for that part of the sea is rough for the greater
part of the year.

In this war, 39 nurses out of the total above given
died, 409 had to be released from work on account of
illness and other causes, and 2725 were rewarded by
the state either with Orders or with money, or both.

Conclusion.

The above resume will have shown the actual state of
nurses and nursing in Japan as far as the Red Cross
Society is concerned.

In conclusion, let me say a few words with regard to
the special trait of our relief nurses, on whom the society
relies most for its work in time of war. If there be any
point in which they differ from the nurses in other coun-
tries, that difference must come from the fact that they
are trained with the sole object of assisting the medical
service of the army and the navy. It is true that they
are employed for relief work in the case of public calami-

272 A History of Nursing

ties as well, but only so far as there is surplus force, and
then only as a means of exercising the relief work in time
of war. At that time they are incorporated with the
medical organisation of the army and the navy, as al-
ready said. To our knowledge, there is no country
except Japan where only relief nurses — that is, thoroughly
trained nurses bound by oath to serve the society — are
relied upon by the Red Cross Society in preparing for work
in time of war. l Voluntary nurses are used only as an
auxiliary force, because it has been found difficult to
keep up the rigid rules with volunteers, rules which serv-
ice in the army and navy requires. Nobody is obliged
to become a relief nurse of the Japanese Red Cross
Society, but if once admitted and trained as such, the
relief nurses are bound by oath to conform themselves to
all the conditions of service, however strict, which the
society imposes upon them, and that with military
exactness. From this arises the distinguishing charac-
teristic of our nurses, which may be summed up in the
one word — discipline.

They pay attention to the minutest rules of correct-
ness connected with their uniforms, postures, ways of
saluting their superiors and of conversing with their
equals; they are scrupulously clean and tidy, but never
coquettish. They are always taught "to respect the
patients, but not to become familiar with them," so that
they never converse in a low voice with patients or cor-
respond with them in writing. They do not accept
presents in any form from the patients or their relatives,
unless it be through the medium of the society. It is
this fact of their being absolutely well disciplined and
correct that made Japanese military and naval authorities
decide to use the Red Cross nurses in the hospitals of the

1 This will hereafter be true of the United States also. All other
Red Cross societies accept untrained volunteers. — Ed.

Japan 273

army and the navy, and the society is making every
effort to make this precious quality as pronounced as
possible. But, it may be asked, how is this quality
maintained? It is clear that it can only be kept by
constantly holding up a high ideal, strong enough to
counteract all baser inducements, and this ideal is love
of country, which with us is the ideal that burns most
bright in the heart of every man and woman

It is a patriotic thing to nurse the sick and wounded
soldiers, and women can nurse much better than men.
Here, then, is the natural way in which women can be
patriotic and do something for their country. Such is
the thought which makes our nurses endure the hardships
of a long training and respond with willing heart to the
first call in time of war. "The Moral Counsel to the
Red Cross Nurses" contains only twenty paragraphs,
of which the following two will clearly show the intent
of the whole:

"III. — Do not avoid danger or dislike dirt and filth
if it be for the sake of your patients : and even if they be
haughty and rude, never enter into direct dispute with
them, remembering that to nurse the sick and the
wounded is a duty towards the state which patriotism
imposes upon you."

"XX. — The soldiers in time of war separate themselves
from their parents, wives, and children, and undergo
hardships and privations in order to sacrifice themselves
loyally and faithfully to the cause of the Emperor.
They are the iron fortresses of the realm. The role of
Red Cross nurses being to nurse and alleviate the suffer-
ings of these soldiers when sick or wounded, they serve
the state indirectly by giving relief to the patients
directly; and should they perform this work well with
benevolence (towards the patients) and loyalty (to the
state), we may say that they are as meritorious as the
soldiers themselves running about in the battlefields

VOL. IV. — 18

274 A History of Nursing

under the shower of shells and bullets. It is a matter
of great honour for a woman to be able to take part in
service in time of war, and only those that follow in
ordinary times the counsel as set forth in the above
paragraphs shall be able to keep this honour intact.
Hence it is that, over and above the technical studies,
a behaviour in good conformity with the moral ideal is
necessary."1

While this paper relates only to Red Cross nurses,
who set the pattern for the country, there are many
large city, county, and private hospitals in Japan that
train excellent nurses for work in civil life. Their
courses are from two to three years.

The first bold innovation in army nursing was
carried through b}^ Surgeon- General Tadanori Ishi-
guro, who was in charge of field sanitation during
the war with China. He decided to call nurses to
the Reserve hospitals, and says of this campaign :

For the first time in Japanese history, by utilising the
services of the Red Cross medical staff, female nurses
were employed in the Reserve hospitals, these nurses
having been trained for years at the Red Cross Hospital
in Tokio, under the supervision of Dr. Hashimoto. This
employment of female nurses met with loud opposition
from some quarters because of antiquated notions re-
garding the relative status of men and women in Japan,
but I stoutly maintained my original position and em-
ployed the Red Cross Hospital nurses in the military
hospitals of Hiroshima and elsewhere. The results
amply justified my course of action, for all these nurses
proved an unqualified success.2

1 Reports, Int. Cong, of Nurses, London 1909.

2 Fifty Years of New Japan, vol. ii., p. 317.

Japan 275

In May, 19 10, the Red Cross Bulletin of Japan
said of Miss Hagiwara and the London Congress :

The Red Cross Society of Japan was requested by the
International Council of Nurses to represent itself at
the Second Quinquennial Meeting of the International
Council of Nurses, convening in London from July 19
to July 23, 1909, to discuss the methods of nursing and
its development. In response to this, the society des-
patched as delegate Miss Take Hagiwara, chief nurse of
the Red Cross Nurses' Union, and made her report on
"Nursing under the Red Cross Society of Japan." She
served as nurse in the three late military campaigns
abroad, that is, the Chino-Japanese war, the Boxer re-
bellion, and the Russo-Japanese war, and is at present
engaged in the Central Hospital as assistant inspector
of nurses and student-nurses ; so her experience in nursing
may be said to be very rich. She returned from her
commission successfully fulfilled on September 29th. The
International Council of Nurses asked the society to
elect her as vice-president of the Council, to which we
cheerfully consented.

All the world knows how brilliantly Japan distin-
guished herself in nursing, preventive medicine, and
sanitation, as well as by bravery on the field, in the war
with her terrible neighbour, Russia. Dr. Louis Seaman
declared that Japan's greatest triumphs had been in
the humanities of war, * and instanced the fact that
she had reduced the usual mortality from preventable
causes over eighty per cent. The wonderful capacit}'
of the Japanese nurses made it unnecessary for the
nation to apply for nursing help elsewhere, and the

*Red Cross Bulletin, No. 2, 1908, p. 73.

276 A History of Nursing

nursing relief party that was called together and
offered to the government by Dr. Anita Newcomb
McGee may easily have been rather more of an em-
barrassment than help to the heavily burdened
nation. The report of the Japanese Red Cross So-
ciety on the Russo-Japanese war, presented to the
Eighth International Congress of Red Cross Socie-
ties gives a most tactful account of this expedition,
saying :

Mrs. Anita Newcomb McGee, M.D., of Washington,
having made an offer to our government to come to Japan
with 600 female nurses and assist in the relief of the sick
and wounded soldiers, our government consulted the
Red Cross Society about the matter, and decided to
accept her offer provided she would agree to come with
only a few nurses.

Although in the progress of this party there was
something that seemed more congruous with tri-
umphal processions than with the unassuming work
of nursing, yet there were excellent nurses and ad-
mirable women in its rank and file, and, animated by
a sincere desire to be helpful, they did some good work,
and friendships were formed that have had a distinct
part in bringing the nurses of the two countries closer
together.

Perhaps the Japanese nurse who knows America
best is Miss Choko Suwo. After the war, she came
here with friends and took several post-graduate
courses, one at the Woman's Hospital in New York
under Miss Gladwin (who had been with the expedi-
tion to Japan, and who was conspicuously successful
in making the course valuable, thus attracting ex-

ij fl o

"So oJ S

^ .S c

r^3 ^ .2

H c -5

China 277

ceptional women from all over the world), and after-
wards at the Nurses' Settlement on Henry Street.

Miss Suwo intended to organise visiting nursing
and perhaps settlement work on her return to Japan,
though realising well the difficulties in introducing
such innovations. After her first year's effort she
wrote :

It is very hard to help very, very poor people in such
a way. They cannot understand the meaning of it, so
they do not trust themselves to me. We must teach
the mothers first. They are understanding more day
by day, so I can do better in the near future. I under-
stood that everything is very hard in the beginning. I
need a great deal of patience in the work. I hope this
year will bring success to this good work.

Miss Nightingale is greatly revered in Japan.
Nurses are taught her life, and Red Cross Sisters
held a solemn memorial service when she died.

China. In China, as in India, the missions cut the
first path in hospital work, and the first trained nurses
in China were brought there under the auspices of mis-
sionaries. The earliest reminiscences we have found
are those of Sister Ethel Halley, an Australian nurse
who, writing in Una in October, 1910, described her
experiences when, in 1890 or '91, she went, full of
hope and energy, to her life-work in the Shantung
Road Hospital in Shanghai. Nursing, she said, was
unknown, and she spent fifteen years at work in
China before she had any nurses. The training of
young Chinese women is, therefore, of recent date.
Sister Ethel Halley's recollections, besides including

278 A History of Nursing

many humourous aspects of hospital life, ran to the
social conditions of her patients as well — to the cruel
exploitation of little five-year-old children as factory
hands at night work, and to the bitter lives of the
little slave girls who, painted and dressed, had to
earn their living as prostitutes.

St. Luke's Hospital, at Shanghai, which celebrated
its fortieth year of service in 1906, was one of the
first to train pupils. The London Mission, Peking,
had a class studying nursing and dispensing under a
woman physician, Dr. Saville, about 1895, and, in
1905, this work grew into a training school for nurses
by the co-operation of the Presbyterian and Methodist
missions with Dr. Saville for this special purpose.
The school is now growing and prospering. The
training covers three years.

One of the most attractive and interesting of mis-
sion hospitals is the Margaret Williamson, in Shang-
hai, under the management of the Women's Union
Missionary Society. It was opened in 1886.

The Elizabeth Bunn Memorial Hospital at Wu-
chang owed much of its enlarged service to the en-
terprising spirit of Dr. Glanton (a woman), and a
nurse, Miss Susan B. Higgins, a graduate of Blockley,
Philadelphia, who quietly made up their minds to
move into a distant part of the city and work up a
dispensary service. They had a house selected and
everything arranged before making their intentions
known. Others were fearful for their safety; even
the bishop was afraid for them, but they went, and
the success of their venture was immediate and per-
manent. They built up a large dispensary practice,
brought in many bed patients to the hospital, and

China 279

now a training school has grown up. Looking for-
ward to this, Miss Emma H. Higgins wrote in 1907,
with hopeful anticipation:

Two years have been spent in studying Chinese, pre-
paring to teach the pupil nurses in their own language.
Our school will not be open before Christmas. . . .
The Wesleyan Mission has a very good training school
and their experience has been most encouraging. Their
nurses are much liked by the doctors and foreigners for
whom they nurse; they are gentle, capable, and exact,
making very good private nurses. All they need is
some one to train them thoroughly. The Chinese young
women are just beginning to appreciate the opening
which gives them independence ... it is an intensely
interesting field and a work that will go on long after
we are dead, along with the schools of Western medicine
which are opening, ... we want those who can teach
others to nurse, so that the Chinese nurses will be
started right, ready for the time when they decide to
depend on themselves instead of on the foreigner. x

In 1908, a Chinese nurse, trained at the Wesleyan
Hospital, came as assistant superintendent to the
Elizabeth Bunn Memorial. She was very efficient,
and capable of teaching the practical work. In
1909, another graduate, Miss Chiang, was made head
nurse. Miss Higgins considers that her pupils make
good nurses; they are, she says, gentle, quick, quiet,
and observant, and not afraid of work.

In Canton, in the David Gregg Hospital for
Women there were in 1909 eleven Chinese girls in
training, while four had graduated. They were all

1 Letter from China, A. J. N.t December, 1907.

280 A History of Nursing

capable and satisfactory. In this hospital, and per-
haps in others, a text-book used included the trans-
lation into Chinese of parts of Isabel Hampton's
Nursing: Its Principles and Practice. '

The Central China Medical Missions Associa-
tion has pupils under regular training in several
places. Their grade of education is above the mere
ability to read and write, and they are beginning to
understand why the so-called " menial" duties are
important, and to feel the nurse's pride in her work.

In 1908, we find Dr. J. C. McCracken, of the
University of Pennsylvania, in Canton organising
a hospital. Desiring a nurse to grow up with the
hospital and develop there a school to train native
women, Dr. A. H. Woods described the type of nurse
needed in words that show how far above the average
must be leaders in foreign countries, if they would
succeed :

Just a commonplace nurse would not make a success
out here at the present juncture. So far as I know, no
one has yet undertaken in China just the kind of work
that we desire the nurse to do . . . The woman to do
this work should be mature, with proper poise, so un-
questionably a lady that low men-patients would be
unable to say vulgar things in her presence. She must
be not only a good nurse, but able to train others, to
organise the work for us and keept it going. ... If,
to other qualifications, she could add the virtue of
widowhood or celibacy, it would leave us with a freer
outlook. . . . We doctors will keep in close relationship
with the head of the nursing department. We will all

1 Chinese Manual of Nursing, compiled by the Central China
Branch of China Medical Missions Association, Shanghai, 1905.

Chinese Pupil Nurses

By Courtesy of the American Journal of Nursing

China 281

be together and so should be socially congenial. There
will be no such thing as friction, if all recognise that as
specialists each has his own responsibility. The nurse
has the nurse's special work, which is as dignified as that
of an architect employed to erect a building. We
would not look for servile obedience, but we must, of
course, have the ordinary co-operation such as would
exist in a good hospital. ■

The indescribable need of the Chinese poor, es-
pecially the women and children, and their winning
personalities, inspire the mission nurses with the
fullest devotion of which their characters are capable.
"I thank God I was called to China," said Miss C.
F. Tippet, of the Wilson Memorial Hospital at Ping-
yang Fu, when, in London, she addressed an audi-
ence to tell of her work, and of "the women with
their poor, bound feet, often literally rotten; the
blind, made to see, and the lame to walk: If I had
twenty lives they should all be spent there." And
one martyr the nursing community has given to
China. Among the five American missionaries mas-
sacred at Lien Chow, one was Dr. Eleanor Chesnut,
who, before taking her medical course, had graduated
in the class of 1891 from the Illinois training school
for nurses in Chicago. At the time of her death, Dr.
Chesnut had a hospital for women and children at
Lien Chow, and a dispensary ten miles distant.
She had a class of Chinese women whom she was in-
structing in nursing, another to whom she was
teaching medicine, and blind pupils to whom she
taught massage. She had become an expert scholar

1 A. J. N.t May, 1908, p. 607.

282 A History of Nursing

in Chinese, and was making the translation of Isabel
Hampton's Nursing, which her death interrupted.
Her medical work was tremendous, and with it all
she had collected a " family" of helpless dependents
whom she supported. She loved the Chinese, and
often said she would gladly give her life for China.
In return she was dearly loved by her pupils and
patients. z

The foreign nurses in China have organised under
the name, "The Nurses' Association of China,"
and their proceedings are reported in the Nurses'
Department of the China Medical Journal. Their
constitution declares one of its purposes to be "to
raise the standard of hospital training in China by the
adoption of a uniform course of study and examina-
tion for the Chinese"; and to this end a registration
committee examines into the intellectual training,
moral standard, and hospital discipline of all hospital
institutions under missionary, government, or private
control, which may desire to register under the com-
mittee. Three members of this committee of seven
are Chinese nurses, and the general membership
includes all qualified Chinese nurses who hold certifi-
cates from schools registered as being of approved
standards. Local branches are to be formed as
steadily as possible, and the association recommends
to all hospitals that they adopt a course of study and
examination approved by the Medical Missionary
Association of China and Corea.

Representations were made in 1908 to the Central
China Medical Association Board, emphasising the

1 Bulletin, Illinois Training School Alumnce Association,NovembeT,
1905. Article, "Eleanor Chesnut, M.D.," by Katharine De Witt

China 283

need of a unified, thorough training to elevate the
standard of nursing in China, and this board agreed
to conduct periodical examinations and give certi-
ficates. In 1 910, the first ceremonious presentation
of certificates thus gained was made to nurses from
different parts of the Yangtse Valley. J

The rules require a three years' training with theo-
retical and practical instruction, and now, since
central examinations are in force, membership in the
nurses' association means that Chinese nurses have
taken this examination. Of this successful piece
of constructive work the leaders wrote:

The venture has been a great success, and already
there is the spirit of advance manifested. The nurses
are showing more zest in their studies, and the feeling
of competition impels them to put forth their energies in
a way they have never done before. This impetus is
needed more than ever, and it is still difficult to get in-
telligent educated nurses. This is more particularly so
amongst the girls, as the feeling that nursing is no more
than an amah's or p'op'o's work, has not yet died away.

These examinations and public presentation of certi-
ficates are also helpful in stimulating the idea of unity
between the hospitals, making nurses realise that they
are not doing isolated work, but are growing into a great
brotherhood and sisterhood in all parts of the Empire
for the relief of suffering and the extension of the King-
dom of God.2

The leaders in Chinese nursing organisation are
Mrs. Caroline Maddock Hart, first president of the

1 Nurses' Department, China Medical Journal, January, 191 1.

2 Ibid.

284 A History of Nursing

Nurses' Association; Miss Mary C. Ogden, of Anking,
her successor in office; Miss Nora Booth, of Hankow;
Miss Maud T. Henderson, from the Boston City
Hospital, at work in Shanghai in the Refuge for
Chinese Slave Children, whose terrible stories had
originally led her from America to China ; Sister Ethel
Halley, Miss Margaret Murdock, of Hwaiyuan, and
many others whose share in upbuilding cannot yet
be fitly heralded. On the registration committee of
191 1 stands Mrs. Ts'en, the first Chinese nurse to
hold such office.

Surpassing all other efforts in interest are those
projects for medical and nursing schools in con-
nection with hospital work which have been planned
out and set on foot as national undertakings by
the Chinese government itself. In this work, Dr.
Yamei Kin, a woman, whose medical education
was obtained in the United States, stands prom-
inently forward, but, because of the immense revolu-
tionary movement so recently at an acute stage, the
triumphant success of constitutional principles, the
(partial at least,) enfranchisement of Chinese women,
and the resultant intense activity and absorption in
home affairs, the full story of this large plan, which
had been promised by Dr. Kin, must be postponed
for some later historian. In the Tientsin Hospital,
where Dr. Kin directs the Woman's Medical De-
partment of the Chinese Government in North China,
there is already a flourishing training school of forty-
odd pupils, whose nursing superintendent is Miss
Chung, trained at Guy's, in London. * Early in 191 1,
Dr. Kin brought to the Unites States a young Chinese

1 See Chinese Students' Monthly for March, 191 1, p. 479.

Corea 285

woman, who, after a college course, is to be trained at
the Johns Hopkins school for nurses and return to
China to continue the development of the service
entrusted to Dr. Kin. We therefore leave China
on the threshold of momentous changes.

Corea. — Corea, too, has nursing progress to show.
The names of nursing pioneers who blazed a path
there include that of Anna P. Jacobson, whose life
ended after a year and a half of service. She was a
Norwegian, trained in the United States in the Port-
land Hospital, Maine, and her character and labours
made a deep impression on all who knew her. She
went to Corea in 1895. In 1897, Esther L. Shields,
of the Philadelphia training school, was in Corea,
learning the language and making the beginnings of
teaching natives. Her work later flowered fully when
the Severance Hospital opened its well-organised
training school for Corean women, with a good three
years' course, in 1906, Miss Margaret J. Edmunds,
from the Ann Arbor University Hospital (U. S. A.),
in charge, full of enthusiasm and faith in the future
of her work. "The Corean women have proven
their ability to become throughly good nurses," she
wrote. Miss Kimber's A natomy and Physiology, Miss
Maxwell's and Miss Pope's Text-book on Nursing,
and parts of Mrs. Robb's books have been translated
into Corean. A Severance Hospital nurses' association
has been formed, and a nursing journal for Corean
nurses is talked of as the next professional need.
The work at Severance is under the American Pres-
byterian Board of Missions.

It would take a volume to record adequately tht

286 A History of Nursing

growth of nursing in far places: In Aintab, Tur-
key-in-Asia, the Memorial Hospital named for Dr.
Smith opened a regular training class for native
women in 1909-10, with Miss Alice Bewer, Phila-
delphia Hospital, in charge, and Miss Charlotte F.
Grant, of the Boston City, in the operating room.
Four pupils were enrolled, and a course of study
arranged from Miss Bewer's note-books and transla-
tions from Hampton's Nursing and Nursing Ethics.
The head nurse wrote: "On the whole, the work of
the nurses has been most satisfactory and encourag-
ing. Our hope for the future is to have properly
educated girls come to take the course, but we must
first have a proper place to house them, and equip-
ment to make coming here attractive."1

In 1908, the missionary nurses working in Turkey
were voted in as full members of the first conference
of the Medical Missions Association of that country,
and Miss North, stationed in Cesarea, reported excel-
lent work in the training of native women. An asso-
ciation of nurses in Turkey was then first suggested.

In Syria, a wide influence has been exerted by
Miss Edla Wortabet, an English nurse, who wrote
a nursing text-book in Syrian. The training school
of the Protestant College, at Beirut, graduated its
pioneer class of three in 1908, with thirteen pupils
entered and a waiting list of as many more. The head
nurse, Miss Jane E. Van Zandt, of the New York
Post-Graduate, wrote that the educational standard
for nurses was very good and the outlook most
hopeful. 2

1 Bulletin, Central Turkey College, December, 1910.
* A. J. N., January, 1909, p. 274.

Corea 287

In Greece, English nurses have shown a model
of hospital work, and Greek maidens have crossed
the seas for training to carry back for the service of
their country. The first so to come to America was
Kleonike Klonare, in 1900, to the Massachusetts
General, and in 1904 came three Greek girls under
the protection of one of the royal family. Two fol-
lowed Miss Klonare to her alma mater and the
third went to the Baptist Hospital in Boston.

In Persia, amidst all sorts of difficulties, Miss H.
D. McKim, of the Toronto General, worked loyally
from 1903, and so in every corner of the earth the
nurse's cap and pin may be found.

CHAPTER VI

SOME ISLAND HOSPITALS AND NURSES

Collaborators: M. Eugenie Hibbard, Cuba; Mabel
McCalmont, The Philippines.

Cuba. — At the conclusion of the war with Spain in
1908, the Sisters of the religious nursing orders in
Cuba were withdrawn by their Motherhouses, and
the officers of the United States army faced the
difficulty of equipping the hospitals with an efficient
nursing staff.

One of the greatest problems presented to the govern-
ment of the United States at the beginning of the occupa-
tion of the Island of Cuba by the American forces was
how to deal with the appalling condition of her hospitals.
A visit to some of these places would remind one of the
Dark Ages. They were dens of immorality and unclean-
liness in every form. Their unsanitary condition was
responsible for much of the sickness in the cities and sur-
rounding country. No precautions were taken to prevent
the spread of disease. In many instances, where expens-
ive apparatus for the disinfection of clothing had been
provided, it had never been used. Dirty water from the
baths and laundries was often disposed of by being turned
into the street. In some places, clothes were washed in
the rivers without previous disinfection, to breed disease

288

Cuba 289

wherever the river water was used. Those employed in
the care of the sick were of the lowest type of humanity.
The very name enfermero, attendant on the sick, was a
term of degradation. «

So wrote one of the well-known and active members
of the nursing profession in the United States, who
had gone to Cuba in the army service.

The nursing service of the Sisters in the hospitals had
been of a religious rather than a professional nature.
Though under the supervision of the medical director,
they were directly influenced by the Church, and owing
to their vows were unable to perform effectively the
duties of nursing. In domestic management their work
was perfectly done. Evidence sufficient to convince the
most sceptical could be found in the arrangement of
linen-rooms, closets, storerooms, pharmacies, and kitch-
ens, in the care of the linen used in the chapels, and the
various aprons, gowns, etc., used by physicians and
others. The pillow and sheet shams which decorated
the patients' beds on saints' days were beautifully em-
broidered and lace trimmed. No doubt great pride was
taken in this department, but in actual nursing the
Sisters' duties consisted principally in distributing wine
and soup to the very sick ones, and praying beside the
dying. 2

By the voluntary withdrawal of the Sisters and their
return to Spain [said Mrs. Quintard], the field was left
clear for the introduction of American methods, and the

^'Nursing in Cuba," by Lucy Quintard, in Transactions, Third
International Congress of Nurses, Buffalo, 1901.

2 " Cuba, a Sketch," by M. Eugenie Hibbard, American Journal of
Nursing, August, 1904, p. 841.

VOL. IV. — IO

290 A History of Nursing

men to whom this work was entrusted, recognising the
herculean nature of the task before them in reorganising
the hospitals, and realising their helplessness to accom-
plish it single-handed, turned to the nursing profession
for assistance, and met with a hearty response. Good
women answered the call and went to work with a will,
working early and late to co-operate in every way with
the heads of the departments.1

Mrs. Quintard herself was one of the first to turn
from the military nursing to reconstructive work.
In the hospitals' crisis, Major L. J. Greble, head of
the Department of Charities and Sanitation, secured
her services and those of Miss Sarah S. Henry, and
appointed them as special inspectors of hospitals to
assist in the establishment of training schools for
nurses in Cuba. They had both, at different times,
previously held the important position of superin-
tendent of the Connecticut training school, and Mrs.
Quintard was one of its graduates. Before the war,
she had been in charge of the training school of St.
Luke's Hospital, New York. As special inspectors,
these two women laid the foundations of Cuban
training-school organisation, and during 1899 and
1900 many appointments for the new work were
made among the army nurses or those coming direct
from the United States for the purpose.

It was in a sense [said Miss Hibbard], much easier to
rebuild on a comparatively vacant site, than it would
have been to uproot and reorganise at the same time.
So, regardless of the conditions that may have previously

1,1 Nursing in Cuba."

Cuba 291

existed, the Americans could work unhampered by dicta-
tion or tradition, though the customs of the people en-
tered largely into their calculations. Through ignoring
these, it would have been an easy matter to antagonise
and destroy the prospect for good work.

The majority of the hospitals were well located,
well built, and with a certain beauty of their own.
The Mercedes, in Havana, heads the list. In ap-
pearance it is a modern building, and comparatively
new. It is constructed on the plan of an English
hospital, but modified to suit the conditions of the
country. The wards are built on the pavilion style,
securing light and air on three sides. The interlying
spaces are beautiful, cultivated gardens, containing
the shrubs and flowers peculiar to the country. All
of its departments are well equipped and, at the
time of the military occupation in 1898-99, it was
the only institution which could receive or care for
American patients. Its medical director was Dr.
Nunez, a patriot, who had been deported by the
Spanish government to the west coast of Africa, and
had returned to Cuba after several years' absence.
He readily co-operated with General Ludlow, General
Brooke, and Major Furbush, all of whom were es-
pecially interested and instrumental in establishing
a high order of things, and in. August, 1899, the first
training school was opened in this hospital, with
seven pupils, under the direction of Miss Mary A.
O'Donnell, a graduate of Bellevue, who had been
working in the army service and whose contract with
the United States was honourably annulled in order
that she might assume her new position. Miss

292 A History of Nursing

O'Donnell thus holds the proud position of premier
among American training-school heads in Cuba. *

An earlier attempt had been made which must
not be overlooked. In January, 1899, Dr. Raimundo
Menocal had opened a school for nurses in the Havana
Sanitarium. It had twenty-two pupils, who were
placed in the charge and under the instruction of Dr.
Vidal Sotolongo. This school, however, only existed
for five months, the sanitarium being closed in May.
Dr. Menocal remained interested and was actively
helpful in the work of establishing the permanent
schools.

The public charities of Cuba were thoroughly
reorganised in the early part of 1900, and Major E.
St. John Greble became the first superintendent of
the Department of Charities. It was placed under
the general supervision of the Department of State
and Government, and schools for nurses were opened
in connection with the public hospitals in the follow-
ing order: In 1900, in March, Hospital Civil, Cien-
fuegos, with Miss Jeanette Byers, of the Woman's
Hospital in Philadelphia, as superintendent; in
September, Hospital No. One, Havana, with Miss
Gertrude W. Moore, of Bellevue, who, three months
later, was transferred to a fresh field, being replaced
by Miss Holmes ; in October, Hospital Santa Isabel,
Matanzas, with Miss Hibbard; in November, Hos-
pital General, Puerto Principe, with Miss Mitchell,
of St. Luke's, New York ; in the same month, Hospital
General, Remedios, with Miss Samson, from Belle-

1 During her stay in Cuba, Miss O'Donnell translated Mrs. Robb's
Text-book into Spanish, and wrote notes of her own in the same
language.

A Group of Cuban Nurses

Cuba 293

vue; and in January, 1901, Hospital Civil, Santiago
de Cuba, with Miss Moore, who had been transferred
there from Havana. Each of these women had with
her a staff of trained nurses, representing many of
the schools scattered over the United States.

Seldom, if ever, has so complete a transformation
taken place in hospitals in so short a time, and in such
wholesale fashion. On the retirement of Major
Greble from the position of superintendent of the
Department of Charities, Major J. R. Kean received
the appointment, and the subsequent success of the
schools was due largely to his personal interest and
keen appreciation of the actual requirements at this
critical period of the schools' existence. Like all
men who have been successful in furthering the es-
tablishment and maintenance of good nursing he
was willing not only to be advised by nurses, but to
accord them spheres of real responsibility, and to
treat them as equals and co-workers. The results
in Cuba have been so brilliant and so sound as well,
that Major Kean and the women with whom he
worked in harmony deserve a very special distinction
among their fellows. No country has had a more
carefully planned and wise design to develop and
conserve a high standard of nursing education under
the guardianship of the state, a standard which it
has steadily upheld. In July, 1901, soon after taking
office, Major Kean issued an order, reading as follows :

Office Superintendent, Department of Charities,
Havana, Cuba, July 16, 1901. By authority of the
Military Governor, a board will be convened to meet in
the office of the Superintendent of Charities, Havana,

294 A History of Nursing

Cuba, at twelve o'clock, July 22, 1901, or as soon there-
after as practicable, to draw up a system of regulations
for the training schools for nurses in Cuba. They will
also fix the course and duration of instruction, the re-
quirements for admission, the standard to be required
before graduation, and make recommendations with
regard to salaries and allowances. The board will also
recommend a suitable manual for use in the nurses'
schools, and in the hospitals under state control. The
board will be composed as follows:

Dr. Manuel Delfin, Vice-President of the Central Board
of Charities, Havana; Dr. Emiliano Nunez, Medico-
Director of Mercedes Hospital, Havana; Dr. Enrique
Diago, Medico-Director of Hospital No. One, Havana;
Mrs. L. W. Quintard, Inspector, Department of Chari-
ties; Miss M. Eugenie Hibbard, Superintendent, School
for Nurses, Matanzas. . . .

(Signed) J. R. Kean, Major and Surgeon, United
States Army, Superintendent Department of Charities.

The meetings, several in number, were well at-
tended, and by the end of August, 1901, a plan of
general regulations was submitted for the approba-
tion of the central board of charities. In October
it was somewhat enlarged, made more comprehensive,
modified in particulars, and again submitted. On
January 3, 1902, the plan was approved in entirety
by the military governor, General Wood.

The object of these schools shall be, first, to further
the best interests of the nursing profession by establishing
and maintaining a universal standard for instruction,
and providing students with the proper means of educa-
tion in the practical care of the sick ; second, to secure for
the student upon graduation a degree or title, which will

Cuba 295

be a protection in practising her profession, and be a
recognised means of securing employment; third, to
provide hospitals and institutions in the island with
skilled service in the nursing department, and a proper
number of graded assistants, thus conferring a benefit
on the mass of suffering humanity. «

So ran the preamble, the work of Miss Hibbard,
which introduces one of the most creditable pieces
of work that has fallen to the lot of American nurses,
for the two women on this board practically framed
the working plan and details of the training-school
organisation for Cuba, their expert knowledge being
readily deferred to by the Cuban physicians. Major
Kean wrote later: "The Cuban law to regulate the
education and the practice of the profession of
nursing was drawn up under my supervision, but
is in the main Miss Hibbard' s handiwork. ... It is
considered a very advanced and satisfactory law."

Miss Hibbard wrote :

The aim and fixed intention of those interested in or-
ganising these schools was to put them at once on the
highest attainable plane, giving the result of similar
work in other countries as sufficient reason for establish-
ing a standard that would at once command the respect
of the people and the self-respect of the accepted student,
defining emphatically the position for the nurse in a
country until recently ignorant of her existence. To
start with a high standard is a more effectual way of
attaining success, than placidly to allow conditions to
evolve.2

1 Included in Governor's report, dated January 3, 1902, p. 989.
'"Establishment of Schools for Nurses in Cuba," American
Journal of Nursing, September, 1902, p. 989.

296 A History of Nursing

These schools are all in a healthy, flourishing condition,
[wrote Mrs. Quintard in 1901]; they have been estab-
lished on a good, firm foundation, and if the present
status can be maintained, and good American nurses
kept at the head until their own women have sufficient
experience, after their training, to occupy positions as
superintendents and head nurses, there is no reason
why Cuba should not, in a few years' time, be able to
boast of a fine nursing service in her hospitals, as well
as of a thoroughly trained corps of women to meet the
demands of private patients.

This forecast has been realised. Under the pro-
visions so wisely made, and as a result of the good
standing given to the nurse, the schools were quickly
filled with young Cuban women of refinement, whose
families would never before have dreamed of con-
sidering for a moment letting their daughters go into
the wards of public hospitals to perform duties
which, it had always been believed, no one but a
religious Sister could perform without loss of woman-
liness.

The regulations, which are well worth repeating
in full, shall be summarised briefly. The schools
were to be state institutions, attached to hospitals
for mutual benefit, but under the direct control of the
Department of Charities. They might be established
in all cities of Cuba where there were public hospitals
of over one hundred beds, after previous approval
by the department and inscription in the school of
medicine at Havana. Not less than twenty students
should be taken into a school. A committee, of
which one member must be a graduate nurse having
held superintendent's post, was appointed to deal

Cuba 297

with affairs of a general character affecting the
schools, while a superintendent of nurses with
trained assistants was to direct the pupils' training
under the medical director of the hospital.

The training course was to be three years, followed
by the bestowal of a diploma by the faculty, which
was to have the protection of the state. The practice
of nursing without this diploma was forbidden. An
eight-hour day was to be the rule, with twelve hours
for night duty. Private nursing was forbidden for
students, except for a three months' period during
the final year if desired. Any fees received for such
service were to be kept for a prize fund for nurses on
their graduation, thus removing all mercenary motive
for sending pupils out. The powers and duties of
the superintendent of nurses were those usual in the
best schools. Thus Cuba led the way in compulsory
registration for nurses.

Had it not been for the faithful manner in which the
Cuban Central Board of Charities and Hospitals has
adhered to the letter and spirit of Order No. 3, 1902
[wrote a close observer in Cuba], the nursing profession
in Cuba would have become demoralised long ago.
There are a number of hospitals throughout the island
maintained by fraternal societies of various kinds for
the benefit of their members, and these institutions
have tried to have their pupils take the university ex-
aminations, but have been refused on the ground that
their certificates of instruction and training are not
from schools recognised by the National University.
Sisters of religious orders have likewise been refused on
the same ground. The word enfermero, nurse, may not
be used except by a graduate of the recognised schools,

298 A History of Nursing

nor may institutions apply this title to other women.
The graduate nurse is entitled to the protection of the
courts. The non-graduates are not recognised.

There is a roll of honour of the men in power who
have consistently kept the standard of nursing to
its original level: they are Dr. Emiliano Nunez, di-
rector of the Mercedes Hospital; Dr. J. M. Pla, second
director of charities and hospitals ; Dr. Carlos Finlay
and Dr. Emilio Martinez, members of the Central
Board of Charities; and Dr. M. Delfin, first director
of charities and hospitals. With vigilant care and
professional pride, they have kept close watch to
prevent any signs of deterioration.

The American nurses gave admirable service in
the reformation of the Cuban hospitals. It was their
first piece of work on a large scale outside their own
country, and many made brilliant records. The
whole number who took part in the achievement
reached close to seventy-five. On the 31st of De-
cember, 1 90 1, the lists in the official reports showed
thirty-seven American nurses staffing the hospitals
as head nurses or superintendents of schools. Many
of them are now members of the order of Spanish-
American War Nurses, by virtue of selection, ap-
pointment, and duty performed as contract nurses
in the United States Army, previous to December,
1908. Among these were Rose Abel, Minnie Cooke,
Wilhelmina Giesman, Frances McCurdy, Mariette
Meech, Anna O'Donnell, Mary O'Donnell, Olive Pen-
dill, Genevieve Russell, Anna Turner, Rosa Tweed
(now dead), Hannah Waddell, Mary McCloud,
M. Eugenie Hibbard, and Annie O'Brien. The last

Cuba 299

named is still (1910) in charge of Las Animas con-
tagious hospital, a position that she has held for
nearly ten years.

Training schools all over the country were repre-
sented in this list, which we cannot attempt to repeat
in full: Blockley and Bellevue, St. Mary's of Brook-
lyn, Grace of Detroit, Charity of New Orleans, and
the Pennsylvania. Miss Pearson came from the
Massachusetts General ; Miss Meech from the Illinois
training school, and Miss Pendill from St. Luke's,
Chicago. St. Luke's of New York furnished two
superintendents, Miss Mitchell and Miss Robertson.

As the schools became securely established, and
the commencement exercises saw increasing numbers
of young Cuban women entering the nurse's career,
the Americans began to think of going home. The
American occupation was passing, and United States
officials were leaving the island. The nurses, it is
said, were among those who were most welcome to
stay to the last, even though, at first, their rigid
standards of order and cleanliness had been more or
less resented by the patients, who were sometimes
heard to mutter "Cuba Libre" when they were under
the hands of the women in blue and white.

Promotion time for the young Cuban nurses came
in 1909, when six of them were placed at the heads
of training schools. The first appointed was Senorita
Rosa Sieglie, to the Santa Isabel, Matanzas, a post
that she held for six years. Martina Guevara went
to the Mercedes, in Havana; Trinidad Cantero, to
Hospital No. One; Rosa Gallardo, to Cienfuegos;
Victoria Bru, to Camaguey; and Hortensia Perez
to Santiago de Cuba.

300 A History of Nursing

Preventive social work now received the attention
of the Cuban patriots and war heroes, and Miss
Hibbard was selected to organise a corps of visiting
sanitary nurses which should constitute a special
service under the Department of Health. The
members of this corps included three of the retiring
American superintendents, Miss M. A. O'Donnell,
who had a record of nine and a half years' continuous
service; Miss M. Jeanette Byers, who had served
six years as a superintendent and had been in Cuba
for eight or nine years in all; Miss Mary E. Pearson,
who had a similar record, and three Cuban nurses,
Senoritas Adelada Jimanez, Rosa Luisa Ortiz, and
Emma Deulofeu.

Miss Hibbard' s nursing career merits more than
passing mention. Half Canadian and half American,
she was trained in the historic school of St. Catha-
rine's, and had made a reputation in hospital and
training-school administration when the war with
Spain broke out. Her vacation was spent in the
typhoid camps, and an eventful war service followed.
This was concluded by her voyage to South Africa
as Superintending Sister in charge of the hospital
ship Maine. She was called to Cuba in 1900, and
after two years there, was appointed by the Isthmian
Canal Commission as chief nurse in the Ancon Hos-
pital, Panama. Of the two and a half years spent
there, she said: "There was, I realised, a stupendous
piece of work before us, and so it proved to be : most
difficult at the time ; now the most satisfactory piece
of organising work I have done." (Two Belle vue
nurses, Miss Markham and Miss McGowan, ac-
companied her to the isthmus.) Recalled to Cuba

I *

M. Eugenie Hibbard

A Leader in Cuban Nursing

Cuba 301

in 1908 as inspector-general of nurses, and, in 1909,
entrusted with the responsible duty of developing
instructive visiting nursing for the republic, she has
been identified in a very special way with the growth
of Cuban nursing.

In the new work, she and her staff came into close
relations with the secretary of the department, Dr.
Matias Y. Perdone Duque, man of science, revolu-
tionist, and altruist. He had served in the war under
General Gomez, and afterwards rose by a series of
promotions to be the first Secretary of Health and
Charities, a cabinet office, newly created, than which
there is no more important position in Cuba, as her
relations with the United States bind her to main-
tain a satisfactory sanitary condition throughout the
republic.

Among the many innovations of the new depart-
ment was an active anti-tuberculosis campaign, inau-
gurated by Dr. Duque, for the success of which the
hospitalisation of the tuberculous was regarded as
being of first importance in the suppression of the
disease. A corps of medical inspectors, with the nurs-
ing staff, was organised to investigate the living con-
ditions of tuberculous patients, and Dr. Duque was
hopeful of relieving the helplessness and misery of the
poor in their homes by improvements in housing con-
ditions, and the enforcement of preventive measures
making for the suppression of transmissible diseases.
A service of medical school inspection was also es-
tablished. The training schools for nurses received
special attention from Dr. Duque, that they might
continually advance and maintain the highest pos-
sible standards. To promote educational progress,

302 A History of Nursing

the creation of post-graduate courses on special
subjects was undertaken.

How striking the contrast between the old and the
new regime, and how remarkable the results gained
in one decade of teaching young and impressionable
women the possibilities of public duty and social
usefulness under freedom, was brilliantly demon-
strated when two Cuban nurses appeared at the
London Congress in 1909, to report on their country.
This happy event was brought about by the kind of-
fices of Miss Hibbard, and the liberal attitude of Dr.
Duque toward the nurses and their work. It was
his desire to have the Cuban delegates sent officially
by the government, but, the non-official nature of
the congress making this impossible, they were sent
as delegates from the Department of Health and
Charities. The nurses chosen were Miss Marguerite
Nunez and Miss Mercedes Monteagudo. With them
came Miss Hibbard. They brought the kindest
letters from Dr. Duque, whose interest in high
standards of education, and desire that the young
nurses should enter the international group, were
fully appreciated. Miss Nunez brought with her a
paper describing the schools for nurses, as here im-
perfectly outlined, and added the plan for extending
modern methods to the care of the insane, saying:

Our nurses receive experience in all branches of nursing.
In the insane asylum, in our National Manicocomium,
there exists a school for special nurses ; but the specialty
does not consist in more advanced studies, but in dedica-
tion to that branch of medicine, without acquiring, how-
ever, other knowledge than that necessary to take care

Cuba 303

of the poor lunatic. This is, of course, a defective or-
ganisation, and the nurses who graduate from this school
have not acquired a general knowledge of nursing. At
present the Secretary of Health and Charities is giving
the school a more scientific and practical organisation.
He now intends that only graduate nurses shall take this
special course, and shall receive a diploma qualifying
them to care for mental cases, provided, of course, that
they pass the examinations. Our Manicocomium is
situated some nine miles from Havana, on a large estate,
and the asylum has accommodation for 2.S00 patients,
which is an evil, because the unfortunate insane cannot
be sufficiently well attended, especially from the medical
point of view.

The school for nurses annexed to this asylum will now
open with ten undergraduate and eighteen post-graduate
students, and eighteen young ladies more, who will ac-
quire the knowledge sufficient for the mechanical care,
if I may be permitted the expression, of the insane.
After next August, it will be in charge of Miss Walker,
of the United States, who, until a year ago, was the
directress of the school in Hospital No. One in Havana
and from whom I expect the best results, in view of her
fitness, her energetic character, and her intense fondness
for work. The government of Cuba, on the advice of
the present Secretary of Health and Charities, has sought
in the city of London two young ladies with expert
knowledge of mental diseases, in order to appoint them
professors of our school. ... My colleagues, as well as
myself, entertain very great veneration for our teachers,
and I should especially mention Miss O'Donnell, who
was my teacher, and more, my good and kind friend
and counsellor, who with her advice gave me strength to
face the sad scenes of the hospitals at the beginning of
my professional studies. To this noble woman I am in-
debted for what little I am, and if I have not achieved,

304 A History of Nursing

the fault is not hers, but my own insufficiency. . . .
I do not claim that the schools for nurses in Cuba are
organised in a perfect manner. There are certain short-
comings which the Director of Charities, Dr. J. M. Pla,
intends to correct, in order that the schools may be com-
plete, and with respect to these reforms much depends
on my observations and studies here. . . .

As mentioned by Miss Nunez, two English nurses,
specially trained in the care of the insane, were in-
vited to Cuba, but with the regretted resignation of
Dr. Duque (for political reasons), in October, 1909,
the arrangement of work at Mazorra had gone back-
ward. His successor returned to the old methods,
and the English nurses, whose work had been ex-
cellent, went home.

The state hospitals of Cuba now employ ninety
odd nurses in permanent positions. They are dis-
tributed among the institutions receiving state ap-
propriations, of which there are twenty-three aside
from the training schools, the latter being classed by
themselves. The republic yearly sets aside an appro-
priation sufficient to educate one hundred and eighty
probationers, and, since 1902, one hundred and
ninety-six nurses have received the state diploma.
It seems probable that Cuba will not be overstocked
with nurses; nearly twenty per cent, marry, and
marry well. Signorita Marie Sieglie became the
wife of Dr. Finlay, son of Dr. Carlos K. Finlay,
who wras the first to suggest the possibility of the
transmission of yellow fever by mosquitoes, and
who received for this service the decoration of the
Legion of Honour from France.

Cuba 305

If we should now, in 19 10, follow up the first set
of Cuban graduates of training schools for nurses, we
should find Manuela Barreras, Rosa Gallardo, Martina
Guevara, Mercedes Monteagudo, and Rosa Sieglie
holding superintendents' positions; Trinidad Can-
tero studying medicine, Marguerite Nunez inspector-
general of training schools, Aurelia Perez occupying
a post in the hospital division of the women's depart-
ment in the prison of Havana, Caridad Tuduries
night superintendent in a large hospital, twenty-two
others in head-nurse positions, one in private duty,
and three at home. Two have died, and twenty-
three have married. The Cuban nurses have also
had their first emergency service in a national dis-
aster. A letter, describing this, said:

We had a very serious explosion of dynamite at Pinar
del Rio, about six hours' ride from Havana. The news
immediately telegraphed to the President, reached him
at six o'clock, an hour after the accident. Relief was
organised at once. The President sent the Secretary of
Government with assistants to keep order, the Secretary
of Public Works with a staff to remove the living and
dead from the wrecked buildings, and the Secretary of
Health with eighteen nurses and ten physicians to assist
in the care of the wounded. All left Havana on a special
train, leaving at 7.30. The nurses, under Senorita Mar-
garita Nunez and Senorita Martina, the superintendent
of Mercedes Hospital, are doing excellent work, and have
been on duty since the accident happened. This is the
first time the Cuban nurses have been depended upon to
help in time of national disaster, and I do feel so proud
of them. All I hear so far is praise of their work, and
appreciation of the spirit they have shown. The nurses

VOL. IV. — 20

306 A History of Nursing

went by government order, as they could be mobilised
much more quickly than under the Red Cross. x

The Governor of Pinar del Rio afterwards sent a
silver commemorative medal to each of the nurses.

The first Cuban pioneer to other countries has also
gone forth in the person of Senorita Maria Luisa
Aguirre, who has replied to a call from Panama to
become assistant superintendent in Santo Tomas
Hospital. Dazzling visions of future opportunities
opening before the nurses of Cuba in transforming
the hospital situation throughout the whole of the
South American continent rise before the eyes, as
one contemplates the annual group of alumnas sent
forth from the Cuban hospitals. By their birth and
language, their knowledge of the customs and habits
of tropical countries, their experience of what sanita-
tion has done in their own land, and their triumphant
success in demonstrating the ability of the daughters
of the south to take command, they are clearly the
ones in line for this oncoming immense piece of up-
building. There can be no doubt that, in a few years
more, advance guards of Cuban nursing battalions
will begin penetrating these as yet non-nursed coun-
tries, carrying into them a practical application of the
principles of prevention of needless disease and
misery. And may it not be possible that the Spanish
nursing field is also waiting for the Cuban nurses?

The National Association of Nurses of the Republic
of Cuba was established March 29, 1909, and within
one year numbered three hundred members. Its
first honorary member was Senora America Arias de

1 Letter from Miss Hibbard, May 23, 1910.

Isabel Mclsaac

Formerly Superintendent of the Illinois Training

School and then Interstate Secretary;

Head, Army Xurse Corps

Porto Rico 3°7

Gomez, wife of the President of the Republic.
Rightly directed, their association will be the most
powerful organ that the nurses can have for main-
taining their professional and ethical standards.

Porto Rico. — Porto Rico has also a record of good
work done. There are two excellent training schools
in the island, one in the Presbyterian Hospital which
is under mission auspices, and the larger insular school
connected with the Municipal Hospital. The latter
was founded and placed on a firm basis by Miss Amy
E. Pope, from the New York Presbyterian. She had
there, as assistant, a young Porto Rican, Senorita
Pilar Cabrera, who had been trained in Baltimore
at the Mercy, then the Baltimore City, Hospital.

When Miss Pope returned to the United States,
Miss Cabrera was made superintendent of the school,
and amidst her other work translated into Spanish
the text-book which had been written by Miss Max-
well and Miss Pope together, and which spoke the
latest word in scientific nursing. Miss Cabrera also
trained a class of ten Sisters of Charity besides her
group of lay pupils, who number about twelve in a
class. She feels deeply gratified with their earnest-
ness and capability, and is hopeful for the future of
nursing in her native land.

The Philippines. — Nursing in the Philippines has a
history on which we may look back with satisfaction,
for, while carried on almost entirely by Americans in
the early days of the occupation, its speedy adoption
into the life and education of the Filipinos themselves

308 A History of Nursing

and its wonderfully rapid development have probably
not been surpassed elsewhere.

There were about one hundred and twenty-five,
in all, of American nurses who, in the army service or
under the Red Cross, came to the islands during or
soon after the war with Spain. Interesting as their
story would be, their work was not especially signifi-
cant in relation to the development of the nursing
profession, for, as soon as their immediate duty was
fulfilled, most of them left the islands. Some few
Red Cross nurses joined the army service, but with
the adoption of civil government the army nurse corps
has been gradually reduced. The work of the army
and navy nurse will always be localised and devoted
practically to Americans; the real nursing of the
Philippine Islands — the work that will reach the
people — will be dependent upon, and represented by,
the nurses employed by the civil government, those
of private institutions, and lastly, but most important,
by the native trained nurses themselves.

The Bureau of Health, in charge of all civil govern-
ment hospitals in the Philippines, with their accom-
panying nursing force, directs and operates the Civil
(now the Philippine General), Bilibid, and San La-
zaro, all of Manila; the Baguio at the summer capital,
the Tuberculosis at the San Juan tuberculosis camp,
and the Culion Leper Hospital. It is also responsible
for the medical and sanitary inspection of the islands,
besides aiding many private hospitals and charitable
organisations.

The Civil Hospital of Manila was originally
founded for the purpose of furnishing free treatment
to all insular government employees, besides doing

The Philippines 309

private and emergency work. It has now been
merged into the beautiful and commodious Philippine
General, doing the work of any large city hospital,
and open to all nationalities. The San Lazaro takes
care of cholera, small-pox, and other communicable
diseases, with special departments, in charge of native
helpers, for leprosy, insanity, victims of drug habits,
etc. The Bilibid is connected with Bilibid prison,
and is a very complete new hospital with a capacity
of four hundred beds, the work carried on at present
by native attendants under direction of an American
nurse. Pupil-nurses will soon be placed there for
training. The Baguio is intended for sick and con-
valescent insular government employees, as well as
for the Igorots, a semi-civilised tribe, in the heart
of whose country Baguio is situated. The Igorots
are a bright, friendly, tractable people, and each day
the dispensary at Baguio treats and cares for a large
number of them. New hospitals have been planned
for Cebu, the second largest city in the Philippines;
at Bontoc, especially for the mountain tribes; at
Sibul Springs, and in several other sections. All
new hospitals erected in the Philippines, with a few
minor exceptions, are of reinforced concrete, — fire-
proof, earthquake- and storm-proof; with equipment
of the most modern character, and with nursing
performed almost entirely by the Philippine training
school for nurses under the supervision of American
nurses.

The Culion Leper Colony is the largest in the world.
There are at present about 2200 lepers there, and but
a few more segregated and awaiting entrance. The
completion of the segregation of the lepers of the

3io A History of Nursing

Philippines marks an epoch in the health history of
the islands. At the colony there is a large modern
hospital, recently completed, with a capacity of sixty
beds. Lepers are, of course, subject to every other
disease, and the hospital treats beriberi, small-pox,
dysentery, and other tropical diseases, in addition
to the extreme cases of leprosy. The work is carried
on by two American physicians and six French
Sisters of Mercy. There have been applications for
a number of American and English nurses desirous
of doing this work, but thus far it has not been con-
sidered advisable or desirable to take the work out
of the hands of the Sisters, who are very happy and
contented there. Their sweet cheerfulness means
not only a very great deal to the unfortunate lepers,
but is a lasting inspiration to every thoughtful person
visiting Culion. The work does not mean life-long
isolation, as many suppose. The non-leprous em-
ployees, priests, and Sisters, with proper disin-
fecting precautions, go and come from Manila as
often as they have the opportunity. It is a great
field for missionary work, the children of the colony
being dependent upon the busy Sisters for their
schooling, moral training, etc.

In addition to the foregoing work, three great
health campaigns have been started by the Director
of Health. One is for the reduction of infant mortal-
ity ; another, a great hook-worm campaign ; and the
third, against the omnipresent tuberculosis, a scourge
that has attained the same appalling stature in the
Philippines as in other countries. Towards the re-
duction of infant mortality, creditable work has been
begun, chiefly by Filipino doctors and philanthropists,

The Philippines 311

but it is a work wherein American nurses must
eventually figure, in the way of supervision at least,
and where graduate Filipino nurses will soon be of
inestimable value. With an infant mortality of
forty -four per cent, (of total number of deaths), there
is an immense field right here for visiting nurses*
settlements.

Investigation has shown the impaired health and
weakened condition of the Filipino people (who are
not a strong or enduring race) to be largely due
to the prevalence not only of tuberculosis, but of
the hook-worm disease, which seems to have no
equal in its capacity to enervate and undermine the
system. Nurses have thus far not entered this work,
but it is believed that the graduate male nurses will
soon play an important role in this and similar fields,
as their training has been planned particularly to fit
them for the general health work of the islands.
The third campaign was begun by the organisation
of a society for the prevention of tuberculosis, and
received its great impetus during the official visit of
the Secretary of War in 19 10. To be successful it
must be an educational one, and must be carried on
by the schools as well as by the Bureau of Health.
Education concerning the prevention of disease has
been made a particular feature of the new curriculum
of study planned for the Philippine training school
for nurses.

The rest of the nursing work done in Manila is
accomplished by the University Hospital, St. Paul's,
the Mary Johnson Memorial, San Juan de Dios,
and Sampaloc's. The University is an Episcopal
hospital of about thirty beds, with a force of

312 A History of Nursing

American nurses and a training school of Filipino
pupils. Two settlement workers are also main-
tained here — young, enthusiastic women who are
doing splendid work with an orphanage, the establish-
ment of a most successful women's exchange, neigh-
bourhood visiting, children's classes, etc. St. Paul's
is a large Catholic institution of about two hundred
beds, conducted by French Sisters of the order of
St. Paul de Chartres. Here, for a couple of years, a
training school of twenty pupil-nurses has been under
the direction of two American nurses. The nurses
in charge, however, have recently been dispensed
with, and the wisdom of this policy, so far as the
pupil-nurse is concerned, is yet to be demonstrated.
These French Sisters also conduct the Sampaloc
Hospital, an institution of sixty beds, supported by,
and maintained exclusively for, the prostitutes of
Manila. The Mary Johnson is a small mission
hospital of the Methodist Episcopal Church. A
successful training school is being conducted here, and
much excellent work done, particularly along the
lines of maternity work and infant hygiene. San
Juan de Dios is a Spanish institution conducted by
Catholic Sisters for the benefit of orphans, the feeble-
minded, the insane, and paupers.

The Philippine General was established in October,
1902, with Miss Julia Betts, a former Red Cross and
ex-army nurse in charge, and two attendants for
assistants. The capacity, then about forty beds,
rapidly increased to eighty, with eighteen nurses,
and ten or twelve male attendants. An old Spanish
house with several others on the same property had
been utilised. Lack of plumbing and other facilities

The Philippines 313

made the establishment and conduct of this hospital
an heroic task. The practical completion of the
Philippine General in August, 1910, was therefore a
welcome relief to the entire city. The new hospital
is doubtless one of the most beautiful in the world.
The entire scheme is designed to accommodate one
thousand patients. There is a nursing force of
twenty-five American supervisors, with about one
hundred and fifty Filipino nurses of both sexes.

The establishment of a training school for Filipino
nurses was agitated shortly after the American oc-
cupation, and a bill for that purpose was put before
but failed to pass the Commission as early as 1903.
The project was one of the many admirable recom-
mendations of Major Edward C. Carter, Surgeon
U. S. Army, and the Commissioner of Health of the
Philippine Islands during 1 903-1 905. The necessity
of such a school seemed very apparent to him, but
new projects move slowly, and it was not until 1907
that the training of nurses was introduced as a spe-
cialised branch of the Philippine Normal School,
under Miss Mary E. Coleman, for six years dean of
women there. To her and to Mrs. Jaime de Veyra,
one of the most progressive of Filipino women,
belongs largely the credit of successfully launching
this most important movement.

The idea of women nursing was an entirely foreign
one to the Filipino people. To them the work
seemed menial and wholly beneath a person of any
family or birth. Not only did this idea have to be
entirely overcome with both parents and young wo-
men, but the latter, as students, had to be grounded
in the very a-b-c of hygiene and sanitation, — nidi-

314 A History of Nursing

mentary knowledge which, in our country, is assimi-
lated we know not when or how, — it is almost inborn.
It is difficult for us to realise that some of the most
primitive customs prevail among persons of more or
less education in the Philippines. All this was up-
hill work, but the school was finally started. Another
struggle was involved in the donning of a uniform.
The Filipino has worn the same style of costume
for about three hundred years. This dress has a
long train which carries with it class distinction.
It is almost symbolical of the leisure or wealthy
upper class: the longer the train, the higher the
class; absence of train, lack of class. To abolish
this costume, even for the period of "duty," was,
therefore, something to accomplish, but it was done,
and the student nurses now look most attractive in
their striped, gingham uniforms, with white caps and
aprons. Pleasant to relate, they have really become
very proud of them, though they return to their
native costumes as soon as off duty. The wearing
of shoes and stockings came with this change, for
the majority of Filipinos go bare-legged, with a
simple sandal to protect the foot.

Miss Charlotte Layton had charge of the theo-
retical work of this school (under the Bureau of Edu-
cation) for about the first two years of its existence,
or until it was turned over to the Bureau of Health
by an act of the legislature. The school started with
sixteen scholarships, ten furnished by the govern-
ment, and six by private individuals. After one
year's study in the normal school, six of these student
nurses were sent to St. Paul's for practical work,
three to the University, and seven to the Civil Hos-

The Philippines 315

pital. After a short time, St. Paul's bought over
their six scholarships and used these nurses as a
nucleus for their own training school. The Univer-
sity Hospital did likewise. The class of seven sent
to the Civil Hospital remained intact, and was the
first graduating class under the civil government.
The school now has an enrolment of thirty, the
maximum number of one sex allowed by law.

When Miss McCalmont took charge of the nursing
force in the Philippines, a peculiar state of affairs
existed. All male patients, even the Americans, were
cared for by male attendants only. In the men's
wards, the nurses did only desk work, charting, and
giving out medicines. Baths, treatments, and nearly
all surgical dressings were done by the attendants,
who were generally ex-army corps men, with even
less than the ordinary training. There were many
instances of neglect, and the situation was altogether
unsatisfactory. It seemed impossible to get the
nurses back into the hospital habits of the United
States, and an attempt was made to solve the prob-
lem by a training school for men. This, at first,
was greatly discouraged, but finally put into effect
with marked success. In March, 19 10, a training
school for hospital attendants was opened with an
enrolment of sixteen pupils and a surprisingly long
list of applicants. This was merged a few months
later with the training school for young women, and
with practically the same curriculum of study.

It had not proven satisfactory to have the theo-
retical work conducted under one bureau, and the
practical work under the direction of another; con-
sequently, by an act of the legislature, the training

316 A History of Nursing

of nurses of both sexes was put under the direction
of the Bureau of Health, with Miss Mabel E. Mc-
Calmont as supervising nurse, and Mrs. Eleanor
Underhill Snodgrass as superintendent of nurses.
Under this act, appropriation was made for sixty
government scholarships yearly. A thorough course
of study was arranged, including, besides all the
usual subjects, the nursing of tropical diseases, the
sanitary work of the Bureau of Health, public instruc-
tion in dispensary and school work, English grammar
and colloquial English, and industrial and living
conditions in the islands. The elementary course was
planned to cover two and a half years of satisfactory
work, with elastic modifications to meet the special
conditions of race and climate. The preparatory
course of six months gives the pupils from five to
six and a half hours daily in diet kitchens, laundry,
supply-rooms, etc., to familiarise them with hospital
routine. Class work and demonstrations are given
daily, while lessons in English are of first importance.
Ward service is not entered on until the preparatory-
course has been successfully completed. The junior
year has six and a half hours of daily ward work,
with one period of class daily for five days of the
week. The senior year brings eight hours' ward
work, with one lecture weekly, but no classes. The
pupils, during training, pass through every branch
of practical service. Those who have finished high
school or have had superior educational advantages
are chosen in preference to others.

In the work of nursing and health education, which
is of such vast significance and importance to the
Filipino people, there are certain fields which neces-

The Philippines 317

sitate special training for those undertaking the
work. These are along the lines of administrative
or executive hospital work; dispensary management
and public instruction; school teaching along the
lines of hygiene, sanitation, and practical nursing;
and sanitary inspection, — the last-named course de-
signed for the male nurses particularly. Post-grad-
uate courses of six months will be given in each of
the above subjects. Graduates will be selected who
have shown particular ability along these lines, and
during their post-graduate course they will be paid
thirty pesetas per month, with subsistence, quarters,
and laundry. After completion of this course they
will receive appointments and salaries in proportion
to their ability. There are probably no other posi-
tions in the islands where the work is as remunerative,
as interesting, and of such great importance to the
people. These special courses will open up lines of
work which it is believed will be especially attractive
to the Filipino student and for which it is believed
he is particularly adapted.

To establish the Filipino people physically is to
insure their future effectiveness and prosperity. It
should be the basis of all the educational work
of the islands. To decrease the high infant mor-
tality, to stamp out small-pox, cholera, tuberculosis,
malaria, hook-worm, beriberi, and many other
diseases which are retarding the progress of the
Filipinos is absolutely necessary in order to build
scientific and industrial education on a substantial
foundation. This great work can not be accom-
plished in any other way than through the education
of the people. And the instruction of the masses

318 A History of Nursing

can only be accomplished through the specialised
education of a selected number, who will then spread
the leaven of their instruction, in the dialects of their
own people, among those who have grown up in
ignorance and superstition.

This, then, is the object and purpose of the Phi-
lippine training school for nurses. These young
men and women, from all sections of the islands, are
to be trained not only in the care of the sick,
but in the prevention of sickness. They are to
be given the best knowledge obtainable along the
lines of nursing, hygiene, and sanitation. They are
to be given this knowledge in such a way, it is hoped,
that, even without expensive equipment, they can
apply their instruction in a practical manner in the
homes of the poor and those of moderate means.
They will be able to disseminate this knowledge,
either in hospital work in Manila or in the provinces,
where provincial hospitals and dispensaries are now
rapidly to be built; in the schools, teaching it as a
specialised branch; in the provinces, as sanitary7 in-
spectors; or in the work of public instruction, viz.,
in dispensaries, where persons may come and receive
free instruction in the care of the sick, the bathing,
feeding, and care of infants, the elementary principles
of nursing, the proper preparation of food for both
the sick and the well, the prophylaxis of tuberculosis
and other communicable diseases, etc.

For the present, it seems wisest to spread as much
knowledge of hygiene and sanitation as possible, mak-
ing a feature of preventive rather than curative mea-
sures. As the work develops, however, it will have to
be more and more modified to suit the living condi-

The Philippines 319

tions of the country at large, and more particularly
adapted to the people of the isolated provinces. This
will be a task beset with difficulties. The problem is
comparatively simple as far as the nurses are concerned
who are being fitted for hospital work in Manila or
other large towns, but for those who will be expected
to carry their training and skill into remote and semi-
civilised regions, the task is a formidable one.

The tao or peasant class comprises a widely-
scattered, poverty-stricken population living in ignor-
ance and superstition, and hopelessly content to do
so. They speak nearly sixty different dialects, none
intelligible to the others. To give the Filipino nurses
a training adequately adapted to the primitive con-
ditions of living found in these provincial districts,
is the serious problem awaiting solution at the hands
of those responsible for the training of these student
nurses. No other educational movement in the
Philippines has, as yet, been thus practically solved,
and it would be a triumph almost beyond realisation,
if this, one of the greatest movements on foot in the
islands, should be thus successfully launched and
steered through the rocky course all progressive and
pioneer movements must run.

The problem is largely economic. The average
Filipino subsists on probably less than ten centavos
(five cents) a day. He lives in a primitive, one-
or two-room shack with his entire family and
much of his live stock. Cooking utensils are of the
fewest possible number; knives, forks, and spoons
for eating purposes are unknown ; the stove is a shal-
low earthen vessel in which charcoal is burned, and
over which the entire dinner is generally cooked in

320 A History of Nursing

one pot or pan. There are no beds or bed-linen.
The family squat on the floor at meal-time, gathered
around the common stew-pot, and eat with the
fingers. The diet consists generally of rice, fish, or
chicken, and a few uncultivated native fruits and
vegetables. No water is safe to drink unless first
boiled, but, needless to say, very few Filipinos take
this precaution.

Among those people, skin and venereal diseases,
tuberculosis, dysentery, malaria, cholera, small-pox,
beriberi, and other tropical diseases are liable to
occur. Unless within reach of the comparatively
few hospitals as yet constructed in the Philippines,
such diseases will have to be cared for in these poor
homes. The young graduate nurses, most of them
from very good families and reared in comparative
comfort, all of them receiving their training in a most
modern hospital with an unlimited amount of com-
plicated and expensive equipment, with American
standards of living, cooking, and eating developed
almost to the exclusion of their own, — what are these
young nurses going to do after they have left the
hospital and its careful supervision?

As a people they lack the American ingenuity,
inventiveness, and adaptability, though, like the
Japanese, they are clever imitators. But unless
they are taught to apply fundamental principles to
such crude conditions as have been described, they
will surely flounder. Unless they are trained to de-
vise a proper dietary out of rice, dried fish, and vege-
tables, realising that the only milk supply comes out
of a tin can and at a prohibitive price; unless they
can manage a hot and cold sterile water supply with

The Philippines 321

no convenient tap to turn which would give them
both; unless bathing and cleanliness can be made
possible with an almost total absence of soap and
linen; unless a few poor utensils can be made to
serve the manifold needs of the sick ; unless they are
really trained to do all this at a minimum cost, then
only to a limited extent will their training be of use
to themselves, their people, and to the country at
large. And only by such measure of usefulness and
adaptability can the success of training Filipinos be
guaged. To have a large training school of bright,
eager young people, making phenomenal progress in
theoretical work; to have a bulging list of applicants
clamouring for admission, is not enough. That much
only means that these most likable, responsive
Filipinos see their opportunity and are ready and
willing to do their part. The question is, can we
and will we wisely do ours?

[The work done by Miss McCalmont and Mrs.
Snodgrass in the Philippines merits a few words of
detail. The former nurse, graduate of the Homoeo-
pathic Hospital in Washington, D. C, not only re-
organised the entire nursing service of the Civil
Hospital, but also, while holding the position of
hospital superintendent, reduced the running expenses
under circumstances of such peculiar difficulty as
to make her work a piece of real civic duty, fearlessly
done, for which she received the thanks of the admin-
istration. She also designed the plans and ordered
the equipment of the Philippine General as well as of
provincial hospitals for the interior. After accom-
plishing this task, she returned to the United States
and gave an interesting example of the variations in

YOL. IV. — 21

322 A History of Nursing

work possible for nurses, by opening a career as con-
sultant in hospital construction and furnishing.

Mrs. Eleanor Underwood Snodgrass, graduate of
the S. R. Smith Infirmary, Staten Island, and of the
special course in Hospital Economics at Teachers
College, was a woman whose ability and lovable
characteristics gave promise of the brightest future.
When she became superintendent of nurses in the
reorganised training school, it was generally felt that
not only success, but distinction, awaited her, — an
outlook too soon clouded by her death only a year
later. Miss Margaret Wheeler and Miss Elsie Mc-
Closky succeeded to the direction of the work left
by the two pioneers.]

The sketches of nursing development we have
here given show, we believe, in a very striking way,
the gradual change from the " sick nursing " of past
ages to the "health nursing" foreseen by Florence
Nightingale. The conquest of disease is rapidly
extending, and as it does, the nurses' sphere will
also change, until, perhaps, the nurse herself may
become obsolete. If this day comes, our " History "
may be as a voice out of the Dark Ages.

BIBLIOGRAPHY

[Limited to material of propagandist or historical character, or dealing with
education in the broad sense. Space does not permit a complete list of liter-
ature on nursing, nor the inclusion of technical works.]

GREAT BRITAIN1

The History and Progress of Nursing in Poor-Law Infirmaries.
Josephine L. De Pledge. Westminster Review, Aug., 1894.

The Need of a British Nurses' Association and of Stale Registration
for Nurses. Ethel Gordon Fenwick. Read at first meeting of
Matrons, Nov. 21, 1887: at larger one, Dec. 10, and at full meeting,
Matrons and medical men, Jan., 1888, all at 20, Upper Wimpole St.

The Matron, 1st An. Report, and The Registration of Nurses, 2d
An. Report, British Nurses Association, 1 889-1 890. Ethel Gordon
Fenwick.

The Necessity for Union amongst Nurses. Ethel Gordon Fenwick.
The Nursing Record, July 5, 1888.

The Development of the Art of Nursing. Ethel Gordon Fenwick.
Ibid., Oct. 11 and 18, 1888.

The Profession of Nursing. Ethel Gordon Fenwick. The Queen,
1889, and a similar paper, Woman's Herald, 1 891.

The History of Nursing. Ethel Gordon Fenwick. The Queen,
1893.

The Better Organisation of the Nursing Profession. Ethel Gordon
Fenwick. Read by request, An. Conf. Nat. Union of Women
Workers, 1897.

A Practical Standard of Nursing. Ethel Gordon Fenwick.
First Annual Conference Matrons' Council, 1898.

The Evolution of the Trained Nurse. Ethel Gordon Fenwick.
The Outlook, Jan., 1900.

Organisation and Legislation among Nurses. Ethel Gordon

1 Thanks are due to Miss Beatrice Kent, London, for the compi-
lation of an exhaustive bibliography which our limits do not enable
us to use.

^23

324 Bibliography

Fenwick. Read at Int. Cong, of Nurses, Buffalo, 1901, Transactions,
P- 335-

State Registration of Trained Nurses. Ethel Gordon Fenwick.
Read at Women's Institute, Nov. 5, 1902.

Trained Nursing as a Profession for Women from an Educational,
Economic, and Social Aspect. Ethel Gordon Fenwick. Read at
Int. Cong, of Women, Berlin, 1904.

The Organisation of the Nursing Profession: By Its Members; By
the State. Ethel Gordon Fenwick. Trans. Paris Conf., 1907, p.
167.

State Registration of Trained Nurses. Ethel Gordon Fenwick.
Nineteenth Century and After, vol. lxvii., 1910, p. 1049.

Report from the Select Committee of the House of Lords on Metro-
politan Hospitals, Aug., 1890.

Report, Select Committee on Registration of Nurses. House of
Commons Papers, No. 281, 1904.

The Queen's Poor. Mary Loane. 1905.

Neighbors and Friends, 1910. Mary Loane.

Voluntary Workers' Report of Poor Law Commission, and other
books. Mary Loane. London.

In Japanese Hospitals in War-time. Mrs. Richardson. Black-
wood & Sons, 1905.

UNITED STATES

State Registration for Nurses. Louie Croft Boyd. Phila., 191 1.

Annotated List of Text and Reference Books for Tr. Schs. for Nurses,
1910. Department of Nursing and Health, Teachers College.

Louise Darche, A Memorial. The Trained Nurse, Sept., 1899.
L. L. Dock.

A General Presentation of the Statutory Requirements of the Different
States. Annie W. Goodrich. Amer. Journ. of Nursing, Sept., 19 12.

Negro Self-Help in Hospital Work. Geo. C. Hall, M.D., Chicago.

Report of Interstate Secretary to the American Nurses' Association.
Isabel Mclsaac. Amer. Journ. of Nursing, Aug., 1912.

The Educational Status of Nursing. M. Adelaide Nutting.
U. S. Bureau of Education, Bulletin No. 7, 1912.

The Department of Nursing and Health at Teachers College, Colum-
bia University. M. Adelaide Nutting. Read at the Int. Cong, of
Nurses, Cologne, 1912.

A History of Nursing, 2 vols. Nutting and Dock. Putnams,
1907.

The Nurse in Education, Part II. M. A. Nutting and Isabel M.

Bibliography 325

Stewart. Ninth Year Book, Nat. Soc. for the Study of Education,
Univ. of Chicago Press, 1911.

A Letter on Nurse Training, New York, 1907. N. Y. City Vis.
Com. of the State Charities Aid Association.

Editorial Comment, Sophia F. Palmer, Am. Journ. of Nursing
files.

Reports of the Congress on Hospitals, Dispensaries, and Nursing,
Chicago, 1903.

Reminiscences. Linda Richards. Whitcomb & Barrows, Boston,
1911.

Nursing Ethics. Isabel Hampton Robb. Savage, Cleveland, 1903.

Educational Standards for Nurses. Isabel Hampton Robb.
Koechert, Cleveland, 1907.

Circulars of Information, No. I. U. S. Education Bureau.

Training Schools for Nurses, 1882. U. S. Education Bureau.

Reports on Professional Schools. U. S. Education Bureau.

Medical Inspection in the Public Schools. Lillian D. Wald.
Ann. Am. Acad, of Polit. and Soc. Sci., xxv., Mar., 1905.

Educational Value and Social Significance of the Trained Nurse in
the Tuberculosis Campaign. Lillian D. Wald. Proceed. Int. Cong,
on Tuberculosis, Washington, 1908.

Plea for the Creation of a Federal Children's Bureau. Lillian
D. Wald. Ann. Am. Acad, of Polit. and Soc. Sci., Mar., 1909.

Nursing — Vocation for the Trained Woman. Lillian D. Wald.
Boston Woman's Educational and Industrial Union, 1910.

The Doctor and the Nurse in Industrial Establishments. Lillian
D. Wald. Proceed. Acad, of Polit. Sci., vol. ii., Jan., 191 1.

Visiting Nursing in the United Slates. Yssabella G. Waters.
Russell Sage Foundation, New York, 1909.

FRANCE

Le petit Personnel Medical en Angleterre et Reformes d, introduire
§n France. Dr. M. Blatin. Paris, 1904. Thesis.

Dans les Hopitaux Parisiens. Georges Cahen. Rev. Polit. et
Litteraire, June-Aug., 1907.

Conseil Superieure de V Assistance Publique-Rapport sur le re-
crutement du Personnel Secondaire des Etablissements Hopitaux.
M. le d'Henri Napias, Paris, 1898.

La Carrier e de la Garde- Malade: Le Bien Public, 1892 or 1893.
Anna Hamilton, M.D.

Considerations sur les Infirmihes des Hopitaux. Anna Hamilton,
M.D. Montpellier, 1900. Thesis.

326 Bibliography

Instruction professionelle et Situation du Personnel secondaire des
Hdpitaux. Anna Hamilton, M.D. Reports, vol. i., Cong. Nat.
d'Assistance Publ. et Bienfaisance Priv., Bordeaux, 1903.

UHeroine des Ambulances de Crimee. Anna Hamilton, M.D.
La Garde-Malade Hospitaliere, vol. ii., 1908, p. 1.

Florence Nightingale (O.M.). Anna Hamilton, M.D. La Garde-
Malade Hospitaliere, vol. iv., 19 10, p. 165.

Quelques Conseils de Mile. Nightingale sur les Hdpitaux et le Nurs-
ing. Anna Hamilton, M.D. La Garde-Malade Hospitaliere, vol.
iv., 1910, p. 172.

La premiere Ecole Frangaise, systtme Florence Nightingale.
Anna Hamilton, M.D. La Garde-Malade Hospitaliere, vol. iv., 1910,
p. 1.

CEuvres de Florence Nightingale. Anna Hamilton, M.D. La
Garde-Malade Hospitaliere, vol. iv., 1910, 188.

Pensees de Florence Nightingale. Anna Hamilton, M.D. La
Garde-Malade Hospitaliere, vol. v., 191 1, p. 81.

La Garde-Malade Visiteuse des Pauvres au Congres de Nantes.
Anna Hamilton, M.D. La Garde-Malade Hospitaliere, vol. v.,

19", P- 173.

Ve Congrls Nat. d 'Assistance Publique. Anna Hamilton, M.D.
La Garde-Malade Hospitaliere, vol. v., 191 1, p. 84.

Le Systeme Florence Nightingale. Anna Hamilton, M.D. La
Garde-Malade Hospitaliere, March, 1912, p. 33.

Plan pour les Cours Theoriques d'une Ecole Hospitaliere de Gardes.
Malades systeme Florence Nightingale. Anna Hamilton, M.D.
Bordeaux, 1912.

GERMANY

Sliefkinder der Sozialpolilik. Anon. Ernst Reinhardt, Munich.

Die Staatliche Prufungsordnung fur Krankenpflegepersonen in
Deutschland. Charlotte von Cammerer. Int. Conf. of Nurses,
Paris, 1907, p. 177.

Die Schwester im Krankenhaus in Gegenwart und Zukunft. Char-
lotte von Cammerer. German Nurses' Association, 22 Nurnberger
Str., Berlin, 19 12.

Notstand im heutigen Krankenschwesternwesen. Marie Cauer.
I-itschr.f. Krankenpflege, pp. 37, 71, 1910.

Staat und Krankenpflege. Marie Cauer. Die Frauenbewegung,
No. 5, 1902.

Weibliche Krankenpflege auch ein biirgerlicher Beruf. Marie
Cauer. Felix Dietrich, Leipsic, 1906.

Bibliography 327

Die Berufsorganisation der Krankenpflegerinnen Deulsch'ands.
Agnes Karll. Die Krankenpflege, 1902-1903, vol. ii., sec. 5, Georg
Reimer, Berlin.

Die Notwendigkeit einer ausreichenden Alter sversorgung fur das
Pflegepersonal. Agnes Karll. Die Krankenpflege, 1902-3, vol.
ii., sec. 1.

Die Berufsorganisation der Krankenpflegerinnen Deutschlands.
Agnes Karll. Neue Bahnen, 1903, No. 5, Richard Schmidt,
Leipsic.

Die Krankenpflege auf dent internationalen Frauenkongress in
Berlin, 1904. Agnes Karll. Deutsche Krankenpflege Zeitung, 1904.
No. 14.

Die Pflichten der Aerzte fur die Entwicklung der deutschen Kranken-
pflege. Agnes Karll. Zeitschrift f. Krankenpflege, 1907, No. II,
p. 321.

Die neue Prufungsordnung fiir Krankenpflegepersonen. Agnes
Karll. Medizinische Reform, 1907, No. 12, p. 143.

Die Geschichte der Krankenpflege und ihre Bedeutung fiir die
Frauenbewegung. Agnes Karll. Centralblatt d. Bund Deutscher
Frauen Vereine, No. 17, p. 131.

Krankenpflege und Frauenbewegung. Agnes Karll. Die Frauen-
bewegung, 1910, No. 23, p. 183.

Geschichte der fiinf ersten Jahre unseres Verbandes. Agnes Karll.
Reprint from Unterm Lazaruskreuz, Jan. 15 to Aug. 15, 1908.

Die Geschichte der Krankenpflege. Agnes Karll. In 2 vols.
Translated from the English, Dietrich Reimer (Ernst Vohsen),
Berlin, 1910.

Bahnbrechende Frauen in der Krankenpflege. Agnes Karll.
Bahnbrechende Frauen, p. 305, Lyceum Club, Berlin, 1912.

Antrag auf staatliche Prufung der Krankenpflegerinnen. Elsbeth
Krukenberg. Die Krankenpflege, 1902, pp. 857-861.

Die soziale und rechtliche Lage der Krankenpflegerinnen. Else
Luders. Soziale Praxis, No. 31, 1910.

Religion und Krankenpflege. Marthe Oesterlen. Deutsche Kran-
kenpfl. Zeil'g, i , p. 201, 1898.

Arbeitsverhdltnisse in der Krankenpflege. Charlotte Reichel.
Soz. Praxis, No. 27, 1910.

Der Dienstvertrag der Krankenpflegerinnen unter Berucksichtigung
der Sozialen Lage. Charlotte Reichel. Fischer, Jena, 19 10.

Lage der Krankenpflegerinnen. Charlotte Reichel. Zeitschr,
f. Krankenpflege, No. 57, 19 10.

Selbsthilfe und Sozialpolitik. Charlotte Reichel. German Nurses'
Association, 22 Nurnberger Str., Berlin.

328 Bibliography

Die freie Krankenpfiegerin. Elisabeth Storp. Frauendienst,
pp. 28-33, 1902.

Die soziale Stellung der Krankenpflegerinnen. Elisabeth Storp
Dresden, 1901.

Zur Krankenpflegerinnenfrage. Elisabeth Storp. Die Kranken-
pfiege, p. 270, 1902.

Die Wirtschaftliche und soziale Lage des Krankenpfiegepersonals
in Deutschland. Georg Streiter. Fischer, Jena, 19 10.

Pflegeverband im Vergleich zur freien Krankenpflege. C. von Wall-
menich. Blatter d. bayr. Frauenvereins v. Roten Kreuz, p. 273, 1902.

Die Stellung der Oberin im modernen Krankenhaus. C. von Wall-
menich. Munich, 1902.

Selbstverwaltung in einer Schwesternschaft. Friedrich Zimmer.
Die Zeit, No. 50, 1902.

MISCELLANEOUS

Per le Scuole delle Infermiere. Anna Celli. Nuova Antologia,
OcL, 1908.

Woman's Work in the Red Cross Society. T. Goranson. Stockholm.

Articles by "Hollandia," in British Journal of Nursing. See files,
1904 to date.

Het Rapport van den Centralen Gezondheidsraad. J. C. Van Lan-
schot Hubrecht. Nosokomos, Sept.-Oct., 191 1.

The Fight against Tuberculosis through Dispensaries. Emmy
Lindhagen. Stockholm, 1910.

Florence Nightingale and the Reform of Nursing. S. Ribbing.
Stockholm.

Riforma delV Assistenza ospedaliera. Amy Turton. Rivista
delta Beneficenzia Pubblica.

FOR CURRENT HISTORY

American Journal of Nursing, The, 226 S. 6th St., Phila., Penna.

Australasian Tr. Nurses Journal, The. Sydney, N. S. W.

British Journal of Nursing, The. 20, Upper Wimpole St., London.

Canadian Nurse, The. McKinnon BTd'g., Toronto*

De Vlamsche Verpleging. Antwerp.

Epione, Kopmansgatan 6. Helsingfors, Finland.

Kai Tiaki. Government Bldgs., Wellington, N. Zealand.

La Garde-Malade Hospitalilre. 96bis, rue Laroche, Bordeaux.

Nosokomos. 13 Van Eeghen Str., Amsterdam.

Nurses' Journal of the Pacific Coast. San Francisco.

Bibliography 329

Nursing Journal of India. Bon Espoir, Ootacamund, South
India.
Swedish Nurses* Journal. 25 Tunnelgatan, Stockholm.
Tidsskrift f. Sygeplege. 50 Kronprinsessegade, Copenhagen.
Una. Equitable Bldgs., Melbourne, Australia.
Untcrm Lazaruskreuz. 22 Nurnberger Str., Berlin, W. 50.

INDEX

Acts of Parliament relating to
nursing. See England

Africa, iv, 222-228

Campbell, Emily, work of,
225; Chevalier, Mme., life in,
226; Dufferin Fund in, 226;
English nurses in, 222; Ger-
man deaconesses in, 223;
Henrietta, Sister, work in
Kimberly, 226; state registra-
tion of nurses in, 226-228;
training natives in, 224;
Universities Mission, 225

Almshouse nursing reform. See
U.S.

Aletrino, Dr. and Mrs. See
Holland

Allerton, Eva. See U. S.

All Saints Sisters. See India

Aloysius, Mother M. See Ireland

Ampthill, Lord. See England

Army nursing. See name of
country.

Australia, iv, 172-189

Adelaide General Hospital,
176; Alfred Hospital, 174; As-
sociations of nurses in, 177-
179; Australasian Trained
Nurses' Association, 177-178,
182; Brisbane Hospital, 176;
bush nursing, 186; early nurs-
ing history in, 172-174; Farqu-
harson, Miss, 174; Melbourne
Hospital, 175; mental nursing
in, 181; McGahey, Susan,
work of, 174; midwifery in,
189; Nightingale nurses in,
173-174; nursing journals of,
184; organisation in, 177;
Osburn, Lucy, 173; Prince

Alfred Hospital, 174; public
schools nursing in, 187; regis-
tration: by the state, 182-
183; voluntary, 180; Royal
British Nurses' Association in,
177; Royal Victorian Trained
Nurses' Association, 177-179;
Sydney Hospital, 172; Talbot
Milk Institute, 188; Tasmania,
Nightingale nurse in, 173
Average working period German
nurses, iv, 47

Baxter, Grace. See Italy
Belgium, iv, 74-78

Cavell, Miss, pioneer Matron
in, 76, 78; Ecole beige d'lnfir-
mieres diplomees, 76; muni-
cipal schools in, 75, 78; outline
of early history of, 74_75;
physicians' interest in nursing
reform, 78; state registration
in, 76-77;
Bibliography, iv, 323-329
Blackwood, Hermione. See Ire-
land
Bottard, Mile. See France
Bourneville, Dr. See France
Breay, Margaret. See England
Brodrick, Albinia. See Ireland

Canada, iv, 122-170
Alberta, hospitals in, 141;
army nursing, 149-150; Brent,
Louise, 143; British Columbia,
nurses in, 142 ; Catholic orders,
training schools under, 124,
137,139, 140; Columbian Coast

331

332

Index

Canada — Continued

Mission, 142; early French
hospitals, 123-124; educa-
tional standards in nursing,
158-160; Female Benevolent
Society of, 135; first secular
hospital, 125; French regime,
122; Grey Nuns in pestilence,
136-137; hospitals for child-
ren, 143; Kingston Compas-
sionate Society, 135; Living-
ston, Norah, 129, 134; Mac-
kenzie, Mary A., 166; Mani-
toba, nursing in, 140* mental
nursing, status of, 147-148;
Milk Commission, 156; Mont-
real, first training in, 126;
General Hospital of, reforms
in, 128-129; new lines of nurs-
ing work, 161-162; Nightingale
nurses in, 128; nursing journal
of, 167; organisation in, 162-
165; Ottawa General Hospital,
137; post-graduate courses,
158-161; preliminary courses,
130, 138, 159-160; public
schools, nursing in, 156-157;
Robertson, J. Ross, 143-144,
157; Royal Victoria Hospital,
138 ; Saskatchewan, 141 ; settle-
ment work, 156; Sisters of
Hdtel-Dieu of Montreal, 138-
139; Snively, M. A., hos-
pital work of, 133; public
work of, 134, 159, 163; state
hospitals, 144-149; Toronto
General Hospital, history of,
130; training school of, 131-
132; tuberculosis nursing, 157;
Victoria General Hospital,
134; Victorian Order of Nurses,
the, 1 51-155; Winnipeg Gen-
eral Hospital, 140; Yukon,
nursing in the, 142

Canadian Presbyterian Mission.
See India

Catholic Nursing Orders; atti-
tude toward registration in
Belgium, iv, 77; in Germany,
iv, 30; in U. S., iii, 149; Cana-
dian hospitals, work in, iv,
124; plague service in Canada,
iv, 136-137; revival in Ireland,
iii, 85; statistics of health,

middle Europe, iv, 37; status
in France and Italy {see those
countries) ; training school
work of. See Canada, Ireland,
and U. S.

Celli, Anna. See Italy

Chaptal, Mile. See France

China, iv, 277-285

Central China Medical Asso-
ciation gives certificates, 283;
Chesnut, Dr. Eleanor, work
and death of, 281; Chinese
nurses in associations, 282;
in hospital positions, 279;
Chinese training school at
Tientsin, 284; Chung, Miss,
Matron of, 284; early nursing
work in China, 277; Elisabeth
Bunn Memorial Hospital, 278;
Hart, Mrs. CM., 283; Kin, Dr.
Yamei, hospital work of, 284;
Margaret Williamson Hospi-
tal, 278; Nurses' Association
of China, 282; St. Luke's
Hospital, Shanghai, 278; Tip-
pett, Miss C. F., on mission
work, 281; uniform standards
of training proposed, 282

Corea, pioneer work in, iv, 285

Cuba, iv, 288-307

American nurses in, 298;
Cuban nurses at London
Congress, 302; Dept. of Chari-
ties and Nursing, 296; emer-
gency work of Cuban nurses,
305; first in hospital posts,
299; Hibbard, Eug6nie, career
of, 300;- organisation work
of, 295; hospital conditions
at end of war, 288; Kean,
Maj., share in nursing reform
of, 293; mental nursing, 303;
Mercedes Hospital first train-
ing school, 291; O'Donnell,
Mary A., first training school
superintendent, 292; organi-
sation in, 306; preventive and
social work, 300-301; regula-
tions of training schools, 296-
297; reorganisation in Cuban
hospitals, 290; state registra-
tion established, 297; training
schools opened in sequence,
292

Index

333

Deaconesses. See name of

country-
Delano, Jane A. See U. S.

Denmark, iii, 254-263

Danish Nurses Association,
258-259; activities of, 261;
petition to Minister from, 262 ;
Deaconess Institute, 254; Fen-
ger, Dr. C. E., work of, 256;
Lutken, Cecilie, 258; Norrie,
Charlotte, 259; nurses' journal,
262; Red Cross organisation,
256-257; rural nursing reform,
258; St. Lucas' Institute, 256;
Tscherning, Mrs. Hermy, 259

Department of Hospital Econo-
mics, iii, 132

District nursing. See name of
country

Doria, Princess, iv, 107, no

Drown, Lucy, iii, 128

Dufferin, Countess of. See
India

Eight hour day in hospital New
Zealand, iv, 219; U. S. iii, 135

Elston Catharine. See France

England, iii, 1-61

Acts of Parliament relating to
nursing: Asylum officers' su-
perannuation, 8; Education,
28; Midwives, 27; Notifica-
tion of births, 27; Poor law
officers superannuation, 4;
Ampthill, Lord, champions
registration, 58; Army Nurs-
ing, 19; Breay, Margaret, in
suit against officers R. B. N.
A., 50; in work for Matrons'
Council, 53; British Journal
of Nursing, 34; British Nurses'
Association founded, 33; City
financiers' scheme to control
nurses, 57; district nursing,
beginnings of, 23; Fenwick,
Mrs. Bedford, organisation
begun by, 32; government
service, nurses in, 18-21; Guy's
Hospital, difficult reforms at,
2; regulations of, 13; Holt-

Ockley system, 25; Hospitals
Committee, policy of, 37;
Hughes, Amy, 27; lady pupils,
13; Leagues founded, 54;
Loane, Miss, 30; Local govern-
ment board, 4, 8, 9; Loch,
Miss, 20; Manson, Ethel
Gordon (Fenwick), 31; Ma-
tron, the, 16; Matron's Council
founded, 52; mental nursing,
21-22; midwifery, 30; Monk,
Katherine, 2; National Coun-
cil of _ Nurses founded, 55;
nurse inspectors, 9; Nursing
Record, The, 34; Pearse, Helen,
28; pioneers in nursing reform,
1-2; Plaistow nurses' home,
26; Poor Law infirmaries, 3-6;
preliminary training, 12; pub-
lic school nursing, 27; Queen
Victoria's Jubilee Institute,
17-22; relief of sickness, how
organised, 3; royal charter
gained, 42-43; Select Com-
mittee on registration, report
of, 56; State registration pro-
posed, 36; State Society for
registration formed, 55; Stev-
enson, Louisa, 56; Stewart,
Isla, 52 ; struggle for organisa-
tion, 30-60; Twining, Kathe-
rine, 26; Louisa, 7; union of
forces to work for registration,
58; village nurses, 25; work-
houses order in nursing, 8

Fenwick, Ethel Gordon. See
England

Finland, iii, 263-275

Association of nurses of, 273-
275; Broms, Anna, 270; early
nursing in, 263; first general
hospital in, 265; House of
Deaconesses, 267; Karamzine,
Mme., 267; Lackstrom, Mrs.
Olga, 27 1 ;Mannerheim,Mme.,
271; Nightingale, advice and
gift of, 274; nursing journal
of, 275; preliminary training
in, 274; Saltzmann, Dr. F.,
269; Sister Lina, 268; Surgical
Hospital, Helsingfors, 270;

334

Index

Finland — Continued
three years' course established,
272; University Clinics train-
ing school, 272

France, iii, 279-340

Army nursing established, 325 ;
Augustinians in Boucicaut
Hospital, 340; leave Hotel-
Dieu, 279; Bordeaux schools,
316; Bottard, Mile., life of,
284-285; Bourneville, Dr.,
story of, 289-291; Bru, M.,
novel by, 337; Chaptal, Mile.,
work of, 339 ; Circulars, official,
on nursing, 330-331; early
reforms in nursing, 282-286;
early^teaching of nurses, 295-
296; Ecole professionnelle, new
school in Paris, 334, 338;
Elston, Catherine, work of,
309; Hamilton, Anna, at Con-
gress Public and Private
Charities, 332; letter from, to
Red Cross International Com-
mittee, 326; personality of,
299; story of, 300-305; La
Garde- Malade Hospitalise,
328; Lande, Dr., active re-
forms of, 310; death of, 329;
Luigi, Mile., at Beziers, 319;
at Rheims, 320; Maison de
Sant6 Protestante, 305-308 ;
Mesureur, M. G., article on
nursing reform, 334; municipal
courses for nurses, Paris, 292 ;
provinces, 331 ; new school for
nurses, Paris, 334; Nightingale
influence of, in France, 299;
nursing journal, Bordeaux,
328; Nectoux, Mile., in Albi,
321 ; numbers of nurses, Paris,
329; organisation of Paris
hospitals, 335; Pasteur, influ-
ence of, 280-281 ; problems of
Paris hospitals, 337 ; provincial
hospitals, Bordeaux nurses in,
319-320; public school nursing
in Bordeaux, 328; in Paris,
339; Red Cross methods of,
306, 308; Regnault, Dr. Felix,
on hospital system, 333; regu-
lation of May 1, 1903, 334;
Sabran, M., views as to Ma-
tron's position, 333; School of

the Rue Amyot, 297; Sisters
of Mercy in Pasteur Hospital,
340; St. Andre\ nurses' diary
in,3i3;training begun in , 3 1 1 -
312; Tondu Hospital, train-
ing in, 315; visiting nurse in
Bordeaux, 327-328

Germany, iv, 1-5 1

Arendt, Sister Henriette,
author of White Child Slaves,
34; average working period of
nurses in, 47; Catholic nursing
orders in, 2; numbers of, 51;
Diakonie Verein, 5; Eppen-
dorf-Hamburg nursing associ-
ation, 3; Free Sisters, the, 7;
German Nurses Association,
branches of, 21, 33; founded,
16; growth of, 20; relations
with Dusseldorf Hospital,
26; with Frankfort City Hos-
pital, 23; Hecker, Dr., article
by, 51 ; Kaiserswerth and Cha-
rity, 36; Karll, Agnes, early
articles by, 8; letters of, 30-
32; principles urged by, 9;
story of, 10-24; Lazarus cross
chosen as symbol, 25; legal
status of nurses, 48 ; morbidity
and mortality statistics of
German Nurses' Association,
39-46, of Von Lindheim, 37;
Nightingale nurse in Germany,
3; nursing journal founded, 24;
numbers of nurses to patients,
49-51; overstrain among
nurses, 36, 38; Red Cross
motherhouses, 4; Reichel Frl.,
investigations of, 48; social
service and new lines of work,
33-34; State registration at
Charite\ 18; conference on, 29;
established by Bundesrath, 27;
standards of, 28-29; St. John,
order of, 6; Storp, Elisabeth,
pamphlet by, 11; Unterm
Lazaruskreuz, 24; opposition
of Red Cross to symbol, 26-
27 ; Victoria House, 2 ; Virchow
proposals of, 2; Wiesbaden
meeting passes resolutions,

Index

335

Germany — Continued

14-15; woman movement and
nursing reform, n, 30

Hampson, Sara. See Ireland
Hampton, Isabel, See U. S.
Haughton, Louisa. See Ireland
Henley, hospital poems, iii, 68-69
Holland, iv, 55~74

Aletrino, Dr. and Mrs., work
of, 63; "Bond," the Dutch as-
sociation for sick nursing, 57-
59, 61 ; early nursing conditions
in, 55; Maandblad, hospitals
journal, 59; Matrons, weak-
ness of, 59; Nosokomos, nurs-
ing journal, established, 62-64;
headquarters of, 74; Reyn-
vaan, Miss, work of, 57; state
registration demanded, 68;
government report on, 72;
medical men's attitude toward ,
69; state registration society
formed, 74; van Lanschot
Hubrecht, Miss, work of, 64;
viewpoint of, 65-67
Huxley, Margaret. See Ireland

India, iv, 229-256

Albert Edward Hospital, Kol-
hapur, 246; All Saints Sisters,
244; American Evangelical
Lutheran Mission, 247; As-
sociation nursing superinten-
dents of India, 249; Cama Hos-
pital, Bombay, 241; English
Baptist Zenana Mission, 248;
first training school for native
nurses, 241; midwifery, status
of, 239; Mills, Miss, 245;
Minto, Lady, nursing associ-
ation, 251; missions advance,
231 ; National Association sup-
plying medical aid, 233; ob-
jects of, 235; Nightingale,
writings on India, 229; North
India School of Medicine, 245;
Nursing Journal of India, the,
249; organisation in, 254;
plague nursing incident of,

243-244; registration in Bom-
bay Presidency, 251; in Nurs-
ing Journal, 250; Seva Sadan,
the, 252; Thorpe, Winifred,
255; Tindall, Miss, 242;
Trained N urses ' ' A ssociation,
249; uniform training, work
toward, 250; U. F. Church of
Scotland Mission, 248; Zena-
na Bible Mission, 242

Ingenbohl. See Switzerland

International Council of Nurses,
inception of, iii, 54

Ireland, iii, 82-115

Aloysius Mother, testimonials
to, 100-101; Brodrick Albinia,
work of, 115; Catholic orders
training school work of, _ 97,
104; Children's Hospital,
Dublin, 98; City of Dublin
Nursing Institute, 96, 104;
Dun's Hospital and Nursing
Institute, 93; early hospital
history, 82-84; first school
for Catholic nurses, 92; Han-
nan, Miss, work of, 102; Irish
Nurses Association, 110-113;
Irish nursing journal, 113;
Kelly, Miss B., work of, 92,
97; MacDonnell, Annie, work
of, 95; Mater Inf. Hospital,
Belfast, 101; Mater Miser.,
Dublin, 100; Mercy Hospital,
Cork, 99-100; Nightingale
Nurses in, 91, 95, 103; Pringle,
Miss, work of, 102; Queen's
nurses in Ireland, 106-108;
Queen's Nurses' Magazine, 1 10;
Religious orders, revival of,
85; Rotunda Hospital, changes
in, 95; Sister M. Albeus Fo-
garty, 102-104; Sisters of
Charity in Cork, 86; in Dub-
lin, 85; Sisters of Mercy in
Cork, 86; to Crimea, 86;
South Charitable Infirmary,
Cork, 102; Steevens Hospital,
history and nursing of, 83,
88-92; St. Philomena's train-
ing school, 101-102; Treacy,
Mrs. Kildare, 107; Trench,
Archbishop, work of, 87

Italy, iv, 79-117

Barriers to modern system, 86*

336

Index

Italy — Continued

Baxter, Grace, letters of, ioo-
106; Blue Cross Society, ioo;
Catholic orders, their nursing
work, 82, 114; Celli, Anna,
article on early conditions, 79;
on later conditions, 81-85,1 14-
115; comparative numbers
of nuns and nurses, 114; Con-
gress of Italian women, 107;
passes resolution on nursing,
108; Doria, Princess, 107, 109;
Nightingale, Miss, influence
in Italy, 89, 112; opening of
new school for nurses, 112-
113; Ospedale Gesu e Maria,
Miss Baxter's work in, 99;
Policlinico, Rome, field of new
school, in; Scuola Convitto
Regina Elena, 117; Snell,
Dorothy, work of, 1 1 1 ; Stron-
goli, Princess of, part in nurs-
ing reform, 99-100; Tonino,
Signorina, work of, 106; Tur-
ton, Amy, a pioneer, 86; dia-
ries of, 91-98; story of, 87-91,
109-113; views of, on nursing
in Italy, 11 5-1 16

Japan, iv, 256-277

American nurses in, 276;
charity hospital in, 257; Civil
hospitals, 274; efficiency of
Japanese nurses, 276; first
training school in, 258; Hagi-
wara, Take, at London Con-
gress, 259, 275; Nightingale,
influence of, 277; Komeyo,
Empress, legend of, 256; Mc-
Gee, Anita, expedition of, 276;
nurses in Reserve hospitals,
274; Red Cross nursing organi-
sation, account of, 260-273;
Relief nurses, 262; Richards,
Linda, in Japan, 257; sanita-
tion, triumphs of, 275; Suwo,
Choko, work of, 276; volun-
tary nurses, place of, 265;
visiting nursing, initiation of,
277

Journals of Nursing. See under
countries and bibliography

Labrador, coast mission of, iv.

171
La Source. See Switzerland

Mental nursing. See under name

of country
Midwifery. See under name of

country

Negro nurses. See U. S.

Newfoundland, nursing in, iv,
170-171

New Zealand, iv, 189-222

Army nursing in, 222; Auck-
land Hospital, 190; Back
blocks nursing, 290; Christ
Church Hospital, 195; coun-
try hospital work, 221; dis-
trict nursing, 211; Dunedin
Hospital, 197; early history,
189; first training school,
194; government inspection
of hospitals, 201-202; Kai
Tiaki, 216; legislation on hos-
pitals and health, 216-217;
Maclean, Hester, work of,
209, 215; Maori nurses, train-
ing of, 213; mental nurs-
ing, 218; midwifery, 206-208;
Neill, Grace, work of, 202;
Nelson Hospital, 200; nursing
journal, 216; organisation of
nurses, 215; R. B. N. A., 202,
203; Seddon, Mr., tribute to,
209; society to promote health
of women and children, 212;
state maternity hospitals, 207;
state registration of nurses,
203-206; Trained Nurses,
Association, 215; tuberculosis
nursing, 218; Wellington Hos-
pital and matrons, 194-195

Nightingale, Florence, comment
on registration, iii, 43; death
of, iii, 61; influence in Austra-
lia, iv, 173-174; in Finland, iii,
274; in France, iii, 299; in Ire-
land, iii, 91-95, 103; in Italy,

Index

337

Nightingale, — Continued

iv, 89, 112; in Japan, 277; in
Johns Hopkins Hospital, iii,
122; in Sweden, iii, 240; Maga-
zine, The Nightingale, iii, 119;
Nightingale nurses in Austra-
lia, 173, 174; in Canada, 128;
in Germany, 3; in Ireland, iii,
91,95, 102; in New Zealand, iv,
200; in Scotland, 66, 72; in
Sweden, 242 , 2 4 8 ; in Tasmania,
iv, 173; writings on India, iv,
229

Norway, Red Cross nursing of,
iii, 276

Nurses Settlements. See U. S.

Persia, Toronto nurse in, iv, 287
Philippines, The, iv, 307-322
American nurses in, 308; hos-
pital organisation in, 308-309;
McCalmont, Mabel, work of,
315-321 ; men nurses for, 315;
problems of public health, 311;
Snodgrass, Mrs. E., death of,
322; training school -ouiided,

313
Porto Rico, pioneer work in,
iv, 307

Queen's Nurses. See England
S

Scotland, iii, 61-82

Aberdeen, Royal Infirmary,
74-75; Allen, Dr., 78; Barclay,
Miss, first trained superin-
tendent, 66; Bell, Dr. J., 72;
Deaconesses in Scotland, 68;
district nursing pioneers, 23,
75; Dundee infirmary, reform
in, 67; early nursing history
61, 66; Edinburgh, Royal In-
firmary, 61-66; fever hospital
nursing, 78; Glasgow Royal
Infirmary, 70-71; Henley,

hospital poems of, 68, 69;
local Government Board, nurs-
ing under, 76-77; Lumsden,
Rachel, work of, 75; mental
nursing, 80; midwifery, 80, 81;
organisation, 81; Porter, Mrs.
Janet, 68; preliminary courses,
73 ; Pringle, Miss, work of, 72 ;
registration movement in
Scotland, 81 ; sanatorium nurs-
ing, 79; Sinclair, Mrs., work
of, 78, 79; Spencer, Miss, 72;
Strong, Mrs. Rebecca, 67, 71,
73; Western Infirmary, Glas-
gow, 73-74

Spain, iv, 11 7-1 21

Foundation of Rubio Insti-
tute, 117; training school in,
118; Zomak, Sister Marie,
work of, 120

Sweden, iii, 237-254

Army and nayy nursing, 250;
Deaconesses in, 230; district
nursing in, 250; early nursing
history, 237; Fredrika Bremer
Association, 247, 250; Insti-
tute of deaconesses, 238; of
deacons, 247; Lindhagen,
Emmy, 252; nursing journal of
Sweden, 251; organisation de-
veloped, 252, Rappe, Emmy,
240; Red Cross Society and
nursing, 238, 240, 242; Rodhe,
Estrid, 251 ; Sabbatsberg Hos-
pital, 246; Samaritan Home,
245; Sophiahemmet, the, 242,
244; South of Sweden Nursing
Home, 246; Tamm, Therese,
253; tuberculosis work, 252

Switzerland, iv, 52-55

Deaconesses in, 54; Gasparin,
Mme. de, 52; Ingenbohl,
nuns of, 54; La Source train-
ing school, 52-53; organisa-
tion, 53, 54; Red Cross train-
ing school, Berne, 53; Zurich,
training school in, 53

Syria, work of Miss Wortabet
in, iv, 286

Turkey, outline of pioneer work
in, iv, 286

338

Index

United States, iii, 115-236
Affiliation for training, 186;
first examples of, 118, 123;
army nursing bill, 211; Aller-
ton, Eva, work of, 148; Alline,
Anna, work of, 133, 152;
almshouse nursing reform, 221,
228; alumnas societies, 120;
American Journal of Nursing,
198-199; American-Indian
nurses, 192-195; associated
alumnae founded, 128-129;
Buffalo Nurses' Association,
147; Catholic orders and regis-
tration, 149; Cleveland Visit-
ing Nurse Association, report,
233-234; Delano, JaneA.,211:
Drown, Lucy, 128. Edu-
cation— action of Miss Ban-
field on, 139; Beard, Dr.,
standards of , 139; Committee
on, 132; growth of, 131 ; Hurd,
Dr., attitude toward, 138;
Isabel H. Robb scholarship
fund, 134; Mills, Prof., action
of, 139; report hospitals com-
mittee on, 138; Teachers col-
lege course, 131- 134; Texas
university, action of, 139; three
years' course, 135. Ethics,
first book on, 119; examining
boards, {see names of states) ;
Fen wick, Mrs., in U. S., 125;
Goodrich, Anna, work of, 153;
Gretter, Mrs., in Detroit, 135;
Hampton, Isabel, 122-126;
health talks by nurses, 230;
Johns Hopkins Hospital
opened, 121; journals of nurs-
ing, 198, 200; Lent, Mary E.,
paper by, 234; Maxwell, Anna,
at Chickamauga, 205-210;
Mclsaac, Isabel, work of, 201 ;
mental nursing, 139-140;
Naval Nurse Corps, 213;
Negro nurses, 195-198; Night-
ingale magazine, the, 119;
Nurses Settlements, 215, 221-
223; Nutting, M. A., work of,
133-135; Palmer, Sophia F.

H3 f H5» 147, H8, pioneer
authors and nurses, 11 8-1 19;
preliminary course, first, 134;
public school nursing be-
gun, 224; Red Cross Nurse
Corps, 212-213; religious or-
ders, 187-192; Robb, Mrs.,
129, 130-132, 134, 142, 146,
202, 211; Rogers, Lina, work
of, 224; school for district
nurses, 231; Sisters of Mercy,
Chicago, 187-189; Social Ser-
vice in hospitals, 228-230; new
lines of, 225-228; Society of
training school superinten-
dents founded, 127; Spanish-
American war nurses organise,
204; state registration first un-
dertaken, 142-144; work for,
in Cal., 159; Col., 160; Conn.,
161; D. of C, 162; Del., 175;
Ga., 169; 111., 167; Ind., 158;
la., 166; Md., 157; Mass., 182;
Mich., 180; Minn., 166; Mo.,
179; Neb., 173; N. J., 154;
N.H., i65;N.Y., 151; N. C,
153; Okla., 172; Ore., 184;
Penn., 175; Tenn., 185; Tex.,
174; Vt., 185; Va., 156; Wash.,
172; W. Va., 163; Wis., 185;
Wyo., 171; statistics of train-
ing schools, U. S. Bureau,
1909, 141 ; St. Margaret, Sisters
of, 190-192; St. Vincent, Sis-
ters of, 187-188; superinten-
dents in Cuban war, 204;
undergraduate private duty,
136; visiting nursing for in-
surance company, 224-225;
visiting nursing, growth of,
234; Wald, Lillian D., work
begun, 215; story of, 216-220;
war service, 201-21 1; Welch,
Dr. Wm., on registration, 158

Visiting nursing. See name of
country

Zomak, Sister Marie. See Spain

RT
31
F07

BOSTON UNIVERSITY

1 l?n D1177 DE3^

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