With the Author's Compliments. The Systematic Training of Nursery-Maids. m SAMUEL S. ADAMS, A.M., M.D., PROFESSOR OF THE THEORY AND PRACTICE OF MEDICINE IN THE NATIONAL UNIVERSITY. Third Annual Address to the Graduating Class of the Medical and Dental Departments of the Na- tional University,, Washington, D. C. Reprinted, from the Journal of the American Medical Association, July jo, 1887. CHICAGO: Printed at the Office of the American Medical Association. 1887 THE SYSTEMATIC TRAINING OF NURSERY-MAIDS. Mr. President, Ladies and Gentlemen: The achievement of some objects requires a life- time of arduous labor; the achievement of others is never attained; while the success of a few is guaran- teed from the start. If the object be surrounded by the most favorable circumstances its accomplishment is not a surprise; but when it is apparently obstructed by opposing obstacles, and then succeeds, even its enemies join in the jubilee of its success. We are here to-night partly to witness the triumph of an undertaking of the latter class, begun amid predictions of failure, because there were too many already in existence; the experiment would be ex- pensive; and the professors -were amateurs. They received only discouraging advice from those who had grown old in accomplishing similar things; but in the face of the gloomiest predictions from their dearest friends the young men constituting the faculty, strongly imbued with the aspirations of ambition, determined to undertake the work. They possessed the prerequisites of success : manhood, health, vigor, and a will to battle with discouragements. Some had never appeared before the unmerciful eye of the critic, and a few had only engaged in minor work where criticism is least likely to descend. They were will- ing, however, to struggle with adversity, because they believed that their united efforts would not be branded with the stigma of failure. Like most beginners, they were poor, but willing to work if a field could be se- cured. It was not long before a habitation was secuied for the first year. To be sure, it was poorly equipped and unostentatious, and in a portion of the city where it would hardly attract the glassing stranger. 2 It must be confessed they had very little to encour- age them the first year. The opposition to their work was apparent on every side, and even their warmest friends urged them to abandon it. What wonder, you will say, when I tell you that during the first term, at least three of the professors spent their best efforts in lecturing to one solitary student. The prospects for the second year were brighter; the opposition had begun to wane, outsiders offered encouraging smiles, and they entered upon their work with renewed vigor. They soon realized that they would not need the financial assistance of their friends. Many of those who had predicted failure came for- ward with valuable counsel. At the beginning of the third year it was evident that the building then occupied was too small for the work, and a larger one, in a more desirable part of the city, was secured. More appliances were intro- duced. This was to be the year of determination. If the project were a failure it would be abandoned, but if a success, then there would be the reward of a wider field, a greater work. Thus, after three years of hard work, without the hope of remuneration, and after surmounting many and formidable obstacles, we take great pleasure in presenting to-night our achievement: The Medical and Dental Departments of the National University. These schools were inaugurated under the most discouraging circumstances. There were three med- ical schools of National repute already in the city, and few people could see the necessity for the fourth. The Regents of the National University thought dif- ferently, and determined to establish it. The great- est opposition was to the Dental School. It was claimed that it could not be successful without a good financial backing; that the time had not arrived for such a school; and that young men could not con- duct a college. The results have proved otherwise, and these prognostications have not been realized. 3 The Faculty have a well equipped building in a de- lightful location; they have a free dental infirmary; and they do not owe a cent they cannot pay on de- mand. They have shown that incapacity to conduct a college is not a necessary attribute of youth. We think they have shown that a professional man does not require the restraining influence of age to accomplish a good work. In professional life there is, unfortunately, too much of a tendency among learned men to suppress the aspirations of youthful ambition, not so much because their work falls in merit below that of their seniors as because it is the work of youth, and therefore presumably immature. Youth would seem to be a stigma in the minds of those to whom gray hairs seem to be the greatest mark of mental capacity. You are young and your work has just begun. If you can discover the elixir of old age and will imbibe freely, you may hasten to achieve appreciation and with it success—though you may shorten your life; but who would not rather die even of old age in his youth, if thereby he can secure a lasting name through good work, fairly ap- preciated? A still greater misfortune is that of being an un- married doctor. You will hardly have quitted this hall, buoyant with the hope of a brilliant practice, ere some solicitous friend will inform you that you will never succeed as long as you are single. In- deed, you will be urged to marry just as if it were the simplest mercantile transaction. They will in- sist that you will have no trouble in getting a wife, and still less in supporting her. If one can judge by the number of single doctors, women are rather slow in sharing the responsibilities of early profes- sional life. To overcome the financial embarrass- ments you will be advised to secure a wealthy wife. But, judging from the number of poor married doc- tors, it is just possible that rich women are not so plentiful, or that they prefer other professions. Those 4 who object to you because you are single would find some cause for complaint if you were to marry to please them. The struggle for existence in the first years of practice is well known; the expenses are ever on the increase, and the problem of supporting two or more as easily as one is as difficult of solu- tion as that of the Sphinx. Do not get married with the expectation of an immediate increase in your in- come, because your wife might be more objectionable to your advisers than your youth and bachelorhood. Wait until your practice warrants you in assuming the responsibilities of a family, and then marry to suit yourself. If these two formidable forces greet you upon the very threshold, then you may as well settle down to the fact that you will have ample time for serious re- flection not only upon the possibility of success, but also upon the survival of the fittest. However, Dar- win to the contrary notwithstanding, success does not always fall to the fittest. The recognized fittest may have to struggle for existence, while the success of others, of far less mental calibre, will be phenomenal. The physician who is recognized by his colleagues as superior and successful, in a professional sense, is not always the most popular man with the laity. These qualities are discounted by others which, while not professional, you will soon discover are quite as valu- able as aids to early success. We may instance a few: Pleasing address; gentle ways; neatness; cheer- fulness; sympathy; and last, though not least, the aid of friends. The best recognition of a doctor’s ability is when one of his colleagues is taken sick; the pa- tient will not call the popular man, but the one who is recognized by the profession as the head of it. It might have been more charitable to have offered greater hopes for your early work; but it has seemed better to forearm you for the battle. “If there is any great and good thing in store for you, it will not come at the first or the second call. ‘ Steep and 5 craggy,’ said Porphyry, ‘ is the path of the gods.’ ” You will have plenty of leisure time unless you con- tinue to exercise your brain. The selection of a field in which you shall labor is not an easy task, so I may be pardoned for suggest- ing one. It is a field in which neither your age nor your bachelorhood will be objectionable; and it is one in which the laity will be glad to assist you. It is also one in which both branches of the class can take an active part for I believe all of you desire to benefit mankind. The field I propose for you is, so far as I am aware, a new one, but none the less wide and useful. It is that of organizing a training school for nursery-maids —that portion of our home-guard which manages your patients during the periods of greatest sickness and mortality: infancy and early childhood. That the management of children in general is wrong, unreasonable and unnatural is evident to any one who will consider the disproportion there is be- tween the physical and mental capacities of the present generations, and diligently seek the causes. We not infrequently meet in early life examples of unusual mental activity supported by a tottering physique; or in another case an early sacrifice of both mind and body. By excluding transmitted vices of constitution, this impaired mental and physical condition is in my opinion largely due to bad nursing and bad habits contracted in early life. As a method for the correction of the evils consequent upon the mismanagement of children I now ask you to con- sider the necessity for and desirability of the system- atic training of nursery-maids. In thus attempting to invade the sanctity of the nursery I trust that I may not be charged with tres- pass, as my sole object is to convince mothers of the importance of early training. My ideas on this sub- ject are not those of a doctrinaire but are the natural outgrowth of a decade’s experience with children of 6 different races and nationalities and of various sta- tions in life from the highest to the lowest. During this period the children that have passed under my care and observation have been in great part sick; but this has had but little weight in the formulation of my opinions. I feel that an experience of eleven years, much of it with children in public and private practice, will certainly justify me in offering a few suggestions to young mothers as well as young doc- tors. It may be said that it is unfair to judge of the early training of children from their manner, habits and conduct while sick. I admit the force of this so far as the child is concerned, but when we witness the glaring defects of parental management which are so apparent in the sick-room, we are justified in the conclusion that the like management in health cannot be what it should be. For although the dis- position of the child may be affected by disease the management of a sick child is a good exhibition of parental government. It is a sad commentary upon our boasted civiliza- tion that even educated women are not prepared for maternal cares, but are greatly dependent upon ig- norant domestics for that knowledge of infantile re- sponsibilities which should be learned in anticipation of maternity. There is a kind of modesty pervading the female mind which seems to prohibit all refer- ence to motherly cares by intelligent advisers. This important duty has been too long left to uneducated women who are influenced by the examples and transmitted customs of their great-grandmothers whose minds were warped by superstitious practices. Indeed, so sacred are some of these superstitions that any attempt to convince an “ old granny” that her methods are wrong will engender a prejudice against you that will have its effect beyond the nur- sery. Nursing is gradually becoming more conform- able to reason and common sense, though nurses still retain many traditional prejudices and, fancying 7 that nature has endowed them with superior skill and wisdom, they often do much harm where they in- tended to do good. If there is such a liability of young mothers being influenced by ignorant nurses to accept crude, barbarous and detrimental methods of nursery government, the importance of educating women for nursery maids would seem to be manifest. It cannot be expected that a mother can properly superintend the mental and physical development of her offspring until she has studied the necessities of childhood, the characters of children, and the conse- quences of good or bad management. It is in the nursery that many good and evil habits are formed. If the evil are overlooked they may possibly be cor- rected later in life at the cost of much suffering and trouble; but it is much easier to prevent bad habits than cure them; hence it would seem more profit- able to sow good seed in the garden and not leave the soil barren, trusting to luck for good fruit. It is no less true that the laborer in the nursery should be capable of distinguishing between traits of character which should be developed and those which should be eradicated. The education and early habits of nurses, and their training for the duty they are expected to perform, are sadly deficient. It is necessary to have their services, therefore, they should be trained for the work. In fact we complain of their bad qualities and ignorance, but seldom use any means to correct them. I do not hope to eradicate this evil in the lower classes, but it can be modified by instructing the mind and appealing to the reason and the best feelings of human nature by means of example, pre- cept, counsel and sympathy. The gradual removal of these defects can best be accomplished by enlight- ening the understanding of those who are to have charge of the nursery. It is a rule in all professions that a person must have a general knowledge of the work before he can 8 perform it, but this is not so in the management of the nursery. We expect the watchmaker to under- stand the mechanism of a watch, the groom to be familiar with the peculiarities of the horse, the cook to be proficient in the mysteries of the kitchen, and the maid to know the latest style of dress-making, hair-dressing, and millinery; but we are willing to entrust the delicate mechanism of a child to one of whom rarely more is required than a good name, a little experience, an even temper, and a recom- mendation which is seldom investigated to see if it is genuine. When mothers are convinced that some- thing more than these few attributes are essential to & competent nursery-maid, we may hope to see the mental and physical health of our children improved. All children require moral and physical treatment, and whether they be rich or poor their physical being demands proper food, proper clothing, sleep, ventil- ation and exercise; while their moral training re- quires example, discretion, and cultivated senses and faculties. In the higher walks of life a radical reformation in nursery government cannot be expected as long as the social duties of parents is such that the care of their children is consigned to a supposed competent maid hired to act as sponsor for their mental and physical growth upon no other justification than a neat appearance and a good recommendation from some unknown last employer. If I should as"k a mother what she considered the duties of a good nurse to be, I venture to assert that she would reply: to wash the child, dress it, feed it, put it to bed, take it up again, take it out for an air- ing, and not let it fall out of her arms. Now if she should ask me to define her duties, I would say that she should be capable of giving proper attention to the bodily necessities of the child and like attention to the necessities of its mind. I do not pretend to have any novelties to offer, 9 either in theory or practice, but only desire to define what the duties of a nursery-maid are and why they are her duties, and how she can best be instructed as to their performance. Her ignorance of the proper methods of nursing is a misfortune rather than a dis- grace. She should have the opportunity of being taught such methods by qualified instructors. The successful operation of the training school for sick-nurses has demonstrated the advantages of skilled nursing in the sick-room. It has seemed to me of quite as great importance to establish a training school for nursery-maids. With the aid of the former we can undoubtedly manage disease better; with the aid of the latter we may fulfil the higher mission of preventing disease. In an examination of the vast amount of literature in the U. S. Army Medical Library, upon the nursing and management of children, I failed to find any ref- erence to a training school for nursery-maids, so I may be the first to suggest such an institution. Its value will seem more plausible when we consider the natural method of instructing children which has been so successful in our public schools. The ease and rapidity with which children learn from object teaching will astonish the most sceptical. The school should embrace a corps of instructors whose duty should be to lecture upon various sub- jects appertaining to the nursing and management of children. The requisites for admission should be a kindly, gentle disposition, a good moral character, a healthy constitution, a prescribed age, and a limit- ed education. They should be taught the dietary suitable for different ages, and when and how it should become more liberal; the various qualities of foods, and the best methods of preparing them, and gener- ally their qualities in regard to digestion and assim- ilation. Another important subject to be taught in such a school would be the proper clothing for children, a 10 field in which there is ample room for reform. I hesitate to particularize lest in disentangling the limbs of the children I find myself the object of maternal indignation for thus rashly invading the peculiar province of feminine talent. A sleeping child is the picture of contentment. The bright smiles flitting across its face indicate the pleasant dreams of health. Sleep is its normal con- dition for most of its day and night, and if it does not sleep, it is because it has been overfed or is in a painful position, or has not had sufficient exercise, or is sick. Your nursery-maids should be taught all this, and what the indications of the various causes of unsettled sleep are. They should further be taught not to walk or rock the child to sleep, and instructed in the various methods of management, especially in this regard. They should be taught proper methods of open-air exercise for children; the effect of atmosphere, of exercise, of sufficient and insufficient clothing, the dangers and consequences of exposure, and the ne- cessity for constant and unremitting care and pru- dence when out for the daily airing. A few lectures upon the anatomy and physiology of childhood would prove beneficial in preventing the numerous injuries incident to rough handling, and in saving the child from the many troubles which are frequently the results of the violation of physiologi- cal laws. Another branch of instruction, and one of the most important, perhaps, should be in regard to the moral training of infants, for the influence of the nur- sery is great and very frequently continuous through life. She should be instructed that the infant knows practically nothing until it has been taught, and that the best means of teaching is by sight, hearing, taste, smell and feeling. As children learn largely by imi- tation, it follows that a good example, good manners and cleanly habits should be carefully taught as an 11 important branch of thie education of nursery-maids; and among things she should be taught not to do, is the indulgence in deception, vulgar talk, ugly facial expressions, ungraceful attitudes, the use of “ ghost stories” or thrilling narratives; and, in fact, the avoid- ance of all unseemly, indecorous and improper lan- guage and conduct in the nursery. I have no doubt that many of my hearers have seen the consequences of some or all of these. Finally, to conclude this brief summary of what should be taught in the proposed school, I have left to the last what may be, perhaps, the most important —the necessity for studying the various peculiarities of disposition and character, and of moulding and modeling the child with reference to them. With this brief resume of the scheme of instruc- tion to be pursued in the field proposed, I submit to you that if you will interest yourself in it, and by so doing succeed in correcting the numerous mistakes and errors now so common in the nursery, you will find that your earlier professional days will be pleas- antly employed, and that you will not have labored in vain. And now, a last word. I welcome you into the profession with feelings both of joy and of sorrow. To those who are to labor in distant fields, I extend a hearty God-speed and prayer for their early and complete success; to those who are to pitch their tents in this well-doctored city, I tender my heartfelt sympathy for the disappointments which may be in store for them, but at the same time add, that to those who strive earnestly, faithfully, and with reasonable capacity, there is always room and re- ward, and to all I say, never forget that he who is worthy of success will succeed; for, repeating what a famous teacher in another branch has said, I beg you to remember, “There is always room at the top! ” 1525 I Street.