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NLM 052fl555b  D
NATIONAL LIBRARY OF MEDICINE
SURGEON  GENERAL'S OFFICE

     LIBRARY.

  IHHBX    -*---

Section___________________________
  No. 113,   NO
W. D.S.G. 0.
.1
3—613
NLM052855560 
 
 
NURSES FOR OUR NEIGHBORS 
 
NURSES  FOR OUR
      NEIGHBORS
             /    BY
            X *
   ALFRED  WORCESTER, A.M., M.D.

Fellow of the Massachusetts Medical Society ; Member of the Obstetrical
  Society of Boston ; Ex-President of the Harvard Medical School
   Alumni Association ; President of the Waltham Training
     School for  Nurses; Chief of Maternity Service,
       Waltham Hospital; Consulting Physician
          Elliot City Hospital, Keene, N.H.
       Z / 9f73
    I/irrRABY
:iRfiPSfiFjn"H!^ (IFF
       JUL 10 1914
     BOSTON AND NEW YORK
HOUGHTON MIFFLIN COMPANY

            1914 
  Tranrf-tred from the Library

  OopyrishtAotofMoh.4,1909
COPYRIGHT, 1914, BY ALFRED WORCESTER,

      ALL RIGHTS RESERVED


       Published May 1Q14
        wy
         100


/^'Ax g$»c)^   2-f^^  jit
JUN--219J4

©CU374285c/^. 
TO E. J. W. 
 
NOTE
  Some of these chapters have been previously pub-
lished, — Chapter II in the Boston  Medical and
Surgical Journal,  a portion of Chapter VIII in the
Trained Nurse and Hospital Review, and several other
chapters, or parts of them, in the Waltham News
Letter. Permission  to republish  has  been  kindly
granted by these journals. 
 
              CONTENTS
   I. Our Common Problem               i
  II. Medical Methods Old and New   . 20
 III. Ideal Nursing: My  Search for It . 52
 IV. The Art of Nursing in the Old World 87
  V. Old-Time  Nursing in New England . 107
 VI. American Nursing Schools  .  .   .126
 VII. Responsibility  for  Shortcomings  of
       Modern Nurses.....145
VIII. How to get Better  Nursing  Schools 177
 IX. Amateur Nursing and Neighbor Help-
       ing  .........222 
 
     NURSES  FOR OUR

           NEIGHBORS

              CHAPTER I
          OUR COMMON PROBLEM
  How to take care of the helpless is the great-
est of sociological problems. Although it more
immediately confronts the medical and nurs-
ing professions, it also directly concerns us all.
For however vigorous any of us may be during
the days of our strength, at the beginning and
at the  end of our lives we are absolutely de-
pendent upon  the helpfulness of those about
us. Few escape at least temporary periods of
helplessness at other  times. And, even if be-
tween our own cradles and deathbeds any of
us may be so  fortunate as to escape similar
conditions of helplessness,  we know only too
well  the unlikelihood that  those whose lives
we love more than our own will escape such
conditions.
                    i 
     NURSES FOR OUR NEIGHBORS
  The  problem, moreover,  is by  no means
merely a personal one: it also directly concerns
the whole human family. The world is begin-
ning to realize that all suffer when one suffers,
and that all are weakened by the weakness of
any. As civilization advances, the instinct of
self-preservation thus extends its scope, first
to  include  the  immediate  family,  then  the
race, and finally all human creatures. But the
greater interest now being taken in the problem
of caring for the helpless is due, we may hope,
not so much to the extending scope of instinc-
tive self-protection, as to increasing kindness
and good will among men.  Much that has al-
ready been done, and much that is now being
done, justifies this  hope.  And undoubtedly
there is a larger supply of latent willingness to
help the helpless than has  yet  been brought
into action.
  In times of war and pestilence, and of other
national disasters,  helpers in abundance vol-
unteer.  But  in eras of peace and  prosperity
the common  forms of helplessness do not so
surely stir the hearts of those able to give the
                    2 
OUR COMMON PROBLEM
help that is needed. Even the existence of such
needs is often unknown; and where known it is
too often taken for granted that they are being
met by those who are supposed to be specially
employed for this purpose.
  It is true that the agents of the various char-
itable organizations, and the official dispensers
of the public charity, do a great deal of this
work. But even in such relief of the helpless,
the good-heartedness of the community ought
to be more plainly manifested. For not only is
the benefit to  the recipients of such charity
great in proportion to the heartiness of it, but
there is also a  still greater benefit at stake in
the effect of the giving upon the givers.
   It is therefore a double loss to the commun-
ity when the obligations resting upon all  are
delegated to the official few, and then ignored.
For the obligation of caring for the helpless is
really a privilege rightly belonging to the well
and strong.  And where this is entrusted to
physicians and nurses,  to hospital and dis-
pensary officers and servants, it is of highest
importance that those to whom the service is
                      3 
NURSES FOR OUR NEIGHBORS
entrusted shall be considered as the agents of
the community.  The worth of their work and
the character of the community alike depends
upon its being so considered by all concerned.
  And yet, after all, where one is cared for in a
hospital or by some other organized charity,
ten of  our helpless neighbors are cared for in
their own homes by their relatives. This too
often means  both  that the  care given  them
is  inadequate and  that the family is  over-
burdened.
  Without undertaking to discuss the question
if diseases and all other bodily afflictions are in
themselves evils, it may well be observed that
the  helplessness of the  neighbor, however
caused, affords fine opportunity for fellow-
service.  Separated  as  neighbors may be by
race and by other social characteristics, phys-
ical  helplessness levels  all such distinctions.
The pauper and the millionaire alike  are but
beggars then. And a flower or even a kind in-
quiry offered  at such times often is the begin-
ning of a lifelong friendship.
  In ideal conditions the infant in its  help-
                    4 
OUR COMMON  PROBLEM
lessness receives loving parental care, and the
aged are cared for by their children; but in the
great human family there are many orphans
and  many  childless  old  men and women.
Whose business is it to care for them? And
then  there are the defectives of every sort,
whose permanent or temporary helplessness
resembles that of infancy or of superannua-
tion.  Indeed, at first thought the number of
those needing help is appalling. But  in reality,
except in times of war or of pestilence or of
other great disasters, the number of the help-
less is small in proportion to the number of the
able-bodied.
  For many reasons this proportion is greater
in our cities than in the country. Conditions
of living among the poor  become steadily
worse as the density of the population in-
creases.  This is particularly true in English
and American cities, where  the  poor inhabit
certain districts of the city quite unknown by
the residents of the better districts. In Ger-
man cities, on the other hand, where the poor
live in the basement or attic  apartments, their
                     5 
NURSES FOR OUR NEIGHBORS
needs are known and supplied by prosperous
neighbors who live in the more desirable inter-
mediate flats.
  In our villages there is still much of the old-
time neighborliness; but in our larger cities,
where it is not so easy as it is in village life for
one family to look out for another, people eas-
ily forget and  neglect the duty of neighborli-
ness, and the whole business of looking out for
the neighbor in distress goes by default.  We
often know  of the death of a neighbor only
when we see the obituary notice in the news-
paper or crape on the door.
  Such conditions, however, are only appar-
ently heartless,  and are largely due  to the
specialization of labor that characterizes the
present age. In the old days everybody knew
how to do everything, but now one man knows
how to do and does only one kind of work.  For
instance, in  old  times every man was a  fire-
man, and at alarm of fire hurried to save his
neighbor's property from destruction.   But
now, in case of fire, every citizen knows that
the best service to his neighbor is to keep away
                    6 
        ,OUR COMMON PROBLEM
and  leave the field to  the  firemen  who are
specially trained and employed to fight fires.
But  what should be thought of a city where
the volunteer firemen go out of existence before
a regular fire department is organized?
  So, in taking care of the  sick, either those
who are well must go to  give help wherever
there is sickness, or else they must see that
somebody else is ready to go. If for no other
reason than the low reason of self-protection,
this  is one of the obligations of citizenship.
Pestilence unchecked is certainly as dangerous
as fire. And human life is surely as valuable as
house or barn.
   In order  to bring into action the general
willingness of the well and strong to help the
weak and the sick, wise organization is plainly
necessary.  But in most communities the great
need is not so much for new avenues of outlet
for kind-heartedness as it is for more effective
expression of it in lines of work already pro-
jected.  Too often it  happens  that what is
really of most value in charitable undertakings
is obscured or even entirely lost in their devel-
                     7 
     NURSES FOR OUR NEIGHBORS
opment.  Great endowments of charitable in-
stitutions sometimes serve, first to release the
community from all exertions for the mainte-
nance of these institutions, thus depriving the
institutions of public interest, and afterwards
to allow  wastefulness and callousness in the
managers of  them. And when such institu-
tions are adopted by the city government, to
be henceforth entirely supported by taxation,
the spirit of  them often is  sacrificed to the
greed and graft of politicians.  Even if such
disastrous consequences do not follow, never-
theless, when public interest disappears in any
form  of  charitable work, there is  always a
double loss; for the gift without the giver is
bare both to  the giver and to the recipient.
  In  the management of  such  institutions
there may be scientific accuracy and economy,
and in the treatment of the beneficiaries ex-
emplary technical skill, and yet woeful lack of
love and sympathy. The workers in such in-
stitutions, instead of being  the agents of the
community in  carrying into effect our com-
mon duty of neighborly helpfulness  to the un-
                     8 
OUR COMMON  PROBLEM
fortunate, often become infected with the arro-
gance of institutionalism. There are, of course,
frequent exceptions to  this  tendency,  and
many shining examples of good-heartedness in
institution officials.  But even such need the
encouragement of the people's interest in their
work.
  Although human necessities are much the
same the world over, there is often the widest
divergence in  contiguous States and even in
adjoining towns in the methods of caring for
the helpless. Probably there is no community
that would not profit by adopting methods in
use elsewhere. Until recently, however, differ-
ent cities and countries have known very little
about each other's charities. Travelers have
for long been well acquainted with the natural
scenery,  with the art  and architecture, and
with  the  political machinery of other coun-
tries, but only in later years have the different
eleemosynary methods received similar atten-
tion.  Much  good has already  been  accom-
plished  by conventions and  associations of
workers in these lines.  But so far theories and
                    9 
     NURSES FOR OUR  NEIGHBORS
statistics and possible economies have been the
principal subjects for the consideration of such
assemblages.
  This is a scientific age, and we may rightly
rejoice in the advance of scientific philan-
thropy.  But somewhere,  somehow,  there
must also be a more general forward movement
in loving fellow-service to the helpless. Hearts
as well as heads must be educated.  And the
first steps in this desirable movement must be
taken in learning  what has  been done and
what now is being done in the world around us.
Different methods of caring for the helpless
must be studied, their defects avoided, and
their excellences appropriated.  In this way,
and only in this way, can real progress be se-
cured.  The study of the outward mechanical
details of the different methods employed is
easy enough. There is,  to begin with, a large
amount of published material available, and
visitors in all charitable institutions can walk
through the wards and kitchens and laundries;
but the searcher after the  right spirit of such
work has a far harder task.
                    10 
OUR COMMON PROBLEM
    " A fugitive and gracious light he seeks,
      Shy to illumine; . . ."
There is, however, a charm in this very elu-
siveness of the subject. And amid most dis-
couraging conditions  lovely surprises  are  in
store for persistent searchers.
  Perhaps it is inevitable as life becomes more
complex that the higher and finer human qual-
ities should be deeper hidden.  We should not
wish them to be paraded, nor expect their sur-
vival  if they were. But,  on the  other hand,
buried talents not only fail of increase; they
are taken from us.
  In the simpler life of earlier days, and in the
simpler conditions of peasant life to-day, it is
far easier to find loving service to the helpless
than  it is to find it in modern charitable insti-
tutions.  And yet it cannot be doubted that
there is really more love for the neighbor as
civilization advances.  Our task,  therefore, is
to uncover it, that the light may  shine for the
guidance of those who have not yet learned
how to use their hearts.
  We hear nowadays  too much  about the
                     n 
NURSES FOR OUR  NEIGHBORS
infectiousness of disease  and of evil, and  too
little about the far greater contagiousness of
enthusiasm and  of loving-kindness.  It is all
very well to provide strict quarantine against
what is hurtful, but we should remember that
the surest protection of the human family is
ever to be  found not in negative but in posi-
tive living. Instead of guarding against  the
possible excesses of Socialism, it is far wiser to
strive for the blessings of universal brother-
hood.
  Inasmuch as most of the work of caring for
the helpless necessarily devolves upon physi-
cians and  nurses, who  in such service  are
really only  the agents of the community, it is
plainly a common duty to provide for the best
education and training of these agents.  As
regards the necessary scientific and technical
training, that of course can rightly be left to
the professions; but that is only a part of  the
preparation needed.
  We here  have additional reason for making
sure that all patients in hospitals and asylums
shall be cared for as perfectly and tenderly as
                    12 
OUR COMMON  PROBLEM
we  could  wish for our  dearest. For it is  in
these institutions that our future physicians
and nurses are being trained.  As they begin,
so they will continue: if from the first they
are not taught both by precept and example
to respect the sensibilities, to heed the yearn-
ings, to reverence the souls of their patients,
such  service need  never afterwards  be  ex-
pected from them.
  The asylums and hospitals, and the medical
and nursing schools, are supported by the pub-
lic or by endowments given by the laity. And
beyond doubt much good would result from a
deeper  public interest in them which is thus
warranted.  Great scientific progress has al-
ready resulted from the endowments of labora-
tories and professorships of research into  the
causes of disease. But as yet nothing has been
given to promote in medical schools the study
of the history, the principles, and the purposes
of  organizations devoted to the care of  the
helpless.
  Without such instruction it is folly to expect
from the medical profession wise leadership in
                     13 
NURSES FOR OUR NEIGHBORS
the formation and management of eleemosy-
nary institutions. Until some improvement is
made in this direction, and until the  art of
medical practice is as well taught  as  is the
science, we need not expect to escape the lack
of cooperation that now too frequently exists
in hospitals between their lay supporters and
their staffs. To modern surgeons and physi-
cians the sole function of the laity is to provide
the money for the hospitals and dispensaries.
They do not understand the  longings of men
and women to give their hearts, as well as
their brains and purses. Nor do they appre-
ciate the fact that the real  worth of  every
organization for helping the helpless depends
far more upon the love and kindness in opera-
tion therein than upon professional skill and
science.
  This failure of physicians and surgeons to
recognize that one of their  functions  is  to
serve as agents of the kind-heartedness  of the
community is not so bad as is  the same failure
of modern nurses. For to the nursing pro-
fession the arts of soothing,  comforting, and 
OUR COMMON  PROBLEM
sustaining have been especially delegated. In
surgical operations upon the poor and home-
less for the relief or cure of suffering, or for the
direct saving of life, the kindness of the com-
munity in providing the proper facilities may
or may not be seen. The excellence of the sur-
geon's work, it may be admitted, is not very
dependent upon such recognition.  So, too, in
the wards, excellent direction for the scientific
treatment of the patients can be given by a
surgeon oblivious of his function as the agent
of those whose hearts have been stirred to sup-
port the hospital. But when it comes to the
preparation of the patients for operation, and
the tending of them afterwards, and the long
day and night nursing in the wards, the sup-
porters of the hospital  ought to be sure that
most tender and devoted service is given. And
of this there can be no surety unless the nurses
recognize that, besides their duties as medical
and surgical assistants, they are also the agents
of the community and charged with its sacred
obligations.
   In small hospitals, and especially in those
                     15 
NURSES FOR OUR  NEIGHBORS
depending upon kind neighbors for daily sup-
port,  the nurses  are not so liable  to forget
this part of their duty as they are in large pub-
lic or  richly endowed institutions. And this is
one of the great advantages of the small hospi-
tal, both for the  patients and for the nurses
who are in training.
  In the home the nurse cannot help sharing
the anxiety of the relatives for her patient's
comfort. In her nursing she naturally delights
in carrying into action, for the patient's relief,
the loving desires of the family and friends. She
is their agent.  In the village hospital the influ-
ence of relatives  and kind neighbors  is still
potent,  working  through  the  nurses.  And
there  is no valid reason why the nurses in our
largest hospitals and asylums, in the care of
the friendless, should not also be the conscious
agents of the  love and kindness of the com-
munity.
  It is not enough in such service that the
nurse herself shall be a kind-hearted woman.
That, of course,  is  indispensable.  But she
must  also be the transmitting medium of a far
                    16 
         OUR COMMON PROBLEM
larger supply of love than any human heart
possesses.  Nurses belonging to the religious
orders, and those who believe with them that
the best nursing can be done only by the con-
secrated  servants  of God, rightly insist that
there is but one unfailing Source of this need-
ful love.  The high incentive of such  devout
souls is their belief that in nursing the friend-
less they are really serving the Master Him-
self.  Without intending the slightest  dispar-
agement of nursing thus inspired by religious
ecstasy, it may be observed that  this motive
is not commonly active in these days.  There
is, however, widespread  recognition  of the
fact that
" 'T is God himself becomes apparent, when
   God's wisdom and God's goodness are display'd,
   For God of these his attributes is made."
The increasing love of the neighbor is to many
of us the  surest sign of the coming of God's
kingdom on earth.  Those who thus  believe
find their highest incentive to loving  care  of
the helpless in realizing that such service is
what the community desires.  But this desire
                     17 
NURSES FOR OUR NEIGHBORS
ought to have fuller expression.  For without
question the character of the nursing service
in every institution, as  regards  the essential
qualities of kindness, devotion, tenderness, and
encouraging hopefulness, is directly dependent
upon the inflowing stream of kind neighborly
interest in the work of that institution.
■' • Not a flower that is brought, not a song that
is  sung in the wards,,  not a  friendly  visit,
misses  the mark.  The patients  are cheered;
somebody cares for them. The nurses are in-
spired by realizing anew that the surrounding
world, dreary and cold as it sometimes seems,
is still permeated with Love.
  Only  occasionally nowadays is the oppor-
tunity  given to succor a wounded wayfarer;
but countless opportunities offer to inquire at
the inn if every comfort is being given him.
Just as of old the host was commissioned by
the good Samaritan to take care of the poor
unfortunate, so the nurses of to-day must be
made our agents and assured of our continued
personal interest and support. '
  Success in bringing  about a better working
                    18 
OUR COMMON PROBLEM
relationship between the public and modern
nurses depends upon a more general knowledge
of the development and present status of this
new profession. This will be found to be the
subject  of several succeeding chapters.  But
before our study of modern nursing we must
first consider the changing character of medi-
cal practice, whereby much of what was form-
erly the physician's function is being trans-
ferred to the nurses. This we must do in order
to understand what may fairly be expected of
them.  We may hardly hope to influence the
development of a profession so firmly estab-
lished as is the medical, but in the case of so
new a profession as that of nursing, we can
demand with considerable confidence greater
attention to the humanities.; 
CHAPTER II
     MEDICAL METHODS OLD AND  NEW
  A third of a century ago it was commonly
remarked that medical science had not kept
pace with the advance of other sciences. Then
it might have been hard  to disprove 'the al-
legation, but no such  charge would now be
made.  For within recent years there has been
a rapid succession of brilliant discoveries re-
garding the causation of diseases. And already
much has been learned regarding the destruc-
tion of disease-producing germs.
  Many of the most dreaded diseases are ac-
cordingly in rapid progress of extermination.
It is practically certain that the time of great
epidemics in civilized countries is past. And
just as  surely many  of our endemic diseases,
such as typhoid fever, diphtheria, and tuber-
culosis, might  also  be exterminated.  Only
the application of knowledge already ours is
needed to rid civilization of these pests.
                    20 
  MEDICAL METHODS OLD AND  NEW
  These  facts regarding the wonderful prog-
ress of medical science are well known. But
not much has yet been said about the great
change that the medical profession itself has
meanwhile undergone.  The subject needs at-
tention.
  Let  us first bring into view the  typical
practitioner of forty or fifty years ago.  In some
of the villages, and in old-fashioned corners of
our cities, physicians can still be found who are
practising in much the same way that they
began, and, indeed, in much the same way that
their predecessors began to  practise.  For in
their youth they learned the healing art as ap-
prentices, which, in spite of present methods, is
really the only way any art ever can be learned.
These  old-fashioned doctors do not begin to
know as much about diseases as second-year
medical students now  know; but even when
they left the employ of their preceptors they
knew more  about patients than many med-
ical  graduates of to-day ever will know, for
in the formative  period of their lives they
had greater  opportunities for acquiring this
                    21 
     NURSES FOR OUR  NEIGHBORS
knowledge than  the modern  medical school
affords.
  If you have not known this passing type of
family doctor, and if you are incredulous of his
existence, follow one whom I will select for you
on his daily  rounds. Do not laugh at his old
buggy, nor at his rough-haired horse. Like the
doctor himself, and like his well-worn clothes,
they have seen better days.  For his  practice
is not so lucrative as it formerly was.  The
younger doctors in their  shiny  automobiles
have taken away many of his paying patients.
The specialists have taken most of the rest.
Nor do those unable  to pay even his small
fees in money pay him in kind as they used to
do. And, after he has paid for fuel and food
and provender and his excessive taxes, he has
little enough for  personal embellishment.
  Do not judgeTsy appearances.  Study rather
the man himself. Come in with him into this
cottage where the anxious mother is worn out
by long bedside watching.  Her daughter, till
lately her sole support, is plainly nearing the
end. Too well they both know it.  They have
                   22 
  MEDICAL METHODS OLD AND  NEW
no need of a scientific diagnosis or prognosis.
Little is there in that sick room to interest the
student of disease. It is only a case of common
consumption.  But just watch the old doctor.
See how slowly and quietly he seats himself by
the bedside, how carefully he feels  the pulse,
which still means more to him than does the
temperature, and how  carefully he  inquires
how she has slept, and if she has managed to
swallow the extra eggs  he has been urging.
Then see him  gravely nod his head in regret-
ful  assent  to  her  complaints, and listen to
his  skillful emphasis upon all the little favor-
able details in the story of the past night.
Has he all day to spend there? He shows not
the slightest impatience of the passing time.
He knows far too much of human  cravings
to take out his watch or tell of his hurry to
reach another patient.   For the time being
this one has all of his devotion.  She feels it.
His visit cheers and comforts her.  Nor is his
mission fulfilled the moment he leaves the
sick room.  His thoughtfulness for the poor
mother  prompts him to tarry in the garden
                    23 
     NURSES FOR  OUR NEIGHBORS
as he bids her rejoice in the clear air which
"surely will  make  her  daughter's  coughing
easier." He leaves no drugs, he writes no pre-
scriptions. Quite useless are his visits from the
scientific standpoint, useless,  indeed, in his
own estimation, and yet he goes there day
after day without so much as ever  entering
his visits  in  the  ledger.   Profitless  practice
this, according to modern estimation, but  it
is what he was taught to do.  Never yet has
he deserted a dying patient on the miserable
excuse that he could do nothing more.
  But  now we must hurry if we would follow
him.   His plan  was to  make all the visits
needed along this road, but  an imperative
call has come for  service  in an opposite direc-
tion.  And his life-long habit  obliges him to
inconvenience himself even  upon the chance
of being needed.  Often it is  a false alarm.  So
it  is this  time.  A  boy  had fallen from the
cherry tree. The neighbors thought him killed,
but it was only a stun and as soon as he caught
his breath it was evident enough he was living.
But his crying is hushed as the old doctor
                    24 
  MEDICAL  METHODS OLD AND NEW
drives hurriedly  into the yard.   "You were
quite right,"  he answers the mother's apolo-
gies, "to send for me; you were, of course,
terribly frightened, and it is far better to have
the child thoroughly examined."  The boy is
immensely relieved to see the doctor come in,
— the old doctor who always gives him a smile
as he passes.  Not that the doctor remembers
his name, any more than he can remember
the names of the thousands of other children
he has helped into the world, but there is never-
theless some bond of sympathy between them,
and the boy feels it. His faith in his doctor is
absolute. Without a murmur he lets him pull
off the little jacket and trousers, when only
a moment ago he was  screaming if they tried
to move him. And after the doctor has gone
the little fellow will fiercely resent any omis-
sions or changes in the treatment ordered.
Everything  the  old  doctor did and  every
word he said the boy will remember.  And
later when sick or suffering, if he cannot him-
self go to the doctor, he will  demand a visit
from him. Many a call comes to the old man
                   25 
NURSES  FOR OUR NEIGHBORS
both by night and by day "because the child
would have the doctor sent for."
  The morning's rounds have been interrupted
by this episode, and now we  can follow him
in some of the visits he started out to make.
But notice that before he leaves this neighbor-
hood he asks after several of his former pa-
tients.  "Has your husband found  work yet,
or is his rheumatism still preventing him?"
he asks of a sad-faced woman standing in her
doorway. " Is your mother comfortable these
days?" he asks of another.  And reining up
as he meets the fishman he inquires if "Mary
is doing well."
  As we drive with him into the factory vil-
lage one well might hesitate to enter the dirty
tenements.  For the day is hot, and even out-
side there is little comfort in breathing.  The
kitchens are fearfully close.   In one  there is
a desperately sick baby. The ignorant mother
is doing her best; but between washing and
cooking for  her large  family she  has little
time to brush away the flies or even  to scald
the nursing bottles as she has again and again
                    26 
  MEDICAL METHODS OLD AND NEW
been told she must do. More  discouraging
conditions  could not  be imagined.   What
earthly use is there in giving directions that
will not be followed ? Why, then, does not the
old doctor give  it up ? That is not his way.
Just listen to  him as he tells the mother she
does not realize how sick the baby is, and that
funerals cost more than proper nursing. Is this
the same man who an  hour ago was cheering
the consumptive girl's  mother? Yes, and  his
purpose is the same. He knows how to get the
most help for his patient.  In this case, only
by blunt exposure of the danger can he rouse
the  stolid, discouraged  mother into  action.
After her crying  is over she begs for help
and promises  to obey the orders.  The baby's
chances of recovery are bettered because it
will be better cared for during the next twenty-
four hours. Out  of loyalty to his profession, in
obedience to his  conception of the physician's
duty, the old  doctor forced himself into that
stifling kitchen,  triumphed over  his discour-
agement, and, in his intense desire to help the
helpless baby, he deliberately stirred up the
                    27 
     NURSES FOR OUR NEIGHBORS
mother's anxiety, and then, seizing the psycho-
logical moment, he impressed upon her his
directions.  He is himself pale and wearied as
he comes out. Nor is it wholly because of the
heat and closeness of the kitchen.  That is his
own diagnosis as he mops his wet brow.  But
really he is half faint from intense exertion.
He has given himself, his whole strength of
mind and heart, and the exhaustion of it is
tremendous.
  Can it be that the old man's strength has
been transferred to the  mother and that she
in turn can transfer it to the wee life that hangs
in the  balance? Could any  idea be more un-
scientific ?
  But we must not stop to analyze,  for al-
ready the horse of his own accord has stopped
at a shabby house.  Not a moment is lost. The
pale-faced  widow  herself  opens  the  door.
Everything is ready, so as to save the doctor's
time.  For years, ten or more, he has made
this semi-weekly visit to dilate an intestinal
stricture.  Except for his faithfulness, she long
ago would have died. True, she would have
                    28 
  MEDICAL  METHODS OLD AND NEW
been saved much agony, but her two children
would not have had the modest home her in-
cessant needlework has maintained for them.
No one would have known about all this had
not the old doctor in his pneumonia the winter
before begged the young physician, who took
care of him and his practice, to go on with this
service to the widow in case he should not re-
cover. "And please make no charge," he added,
"she has more than she can bear."  No words
are wasted. The dilatation is done. The widow
in spite of her tears smiles her gratitude, and
the old man hurries away.
  The forenoon has more than gone. He does
not mind that his dinner must be only  a
warmed-over affair; he is well used to that.
But he is worrying to have kept his  office
patients waiting.  Who are they? The first to
shuffle from the old parlor waiting-room into
the little box-like office, which years ago was
hitched on to the house, is a seedy, broken-
down young  man.  Dissipation and poverty
have made sad havoc. Now that  his health
has gone he appeals for help, and not in vain.
                    29 
      NURSES FOR OUR NEIGHBORS
For  the doctor listens to the dismal  story,
gives him some  medicine and only casually
adds the warning that while taking this medi-
cine not a drop of liquor must be drunk.  "If
you at any time feel  that you must have a
drink, come here to me for it." This he always
says  to drunkards.  Sometimes it works, as no
unsympathetic scientific treatment ever will.
And,  however hopeless to others the drunk-
ard's  disease  may  be, the old doctor  never
despairs.  Why should he?  Did: you not on
this morning's drive  see the fishman greet
him ?  Well, he was once a drunkard.  He first
came  to the doctor to have his scalp  sewn up
after a drunken brawl. By the time that was
well he had consented to work for a farmer
for his board.  For many days he was too weak
to be of much use, but the farmer owed the
doctor a heavy debt of gratitude and so for
the doctor's sake kept encouraging the drunk-
ard.  The priest also helped.  And when the
year  of pledge was nearly ended, the doctor,
keeping  the man in mind, with a small loan
helped him to a  hand-cart fish route.  That
                   30 
  MEDICAL  METHODS OLD  AND NEW
was years ago, but never a drop of liquor has
the man since drunk.
  The next patient in the office hastens to say
she has not come for professional advice.  She
wants to find work.  Her husband brings back
only a pittance of his wages, yes, and beats her
when  she can give him no meat for dinner.
Does  she  tongue-lash him? the doctor asks.
"Yes, who would n't?" Then he tells her the
old story  of the wife who tamed her brutal
husband by holding holy  water in  her own
mouth.  Does she ever herself drink? he asks.
And then, taking full advantage of her discom-
fiture, he encourages  her to try once more,
and still again, to make her little home more
lovely and attractive by doing the work in it
that she would do for hire in other homes.  He
has seen wives win by this method, he tells her.
  Now comes the richly dressed lady who has
not concealed her  impatience at having to
wait her turn. Volubly she rehearses her symp-
toms. One would think she was the greatest
sufferer on earth.  Not only are all of her vital
organs out of order; her maid has given notice,
                    3i 
      NURSES FOR OUR  NEIGHBORS
and that, too, when all of the next week must
be devoted to the dressmaker. No one gives
her help or even sympathy.   As for the last
medicine the doctor gave, she positively could
not swallow it, and when she did, "It made
her worse." In vain the old man tries to divert
her. No, she does not want to hear of  others'
woes;" that always makes her more wretched."
Her neighbors' poverty is their own fault; why
do they not save up against rainy days as she
herself does ?
  What can be done for  her? Her case would
discourage the saints. And yet she is diseased,
— and with the most intractable  of all dis-
eases. She is self-centered. But that does not
relieve the doctor from trying to save her. In-
deed, in spite of the annoyance she is to him,
he pities her. And as visions flit before him
of the vast amount of good she might do, of
the comfort she might be to her hopeless, ex-
hausted husband, to her poorer relatives, to
the sick and suffering in her own immediate
neighborhood, if only she could be persuaded
to look outwards and upwards, he braces him-
                    32 
  MEDICAL  METHODS  OLD AND NEW
self to one more supreme effort.  He tells her
squarely that her woes are all imaginary. Her
anger encourages him.  He takes up the long
list of symptoms she has related and shows her
how they contradict each other. His attention
to her dismal story gives him the upper hand,
for his memory of what she said is better than
hers.  Then he softens. Imaginary woes are
always worse than real woes, he tells her. And
when solid bottom has been reached, in answer
to her appeal for help he tells her how to get
up and out of herself. He does not confuse her
with his own long vista of the road she must
travel, of. the high ladder she must climb,
but he gives plain directions for the first steps.
He purposely proposes what  she  especially
dislikes.  He  insists that she shall call on the
Italian family whose cabin  she; has hated to
see built in the edge of the woods she blames
her husband  for not having preempted. He
does not tell her of the lame girl there who he
hopes will remind  her  of the little daughter
she never mentions. Reiterating his explicit
directions, he follows her out to her carriage,
                    33 
NURSES FOR OUR  NEIGHBORS
partly out of politeness, partly for his  own
relief to  see her go. Well has he earned his
fee, the first  one that will be charged on his
books for this day.
  The last to come  in is the saddest case of
all. At first brazenly lying, she soon surrenders
under his mercilessly plain questioning. Yes,
he is right. He has uncovered her secret woe.
She still  tries to evade all blame. Again and
again she protests that  it was only just once
she fell, and that was when no help was near.
But he has been waiting for just this chance.
When her father appealed to him to talk to
her, "to  scare her within an inch of her life,"
he knew too much to join in the useless coer-
cion.'  But now when she is crying so bitterly,
he can do something. Nor in his heart or from
his lips is there one word of condemnation for
the erring child. His very silence comforts her.
In pouring out her confession she finds peace,
not because of any priestly absolution he can
give, but because of her human nature and his.
For the time being he is her father, she is his
daughter. In answer to her piteous pleading
                    34 
  MEDICAL METHODS OLD AND  NEW
to be relieved of the burden she carries, and
of the inevitable shame, he tells her of the great
dangers and of the serious criminality involved.
He tells her that it is not only his own unwill-
ingness to go to State's prison, but his unwill-
ingness to murder the defenseless, that com-
pels  his refusal.   And then he gives her the
chance to go into retirement, he promises to
stand by her and her child so long as they all
shall live. Lovingly he pleads with her.  Yes,
he will be the one to break the awful news to
her parents, and he will  plead with them that
she shall not be cast  out into utter darkness.
  After such a day the  old doctor surely de-
serves to have rest. You who are only follow-
ing him may well be weary.  But  no, Mrs.
Jones's labor has begun.  He too well remem-
bers  what hard labors she always has. It will
be a long night's job for him. Of what use is
it to go out there  now?  Nevertheless,  he
goes. She will have more courage if she knows
he is near at hand. And, besides, there is the
old paralyzed farmer hard by who has lately
been sinking peacefully  away. True, he is ab-
                    35 
     NURSES FOR OUR NEIGHBORS
solutely unconscious, and his devoted daughter
knows his release is near. But then she has never
seen a  body die, and, though long expected,
the end will be a great shock to her. Moreover,
is it not his business to help at the going out
as it is at the coming in? He remembers  his
old preceptor's teaching; and never if he can
help it will he miss standing by his dying pa-
tients.  Too many times he has been repaid by
the last handclasp, and by the last look of un-
speakable gratitude, to doubt such opportuni-
ties for fellow-service. And besides, he knows
how those just bereft  need, as at no other
times in their lives, a strong friend to lean
upon. He remembers how tottering he himself
was when his own dear ones left him.
  We need not follow  him further,  either in
his loving welcome of the newborn child or in
his steadying influence  at the deathbed.  Nor
need we watch him as he returns, completely
tired out, thankful that the world  is asleep
and that  he at  last is  alone with the stars
which from his childhood up have calmed him.
   So much for the passing  type of medical
                    36 
  MEDICAL METHODS OLD AND  NEW
practitioner, the old family doctor, the beloved
physician. Who is taking his place? How are
the medical students of to-day being taught
the art of medical practice?  Was there no-
thing lost when in the evolution of medical
schools the old apprenticeship  system was
given up?
  In the old days a young man who wanted to
be a physician entered into the service of the
most successful practitioner within reach. He
studied anatomy and recited his daily lessons.
Occasionally he had furtive opportunity for
dissecting. He did the chores. He rode and he
lived with his preceptor, who handed down to
him the lessons he himself had learned  from
great physicians gone before. Of course only
the common, everyday ailments were  thus
studied.  There was little learned  about the
nature of diseases, but there was a lot thus
learned about  human helplessness.  After-
wards, in similar  emergencies,  the  man  so
trained would instinctively imitate his teach-
er's methods. And in this way was handed on
from  one generation  to another the art of
                    37 
      NURSES  FOR  OUR NEIGHBORS
curing or of caring for the helpless. We need
not give more than passing notice to the use-
fulness of the courses of lectures and surgical
operations that the young medical student
had to attend in order to get his diploma.
But it is not out of place  to insist  that, how-
ever valueless in comparison  with laboratory
research  didactic  lectures are,  nevertheless
there is positive value to the medical student
in the opportunity to hear and see great phy-
sicians and surgeons giving forth their best.
  The modern medical school offers most ad-
mirable opportunity  for the study of disease.
In the laboratories, and in the hospital wards
and morgues, diseases can be studied in cul-
ture tubes, in human patients, and in guinea
pigs.  But, what opportunity amid such re-
search is there for the study of human nature?
Ability to diagnosticate disease is all very well.
It is one of the necessary foundations for medi-
cal practice, but it is not the only foundation.
A knowledge of materia medica is also a nec-
essary foundation, but of what use is it to
a physician ignorant of therapeutics ? In  the
                    38 
   MEDICAL METHODS OLD AND NEW
hospital and dispensary classes it is true that
modern medical students can see all manner
of diseases.  They can see what treatment is
ordered.  They may see the same patients a
second or even a third time.  But what can
they there learn of  the healing  art?  What
inkling can be taught them there of the truly
serviceable relationship between physician and
patient?
p.  It is generally believed that physicians now-
adays rush into  specialist practice because
of their desire to excel in some one direction.
Such may be the reason with some, but with
many the compelling reason is their sense of
unfitness for general practice.  In the special-
ties it is not necessary to know one's patient,
it  is enough to know his disease; whereas in
general practice poor diagnosticians are often
very successful, because of their  knowledge
of human nature and of the art of caring for
human helplessness.
  There is,  in short, a  radical difference  be-
tween the science of medicine and the art of
medical practice. In the former education of
                    39 
NURSES FOR OUR NEIGHBORS
physicians  little attention was  paid to the
science of medicine, and, indeed,  there was
then not much medical science; but the art of
medical practice was taught.  In the modern
medical schools science is enthroned.  Carried
away by the brilliance of etiological discov-
eries, the whole strength of the schools is de-
voted to the study of diseases. The art of
medical practice is not taught; even its exist-
ence is hardly recognized.  And in consequence
the graduates of the medical schools of to-day
are not properly fitted for the practice of their
profession.
  This is a sweeping charge.  Let us see if it
can be substantiated by  a study of  the new
kind of doctor.  To make the contrast as plain
as possible, let us see how he would meet the
problems that we have just seen confront the
old physician. We must of course make allow-
ance for the difference in age and experience,
but some of the new kind of doctors are by no
means young, and not all of the old-fashioned
doctors are even yet so very old.
  Moreover,  they  both continue to practice
                    40 
   MEDICAL  METHODS  OLD AND  NEW
in the ways they were taught.  One was taught
to think first of the patient, to get into direct
close relationship with him, to feel his pain and
misery, and to strive in every way  to relieve
him.  As a means to this end some  thought
was of course to be given  to the disease.  The
new kind of physician, on the other hand, has
been taught to give his entire attention to the
disease,  and even the  idiosyncrasies of pa-
tients are noteworthy to him only in so far as
they serve to modify their diseases.
   So when we go with the younger doctor into
the consumptive's cottage, it will  be on his
weekly instead of his daily visit.  What if the
girl is dying, is it not of that most uninterest-
ing (because so common)  disease? Moreover,
are they not poor,  and so is it not better to
avoid a large account against them ?  But never
mind his reasoning; come in with him. Brusque
and hearty, he wastes no time.  See him un-
cover the poor girl's chest  to percuss it, and to
listen through his stethoscope to the choking
respiration and to the fluttering heart beats.
Oh no, he never omits that process. Not that
                    4i 
     NURSES FOR OUR  NEIGHBORS?
he supposes it will do any good; he does it
simply because he does not know what else to
do. It is the way he was taught to treat con-
sumptives.  His  answer to her complaints is
another prescription, or another kind of tab-
lets. To the anxious mother he is honest.  He
tells her, what she very well knows, that her
daughter is failing rapidly. He tells her of the
danger to herself of infection, and that no one
can do anything for the poor girl; and, utterly
oblivious of the preciousness to the mother of
every day and hour of her child's life, he almost
voices his own wish that the end shall come
soon. Little wonder is it that families so treated
turn in  their desperation to the Christian
Scientists and to the charlatans who, either in
their absurd denials of the existence of  dis-
ease or for mercenary  reasons, at least leave
some hope in the sick-room.
  The small boy who fell from the cherry tree
will fare better than the consumptive has fared
at the scientific doctor's hands, for although he
will yell while being examined, he will never-
theless be told that no bones are broken.  And
                    42 
  MEDICAL METHODS OLD AND  NEW
his mother will have some comfort in hearing
that, unless some  internal damage has been
done, the boy will be all right again.
  How will  the sick baby's mother fare?  As
far  as  frightening her,  he can do that well
enough. And he can scold her for not follow-
ing his directions.  Instead of the broth  ad-
vised by the old doctor, orders will be left for
some complicated milk modification,  far be-
yond the  mother's  ability to prepare. Very
likely the baby will be studied more carefully;
its dejections at any rate will be. And if only
his orders are carried out, the baby will have
better  chances  of  living.  For it will hardly
feel, and at  any rate will  not remember,  the
doctor's lack of sympathy; and  the  mother
deserved her scolding. Will he go there again ?
Possibly, but not unless sent for, and it is not
at all unlikely the summons will be for another
physician.
  The  contrast between the old and  the new
methods of  medical practice is most glaring
in the department of midwifery. It used to be
recognized that child-bearing after all is some-
                    43 
     NURSES FOR OUR  NEIGHBORS
thing of a natural process, and that most
women if let alone get on very well with having
their babies.  Indeed, it  is not so very long
since doctors  were  first allowed to be present
on such occasions.   It is of course quite true
that obstetric science has saved the lives of
many mothers and babies who otherwise would
have been lost.  And it is also true that many
mothers  and  babies have  been sacrificed by
meddlesome midwifery and by infections car-
ried into the  lying-in chamber  by physicians.
Just at the time when this fact dawned upon
the medical profession, and when it would have
been very becoming of doctors to hide their
heads in shame for their  past blunders, the
new school of obstetricians, instead of return-
ing to a more proper trust in nature, began to
treat this most natural process of child-bearing
as if it were an unnatural surgical operation.
  It was necessary only  that  the doctors
should disinfect themselves. But, lo and be-
hold, they insisted upon such elaborate disin-
fections of the  poor mothers and upon  such
expensive provision for the expected event,
                    44 
   MEDICAL METHODS OLD AND  NEW
that no wonder the problem of race suicide
has engaged presidential attention.  No pru-
dent family could afford to be caught twice.
The outrageously unnecessary expense, how-
ever, is a small part of the damage. The chief
harm of modern  obstetric practice has come
from  requiring such abnormal  preparations,
and such needless subsequent invalidism, that
common folks have come to consider child-
bearing as a burden to be avoided.
  We need not try with the scientific doctor
to  follow the  old physician's  practice too
closely. Some of the latter's patients would
never come to him, or stay with him long.
The widow with the stricture would have been
operated on long before. Perhaps she would
have been made well; and perhaps she would
have been otherwise relieved of her burdens.
  Neither the drunkard nor the wayward girl
would  be so likely to appeal to the  modern
doctor. And if they did, they would not detain
him long.
  The self-centered lady would be given a
name for at least some of her imaginary dis-
                    45 
      NURSES FOR OUR NEIGHBORS
eases. For a time she would be highly gratified
by his attention to her symptoms, by his min-
ute examination of her body and of its excre-
tions. And he will surely find some organ out
of order. It is his business to do so. He does
not yet know that persistent  search for the
abnormal in human bodies will reveal some
trifling trouble nine times out of ten.  Nor does
he yet know enough to keep to himself such
discoveries, at least until he has carefully esti-
mated their insignificance. He has yet to learn
how rapidly physical  defects  become worse
under the concentrated attention of the pa-
tient and of the patient's family and friends.
His ignorance of human nature allows  him,
and his scientific prowess inclines him,  always
to reveal the defects and infirmities that Na-
ture herself is so kindly concealing.  His devo-
tion to what he conceives to be the truth is
admirable.  On  the other hand, his implicit
trust in his own observations and in his own
opinions  is appalling.  While concerned with
examinations of the excretions, or of the dead
body, his methods are unimpeachable, and his
                   46 
  MEDICAL METHODS OLD AND NEW
conclusions are scientifically sound; or, more
strictly speaking,  are  in  accordance  with
present scientific theories and hypotheses. It
is when dealing with the mysteries of life  that
his science fails him. He has not been taught
the therapeutic value of sympathy and of en-
couragement.  In his search for diseases and
for  their causes he is far  ahead of the  old-
fashioned physician. In the prevention of dis-
eases he can be of  immense use to the com-
munity.  That is his real calling.  That is what
he has been trained for. In short, wherever
knowledge of disease is needed, there the mod-
ern doctor excels. But his training has not
fitted him to be a physician.
  Much of human helplessness  is not due to
disease.  There is first the  helplessness of in-
fancy, and then the helplessness of old  age.
And between  these two extremes  there are
many helplessnesses of body and mind which
cannot be classified as diseases.  There is, for
instance, the helplessness caused  by imaginary
disease.  Scientific hypnotism, it is true,  may
succeed well with that, but often not so  well
                    47 
     NURSES FOR OUR NEIGHBORS
as the common-sense  treatment of old-fash-
ioned physicians. And then there is that most
common kind of helplessness depending upon
inadaption to environment. The relief of such
helplessness can be effected either by change
of surrounding influences or by a change of
the patient's very self.  But how can inadapta-
bility be  changed  into  adaptibility, or how
can the patient's environment be changed by
one who studies only the supposed disease and
knows nothing of the patient himself or of his
family and material surroundings?
  While many of the old-fashioned physician's
patients will not  be  found  in  the  modern
doctor's card-case catalogue, some clinical his-
tories can be found there which illustrate the ad-
vance that has been made in medical science.
And not a few of  these histories, it must be
admitted,  begin with a record of  mistakes in
diagnosis and in treatment which old-fashioned
physicians have made in these cases.
  In some few instances the cure has been ob-
tained by the use  of modern medicines;  but
in most instances,  where, after failure of old-
                    48 
   MEDICAL METHODS OLD AND NEW
time methods, modern science has succeeded,
credit will belong to the surgeon rather than to
the physician.  Such  successes are  startling,
and no one would attempt to belittle the fame
of the modern surgeon. But in this study of
old and new methods of practicing the healing
art one may at least inquire about the unsuc-
cessful and perhaps unnecessary operations.
Perfect hospital asepsis  affords  wonderful
operative immunity. Anaesthesia allows surgi-
cal liberty if not license.  And in consequence
of these two great advances in medical science
the character of surgeons has changed.  In
former years only unavoidable surgical opera-
tions were performed.  The greater  danger to
life and  the awful sufferings of  the patient
deterred even the boldest surgeon  from un-
necessary mutilations. Now when  there are
no such deterrents, when only unconscious
patients lie on the operating  table,  and when
the danger of wound infection has been elimi-
nated,  the surgeon's cacoethes secondi  is un-
restrained. We will not speak of the grievous
wrong of unnecessary mutilations, nor of the
                    49 
      NURSES  FOR  OUR NEIGHBORS
financial allurements in modem surgery, but
we must speak of the surgical patients' suffer-
ings during convalescence.  These sufferings,
although of shorter duration, are no less severe
than they always have been. And if the mod-
em surgeon had to spend the following night
with his patients, he then might realize what
it is to emerge from anaesthesia into a perfect
hell of pain and misery.  But this is not the
modern surgeon's way of doing business.  He
must have rest and recreation in order to keep
his nerves steady for the morrow's cutting.
His patients'  sufferings might disconcert him.
So, in response to their begging for his attend-
ance, he telephones his directions to his assist-
ants and nurses. He may even forget to inquire
if his patient  has survived the operation.
  For  the highest surgical success it very
likely is necessary that  surgeons should be
thus relieved of personal relationship with
their patients, and of all acquaintance with
their sufferings. But,  even admitting the right-
ful existence of some few  such specialists, is it
a matter of no concern that the medical  stu-
                     50 
  MEDICAL  METHODS OLD AND  NEW
dents of to-day are being educated to such in-
humanity?  While being taught  modem sur-
gery, should they not also be taught the art
of relieving, of soothing and comforting those
who suffer, and of steadying and supporting
those who walk in the valley of the shadow? 
CHAPTER III
    IDEAL NURSING: MY SEARCH FOR IT
  Perhaps it is an inevitable consequence of
the amazing advance of medical science, dur-
ing the  past  forty  years,  that physicians
should no longer devote so much of their time
and attention to the immediate care of their
patients. When they have made the diagnosis
and given the prognosis, they content them-
selves with directing the treatment. Then they
take their leave, to return in a few hours or
days or when summoned. Their duty, as they
see it, is done. Now, this is all very well when
the doctor can be sure that his directions  will
be followed, and that his patient, between his
visits will be as well taken care of as if he were
at the bedside. But, just  as no ship captain
can rightly go to his cabin unless sure of his
mate's ability to follow the course, and in
emergency to do as much  as he himself could
do  for the safety  of the ship, so no doctor is
                    52 
  IDEAL NURSING: MY  SEARCH  FOR  IT
excusable for leaving his patients in the  care
of nurses he knows nothing about.
  The responsibility for the immediate  care
of the  sick has  been  shifted within  recent
years from the medical to the nursing profes-
sion.  This transfer has gone too far. That the
doctors know they have no right to their free-
dom thus gained, and that nurses have none
to the independent authority they have been
allowed to assume, is plainly shown in the dif-
ferent way they arrange for the nursing care of
sick millionaires and statesmen, whose wealth
or prominence adds nothing, of course, to
their  right of life. This elementary Christian
principle was  only lately exemplified by the
officers and other heroes of the Titanic.  The
same  obligation  of impartiality in the saving
of life rests also upon physicians.
  If the objection be made to my illustration
that in the care of sick magnates there is no
need  of such  constant  medical  oversight of
the nursing as is commonly lavished, then let
only such cases be considered where in  the
physician's judgment his constant attendance
                    53 
NURSES FOR OUR NEIGHBORS
would be of advantage. Not in every battle
need the general be at the front.  Usually he
can trust his subordinates to execute his or-
ders, but that is because he has selected and
trained them or at least has made himself sure
of their ability and discretion.   In any case
he himself is responsible, not for the issue of
the battle, but for having everything done
that can be done to win.
  In the same way the physician is justifiable
in leaving the immediate care of his patients
to their nurses only when he has trained them
or at least has made himself sure of their in-
telligence and faithfulness.  It is not enough
that they have been  recommended by some
employment  agency,  or have  passed  some
state examination. Nor is it fair to put upon
the patient's family, as he often does, the whole
responsibility of selecting  his lieutenants.
Plainly it is  the physician's business to know
more than he generally does know what ideal
nursing is and how to get it.
  As civilization progresses,  one kind after
another of our common human duties becomes
                    54 
 IDEAL  NURSING: MY  SEARCH  FOR  IT
specialized. In ruder times there was only the
division between  man's work and  woman's.
Even that division was not clearly defined,
and one sex must often have undertaken the
work more properly belonging to the other.
In spite of the current notion that there is no
really proper man's work that cannot as well,
if not better, be done by women, there can be
at any rate no question  that some kinds  of
work can be done by women much better than
by men.  Thus women must have always ex-
celled, as they now and forever will excel,  in
caring for  the helpless.  But in this  age  of
specialization of labor, this work, that so pe-
culiarly belongs to womankind, has  within
recent years been delegated to the profession of
nursing.  I need not point out the importance,
not only to the physicians whose business it is
to direct the nursing of their patients, but also
to the women who have thus, and perhaps too
hastily,  surrendered  their peculiar field  of
service, of knowing just what is involved in this
new specialization. What is meant, what ought
to be meant, by trained nursing?
                    55 
NURSES  FOR  OUR NEIGHBORS
  In succeeding chapters I shall try to answer
these questions.  But now I shall only tell
what I have happened to see and hear while
searching for the ideal in nursing.
  My mother was one of the old-fashioned
night-watchers, as those women were called
in New England, who were always ready to
help care for sick neighbors. As a boy I heard
much of what she did for them, and later when
I had begun my medical practice I sometimes
had her help as the volunteer nurse. I am sure it
is not merely from filial pride that now in look-
ing back I consider her nursing in its efficiency
and  tenderness nearer the ideal than what
would generally be considered excellent to-day.
I state this conviction in order to emphasize
the fact that nursing is not a new but  rather
an old art. And an art, of course, can be learned
only by imitation of masters of it. Proficiency
comes afterwards by long experience, provided
always that it is heart work as well as head
and hand work. This was the way  the old-
time neighbor night-watchers learned the art
of nursing. Nor  was their  after experience
                    56 
  IDEAL NURSING:  MY SEARCH FOR IT
small. My mother, for instance, could count a
hundred babies  she  had seen born.  And I
doubt not she also had stood by helpfully as
many more older folks whose lives were hang-
ing in the balance.
  In the fact that some  women considered
especially able were thus " improved " in neigh-
bor nursing, there was already a beginning of
that specialization we now see so highly de-
veloped. A second stage was exemplified by
the old-time experienced nurses, as they were
called, who were paid moderate wages for their
services. A great mistake has been made and
a great injustice done in classifying them as
"Sairey Gamps."  Such may have been  the
type in London; but not in this country. Many
of them were better  nurses than the  average
trained  nurses of to-day.   They  were hard-
working, self-respecting, honest, kind-hearted
women.  So, at least,  were all I have ever
known.   Bigoted, no doubt, they were, and
less teachable the older they grew. And they
were never very young; for in point of fact
only middle-aged women "went out nursing."
                    57 
NURSES  FOR OUR NEIGHBORS
No one of them I ever knew was willing to ad-
mit she did not know everything. That,  in
their estimation, would have been destructive
to their stock in trade.   But, in spite of all
these  rather trying characteristics, these old-
time nurses were immensely useful.
  I shall not describe here the very different
class of  women who were the hospital nurses
of the past. They were a bad lot, judging from
what  I  have heard, and from the reports  of
the investigating committees. They were to be
found only in the hospitals, never  undertaking
private  family  nursing, and by  my  student
time, thirty years ago, the large hospitals were
already  redeemed by the new training  schools.
Only their unsavory memory remained.
  We have now reached the third and present
stage  in the development of the profession  of
nursing.
  Forty years  ago I remember  a charming
visitor at our home, Dr. Susan Dimock, try-
ing to persuade my mother to allow one of my
older  sisters to enter her training school for
nurses,  which she was about  to  start at the
                    58 
  IDEAL  NURSING:  MY SEARCH FOR IT
New England Hospital for Women and Chil-
dren. This was the earliest American school for
nurses. My mother's objections were empha-
tic.  Contrary  ^o Dr. Dimock's insistence,
that such a  school and such a career was en-
tirely suitable for well-educated young women,
my mother maintained that nursing, excepting
of course volunteer  neighbor nursing, could
properly  be undertaken only  by mature
women who must in  some way work for their
living.  To her the idea of a daughter leaving
her parents' home for such a calling was in-
tolerable. She knew of Florence Nightingale's
Crimean  service. Who did not! But she knew
nothing  of  the Nightingale  School at  St.
Thomas's. I remember feeling at the time that
Dr. Dimock somehow was right in her con-
tentions.  And I shall never forget her earnest-
ness and her disappointment as I drove off
with her  to the  railroad station.
  In 1883, as house  physician in the Boston
Lying-in  Hospital,  I was suddenly confronted
by the nursing problem, in all  its  perplex-
ity.  I was told that I was responsible for the
                    59 
     NURSES FOR OUR  NEIGHBORS
nursing service,  and that  if any nurse was
disobedient or inefficient I must discharge her.
That was before there was any pretense of a
training school there. The nurses came to earn
their living and to learn how to do that par-
ticular kind of nursing in private service after-
wards. They were of all sorts, and had been in
the habit of behaving toward the house physi-
cians, and with them, about as  they pleased.
There was no head nurse. Fortunately the ma-
tron, Mrs. E. J. A. Higgins, one of the ablest
and finest women I have ever met, heartily ap-
proved my decision that thereafter all criti-
cisms of the nurses should be given to them
through her. This innovation the nurses natu-
rally enough  resented.  I was boycotted and
duly informed in a letter signed by them all
that I need expect from them only written
communications.   This proved  to be a help
rather than a hindrance; for it was the begin-
ning in that hospital of written orders and writ-
ten reports. They were obedient, and before
long, in spite of themselves, they began to be
interested in the course of lectures I gave them;
                    60 
 IDEAL NURSING: MY SEARCH FOR IT
very likely the more readily because they knew
that these lectures were given in disregard of
the objections of the hospital staff, in whose
opinion nurses should learn only from experi-
ence and without the aid of theoretical instruc-
tion or  any explanations  of the principles
underlying their duties. Some of these nurses
turned out very well.  From them I  learned
many a valuable lesson.  My ideal of  nursing
began  to take definite shape.  And the year
after, in private practice, I sorely missed their
help.
  After  having worked with pupil nurses, I
could not get on with the old-time experienced
nurses, who either would  not or could not
record even their inaccurate observations.  I
might have learned how to work with them
had there been more occasion for it; but it was
seldom their services were  to be had, even
after hunting the town over for days at a time.
As  a class  they were already disappearing.
There were, in place of them, a  few of the
modem trained nurses, but only  in  rare in-
stances could such be afforded by my patients.
                    61 
     NURSES FOR OUR NEIGHBORS
Nor were these always satisfactory when se-
cured.  To my great disappointment the grad-
uates of the few schools then existing, excellent
as their work had been in the hospitals during
their training, when  given  private practice
could not accommodate themselves to  such
very different service.  This I found to my
great surprise was also tme of the nurses I
myself had trained in the Lying-in Hospital.
In many ways, hard to define because the real
spirit  of good service is  here involved, the
modern nurses were not  so helpful as  were
their untrained predecessors. This failure was
particularly noticeable in  the nursing of con-
valescents and of chronic cases, which,  after
all, give  physicians and  nurses  by far the
largest part of their occupation.  There  is no
doubt of the fact that modem nurses as a class
have not even yet fully succeeded in satisfy-
ing either the physicians or the families where
they have served. Some few have been  help-
ful, comforting angels. Many more have given
faithful  service  and have well earned  their
wages, for which alone, as they freely  say,
                    62 
 IDEAL  NURSING:  MY SEARCH FOR IT
they have labored. Some have not even taken
pains to conceal their positive dislike for their
work.  Plainly such women show either their
personal  unsuitability for the nurse's calling,
or the lamentable results of improper training.
  Had I  not elsewhere, in reports of the Wal-
tham Training School, described in full detail
my efforts to train nurses, I should here have
to tell that story; for I have described the pre-
dicament I was in when beginning my practice.
Realizing how important it is for the patient
to have the best possible nursing I felt myself
forced  to provide it for them.  Either  I must
do the  nursing myself or I must see that it was
done by  others, who knew, at any rate, all I
could teach them.  And as soon as our school
of nursing was fairly begun, this  obligation
was vastly extended, for then I  was forced to
provide that our pupil nurses should be taught
as much  as any one  could teach them. This
led  me to search the world for ideal methods
of teaching nurses.
  In the  spring of 1888 I had my first  chance
to visit hospitals abroad. I had read every
                    63 
     NURSES FOR OUR NEIGHBORS
publication about nursing that I could  find,
and was convinced that after Miss Nightin-
gale's classic "Notes," the best work was by
Miss Eva C. E. Liickes, the matron of the
London Hospital.  When I went there and told
my kind guide, Dr. Mackenzie, in answer to
his question as to what I especially wanted
to see, that I wanted to meet Miss Liickes, I
was surprised to hear him say that he would
see if that were possible.  In this country if
the superintendent of nurses was wanted, she
came when summoned.  But there, we went to
her outer office, explained our desire to her
courteous office nurse, and were informed that,
by waiting perhaps half an hour, we might
"see  matron." Before that time expired a
pleasant lady came out of the sanctum.  Dr.
Mackenzie bowed low  and  whispered to me,
"The Princess Beatrice." We were then  ush-
ered in. It was matron's receiving afternoon.
She greeted me cordially and gave me an ap-
pointment for the next day. Then,  and also
when I have since visited her in the charming
apartment provided by the Hospital for her
                    64 
IDEAL NURSING: MY  SEARCH  FOR  IT
use at Bexhill-on-the-Sea, I realized how dif-
ferently hospital matrons are regarded in Eng-
land and in America. There they recognize that
hospitals, after all, are really homes for the
sick, and that there can be no home even for
well folks unless there is a woman at the head
of it. Until these elementary facts are also re-
cognized in this country, and until our  ablest
women undertake this noble service, we need
not expect any higher development of Ameri-
can nursing.
  I will not at this time tell about other great
nurses I saw during my first visit to the many
other famous  London  hospitals, nor could  I
within short  compass  acknowledge the help
I so gained. To Miss Swift of Guy's, and to
Miss Monk of King's College Hospital, I am
especially indebted. But I must not leave Miss
Liickes without thanking her  for her kindness
in the  years following; for not only have we
had her valuable criticisms of all we have at-
tempted in our Waltham School, but our nurses
have again and again been most cordially wel-
comed in  their  long  visits  at the London
                    65 
NURSES  FOR  OUR NEIGHBORS
Hospital and at Tredegar House, where her
probationers are trained.
  Eight years afterwards, in 1895, I saw Flo-
rence Nightingale.  I had been told that it
was out of the question, for she in her invalid-
ism would not see even old friends, and never
strangers, especially men. I wrote to her that
I had been studying  Fliedner's deaconess
school at Kaiserswerth-on-the-Rhine, where
she was trained, and that now I wanted her
direction in studying the varying methods of
training in England. She replied very kindly,
but referred me to the excellent matron of St.
Thomas's, Miss Crossland, who  was at the
same time the superintendent of the Nightin-
gale School for Nurses at that hospital.  That
was  all very well, but, as I afterwards wrote
to Miss Nightingale, I had not yet found the
authoritative guidance I needed for my own
undertakings. Then she very kindly gave me
an afternoon appointment.  You may be sure
I kept it! But my cabman evidently thought
me crazy when I would not let him stop at the
Marble Arch, through which, as  the bobby
                    66 
 IDEAL NURSING: MY  SEARCH FOR IT
confided to him, Queen Victoria was soon to
pass.
  At the door of her modest home, near Park
Lane, I was met by a nurse who took me up-
stairs into a large drawing-room.  There, re-
clining on her couch, as she had been forced
to do for forty years,  was Florence Nightin-
gale, the most famous woman of the nineteenth
century.  Her beautiful snow-white hair, her
lovely fresh complexion, her sweet voice, no
one could have helped noticing  and forever
remembering.    She kept asking questions,
about Kaiserswerth, and about our Waltham
School, which she criticized because of the
too large amount of didactic instruction given
there. She had read everything I had sent to
her, as I soon discovered; and she said she could
not understand why we thought it necessary
to teach nurses so much anatomy, for instance.
Tea was soon served.  She poured my cup,
asking just how I wanted it, and when I was
too busy with  my questions, she called my
attention to the fact that it was cooling, and
finally said it was evidently not to my liking.
                   67 
     NURSES FOR OUR NEIGHBORS
Then I had to stop to drink it.  Fearing I was
overstaying, I started to go, but she  kindly
urged me to stay longer, and finally, in answer
to my beseeching, she advised me to take for
my model one particular school to which she
gave me her introduction.  She was far from
pleased and satisfied with the hospital training
schools as they had developed, and  especially
with their failure to attract the best women.
Whereas, she went on to say, she at first had
had difficulty in  persuading young women to
undertake the nurse's calling,  and then got
only the very best, now floods of applicants
came, but generally only  from mercenary
or sentimental reasons.  When at last I was
tearing myself away, she detained me for a
moment longer, asking God's blessing for me
and for my work.
  During my visit I had been  given her per-
mission to send to her any of our teachers of
nursing who might go to England for further
study. Most graciously was her promise to
help them kept, and they would be  far better
able than am I to tell how much the Waltham
                   68 
  IDEAL NURSING:  MY SEARCH FOR IT
School owes to Florence Nightingale.  And I
must hurry on to describe the training school
that she advised me to take for our model. It
was the school selected soon afterwards by the
Queen's advisers as most worthy of extension
by the Golden Jubilee Fund, which she had
decided to use for the furtherance of nursing.
The Metropolitan  and National Nursing As-
sociation was even then the sonorous name of
a small institution. When I went to its modest
headquarters,  I  found to my surprise both
pupil nurses and  their teachers out.  And
where?   "Why  in the districts, visiting the
sick  poor," was  the  answer.  There I found
that probationers were thus given their first
lessons.  If they proved their aptitude, then,
and only then, were they sent to the hospitals
for one year of training and afterwards taken
back for the completion of their course in the
district work.  Miss Amy Hughes, who after-
wards became the chief of the Queen's Jubilee
nurses had been the superintendent, but I saw
only her assistant and successor, Miss Grey.
  Now the light began to  shine.  Here was
                    69 
     NURSES FOR OUR NEIGHBORS
realized  Miss Nightingale's  heart-wish for
nursing:  the true spirit of helpfulness to the
sick  and suffering was made  of first import-
ance. Technical  skill and theoretical educa-
tion, the latter in only moderate amount, were
to come  later in the pupil nurse's training.
Their hearts were first to be exercised by bring-
ing their kind impulses into action. This as was
there believed can be better  done in the pa-
tients' homes than in the hospital wards; and
as years go by I am more and  more convinced
that this way, which  Miss Nightingale  com-
mended,  is the true way of  training  nurses.
But, as  I  must regretfully acknowledge, in
this  conviction the Waltham School stands
almost alone; and,  for  attempting  to follow
this ideal, its graduates are ostracized by every
nurses' organization of America.  Even  from
the leaders of the nursing profession we have,
with few exceptions, met only  with condemna-
tion. But our critics are not to blame.  Their
own education and  training has been  in hos-
pitals only, and they fully  believe that such
education and training is all that is needed to
                    70 
  IDEAL NURSING:  MY SEARCH FOR IT
fit women for  highest usefulness in private
nursing. Under this system, it is true, hospital
nursing has been revolutionized, but nurses,
alas, have become institutionalized.
  Some years ago, after I had been pleading in
a Canadian city for the establishment of visit-
ing nursing, in commemoration of Queen Vic-
toria's Diamond Jubilee, a lady came forward
with this sad story.  From her mother she had
learned the joy of volunteer neighbor nursing,
and then to fit herself better for it she had
taken the course of training in one of the large
Boston hospitals. After graduation she had
served for several years as a head nurse there.
Then she  came home,  intending to resume
neighbor  nursing.  But, to her dismay, she
could not do so.  Somehow she had lost the
power,  and she said she never knew why.
Evidently it was not that she now knew too
much, nor that her technique  was over-devel-
oped.   No, it was simply because her love  of
fellow service had not been equally amplified.
That greatest of motive powers is God-given,
and, like  every other talent, if  buried  in a
                    7i 
     NURSES FOR OUR  NEIGHBORS
napkin, is lost forever. In the large hospital
wards she had given faithful service to many,
but with whole heart devotion she had served
not one.  Infected with the spirit of much of
the modern practice of medicine, she had been
interested in the diseases more  than in  the
individual sufferers therefrom.   I  hasten to
say that such a result of hospital training is
in my judgment by no means necessary; and
it may not be very common.  Let it be taken,
then, as only an exaggerated example of a
dangerous tendency in  modern  methods of
training.
  Ten years ago, I had reason for hoping that
the education of nurses would be undertaken
in several of our leading universities. Harvard
University at that time was ready to under-
take a school of nursing in connection with its
Medical School if sufficient funds were pro-
vided.  And I was commissioned  to study  the
whole  subject.  That gave me a  year  for
further  search in training schools here and
abroad for ideal nursing and ways of teaching
it.  I will not even summarize my many  dis-
                    72 
  IDEAL NURSING: MY SEARCH FOR IT
appointments. It will better serve my purpose
to give some of the encouraging finds.
  In  the German hospital of Philadelphia I
found the nursing very like what before I had
admired in the deaconess hospitals in Germany,
and yet these nurses were not  deaconesses.
How, then, had the beautiful spirit of conse-
crated service been transplanted ? I asked their
chief, who, with tears of gratitude for apprecia-
tion she said she seldom received, insisted that
any excellence  in her  pupil nurses was due
wholly to the fact that she, their teacher, had
been trained in Neuendettelsau, near Nurem-
berg.  Thither I hurried.  Could I only put in
words what I there saw and heard, that would
be enough.  My lay readers would then under-
stand what I mean by the ideal, by the true
spirit, of nursing.   And yet most  modem
nurses would laugh at the story. Where, they
would ask,  was the hospital? In fact it was
not easy to find, so tiny was it.  And what of
the creche, with its happy well-fed babies, or of
the home for the aged, where every one was
busy in doing something for others, and not, as
                    73 
      NURSES  FOR  OUR NEIGHBORS
in such "homes" here, wearied by being done
for; — and what of the  asylums for rescued
women, for the blind, the epileptic, the insane ?
Surely, as most modern nurses will say, it is
not in such service, nor  in the visiting of the
sick in their cottages, that a proper training
in nursing can be given. No, not from their
point of view.  But, be it ever remembered, it
was in just such an institution that the great-
est nurse who  has ever lived was trained, and
that with this  training she was able to revolu-
tionize hospital nursing.  There were but few
beds in the Kaiserswerth Hospital; at Scutari
there were thousands, yes, and more thousands
of sick and wounded men waiting for beds to
be emptied.  This shows the egregious folly of
estimating the value of  a nurse's training by
the number of beds in the hospital where she
serves; for her efficiency, of course,  depends
solely upon how well she is taught to meet,
yes, and  to forestall, the countless needs and
wants of  each  individual of the very few that
any nurse can  simultaneously take care of.
  The fact is that our modern nurse and the
                    74 
  IDEAL NURSING: MY. SEARCH FOR  IT
old deaconess can neither understand the other.
Thus to the stiffly starched, white-uniformed
American nurse the soft, dark-blue gown of
the deaconess seems very un-nurselike; it does
not mstle enough. The difference, however, is
far deeper than the garb.  It is in the spirit.
Our nurses cannot  understand the pious mo-
tive that  inspires the deaconess, that makes
for her all drudgery a joy; nor can they appre-
ciate the  importance in  the sick-chamber of
her gentle demeanor and jealous prevention of
every disturbing noise.
  There may not be among our nurses, on the
other hand, so much worldliness as the dea-
coness would conclude, for our nurses often
conceal their better selves, and, indeed, many
seem to affect a worldliness that is not really
theirs. They think they  must have seen and
must talk about  the latest plays, that they
must read the novels of the day, and be well
up in society gossip.  Whether or not this is
affectation on their part, nursing is not  the
real vocation of such women. If ever they have
felt the soul-satisfying delight of helping  the
                    75 
     NURSES FOR OUR NEIGHBORS
helpless, they have somehow lost the guidance
of that feeling; and we miss  the lovely shine
of it in their faces, the sweet sound of it in their
voices, and in their hands we miss the tender-
ness of touch. This lack in  them it is that
makes us wish we might have with us, when
our last hours shall come, nurses more like the
dear old motherly deaconesses.
  Some years ago I was in Berlin at  the time
of the International Congress of Nurses.  For
months I  had been admiring the work,  and
especially the spirit, of the German nurses.  I
knew something  of the nursing in every one
of the  hospitals, and I offered to  serve as
guide to any of my countrywomen who  had
come to that congress. But they told me that
they had been forewarned  not to waste their
time in  visiting  the Berlin hospitals,  where
they would find  nothing worth seeing, and,
moreover, that their time would be fully occu-
pied with their business meetings. I succeeded,
however, in persuading some of them to go
with me in the early mornings to see how won-
derfully the ward work was done when the
                   76 
IDEAL NURSING: MY  SEARCH  FOR  IT
night nurses were reinforced by the day shifts;
and at the noon intervals to see how the chil-
dren's wards were hushed and darkened for the
little patients' naps; and to the special wards
for the dying, which are always next the chapel
so that the organ and the old German hymns
the sisters sing may be the last sounds heard,
to see there  how  beautifully the dying are
soothed and comforted.
  From Germany we went to Switzerland  to
see the  famous training school of La Source
at Lausanne.  It was founded by the Count
and Countess de Gasparin in 1859 for Protes-
tant laywomen, thus antedating by two years
the Nightingale school at St. Thomas's in sep-
arating the profession  of nursing from the re-
ligious vocation.
  To those who believe that nurses can be
well  trained  only in hospital wards, the re-
sults of  the school of La Source will never be
intelligible; for not until after half a century
of its existence did the pupil nurses  have any
hospital training,  and even now the  small
hospital conducted by the school has only  a
                    77 
      NURSES FOR  OUR NEIGHBORS
few beds.  The training has always been given
in the homes of the patients and in the dis-
pensary for out-patients.   Each day the pupil
nurses assemble in class  for lectures and de-
monstrations.  In their visiting nursing they
have  constant teaching supervision.  Better
nurses have never been sent forth from  any
school. Not only in private service, but also as
matrons of large hospitals and as  head nurses
of wards  and operating-rooms, these nurses
have won  enviable distinction in many differ-
ent countries and consequently are in great
demand.
  It was  a  great pleasure to  meet the able
director of the school, Dr. Charles Krafft, and
to see and hear  his admirable teaching.  No
better instructions for nurses have ever been
published  than his concise explanations of the
principles  involved in the nursing of sufferers
from all kinds of maladies and injuries.  And
no  other  nursing  journal has equaled  the
"Organ de l'Ecole de  la  Source" in empha-
sizing the tme spirit of nursing. It is beautiful
to see how reverently they cherish the memory
                    78 
 IDEAL  NURSING:  MY SEARCH FOR IT
and counsels of the noble and pious founders
of the school.
  Mrs. Rebecca Strong, of Glasgow, was the
first  to recognize  the necessity of teaching
pupil nurses the physiology they need to know
before giving them work in the wards.  Until
then, and in fact as  even  now is  the case in
ninety-nine of every hundred training schools,
this theoretical instruction was given to them
in their spare hours, no matter how tired their
bodies and brains  might be with  long day or
night nursing.   Mrs. Strong saw the wrong
and folly of this, and she obviated it by insti-
tuting the first preparatory course of theoreti-
cal instruction for probationers. Had she done
nothing more for the  advancement of the nurs-
ing profession, no such pilgrimage as I had un-
dertaken would  be complete  without visiting
her at the Royal  Infirmary.   Moreover, she
had been so kind and helpful to the principal
of our Waltham School, years before, and we
owed so  directly to her our own  preparatory
course, that it was  a duty as well as a privilege
to make this visit. We expected much and were
                    79 
NURSES  FOR  OUR NEIGHBORS
more  than rewarded.   No one after seeing
her could have any fear that, by emphasizing
the factor of  intelligence in  nursing, there
need be any sacrifice of the other equally
important factors of technique and heart de-
votion.
  In Edinburgh, I  was told that if I wanted
to find out how Scottish nursing had attained
its excellence, I must see Joseph Bell, who has
been described by Conan Doyle under the
name of Sherlock Holmes. So I rang his door-
bell, and was admitted to his  library. There
at a large desk-table sat the  man, thin and
spare and white-haired. For an age, it seemed,
he neither turned nor spoke, although my name
had been shouted by the butler.  When finally
he deigned to notice my intrusion there  came
a volley of questions, "Who are you?  Where
are you stopping? How did you know enough
to go to that old-fashioned inn,  the best we
have? Is your wife  here with you ?" I tried to
answer, but he did not seem to heed my words.
He looked me over and up and  down. Then
he  rang for the butler and fired off at him,
                   80 
 rIDEAL  NURSING: MY SEARCH  FOR  IT
"What have we in the house to eat?  Can't
you get a duck or something or other for these
Americans?"  Before any answer could come
from the butler, I was bidden to go, but to
return with my wife "at seven precisely."
  With some trepidation we went, but a more
gracious host than old Joseph Bell never  was
or will be. After dinner he told at length  how
in the late sixties they had appealed to Miss
Nightingale  for her help  in reforming  the
nursing at the Royal Infirmary, and how she
had  sent  to  them from St. Thomas's Miss
A. L. Pringle, who in the sixteen years of her
matronship had revolutionized Scottish nurs-
ing.  And then he told how, after Mrs. Ward-
roper's leaving the Nightingale school, Miss
Nightingale  asked for Miss Pringle's  return
to St. Thomas's.  There was a great outcry
against this, but remembering their obligations
they felt bound to comply.  So their great ma-
tron went to St. Thomas's; and from there,
within a  few years,  because she  became a
Roman Catholic, she  was allowed  to resign.
This was bitterly told.  "Had she become a
                   81 
NURSES  FOR OUR NEIGHBORS
Buddhist, she would not have been allowed to
leave Edinburgh," he added.
  Acting  upon his advice, I  sought Miss
Pringle, and to my joy she agreed to come to
America and for a  short term to take charge of
the Waltham Hospital. As happily  she is still
living, and in active service, I dare  not speak
of her as I fain would do; but without more
than passing mention of  her remarkable char-
acter and career the story of my search for the
ideal in  nursing would be marred by a serious
omission.  In the two years she was with us
we saw  in everyday faithful service Florence
Nightingale's favorite follower.  We saw how
each patient, and every  patient's family and
friends,  received from her the loving welcome,
the real sympathy, the individual interest,
that all  who suffer in mind or body  crave and
need. We saw them encouraged, and, when
that was impossible, comforted. No one who
was ever privileged to work with Miss Pringle
could afterwards doubt the possibility of ideal
nursing.
  I cannot close this chapter without  saying
                   82 
  IDEAL NURSING:  MY SEARCH FOR IT
something  of Pastor  von  Bodelschwingh's
work. If there is any one institution where may
be seen in operation, in the care of every kind
of human helplessness, the true spirit, the high-
est ideal of nursing it is at Bielefeld, in West-
phalia.  Not since Theodor Fliedner has there
been such another directing genius. To see the
man was like a benediction; but "No, no," he
said, "it is not me you  must want to see; it is
the work, the work."
  The story in part may be read in "The Col-
ony  of Mercy," but so far as I  know, this
greatest humanitarian work of the age has no-
where been properly described.  Five thousand
more or less helpless men, women, and chil-
dren were under Pastor von Bodelschwingh's
care at the time of my visit.  Every single one
of them was happy!  And the  double reason
of that evidently was that each was receiving
individual loving care  and each was at the
same time working for others. Not till the last
breath is any one there deprived of this privi-
lege.  For instance, in  the children's ward, a
dying girl was radiantly happy because she
                    83 
     NURSES FOR OUR  NEIGHBORS
was still allowed to soothe by patting with her
wasted hand a hopelessly deformed younger
child who, the nurse said, was always quieted
when crooned to by this little comforter.  Out
in the courtyard were partially crippled tots,
merry at their task of sweeping away the fallen
leaves.  We watched  them till  they hurried
to their benches where, before  dipping  into
their bowls of porridge, they folded their small
hands and asked God's blessing.  By the river-
bank we met a half-witted boy dragging along,
one on each side, two almost helpless idiots.
No one else, we were  told, could make those
idiots take their daily walk.  All three were
happy, but the boy's face was radiant. "My
mother is coming to see me," he called out to
us. "Once a year she makes this  visit," we
were told, "and he is  always looking forward
to the next time."  In the  Feier Abend Haus,
the home for the happy close of this life, an
aged blind woman was busy rolling bandages,
humming to herself meanwhile.  When asked
why she sang she answered because every one
here and God above is so very kind. But it
                    84 
  IDEAL NURSING: MY  SEARCH  FOR IT
was plain that one reason for her  happiness
was in the work she was given  to  do.  This
foundation of happiness for the disabled, only
lately recognized in this country for its thera-
peutic value, is the main principle not only
in the Bielefeld institutions, but also through-
out Germany.
  In Kaiserswerth years ago I was taken into
the garden to see their oldest nurse. She was
not of the first year's class, for she  entered
Fliedner's school during its second year. She
had long since had her golden jubilee, after
fifty years  of nursing service. There she sat
under an apple tree, then in full blossom, busy
counting the linen  as it had come from the
laundry. Behind her was a smiling young pro-
bationer keeping tabs, who, in a voice aside,
told us that the dear old nurse could no longer
count straight, "but we never let  her  know
that." Here evidently  is one of the princi-
ples of  perfect  nursing service, — to supple-
ment the patients' inability and  incapacity in
such self-effacing ways  as may  most surely
escape notice, all the while providing for them
                    85 
NURSES  FOR  OUR NEIGHBORS
just so much occupation of mind and body as
will refresh and not fatigue them.  But this,
after all, is only one of the countless methods
of the art of nursing, and not of much use is
this or any other method unless employed by
those who find their deepest joy in loving fel-
low service.  Only such can ever be excellent
nurses. 
CHAPTER IV
 THE ART  OF NURSING IN THE OLD  WORLD
  Unlike  all other arts, the art  of nursing
belongs distinctively to the Christian dispen-
sation.  Undoubtedly  the sick and suffering
have been  more or less tenderly cared for by
their friends from the beginning of civilization,
but the obligation of caring for all the helpless
was first taught  in the parable of the  good
Samaritan.
  In apostolic times pious women began  to be
set apart and consecrated as deaconess nurses.
One of them, Sister Phcebe, is described by St.
Paul in his Epistle to the Romans as having
been a " succourer of many," among them him-
self.  She was a district visiting nurse, and no
better description of such service has  since
been given. But nursing was only one of the
early  deaconess's functions.  She was also a
missionary, a teacher, a dispenser of alms, and
an assistant in the church services.
                    87 
     NURSES FOR  OUR NEIGHBORS
  In the early centuries of the Christian Church
there were many followers of Phoebe's example.
In Constantinople, for instance, in the year
400, there were forty such women serving as
parish  nurses, and in 600 a.d. the Patriarch
of that city dedicated the church of  the dea-
conesses, which remains to this day,  but now
serves  as a Turkish mosque.
  During the Middle Ages  many  different
religious orders were  established with the care
of the sick for at least one of their objects, and
by the eleventh and twelfth  centuries hospi-
tals came into existence.
  Immediately  following the Reformation
there was a revival of the deaconess orders in
the Protestant churches.  In the " Confession
of Faith" of one of the Mennonite congrega-
tions of Holland, dated 1632, there is an elabo-
rate definition of the  deaconess's duties as par-
ish  nurse that would serve to-day; and there
are records  in Amsterdam of such service in
the preceding  century. It is interesting to us
New Englanders that the Pilgrims during their
sojourn in Amsterdam had a deaconess nurse.
                    88 
     NURSING IN  THE OLD  WORLD
  During the sixteenth and seventeenth cen-
turies the great nursing orders of the Catho-
lic Church were founded, the Ursuline Sisters
of Charity in 1537, the St. Vincent de Paul
Sisters in 1634, anc* the Sisters of St. Carl
Borromeo in 1663.
  Many nursing orders of  women and some
orders of male nurses have since been organ-
ized both in the Catholic and in the Protes-
tant churches.  But none have done so much
for the advance of  the art of nursing as the
Lutheran deaconess orders of Germany, which
were founded in the second  quarter of the last
century.  The most famous and the earliest
of these deaconess nursing  schools is the  one
established in 1836 by Theodor Fliedner at
Kaiserswerth on the Rhine. In a way this was
a revival of the early deaconess institution, but
really it was much more. It  was the first train-
ing school for deaconess nurses.
  Three years earlier Fliedner had established
an  asylum for discharged  women prisoners;
and this rescue work became  a part of  the
Kaiserswerth deaconess  institution, and also
                    89 
NURSES FOR OUR NEIGHBORS
a part of many others that have since been
founded on the Kaiserswerth plan.
  Another department of these institutions,
which still largely occupies their attention, is
the kindergarten and children's school. This,
in so far  as the care of orphans is concerned,
is  nurses' work; but it has been extended in
many of the deaconess  institutions not only
to day schools for the neighborhood, but also
to great  boarding-schools, the income from
which  largely serves to support the institu-
tions.
  The deaconesses are also employed in vari-
ous other directions — partly for the service of
the surrounding community and partly  for
the income thus derived—which cannot by any
stretch of definition be considered as belonging
to the nurse's calling.  In  many of these em-
ployments it is true that occupation is found
for the reformatory girls, for the orphans, and
for other wards whose partial helplessness is
due to defects  of body or of mind.  The  su-
perintendence of such defectives, of course,
rightly belongs to the nurse.  But, on the other
                    90 
NURSING  IN THE  OLD WORLD
hand, in many of these employments only the
deaconesses themselves are occupied.
  The one controlling purpose of the deacon-
esses' life work, as it is of the Catholic Sisters,
is that of saving their own souls and bringing
others to the knowledge and service of Christ.
Accordingly greatest  stress is laid upon re-
ligious observances. The deaconesses are con-
secrated  in the churches; they  work under
the immediate control of the clergy, and in
reality serve as their assistants.
  The Protestant  deaconesses, however, are
not so strictly bound to the  Church as the
Roman Catholic Sisters are. They are free to
leave at any time.  They may even marry if
they choose to do so, without the slightest re-
proach, although that of course involves their
separation from the order. They serve wholly
without pay; but their home and clothing and
pocket money is given them, and when sick
or helpless from age or other cause they are
beautifully cared for by the "mother house."
  As regards their strictly nursing work, which
now alone concerns us, it is rightly considered
                    9i 
NURSES  FOR OUR NEIGHBORS
as a notable advance upon all preceding nurs-
ing.  As Dietrich,  in his history of nursing,
says, "It must not be forgotten that, through
the  introduction  of  deaconess  service  in
the hospitals  and  district  visiting nursing,
there instantly came  an  improvement, and
one might  say an  awakening, of the practice
of nursing  throughout Protestant countries,
which led to the great improvement of hos-
pital methods."
  When we remember the preponderating in-
fluence of Germany in the wonderful medical
advance  of the last century we  have great
reason to  be  thankful  for the life work of
Theodor  Fliedner.  He was born in 1800, and
died in 1864. There were then sixteen hundred
deaconess nurses working in four hundred dif-
ferent places.  In 1897,  sixty-two years after
the work was begun  in Kaiserswerth, there
were fourteen thousand such deaconess nurses,
belonging to eighty mother houses, and work-
ing in all parts of the world.
  And yet, although the number of deaconess
nurses is still increasing, nevertheless their
                   92 
NURSING  IN THE  OLD WORLD
influence in the profession of nursing is waning.
Even at the most celebrated of the "mother
houses" in Germany there is a growing scarcity
of probationers.  In America it has been proven
very difficult for the deaconess institution to
find foothold.
  As missionary stations in heathen countries
the deaconess hospitals are still of great service,
veritable  oases in the desert, and homes of
refuge for travelers. In some parts of Europe,
as for instance  in Westphalia, where during
recent years there has developed  a mighty
religious revival, the deaconesses are still the
main  dependence in caring for the helpless.
But in  the larger cities of Germany,  where
half a century ago they were the only good
nurses,  their nursing work is now equaled if
not surpassed by that of the lay nurses.
  Although the  deaconess influence in  the
nursing world is not what it formerly was,
nevertheless no history of nursing and no sur-
vey of present methods of caring for the help-
less can  be complete without giving to deacon-
ess nurses a large share of attention.  As has
                    93 
      NURSES  FOR  OUR NEIGHBORS
already been pointed out, like the Catholic
Sisters of Charity they are busy in various
other employments; and, only in lesser degree
than the Sisters, the deaconesses make  their
religious observances  of  first  importance.
Nursing in  their estimation is distinctly  a
Christian service.  In feeding the hungry, in
clothing the naked, in visiting the sick and the
prisoners, they fully believe they are minister-
ing unto their  Master.   One of the famous
mottoes of  the deaconesses is,  "What  do  I
desire?  I desire to serve. Whom do I desire to
serve? The Lord, and his poor  and  suffering.
And what is to be  my reward?  I  serve for
neither  reward  nor  thanks, but in  gratitude
and love: that I am permitted to serve is my
reward." Their inability to understand how
nursing service  can be well performed by lay
women unconnected with the Church probably
reproduces the feeling of the monks a  thousand
years ago when the practice of  medicine was
first separated from the priesthood. And, just
as the world now accepts medical service  from
physicians who not only  are unbelievers in
                    94 
     NURSING  IN  THE OLD  WORLD
Christ but who even deny the existence of the
soul, so in the matter of nursing service it is
now with those who need it a question of the
nurse's skill and knowledge rather than of her
piety and religious devotion.  And yet even
those who believe in the existence of only this
material world cannot help admiring the scrup-
ulous fidelity, the unselfish devotion, and the
loving tenderness of the nurses whose service
for the sick  is for their Lord's sake.
  The most important outward  distinction
between the nursing done by members of reli-
gious orders and that of modern nurses is in
the wider field of the former. Modem nurses
generally are occupied in nursing only the
acutely ill; while deaconesses care also for all
forms of human helplessness. The same differ-
ence is noticeable in the training the two kinds
of nurses receive.  The modern nurse is trained
in hospitals.  She there learns how to care for
surgical patients, for the victims of accident,
and for acute medical cases. Perhaps she may
also have some midwifery experience, and pos-
sibly some training in the care  of contagious
                    95 
     NURSES FOR OUR NEIGHBORS
and  infectious diseases.  But the  common
forms of human helplessness she never even
sees. The deaconess, on the other hand, begins
her training in the creche in caring for well
babies whose mothers are unable to care  for
them, and then she serves in the asylum  for
the helpless aged. She has training also in the
care of the feeble-minded and the insane; and
most important of all  she is trained in caring
for these commoner forms of helplessness, as
well  as  for  the acutely sick, in their own
homes.
  The aim of the deaconess institution is to
serve all the needs of the community, while
the service of the modern hospital is restricted
to the care of the rarer forms of helplessness.
Against  common chronics and all incurables
the doors of the modern hospital are shut.
  The deaconess is trained to help the home
and family of her patient. The modern nurse
knows how to make the home into a hospital;
she also  knows how to  exclude the family, and
too often she does not  know how not to make
life miserable for the servants.
                   96 
     NURSING  IN  THE OLD WORLD
   In the small  hospitals  of  the deaconess
 institutions there is a  homelike  atmosphere
 seldom to be found in the larger and more
 scientifically famous institutions. Nor is there
 wanting the necessary application of modern
 science.   The operating-rooms are just as
 aseptic, and the  after care of the patient is
 just as thorough, as anywhere in the hospital
 world. No detriment comes from considering
 each patient as a living soul, rather than as an
 interesting pathological case.
   The homelike  feeling that  pervades  the
 deaconess hospitals is mainly due to the fact
 that in them  woman's  influence is supreme.
 Every hospital, of course, ought to be a home
 for the helpless.  But no home even for the
 well can exist except a woman be at the head
 of it. Much more is this true in  the case of
 homes for the helpless,  where mothering is
 especially needed.  And yet in the modern
hospital palaces, supported by charitable en-
dowments or by public taxation, there is dire
dearth of true hospitality. The men trustees,
the physicians and  the  surgeons, the male
                    97 
     NURSES FOR OUR  NEIGHBORS
superintendent and his male assistants, and
the host of young house officers, to say nothing
of the medical students who  overrun these
hospitals,  somehow fail to make the wards
homelike.  It is true that there are nurses and
ward maids under the charge of matrons and
women  superintendents; but in  our modern
hospitals women, whatever their titles,  are
merely servants under male supervision.
  The deaconess hospitals are not magnificent.
Many of them, indeed, are dingy old buildings,
but in them the patients are at home.  At the
head of each hospital there is a "mother."
The surgeons  and  physicians visit their  pa-
tients there as they would visit them in homes
where every appliance and every  assistance is
at hand. Unconsciously, no doubt,  this pro-
fessional service is more personal because of
the mother's interest  in each  individual  pa-
tient: moreover, it  is engaged and  paid for
by  the institution.  Perhaps for this reason
among others the doctors cooperate  with the
mother and the Sisters in carrying into effect
the spirit of the institution, which is to treat
                   98 
NURSING IN THE OLD  WORLD
every patient as belonging to the family at
least for the time being.
  As  is  well known, Florence Nightingale
received  her training  in nursing at Kaisers-
werth, under Fliedner's deaconess nurses. The
Nightingale School for Nurses,  which she
founded  at St.  Thomas's Hospital, in  1861,
with the thank offering given her  by English
women for her famous service in the Crimean
War, introduced in England the spirit of dea-
coness nursing.
  No more saintly nursing work has ever been
done than that of some of the early pupils
of this Nightingale School.  Agnes Jones, for
instance,  who was  also a Kaiserswerth pu-
pil  nurse, for her wonderful  redemption of
the workhouse hospital in Liverpool deserves
canonization.
  Because of the popular opposition to young
women's undertaking the nursing career, which
until then had been undertaken only by women
who had previously failed in  every  other di-
rection, only the noblest women ventured to
enter the new school in response to Miss Night-
                    99 
      NURSES  FOR OUR NEIGHBORS
 ingale's soul-stirring appeals.  The success of
 the new regime was thus assured.  And very
 soon  throughout Great Britain there  was a
 demand upon the Nightingale School for hos-
 pital  matrons, for head nurses, and training-
 school chiefs, that could be  supplied only by
 sending out to these posts pupil nurses who
 had received perhaps only a year of hospital
 training.  But these were women of previous
 thorough  education, including all  household
 arts.  Many of them were possessed of inde-
 pendent means and had paid large fees for their
 training in nursing. In actual nursing ability,
 according to modern standards, many of them
 were not proficient, but they knew how to re-
 deem hospitals.
  Even earlier  than the Nightingale School
 several Anglican sisterhoods undertook hos-
pital nursing as an avocation. Although their
work in both  England and America has been
admirable, there have been too few of them for
any notable influence upon the profession of
nursing.
  The  excellent  character  of the training
                    100 
      NURSING IN  THE OLD  WORLD
 schools and hospitals of England and Scotland
 is largely due to the matrons who were trained
 at St. Thomas's during the early years of the
 Nightingale School, or in the daughter schools
 of that institution which were almost as fully
 under Miss Nightingale's influence.  In some
 important respects there was thus continued
 in English hospitals the characteristics of the
 deaconess  nursing in which  she herself was
 trained. For instance, the matron of the hos-
 pital holds a position not unlike that held by
 the "mother" in the deaconess hospital.  The
 head nurses are "Sisters." And in each hospi-
 tal there is a chapel with its chaplain.  Reli-
 gious services are regularly held in the wards.
 In many of the hospitals there is provision for
 a  graduate staff of nurses, and from some  the
 undergraduates are sent out to private nursing.
   But, in spite of these resemblances, English
nursing  differs  essentially  from deaconess
nursing in that the English nurses do not be-
 long  to religious orders.  The laicization of
 the profession of nursing began with the es-
 tablishment of  the Nightingale School, but it
                    101 
NURSES FOR OUR NEIGHBORS
has not yet extended far beyond the English-
speaking people.
  In  the hospitals  of Germany deaconess
nurses are often to be found working side by
side with lay nurses, or in special wards of the
hospitals.  But most of the large public hos-
pitals are dependent for their nursing upon
organizations  formed  upon the  pattern of
the deaconess  institutions and differing from
them mainly in being devoted exclusively to
nursing.  The nurses in these hospitals belong
to a "mother house," where they are trained
in the domestic arts before they are given hos-
pital service.  Afterwards they are sent out to
private or  district visiting nursing from the
same headquarters.  To this home they re-
turn between their different services, and  also
when incapacitated by sickness or finally by
age infirmity.  In lieu of this home care they
may receive a small yearly allowance while in
service and afterwards a modest'pension. Such
mother  houses, almost  without  exception,
are closely connected with the Church.  Each
has its chapel and pastor, and only Lutherans
                   102 
     NURSING  IN THE  OLD WORLD
are admitted as probationers.  Many of these
mother houses are joined in larger organiza-
tions, differing from each other mainly in the
stringency of their religious regulations.  It is
true that under the stimulus of English in-
fluence there  has  latterly developed in Ger-
many a small society of lay nurses who have no
connection with either the churches or mother
houses, but their number and influence is still
inconsiderable.
  In Catholic countries the overwhelming pro-
portion of nurses are still the Sisters of Charity.
  In  Holland  a great nursing  reform was
brought about by the White Cross Society,
which gives to nurses certificates of proficiency
graded according  to their education and ex-
perience.  Protestants and Catholics alike take
these examinations.  It is altogether the most
sensible organization yet devised for the im-
provement of nursing.
  From this brief sketch of the history of the
art of nursing, and of the present conditions
of the  art in Europe, it would seem  as if the
continuity for so many centuries maintained
                    103 
      NURSES  FOR  OUR NEIGHBORS
in the Catholic Church has now been dissi-
pated into a bewildering  variety of semi-re-
ligious organizations.  To those who believe
in the necessity of such organization our Amer-
ican conditions  must  seem confusion worse
confounded.  But, for those of us who believe
that the laicization of the profession of nursing,
like the earlier laicization of the medical pro-
fession, marks a distinct  advance, our only
concern may well be to save all that was valu-
able in past methods of training and practice.
Nor is it necessary in this endeavor to delve
in the misty past, for all that was valuable in
the traditions of the nursing art was gathered
for the Kaiserswerth deaconesses.
  Before establishing this new order of dea-
coness nurses Fliedner had  spent years in
studying all the eleemosynary institutions of
Europe.  He had made the acquaintance of
all who were devoted to the service of the help-
less. He had hunted up the few old deacon-
esses who had served as parish nurses in Hol-
land,  and he brought  back to Kaiserswerth
a larger knowledge of the art of caring for  the
                    104 
     NURSING  IN  THE OLD WORLD
helpless  than any  other person then  living
possessed.  So in our efforts to secure all the
benefits of past experience in the development
of the art of nursing we need not go back of
Fliedner's school. But, if we do so desire, it is
equally easy to study the methods of the great
Catholic nursing orders, for their institutions,
although several centuries older than Flied-
ner's, are like his still continued on practically
the  same  lines upon which they were first
established.
  Undoubtedly some of  the benefits and ad-
vantages belonging to the nursing services of
Catholic Sisters and deaconesses  cannot be
retained in lay nursing.  We need not discuss
the blessings that always belong to truly con-
secrated service, nor need we more than men-
tion the excellence of purely altruistic service;
but we may well emphasize some of the char-
acteristics of the older nursing which might
just as well have been preserved  in modern
institutions and exemplified by modern nurses.
The homelike character of the little deacon-
ess  hospitals, for instance, might just as well
                    105 
NURSES  FOR OUR NEIGHBORS
as not pervade our large modern hospitals, for
it is a quality that depends not upon the small-
ness of  the  hospital, but most largely upon
the greatness of the matron's heart and upon
the supremacy of woman's influence.   The
Lady of the Lamp carried to her thousand pa-
tients in the Scutari barracks hospital the same
loving kindness for every one that she had
learned  how to express in the tiny hospital
at Kaiserswerth.  Then there is the devoted-
ness of the older nursing to all kinds of help-
lessness.  That might just as well as not char-
acterize modern nursing. For now, as always,
the pauper on his deathbed deserves just  as
tender care as the millionaire: from the Sisters
and deaconesses he receives it. And then there
is the helpfulness of the older kind of nurses
in the home. That is much needed now, and it
is just as obtainable if nurses  are trained  in
home nursing for home nursing.  Lastly, there
is the quality of sisterliness among nurses who
work together.  If perfect cooperation is ever
necessary it surely is so among those  who
strive to mitigate suffering and to save life. 
CHAPTER V
    OLD-TIME NURSING IN NEW ENGLAND
  The widow who was  chosen  to  serve as
deaconess nurse by the Pilgrims during their
sojourn in Holland probably came to Plymouth
with them.  For "although sixty years of age
when chosen, she served for many  years as
shepherdess for the flock. She diligently visited
the sick and the helpless, especially the women-
folk, to watch with them  and to render every
possible help, according to their needs. When
they were poor, she collected sustenance for
them from their more prosperous neighbors.
She was a mother in Israel and a handmaid of
the Lord." Her name is not given in the old
chronicles, but she surely is the rightful mother
of New England nursing.  How well her exam-
ple was followed by the Pilgrims may be seen
in the following extract from the vivid pages
of Bradford's Journal: —
  But that which was most sadd  & lamentable
was, that in 2. or 3. moneths time halfe of their
                   107 
     NURSES  FOR  OUR NEIGHBORS

company dyed, espetialy in Jan: & February,
being ye depth of winter, and wanting houses
& other comforts; being infected with ye scur-
vie & other diseases,  which this vioage & their
inacomodate condition had brought upon them;
so as ther dyed some times 2.  or 3.  of a day, in
ye foresaid time; that of  100. & odd persons,
scarce 50. remained.   And of these in ye time of
most distres, ther was but 6. or 7. sound persons,
who, to their great comendations be it spoken,
spared  no pains, night or day, but with abun-
dance of toyle and hazard of their owne health,
fetched them woode, made  them  fires, drest
them  meat, made their beads,  washed their
lothsome cloaths, cloathed & uncloathed them;
in a word, did all ye  homly & necessarie offices
for them wch dainty  & quesie stomacks cannot
endure to hear named; and all this willingly &
cheerfully, without any grudging  in ye least,
shewing herein their true love unto their friends
& bretheren.  A rare example & worthy to be
remembred.  Two of  these 7 were Mr. William
Brewster, ther reverend  Elder, & Myles Stand-
ish, ther Captein &  military  comander, unto
whom my selfe, & many others, were much be-
holden in our low &  sicke condition.  And yet
the Lord so upheld  these persons, as in this
generall calamity they were not at all infected
either  with  sicknes,  or  lamnes.  And what I
have said of these, I may  say of many others who
                    108 
OLD-TIME  NURSING  IN  NEW ENGLAND
dyed in this generall vissitation, & others yet
living, that whilst they had health, yea, or any
strength continuing, they were not wanting to
any that had need of them. And I doute not but
their recompence is with ye Lord.

  Fortunately for the Plymouth Colony, there
was never again such desperate need of  nurs-
ing.  Nor were any other of the New England
colonies ever in such fearful straits.  But in
each settlement the life of every individual
was necessarily felt to be of great worth to the
community.   Probably this instinct  of self-
preservation  was one of the motives of the
neighborly helpfulness that characterized the
communities  in their hard struggle for  exist-
ence. For it must be admitted that our New
England forbears were not over-charitable to
outsiders.  Quakers and Anabaptists, Papists
and  Royalists  fared ill  in the hands of the
Puritans.  But it would be unjust to our an-
cestry  to  let  their uncharitableness  to out-
siders blind us to their kind neighborliness to
those helpless who were believed to have the
right to live in these parts of the world.  Nor
                    109 
NURSES  FOR  OUR NEIGHBORS
 would it be becoming in a people that excludes
 the Mongolians to blame too severely preced-
 ing generations for excluding Frenchmen.
   It certainly is well worth while to remember
 the good old customs of succoring those in
 need.  We need not dwell upon the help that
 was given in building houses, in raising bams,
 for new families or for those burned out, nor
 need we more than mention the labor that was
 freely given to stricken families by the men
 in harvesting the crops and in replenishing
 the fuel supplies, and by the women neighbors
 in baking and mending.  For it is the direct
 service to the sick and suffering that now es-
 pecially concerns us.
  While  such service was considered obliga-
 tory upon all the neighbors, very naturally in
 every community some men and some women
 were recognized as particularly serviceable in
 bedside "watching,"  as it was called.  And so
 it was customary for two or three watchers to
 take turns in nursing a patient whose family
 had become exhausted, while others contrib-
uted delicacies and other supplies.   Such ser-
                    no 
 OLD-TIME NURSING  IN  NEW  ENGLAND
 vice was, of course, absolutely gratuitous. Nor
 was it in the least pauperizing in  its effect.
 Those who served esteemed it a privilege, and
 the recipients, if they recovered, would be only
 too glad  to repay by serving  other  helpless
 neighbors.
   Much of this bedside watching was excellent
 nursing.  These unscientific neighbor nurses
 were  highly skilled in the art of comforting.
 They learned the art by regular apprentice-
 ship.  As  boys and girls they were taken out
 as assistants by their parents or by other ex-
 perienced  watchers, in accordance with the
 custom of selecting for each patient watchers
 of the same sex and similar age.
   Physicians in the olden time were, of course,
 few and far between.  Indeed, during the first
 two centuries of New England, outside of the
 larger towns,  there were almost no doctors.
The art of medicine was practiced only by the
housewives, and  the only druggist supplies
were home-gathered and manufactured. Every
attic was stored with dried herbs, each  kitchen
had its  still, and every garden its  medicinal
                    in 
      NURSES  FOR  OUR NEIGHBORS
plants.  Indeed, many of our common herbs
were  brought to this country  from English
gardens for their medicinal virtues.  Instead
of coryza pellets, bowls of thoroughwort or
boneset tea were given, and, instead of tonic
elixirs, sips of home-distilled cordials. Doubt-
less these old-fashioned home remedies were
just as efficacious as the blood-letting and the
weird combinations  of  outlandish  materials
administered by the medical wizards of the
time.   At any  rate,  the somewhat nauseous
draughts of herb tea carried with them the
faith in their virtue, and the neighborly kind-
ness, of their dispensers. The oils, tried out
from  geese, raccoons, and skunks, served as
well as modern liniments.  Steamed  spice-
bags,  and  onion and yeast  poultices  were
probably more  comforting than India-rubber
hot-water bags.
  Many  of these neighbor nurses, besides
their large experience, had acquired a consider-
able knowledge of the best methods of caring
for the sick.  In critical cases, they had watched
through long nights with the doctor standing
                    112 
OLD-TIME  NURSING IN  NEW  ENGLAND
by, and many  of  the old-fashioned  doctors
were themselves good nurses.  At any rate,
it was their custom to stand by those in dis-
tress. They knew very little about the nature
of diseases, but they knew their patients and
how to comfort them. The greatest pains were
taken in every family to preserve and hand
down every scrap of knowledge of the healing
art.  And so the scanty bits of information
gleaned from the doctors were treasured and
passed on as wise sayings for future times of
need.
  In order to bring more clearly into view this
old-time neighbor nursing of New England, let
us go back a generation or  so and follow one
who long since has rested from her labors. She
was herself the mother of a large family and
yet ever ready to share the comforts of  her
home with the less  fortunate.  By the stand-
ards of to-day  she would have been  a social
failure.   For she gave no  dinner parties,—
although guests were welcome at any meal, —
and she made no formal calls.  Nor had  she
time to spare in visiting "well" folks.  But if
                    H3 
     NURSES FOR OUR NEIGHBORS
she heard of any distress she hurried thither,
to offer every assistance in her power. At night-
fall she would trudge off alone or, with one
of her boys as driver of the  old mare and
double-wagon, she would  ride perhaps  for
several miles to the hill farm where the poor
consumptive lay dying.  In her satchel she
carried  many  comforts; black-currant jelly
for  the parched throat and racking cough,
Irish moss to be made into a soothing drink,
chicken jelly for a nourishing broth, and per-
haps an orange or a lemon.
  Her first task would be to persuade the worn-
out family to go to bed, and once they were
asleep  she would tackle the nursing job in
right good earnest.  Not finding fresh linen,
she would wash all she could find of what had
been used, and after drying it before the kitchen
fire and ironing it smooth, she  would be well
ready for giving the morning bath. And would
the poor sufferer be neglected meanwhile? Not
at all. For at every cough or groan she would
hasten to the bedside.  Under her gentle urging
the broth would be taken and very likely some
                   114 
OLD-TIME  NURSING IN  NEW  ENGLAND
iced milk besides.  Water fresh from the well
would be given before it was even asked for.
The hot face and hands would be bathed and
cooled, and a  hot  foot-bath given to  induce
sleep. Were the patient quiet, she would steal
in noiselessly as if to guard the slumber. Were
the patient restlessly wakeful, she would with
soft sweet voice  tell  simple stories, or repeat
"The Lord is my Shepherd, I shall not want,"
and the Lord's Prayer.
  At early glimmer of dawn, when after fitful
sleep her patient awoke in  damp  discomfort,
she would give a cup of hot tea and, in spite
of the patient's discouraged unwillingness, she
would give the bath.  Gently but perseveringly
she would put it through, for she would never
leave anything unclean. After thorough wash-
ing, she would rub the wasted body with sweet
oil.  She believed in the efficacy of such anoint-
ing. And after the mouth and teeth were also
cleaned, and the hair beautifully brushed, she
would bring in the surprise of the fresh linen.
So by the time the family  came back to the
sick-room every  bit of the morning's nursing
                    n5 
NURSES  FOR  OUR NEIGHBORS
would have been perfectly done. Perhaps not
once would she have been off her feet the long
night through.  Her only refreshment would
have been a cup of tea and now and then a few
whiffs of fresh air on the doorstep while watch-
ing the stars.
  The  drive or tramp home  would entirely
rest her, so she claimed. At any rate, she would
attend  to her home duties the following day
as usual, and after one night's sleep be quite
ready for another night of watching.  If not
there when the end came, she surely would be
summoned;  for it  was the neighbor nurse's
place to prepare the dead for burial. Extor-
tionate undertakers and embalmers are mod-
ern inventions.  And  the old-fashioned way
was to treat the bodies  of the dead with utmost
delicacy and tenderness, exactly as if guarding
the most sensitive sensibilities.
  But  we need not dwell  longer upon these
saddening experiences.  For most of the sick
recovered under former methods of treatment,
as, indeed, they now recover under present
methods. And besides the joyfulness of such
                   116 
OLD-TIME  NURSING  IN  NEW  ENGLAND
recoveries, there were then as now the joyous
welcomings of new life into the world. Upon
such occasions the neighbor nurse we are re-
membering was superb.  Her previous calls
upon the expectant mother were not for con-
dolence, but to congratulate and encourage.
She  used to say that there was a heavenly
mother and child  companionship that  could
then be realized by those who made light of
their discomforts, and that there was a special
safeguarding of those who are  willing  to be
gently led.
  Well do her children  remember her  many
a time returning after perhaps  several days'
absence, not exhausted as would be expected,
but exhilarated by having shared a new moth-
er's  joy that a child was born into the world.
To one of her sons, who she prayed might be a
physician, she used to tell how great oppor-
tunities a good doctor  has at such times of
helping where help is sorely needed, and when
in later years occasionally he  had  his own
mother as his obstetric nurse, when he realized
her unstinted devotion  of  heart and soul in
                    117 
NURSES  FOR OUR NEIGHBORS
lending her own splendid strength to the labor-
ing patient's relief, and when he saw her lov-
ing radiance in washing and dressing the new-
born child, his pride in scientific nursing was
modified by  his admiration for the old-time
neighborly nursing that  now, alas, is fast dis-
appearing.
  It is, of course, true that no people, no more
than any  individual, can ever go backward,
can ever repeat the past; but that  does not
involve the sacrifice of one's whole inheritance.
It is a thousand pities that  modern nurses,
instead of scorning old-time nursing as of no
possible value, have not sought out and gar-
nered for the  use  of future  nurses all that
was known of the art before training "schools
began.
  The first specialization of nursing in New
England was, as we have seen, the  choice of
some in the community, who were by common
consent held to be especially fitted, for such
neighborly service.   It was left for them  to
select and teach their successors. The young
folks  so selected were proud  to be  asked  to
                    118 
OLD-TIME  NURSING  IN  NEW  ENGLAND
assist as night watchers, and thankful to be
taught by their experienced elders.
  Then  another  step  toward specialization
was taken when working-women were induced
"to go out  nursing" for their living.  Only
poor widows and spinsters were thus commis-
sioned.  Such service at first was only occa-
sional.  Between  their  times of nursing they
"took in sewing," or helped at house-cleaning,
or busied themselves in  their own small homes.
These women became the professed nurses,
the experienced nurses, or, as they now best
liked to be called, the untrained nurses.  They
were  entirely different from the wretched
hospital nurses who  preceded the training
schools.   Thoroughly  respectable and  trust-
worthy they were always, often kind-hearted
and hard-working,  and sometimes teachable.
Many of these untrained nurses are still in
active service  and doing  very good  work.
Indeed,  in only a few  of the smaller country
towns have modern trained nurses made any
headway in displacing these  "old-timers,"
and in the cities they are still the only depend-
                    119 
NURSES  FOR  OUR NEIGHBORS
ence of moderately well-to-do families;  but
they are fast passing off the stage.  Who will
take their place? Who now will learn to do such
work as theirs, for such modest wages as they
command? This is a most serious question for
sociologists.
  As the untrained nurses have been so often
maligned, it seems only fitting in this sketch of
New England nursing to describe at least one
of them as she was known and loved  in our
neighborhood.  Her name was Mary K. Green,
and her little gravestone says she died in 1884,
aged seventy-three years.  She was born in
one of the up-country villages of Massachu-
setts,  the oldest of seven children, on a poor
farm where it was a hard stmggle to get food
enough for the family.  When Mary was only
twelve, her mother died, leaving a baby daugh-
ter, Ruth, with five brothers in between.  For
four years Mary did all the housework for this
family.  She then started out to earn her own
living and to help support the old home.  She
found work in  a farmer's family in Waltham,
where she slaved from four  in the  morning
                   120 
 OLD-TIME  NURSING IN  NEW  ENGLAND
 until well into the evening.  Besides the ordi-
 nary housework, as it now is counted, she had
 the churning and cheese-making, the poultry-
 raising and the kitchen-gardening to do.  For
 the first year she had ninepence a week, for
 the second year a shilling; and then, when she
 went  to live with another family, "Marm
 Fiske" gave her a silver thimble, which for
 long years was her most treasured possession.
   In her new situation she had an easier time
 of it.  But, besides the ordinary work of the
 farmhouse, she had the care of the old grand-
 father in his dotage, and of many of  the little
 grandchildren who were sent back from their
 city homes to build up in the country, and she
 was also often called upon  for a few weeks'
 special service in one  after another of  the
 daughters' homes when there was sickness or
 any extra stress. As the grandchildren grew up
 and married, she extended her visiting serv-
 ices to their families, and before  her labors
 ended she had  cared for many of the great-
 grandchildrens' children. Her service to this
one family was thus given to five generations.
                   121 
      NURSES FOR OUR  NEIGHBORS
  All of her scanty wages went to the support
of her own family who continued desperately
poor. She provided a  small cottage home for
her only sister, who for many years was a hope-
less consumptive.  From the families where
she worked she collected all sorts of no longer
wanted material, which she always  declared
would be of use in the old up-country home.
At making over worn-out garments she was a
past-master. She was never much on style. To
her a button was  a button, and if she could
not find two alike for the garment  she  was
making over, it mattered not; she would make
their buttonholes of different sizes to fit.  She
was always in a hurry, in the long days from
dawn till dark, and, in winter, from  long be-
fore light throughout the short days and long
evenings.  On Sundays she always went "to
meeting" and thoroughly enjoyed it.  In her
six days of unremitting labor she well earned
her Sabbath rest.  Her religion was of the
practical sort, — kind  to everybody,  devoted
to the helpless, rigidly honest. A  terribly hard
worker she was, but a great lover of fun, never
                   122 
 OLD-TIME NURSING IN  NEW ENGLAND
 overawed by "stuck-up folks," a perfect mine
 of quaint stories and of good old Yankee com-
 mon sense.
   For the last half of her life Mary Green was
 an "untrained" nurse. How did she become
 one, and of what sort was her nursing?  Dur-
 ing her early years the only nurses were the
 neighbor nurses already described. Often in
 the families where she was working she served
 as an assistant watcher; but it was not until
 she was of middle age that she was taught the
 art of nursing. Nor was she in any hurry to un-
 dertake this responsibility. But finally she was
 persuaded to do so by an expectant mother,
 who promised to teach her  what nursing she
 herself would need, and then to recommend
 her, and teach her at these cases what nursing
 was needed for  them.
  In this way Miss Green, as she then came to
 be called, was launched upon her nursing ca-
 reer.  After her long preparation of helpful
 service,  it was no wonder she soon became a
famous  nurse.  Fortunate,  indeed, were the
families that found her in their times of need.
123 
     NURSES FOR OUR NEIGHBORS
For not only would she do the strictly nursing
work in tending the patient, but she also de-
lighted in doing the family washing before
breakfast, the ironing in the forenoon, and the
mending before or after  nightfall, with the
baby on  her lap.  Much of the cooking and
general  housework she would do between-
times.  The amount of her  day's work was
astonishing, nor were her patients ever neg-
lected.
  While  faithful to  old doctors whom she
knew, and  always punctilious  in  giving the
medicine as ordered,  she was a terror to the
younger physicians for whom  she had  little
use. To one of them, who incautiously asked,
"How is your patient?"  her snappy answer
was, "That is for  you to  find  out"; and
again when he asked  if the fine breast band-
age he had so proudly applied the day be-
fore had proved a comfort, she  admitted that
she had taken it off directly after  he left the
house.   She " did n't like them things," she
added.
  For the clinical thermometer and for mod-
                   124 
OLD-TIME  NURSING  IN  NEW ENGLAND
em antiseptics she had supreme contempt.
Soapsuds were cleansing enough for anybody
sick or well, she would say; "and as if any fool
ought not to be able to tell without thermom-
eters whether the patient  or the chamber
were too cold or too warm."  It was no use
to allow fruit or any other "outlandish diet"
to her patients.  She believed in gruels  and
broths, fresh air and perfect quiet. What she
believed in would be given; and nothing else.
" If you want any other kind of nursing, get
it," was her ultimatum.
  Though she died a full generation ago, she
is still missed, and she deserves a more fitting
memorial. 
CHAPTER  VI
        AMERICAN NURSING SCHOOLS
  The idea of training women in American
hospitals for subsequent service in private
families originated in the hospitals for women.
These special hospitals were then new.  They
came into existence in consequence of the dis-
coveries  of surgical methods for  relieving
womankind of their special troubles. The first
of these hospitals was founded by the women
of New York for Dr. Marion Sims. But there
soon arose  a  demand for hospitals  where
women patients should have women surgeons^
and where women students of medicine should
have educational opportunity.
  The New York Infirmary for Indigent Wo-
men was the first, and the Women's Hospital
of Philadelphia the second, of these special
hospitals. But the New England Hospital for
Women and Children, in Boston, was the first
institution  chartered with the education of
                   126 
AMERICAN NURSING SCHOOLS
nurses as one of its stated objects. This char-
ter was granted by the Massachusetts Legis-
lature, March 13,1863. The hospital had been
in operation since the preceding July.
   For the first ten years of its existence no
more was done in this hospital for the training
of  nurses than was done in other women's
hospitals.  Most of the nurses employed had
had previous experience and considered them-
selves  proficient in the art.   Dr. Marie E.
Zakrzewska, who was the leading spirit in the
establishment and management of the hospi-
tal, had difficulty in persuading these nurses
to  give even the six months' service which
was then required for a certificate. The train-
ing given them was almost wholly in obstet-
rical nursing.
  To Dr. Susan  Dimock,  who  became the
resident physician of the New England Hos-
pital for Women and Children in 1872, belongs
the honor of having started the first real train-
ing school for nurses in America. She had just
returned from Europe. After completing her
medical education in Zurich,  she had spent
                    127 
     NURSES FOR OUR NEIGHBORS
some time  in Kaiserswerth, and in England
she had made the acquaintance of Florence
Nightingale.
  As might have been expected, she was well
primed with enthusiasm for her pioneer work.
She was the first in this country to urge well-
educated young women to leave their comfort-
able homes in order to fit themselves by study
and hard work for the profession of nursing.
Only those  of us who remember the opposi-
tion she encountered, from  the families and
friends of the young women she thus inspired,
can appreciate  Dr. Dimock's  great service.
Most unfortunate was her loss on the ill-fated
steamship Schiller in  1875.
  This  first  American  training  school for
nurses began September 1,1872, with five pro-
bationers.  For three months they were paid
nothing.  They were on duty from 5.30 a.m.
to 9 P.M., and for the first six months they
slept in rooms off the ward, from which they
were summoned for the night nursing needed.
They were trained in surgical and  medical as
well as in obstetrical nursing.  Only twelve
                    128 
AMERICAN NURSING SCHOOLS
regular  lectures  were given them, but they
received most valuable  instruction from  the
attending physicians, and especially from  Dr.
Zakrzewska.  The course  was for one year;
and the first to  complete it, and  so the first
nurse to receive an American diploma, was
Miss Linda Richards, whose autobiography,
lately published,1 serves as the early history
of many of the  principal training schools in
this country which were established under her
superintendence.
  During the year following the establishment
of the New England Hospital Training School
several others were begun.  The most notable
of these was the training  school attached to
the Bellevue Hospital of New York. This
was established by the Hospital Committee of
the State  Charities' Aid  Association.  One
of this  committee,  Dr.  W. Gill Wylie, spent
three months in England  and on the Conti-
nent studying the systems of training nurses
in those  countries.  Upon  his  return  he
presented a  most instructive report which
         1  Whitcomb & Barrows: Boston.
                    129 
NURSES  FOR OUR NEIGHBORS
embodied a letter of advice from  Florence
Nightingale.
  Dr. Wylie's report, published by the State
Charities' Aid Association at the close of the
year 1872, served to guide the steps not only
of the New York, but also of the New Haven,
Philadelphia, and Boston committees, in  es-
tablishing their training schools.
  The Bellevue Hospital Training School was
opened in May,  1873, with a staff of six pro-
bationers under the superintendence of Sister
Helen, of the  All Saints' Sisterhood, which
then was connected with the University Col-
lege Hospital of London. Miss Linda Richards
became the night superintendent of the Belle-
vue School in October of the same year, and
then superintendent of the midwifery wards
for the short time before this department was
removed to Blackwell's Island.
  Class instmction did not begin in the Belle-
vue School until the autumn of 1874.  The
course was  for two years.  But the  student
nurses had the  advantage of  some private
family nursing during  their course, as was
                   130 
AMERICAN NURSING SCHOOLS
the early custom in other American training
schools.
  The third school was the Connecticut Train-
ing School for Nurses, which began with four
probationers, October 6, 1873.   In  the pro-
spectus it was announced "that Miss Night-
ingale's 'Duties of Nurses' will form the basis
of instruction."  To the Connecticut School
America is  indebted for the first textbook on
nursing.
  The Boston Training School began with four
probationers  in the  Massachusetts General
Hospital, November 1, 1873. This school was
started by a committee of the Women's Edu-
cational Association, which, with the addition
of several physicians and laymen, soon organ-
ized as a board of managers.  One of this com-
mittee had had previous experience in plan-
ning the training school of the New England
Hospital. They first sent to New York for the
information Dr. Wylie had brought concern-
ing the Nightingale School,  and they estab-
lished the Boston Training School upon Miss
Nightingale's plan, as an entirely  separate
                   131 
NURSES  FOR OUR NEIGHBORS
institution from the hospital, thereby keeping
the management of the nurses in the hands of
the trustees of the school.
  The surgeons and physicians of the Massa-
chusetts General Hospital were unanimously
opposed to the introduction of student nurses,
and the trustees only reluctantly consented to
a trial of the experiment in what were called
the foul wards.  It was very properly stipu-
lated by the hospital " that the pupils of the
training school shall not attend the patients
of the hospital without previous training in
moving and caring for persons in bed."
  The first year of the school was most dis-
couraging, for lack of proper superintending.
But after Miss Linda  Richards became the
superintendent, in November, 1874,tne school
rapidly improved.
  In  1896  the Corporation of the Boston
Training School for Nurses dissolved, surren-
dering to the Massachusetts General Hospital
its funds and the  entire management of the
school.  The hospital trustees requested this
action on the ground that the best interests
                    132 
AMERICAN NURSING SCHOOLS
of the hospital would be thereby promoted.
Regarding the wisdom of this action we shall
later have something to say.
  It would not be possible within our present
limits even to enumerate the training schools
for nurses  that have since sprung up and
flourished in this country, and much more im-
possible to sketch their beginnings. The in-
stances cited are to be regarded as illustrative
of the general movement. It is important to
our purpose, however, to emphasize the fact
that these early schools were started with the
primary purpose of educating women for the
subsequent practice of private nursing.  An
essential part of the plan was a separate home
for the student nurses, where they should re-
ceive  instruction in the domestic arts, under a
matron employed by the directors of the school.
The student nurses were to serve in the hos-
pitals in order to gain necessary experience.
The hospitals at first, and particularly their
medical and surgical  staffs, strenuously ob-
jected to this employment of pupil nurses. But
the great advantages of such nursing soon be-
                   133 
NURSES FOR OUR NEIGHBORS
came so apparent that the hospitals themselves
began  to establish nursing schools, and the
converted doctors gave unstinted  service as
teachers.
  In order to understand this movement it is
necessary to look back at the previous nursing
service of the hospitals.  In  the first report
of the New York State Charities' Aid Associa-
tion, dated December 23, 1872, regarding the
nursing service in the Bellevue Hospital, it is
said: "The nurses, inadequate in number to
the work, nearly all illiterate, some immoral,
and  others  intemperate, had sought  these
positions simply as a means of livelihood, and
not because  they had any aptitude for or
knowledge of their profession. These women
constantly neutralized the efforts of the phy-
sicians by their ignorance, and their indiffer-
ence to the welfare of their  patients. . . . The
visitors of the Association could not patiently
witness the ignorance and brutality which
daily fell under their eyes." This is bad enough
evidence, but earlier testimony is even worse,
when profligate  women were condemned in
                   134 
AMERICAN NURSING SCHOOLS
the police courts, either to jail, or, if they pre-
ferred, to equal terms of service as nurses in
these same wards.
  There were, it is true, honorable exceptions.
And probably the conditions in the Bellevue
Hospital were the very worst. But generally
in this country as in England, before  the
training schools began, only hardened women
were employed as hospital  nurses.  Nor were
these women under any discipline. Each acted
independently.  Even when  Miss Richards
became the superintendent of nurses  at  the
Massachusetts General Hospital, no progress
had yet  been made in  this direction.  The
managers of the training school had  already
had Miss Nightingale's  advice  that "proper
hospital  nursing  is impossible  except it be
under  perfect discipline, and that such dis-
cipline depends upon a  hierarchy of women,
composed of the matron, the head nurses, the
assistant nurses, and the ward  maids, where
the higher grade knows the duties of the lower
grade better than the lower grade does itself."
But until Miss Richards came they had no
                    135 
     NURSES FOR OUR NEIGHBORS
properly trained matron.  The pupil nurses
were like a company  of  volunteer  soldiers
without officers.  In order to be sure that all
fared equally, there was daily rotation in office.
Thus for one whole day the nurse washed out
old poultice cloths; the next day she was wait-
ress  in  the  dining-room; the third day she
spent in the wards, washing patients' faces,
making beds, sweeping floors, etc.; the fourth
day she was head nurse; the fifth day she be-
came night nurse; then, after a holiday, she
began again the same rotation of service. No
wonder the doctors complained "that nobody
knew anything."
  For the first year Miss Richards,  besides
being the superintendent, also served often as
special night nurse, sometimes for three nights
in succession.  By the end of that year,  how-
ever, she had secured  properly trained  head
nurses; then she obtained  ward maids; and
when at last Miss Nightingale's system was
thus in full operation  the medical staff was
convinced of the advantages of the new regime
and all the nursing of the hospital  was en-
                    136 
      AMERICAN NURSING SCHOOLS
trusted to the training school. The graduates
of the school were soon in great demand for
matronships in other  hospitals which were
hastening to establish training schools.
  It is tme that the introduction of antiseptic,
and then of aseptic, surgical methods, during
the last quarter of the nineteenth century, has
had much to do with the improvement of hos-
pitals.   But their wonderful reformation is
most largely due to the superseding of their
former disgracefully inefficient nurses by stu-
dent nurses.  The medical  and surgical service
in hospitals had always been properly organ-
ized.  The best professional talent was assured
by  the prestige attaching to staff appoint-
ments, and by the opportunities thus afforded
to medical school  teachers. The chances for
experience afforded by the hospitals  secured
for them the service of the best students and
young graduates of the medical schools as ex-
ternes and internes. And now similar efficiency
was secured in the nursing  service by the intro-
duction of the proper discipline and of the pro-
fessional enthusiasm belonging to studentship.
                    137 
      NURSES FOR  OUR NEIGHBORS
  After this hasty glance at the beginning of
the movement, it is a fitting time to examine
somewhat critically the evolution of the train-
ing schools. The resulting improvement in the
hospitals cannot be overstated; order has re-
placed chaos, cleanliness has displaced filth,
virtue has triumphed. In this respect the fond-
est hopes of the founders of these schools have
been more than realized.  But the  redemption
of the hospitals was only a part of their pur-
pose.  Of at least equal importance was their
original intention to prepare women in the best
possible manner for  the  subsequent practice
of nursing in private families and in district-
visiting service.  This intention was explicitly
stated in every prospectus and in every appeal
for financial support.  We may well inquire
how far this has been the guiding purpose of
the numerous training schools  that in later
years  have been established by the hospitals.
  At first the pupil nurses in the hospitals were
paid servant wages,  somewhat less, perhaps,
than the wages of the former nurses, but still
enough to support the young women who were
                    138 
     AMERICAN NURSING  SCHOOLS
thus acquiring their professional education.
In later years these allowances, as they have
been euphemistically called, have been greatly
reduced, and, in a very few of the best hospitals,
they have been discontinued.  But, even with
this expenditure, there can be no doubt that
a pecuniary profit to the hospitals has resulted
from having student nursing service. The vast
improvement in the nursing service ought to
have sufficed, and instead of making a money
saving the hospitals ought to have been more
liberal in improving the training schools.
  A grosser injustice has been inflicted upon
student nurses in some of the small private
hospitals, where the profit from  their almost
gratuitous service has enriched the proprietors
who have contributed  practically nothing to
the education of their nurses.  Hardly  less
reprehensible has been the practice of other
small hospitals,  which, not content with an
almost free service from their student nurses,
have sent them out to private  service  and
pocketed the wages so earned.  That these
earnings have been devoted to the support of
                   139 
NURSES FOR OUR NEIGHBORS
the hospital is no excuse to the managers of
such institutions for  this disregard of their
educational responsibilities. Where education
is  paid for by  service,  it would seem plain
enough that  the earnings from such service
should be applied only in furnishing instruction.
  The custom of paying even  small servant
wages  to student nurses is largely responsible
for these evils. While this has continued it has
been impossible to shake off the traditional es-
timation of nurses as  after all only servants,
entitled to no educational consideration be-
yond what will make them of most service to
their present  employers.  Indeed, some hospi-
tal authorities justify this perhaps  needless
expense, of continuing to pay small wages or
allowances, on this very ground that the stu-
dent nurses are thereby kept in their proper
servile position.   The superintendents  of the
training schools,  on the other hand, unmindful
of their own reports of the many hundred ap-
plications they have been compelled  to refuse,
say that except for these allowances they could
not obtain enough probationers. And some
                   140 
AMERICAN NURSING SCHOOLS
of the leaders of the nursing world go so far as
to say that probationers, who, without these
allowances could not possibly afford  to  fit
themselves for the  nursing profession, make
better nurses than women would who them-
selves or whose families  could afford to pay
for their professional education. It is only too
apparent that such defenders of this custom
have not yet escaped from servile traditions.
  Another striking  instance of the prevailing
poor estimation of their own profession, as
voiced by some of  the leaders of nursing, is
their distrust and dislike of highly  educated
probationers. This prejudice, however, shows
a proper appreciation of the present unfitness
of the teaching in American training schools
for thoroughly educated young women. The
average curriculum is still adapted  rather to
the capabilities of the poorly educated.
  A still more unfortunate handicap  resting
upon  the nursing profession is the prevailing
belief among the leaders of American nursing
that only women of mature age ought to enter
the training schools. And yet many of those
                   141 
     NURSES FOR OUR NEIGHBORS
so believing, in advocating  the advantage of
their profession, talk much of women's rights
and women's wrongs.  They complain of  the
prevailing inequality of opportunities open to
women and to men. And they do not see that
no other inequality compares in hardship with
the restriction they would themselves impose
upon  their own sex, in allowing women to
begin their professional education only at an
age when their brothers, having finished their
education, are already beginning their profes-
sional careers. This distrust of young woman-
hood doubtless is in part a survival of the old
notion about nursing, that  only middle-aged
women ought to undertake it. It would not,
perhaps, be fair to suggest that such distrust
ill becomes superintendents who,  as  proba-
tioners, were themselves of the now distrusted
youthfulness.  If not a reflection  upon  the
powers and capabilities of young womanhood,
as compared with  young manhood, then  the
requirements of older age  for probationers
than for medical students must be considered
as a reflection upon the training schools.
                    142 
AMERICAN NURSING  SCHOOL
  In the deaconess schools of Germany proba-
tioners are received while still in their teens,
and  they  are  given a thorough preliminary
training which is of great value to them as
women, whether afterwards  they continue to
be nurses or  become matrons in their own
homes.  But in most of the  great hospital
schools of this country there is none  of this
invaluable preliminary training, and the pro-
bationers are at once put to work in the hos-
pital wards where the long hours, the  lack of
adequate vacations, and  the depressing effect
of hospital misery  all combine too often to
rob the young probationers of their youth and
their vitality.  It is, therefore, not to be won-
dered at  that the  superintendents of these
schools, in the kindness of their hearts, prefer
more mature probationers who have been some-
what inured to the  hardships of the world.
  Could  the  intervening years be  spent at
home or in any employment, in proper pre-
paration for  the nursing schools, — as, for
instance, in acquiring skill in all domestic arts,
— then much might be said in favor of post-
                    143 
NURSES FOR OUR NEIGHBORS
poning a probationer's admission until the age
of twenty-five.  But such home training, alas,
belongs to the past. And the only alternative
for the young woman, who cannot at the age
of eighteen or nineteen enter a training school,
is generally some occupation that, to say the
least, will certainly not make her better fitted
for nursing.
  The obvious remedy is provision by the
training schools for the needed preparatory
training.  Indeed, it is now generally agreed
that probationers  always ought  to have  a
thorough education in domestic science, and
instruction also in all the foundation sciences
upon which the art of nursing depends, before
they are given actual nursing service in the
hospital wards. But the hospitals which own
the training schools, while admitting the great
advantages  of  such preliminary  education,
plead their poverty as an excuse for  failure to
make such provision. And yet these same hos-
pitals continue to pay in wages or allowances to
their pupil nurses more than would be required
for the support of proper preparatory schools. 
CHAPTER VII
   RESPONSIBILITY FOR SHORTCOMINGS OF
             MODERN NURSES
  If American training schools had succeeded
in producing nurses properly fitted for the sub-
sequent  practice of  their profession, there
would be no need of further criticism. But such
is not the fact; nor would it be reasonable to
expect that in nursing schools established and
maintained by hospitals primarily for their
own advantage women should be well fitted for
private nursing. At best it could only be ex-
pected that nurses so  trained on leaving their
hospitals would be able to make hospitals out
of the homes of their private  patients.  This
service, it  is true, is  sometimes just what is
desired.  In cases, for  instance, of severe acci-
dent,  or  of major surgical operations, or of
acute sickness, where the lives of  patients
hang in the balance, it is sometimes necessary
that the  home shall be so transformed; the
                   H5 
     NURSES FOR OUR  NEIGHBORS
family as well as the furniture must be re-
moved.  But such cases fortunately are the
rare exceptions.  And nurses who have  been
trained only in  hospital methods are often
worse than useless in the care of patients suf-
fering from the ordinary, commonplace forms
of helplessness.  Such, at least, is the general
opinion of physicians and families who  have
employed the modern trained nurses.
  We must, however, admit that the majority
of nursing schools and of  the leading nurses
in this country firmly believe not only that a
full, perfect, and sufficient nursing education
can be given in hospital wards, but also that
no other education is needed or even desirable
for nurses.  So firmly is this belief held that
the national and state associations of nurses
and of superintendents refuse membership to
nurses who have not been trained in hospitals
for at least two  continuous years.  No allow-
ance is made for  time spent in the preparatory
nursing schools or in learning district visiting
nursing.  Florence Nightingale herself would
not have been eligible for membership in these
                    146 
  SHORTCOMINGS  OF MODERN  NURSES
associations.  For in Germany where she was
trained,  and where the  new  profession  of
nursing began, hospital nursing has from the
first been rightly considered only as one of the
departments or specialties of nursing.
  Even if it be granted for sake of argument
that for hospital nursing only such education
is needed as can be acquired in the wards, it
does not at all follow that such an education
fits the nurse for home nursing.  And yet it
is fitness for home nursing, and not merely for
hospital  nursing, that ought to be the objec-
tive of all training schools for nurses, for it is
in home nursing that nine out of ten  nurses
undertake to practice their profession.
  Nursing essentially is caring for the helpless,
whatever may be the cause or form of the help-
lessness, whether it be that of infancy or of
old age or of accident or of sickness; but hos-
pitals admit only certain forms of human help-
lessness, and  generally only the rarer  forms.
Nor is this true only of the specialty hospitals,
many of which, by the way, have the effront-
ery to graduate their nurses, but it is also true
                    H7 
     NURSES FOR OUR NEIGHBORS
of the large so-called general hospitals which
exclude midwifery cases, or infectious cases,
or chronic patients, or the insane, or the neuras-
thenics, or  incurables, or perhaps all of these
common forms of human helplessness. Is it,
then, any wonder that nurses whose training
has been exclusively in hospital wards are of
so little use in private family practice? They
have not even seen the common forms of hu-
man helplessness. Naturally enough, they find
most of their cases stupid and uninteresting;
Unless the  patient's temperature is high, or
there has been some mutilation of the body,
such nurses feel out of place. But, besides their
unfamiliarity with the common kinds of nurs-
ing service needed, hospital nurses when they
attempt home nursing labor under a far  more
serious  disadvantage.   Having been trained
only in the care of patients, they are abso-
lutely ignorant of their duties in the household.
Not only are they unable to cooperate with
the parents or children, with the husband or
wife, of the patient, and so to marshal all sur-
rounding family influences  in  the  fight  for
                    148 
  SHORTCOMINGS OF  MODERN  NURSES
their patient's relief, but in their inexperience
they often cannot help upsetting all the do-
mestic arrangements and even wounding the
hearts of the family.
  Experience in hospital nursing is, of course,
an  indispensable  part  of the perfect  nurse's
training, but it is  by no means the whole of it.
In our hospital training schools nurses acquire
wonderful  technical skill,  and an extensive
knowledge of diseases.  They become adepts
in distributing themselves  and in managing
many patients. As assistants of the hospital
physicians and surgeons, they learn much of
the science, but little of the art, of medical
practice: whereas nurses need to know only
little of the science, but all that is knowable
of the art of helping the helpless.
  It is true that nurses who have been trained
only in  hospital wards may afterwards  learn
to be good  family nurses.  Indeed, many of
them  do.  But graduate nurses do not  learn
as easily as do student nurses to do what is
wanted of them by private  patients and their
physicians.  Once given their diplomas, it is
                    149 
     NURSES FOR OUR  NEIGHBORS
very hard to teach them.  Having spent two
or more years in the hospital wards, they be-
come so steeped in hospital methods that they
do not take easily to family service.  In the
hospital ward, the nurse learns first to do one
thing for twenty persons.  It may be washing
the face, giving sponge baths, or serving food.
She has got to do this one thing for the whole
line of twenty patients down  the ward.  In
order to keep up with her work, she has to
learn how to slight her patients, or at least to
put them off. Now, in home nursing, the nurse
has twenty things to do for her one patient,
and  that brings  her into a personal relation-
ship with that patient's needs which is of the
greatest importance in her development.  A
nurse who has been trained in  this way has  a
more ready power of applying her whole heart
in her service.
   When we are  bom into this world, and on
our deathbeds before we go out  of it, we are
in the condition of absolute helplessness, and
absolutely dependent  on  woman's service.
When in critical conditions of sickness, we are
                   150 
  SHORTCOMINGS OF MODERN NURSES
also in the condition of infants, and again de-
pendent  entirely on the mothering  care  of
womankind.  Women can hold on to life that
is precarious as men never can. A man can go
into the battle for a little time and give direc-
tions, and then if he will keep from going  to
pieces he has to go out of the sick-room; but
woman has the power of holding on. Her great
power is given her of God to bring forth into
fullness of strength the life that erstwhile hangs
trembling in the balance. Now, this natural
mothering  power  expands under its  proper
exercise,  and in home nursing there is a far
larger  chance for its  expansion in  normal,
natural directions than ever is  afforded the
student nurse in the ward.   When beds are
put so close that every patient hears and sees
everything said  and done for other patients,
and when all the work must go with mechani-
cal, factory-like  accuracy, the nurse has small
opportunity for that finer devotion that is the
essential part of nursing. Indeed, should she
show it, she is often rebuked by the authori-
ties, and told that in hospital service there is
                   151 
     NURSES FOR  OUR NEIGHBORS
no time for "sentimentalities." Is it any won-
der that in the larger schools, while they give
a splendid technical  training and a large  ac-
quaintance with  all  acute forms of disease,
the motherly instinct is often either driven out
of the probationers,  or else inclosed in blase
casements ?
  It would be unfair to make such a charge
against all or even against the majority of our
modern trained nurses; but certain it is that
many who have been trained in the large hos-
pital schools, instead of rejoicing in the oppor-
tunities that family  nursing affords, almost
hate such work, and do it only for the money
that they  so may earn.
  To stand helpfully by a soul on earth whose
body is in pain, or in a state of abject helpless-
ness, is one of the highest privileges as well as
a most sacred duty.  It was for such service
that St. Paul commended  Phcebe, the first
nurse.  The nursing  service needed now, as
then, is not merely a technically perfect ser-
vice, nor is it only an intelligent service. These
qualities,  of course,  are needed.   We want
                     152 
SHORTCOMINGS OF  MODERN NURSES
nurses to know what they are about, and we
want them to be dexterous; but, more than all,
nurses are wanted whose hearts have been
stirred and thrilled, whose generous impulses
for fellow-service have been given  such full
sway that their loving-kindness ever after shall
shine forth unmistakably.
  Nursing is simply a department of medical
practice: it is  not and never can be an inde-
pendent profession.  Were this fact more gener-
ally recognized, physicians, instead of grum-
bling at the failure of the trained nurses now
available, would see that it is their business
to provide their  patients with  the kind  of
nurses they know are needed.
  Surely it might have been reasonably ex-
pected that physicians would have welcomed
the new schools of nursing, and helped them
with their guidance. But the astonishing fact
is that with some few notable exceptions they
have not done  so, and, instead, have often op-
posed those who were doing what they them-
selves ought to have done. Without realizing
their obligation to make sure of the  proper
                   153 
     NURSES FOR  OUR NEIGHBORS
education and training of their nurses, they
have put upon them, not only the responsi-
bility physicians formerly carried, but also
the far greater responsibilities resulting from
the advance of medical  and surgical science.
Thus, for example, the discovery of the germ
causation of many diseases  made necessary
in the nursing of patients suffering from them
the application of the principles of antisepsis
and asepsis.  An understanding of these prin-
ciples the nurse henceforth must have: other-
wise it is folly to expect from her the  intelli-
gent efficiency by which alone her patients'
lives may be safeguarded.
   In the domain of surgery the need of highly
educated nurses is most apparent.  Indeed,
upon their intelligence and fidelity to aseptic
principles,  the surgeon's success  and his pa-
tient's life  are absolutely dependent.  Aware
of this, every modern surgeon trains his own
nurse operating assistants.  Without them his
efficiency would largely disappear. But very
few surgeons are wise enough to train equally
well a staff of nurses to take the  subsequent
                    154 
  SHORTCOMINGS  OF MODERN  NURSES
care of patients during their convalescence.
And, as might be expected from this failure,
many  a  patient, whose  operation  was bril-
liantly performed,  afterwards succumbs for
lack of intelligent nursing devotion, and many,
many more suffer needlessly. Surgeons know
this, and so they often insist upon sending to
hospitals patients who might better  stay in
their own homes if only proper nursing ser-
vice could there be assured.  For in too many
hospitals additional security of life is accom-
panied by an unnecessary sacrifice of comfort,
which  would not  occur were the  surgeon's
supervision more constant or were the nurses
there as well trained as are his  operating
nurse assistants to carry out his orders.
  Less plain, perhaps, but still of certainly as
much importance,  is the need of better nurs-
ing service in other departments of medical
practice.  In critical cases this need  is  least
noticeable. Modern nursing then shows off to
best advantage.   But in the long-drawn-out
convalescence, and in  sickness so mild that
instead of insensibility to all surroundings the
                    155 
     NURSES  FOR  OUR NEIGHBORS
patient's sensitiveness is abnormally acute, in
neurasthenia and mental diseases, in the help-
lessness of infancy and of old age, nursing of
a far higher proficiency than is  now available
is sorely needed.  Indeed, many physicians
as well  as their patients  look back longingly
to the old-fashioned  nurses.  This  they do
without  stopping  to think how inadequate
such nurses now would be, and what disasters
would  result from their  lack of intelligence.
So, of all stupid expedients ever  proposed, it is
hardest to have patience  with the recent out-
cry of some physicians for less instead of more
intelligent nurses.  As if any one in this world
of ignorance could ever know too much! Such
complaints are  like those forwarded from the
Scutari  Hospital to  the  British War Office,
regarding Florence Nightingale, which brought
everlasting ridicule upon the man who asked
for her recall and for the  reinstatement of the
brutally ignorant nursing service she displaced.
  General discontent with existing conditions,
however, is commonly considered a hopeful
sign of improvement. And if in this case that
                    156 
  SHORTCOMINGS OF MODERN NURSES
is true, then a great reform is at hand; for few
can be found who are in any degree satisfied
with our present nursing service.
  Before laying the largest share of  blame
for the shortcomings of modern nurses upon
the physicians, who have not seen to it that
their  lieutenants have been  better trained,
we must examine their possible defense. The
fact must be admitted that the medical pro-
fession has had and now has very little part
in the  establishment  and  management of
hospitals and their training schools. Not long
ago a hospital for general use was built in a
New England city. In it there was no oper-
ating room or even sterilizing apparatus. Need-
less is it to add  that there was no medical
member on that board of trustees.
  How hospitals may be built by lay trustees,
however, is of small  consequence compared
with how they are managed.  If by chance the
medical profession is represented on the board
of managers, seldom is their influence domi-
nant; and where it is so, the lay members of
the board are apt to consider themselves use-
                   157 
      NURSES  FOR  OUR NEIGHBORS
less. Obviously the best results in the manage-
ment of hospitals depend upon the active co-
operation of philanthropic men and  women
with physicians. But this is not the place for
discussion of ideal hospital management. I
desire merely to point out the fact that not all
the responsibility either for the excellence or
defects of our hospitals can be justly ascribed
to the medical  profession.  This is still more
true as regards  the training schools belonging
to them.
  In  the  beginning  of the  movement, as I
already have related, these schools were started
by outsiders, backed  perhaps by the contribu-
tors to the hospitals, but generally opposed by
the tmstees and the medical and surgical staff.
Afterwards,  when  the immense advantage of
the training schools  became apparent to  the
staffs as well as to the trustees, there was no
longer left any province for outside managers,
whose purpose originally was not only to pro-
vide better nursing for the hospitals,  but to
educate and train women for private nursing.
The earliest training  schools thus deprived of
                    158 
  SHORTCOMINGS  OF MODERN NURSES
outside management, and the many schools
afterwards started by the hospitals primarily
for their own advantage no  longer followed
educational ideals.
  No wonder their graduates have failed to
satisfy outside needs. How could they be ex-
pected to serve acceptably, in private homes,
as the lieutenants of private practitioners?
Misunderstandings, of course, followed, and
on both sides.  The doctors,  if their practice
differed from that of the hospital where the
nurse was trained, were considered by her to
be ignorant of first principles. Too often the
patients have been led to take the same view,
and so have  lost that  confidence  in their
physicians without which no  medical success
is possible. I need not try to give the physi-
cian's estimate of such nurses.  That can be
easily imagined. Nor need I more than point
to the consequent sacrifice of  the patient's in-
terests. And yet, as I have already insisted,
for this failure of modern nursing, physicians
have only themselves to blame. For it was and
is their business to  see that their lieutenants
                    159 
NURSES FOR OUR NEIGHBORS
are so trained  that  their patients' interests
shall not suffer.
  As  individual practitioners, physicians, of
course, cannot be expected to start and man-
age schools for  nurses. If they should do so,
they would  have little time for professional
advancement, as some few have found out to
their  cost.  But why have not the medical
schools, which  have  always  been  managed
by the profession, undertaken this work? To
this question I  can give no answer.  I merely
state the bare fact that no medical school has
yet considered it worth while to teach nursing
or nurses. And yet no surgeon or physician
can be found who would  undertake to deny
that the successful practice of  medicine  and
surgery depends more largely upon the  kind
of nursing care patients receive than upon any
other factor. The only possible excuse for this
delinquency  of the medical schools is  that
so much time is required  in teaching medical
science that none is left for teaching the art
of medical practice.  And  nursing is only one
part of that. Find new germs, — that is the
                    160 
  SHORTCOMINGS OF  MODERN  NURSES
watchword of the day.  And the rank of medi-
cal schools is now determined by  the size of
the laboratories and by the number of paid
professors who never see private patients!
   If those who should be are not, who then are
responsible for the training our modern nurses
receive? No short answer can be  given. As
a matter of fact, the trustees are in authority
over all the departments of the hospital and
therefore over the training school.  Generally
the especial charge of this department is given
to a subcommittee.  But few tmstees under-
stand  their  duties,  especially this duty of
educating and training pupil  nurses.   Their
ignorance or indifference  is inexcusable.  If
charged with it, they plead their  special in-
terest  in institutional economy; they say the
hospital cannot afford to provide for the pupil
nurses any further education than is needed
for their work while there. But they almost
never know what is the real cost of the hos-
pital's nursing service, which if they did know
might  shame them. For then they would see
that they get their nursing service under false
                    161 
      NURSES  FOR  OUR NEIGHBORS
pretenses.  Arguing from the very different
case of their  unpaid medical and surgical ser-
vice, which is gladly given by graduates of the
medical schools in return for opportunities for
professional experience,  they  hold that the
experience gained by the pupil nurses  is suf-
ficient recompense  for  their long days and
nights and years of hard work. They thus ig-
nore the fact that  their hospitals advertise
having schools of nursing, which, if anything
is meant, means that in these schools they pre-
tend to give women a professional education,
or, in other words, to fit them for the  subse-
quent practice of that profession.  In this pre-
tension it is true the trustees  are supported
by many graduates of these schools, who nat-
urally enough suppose that to be tme. No
one likes to admit,  even to himself, that he
has been buncoed. So it goes on.  Each year
the hospitals  hold graduating exercises.  The
chairman of the tmstees, or some distinguished
visitor, gives an address full  of platitudes,
with withering reference to Sairey Gamp and
glowing eulogy of Florence Nightingale; and
                    162 
  SHORTCOMINGS  OF MODERN NURSES
then he bids another class go forth as modern
ministering angels.   Then all  dance and sip
pink lemonade.  With this educational farce
the hospital  trustees are satisfied.   Few of
them,  I  imagine, would acknowledge them-
selves in any way to blame for the unfitness of
these new graduates for the work they thence-
forth will be called upon to do.  Indeed, few
hospital trustees know anything of the his-
tory, and so nothing of the ideals, of nursing.
They are not, however, so very much to blame
for this ignorance, for, as might be expected
in the  case of so new a profession, there is no
easy way of acquiring this necessary informa-
tion.
  While  responsibility for all the misery en-
tailed  by the present unfitness of modern
nurses really belongs to hospital tmstees for
not  providing  better training  schools,  the
blame  usually  but  unjustly  falls upon the
superintendents  of these schools. We there-
fore must consider their opportunities and lim-
itations,  which,  as we shall see, vary greatly.
  In the smaller hospitals, which have ma-
                    163 
     NURSES FOR OUR NEIGHBORS
trons as superintendents, the training schools
are, as they always should be, under the sole
direction of women who  have attained dis-
tinction as nurses. The disadvantage in such
institutions is that few women are physically
able and otherwise competent for the double
duty of managing both hospital and school.
In a few instances this duty is divided between
a matron in charge of the hospital and a super-
intendent of  the nurses, but seldom can two
be found  who can work  well together,  and
divided responsibility is notoriously unsatis-
factory.
  The larger hospitals  usually have a resi-
dent physician for superintendent. Sometimes
he is really interested in  the training school
and of great help to the superintendent of it,
who after all is his subordinate.  But where
the resident physician is chiefly interested in
hospital economy, as, indeed,  he must be in
order to satisfy  the trustees,  and where his
superintendent of nurses is not, and perhaps
cannot be, his loyal co-worker,  the training
school  of course suffers  from their inevitable
                    164 
  SHORTCOMINGS  OF MODERN NURSES
clashing. Educational interests are thus sure
to be sacrificed.
  For many years the superintendents have
been striving to better their schools.  They
have organized an association for this purpose.
And they have already accomplished much,
especially in forcing upon at least one univer-
sity the establishment of a school for  teachers
of nursing. This they did by supporting the
school for  several  years  out of their own
meager salaries.  They have also provided a
curriculum, as  a model, and through state
boards of education, and state examiners for
the registration of  nurses,  they have forced
many training schools to adopt this  curricu-
lum, in some cases, it must be said, to the de-
triment of  these schools.  But in the  main, in
spite of some intolerance of other methods of
training, there can be no question of the help-
fulness of this association of superintendents.
Much more good work might have been done
by them had they had actual authority over
the schools, which only nominally are under
their charge, or had they been better sup-
                    165 
NURSES FOR OUR  NEIGHBORS
ported and more intelligently guided by either
the medical profession, whose lieutenants and
assistants their pupil nurses must be, or by
the hospital tmstees under whose authority
the superintendents serve.
  The alumnae societies of the training schools
and their state and national associations have
also striven for the advance of the nursing pro-
fession. But it is pitiful how much energy they
have wasted in seeking legislation for this pur-
pose.  For however possible it may be, by legal
enactments and formal examinations, to test
the scientific  and technical accomplishments
of nurses, it will never be possible thus to test
their mastery of the art,  including their tact-
fulness and devotion, which  is far more im-
portant. This fact is well  understood by many
who nevertheless have followed leaders  more
inclined to political methods.  Some of  these
unrepresentative spokesmen, not content with
the silly use after their names of the initials of
registered nurse, as if "R.N." were the equiv-
alent of a college degree,  have gone so far as
to ask for legislation to restrict the use of the
                    166 
  SHORTCOMINGS  OF MODERN NURSES
title "nurse" to such as have been licensed by
the State. Comment upon such foolishness is
unnecessary.
  When  we consider the heavy handicap  of
the faulty organization of our training schools
we  well may be astonished at the excellence
attained.  And whenever we blame them for
not fitting their pupil nurses, as they pretend
to do, for the subsequent practice of nursing,
we  must always remember that these schools
have succeeded in reforming hospital nursing,
which has made possible the establishment of
hospitals in almost every city and town of this
country and, indeed, in many of our villages.
The pity is that those responsible for these
schools have been content with that.  Essen-
tial as excellent hospital nursing is, there are
many other equally important needs which
can be supplied only by nurses specially trained
therefor.  I will not further dwell upon the
chief of them all, although too great emphasis
can never be given to the need of better priv-
ate nurses for families in their own homes;
but more than passing mention must be made
                    167 
     NURSES FOR OUR NEIGHBORS
of other lines of work for which the  schools
of nursing ought to fit their pupils. Some of
these are now well known.
  To begin  with there is  district, or,  as  it
should rather be called, visiting, nursing. The
great usefulness of such service, and the neces-
sity  of it, is being more and more generally
recognized. Even in small towns  it is being
attempted. Women's clubs are everywhere
striving for its establishment, and except for
two great obstacles the movement would more
generally succeed and far greater good would
result. The first of these obstacles is that there
are not enough nurses available who have been
properly trained for this service, and the sec-
ond  is that insufficient  salaries  are offered by
the visiting nursing associations.  Not until
recently have the hospital schools undertaken
to provide any training whatever in this very
different kind of nursing.  Indeed, they have
resented the idea that any special  training in
it and for it is needed, or even  allowable in a
model school. In this contention the schools
quite naturally  have  been upheld by their
                    168 
  SHORTCOMINGS  OF MODERN NURSES
graduates who have been taught to believe
that their training in merely hospital nursing
fits them for all other kinds.  Such  has been
their assurance that when a few years ago a
chief superintendent of visiting nursing was
wanted in Canada, to establish this service in
commemoration of Queen Victoria's Diamond
Jubilee, as had  been done for her  in Great
Britain ten years before, several recent gradu-
ates from our American schools applied for the
position. The Irishman who thought he could
play the violin, though he had never tried it,
did not offer himself as a teacher.
  With regard to the second  obstacle to this
most beneficent extension of modern nursing,
the associations alone are to blame. They want,
and, of course, must have, only the very best
nurses, and yet they often offer only half the
salary  such nurses can earn in private practice
where  they have their board and laundry be-
sides.  The lady managers thus expect to get
their visiting  nurses for less  than they pay
their cooks. It is all very well to require  self-
sacrifice on the part of those whose work must
                   169 
     NURSES FOR  OUR NEIGHBORS
be angelic; but it is at the same time folly to
expect best professional service in the poorest
paid positions.  There is room in plenty for
any amount of self-sacrifice and  devotion in
every kind of nursing, especially in visiting
nursing, even when all the material interests
of the nurses are amply provided for, without
expecting them to sacrifice half their earning
capacity.
  One of the reasons for  this short-sighted
economy of the associations is their mistake in
limiting their field to families that are not ex-
pected to pay anything for the visits  of  the
nurse.  To those few who really cannot afford
to pay even small fees the visiting nursing
service, of course, ought to be freely  given;
but such families in most communities are a
small minority.  By far the larger number of
families needing such service can surely afford
to pay, if not the full, at least some part of the
fees.  The limitation of the service to those
supposed to be too poor  to pay anything for
it shows how little appreciation the managers
of such associations have of the rightful scope
                    170 
  SHORTCOMINGS  OF MODERN NURSES
of their undertakings.  The largest usefulness
of visiting nursing is to families having small
incomes, where resident nurses can be neither
afforded nor even  boarded and  housed.  In
homes where there are spare  chambers, and
where the cost of the nurse's wages and board
can be easily met, it is all very well to have a
resident nurse, and as many of them as are
needed. But even in such homes, where, as is
often the case, only an hour or two of trained
nursing service is wanted, the  continued pre-
sence of a nurse is irksome both to her and to
the family.  In such cases the employment of
visiting nurses is better for all concerned.  And
the money so earned by the association may
rightly go toward providing nurse visits  for
those who can pay nothing. A  most useful
extension of the proper field of these associa-
tions is in furnishing nurses for night watching.
Many a family can take all the needed care of
their sick through the daytime if only they
have help at night.  Without this help either
the patient must suffer or the  others will
break down from overstrain.
                    171 
     NURSES FOR OUR  NEIGHBORS
  The  direct relief afforded by the visiting
nurses  is only a part of the good  they do;
better methods of nursing are taught to those
whose hearts are aching to leam how to do
more for their loved ones. Such lessons outlast
all that are learned under lighter stress. Nor
is it only better ways of nursing; better ways
of living are thus taught and learned. Modem
missionaries these visiting nurses are, teach-
ing the gospel of health.   More  sunshine,
fresher air, better food, not only the sick but
also the well are sure to have, following the
nurses' visits.  It is astonishing to see how fast
and how wide this uplifting influence spreads.
Neighbors leam of it, feel its force, make it their
own, to such extent that when sickness  invades
their households it often seems as if the visit-
ing nurses must have served there  before,
so nearly perfect is the imitation of methods
learned by them in homes perhaps blocks away.
  Another line of work where trained nurses
are of great use to the common weal is that
of  school visiting.  At first  such work was
attempted by physicians employed  by health
                    172 
SHORTCOMINGS OF  MODERN NURSES
boards or by school committees.  But soon it
was found that much more was needed than
physicians could do.  They could do the in-
specting, but they could not follow up their
advice to the parents of children found to be
sick, and still less could they take the time to
hunt up the absentees.  In short, it soon was
found that medical inspection of the schools
was of  little use unless followed by visiting
nursing. Much good has already resulted from
this new department of nursing. In no schools
where it has been undertaken will it ever be
discontinued.  And from all over the country
the cry  is for more school nurses.  The work is
like that of ordinary visiting nursing, and yet
it is different enough to require special train-
ing for it.  This training the schools of nursing
ought to provide.
  There is  still another specialty of visiting
nursing where special training  is  requisite.
At last  the world  is awake to the possibility
of stamping out tuberculosis. Associations for
doing this are everywhere  forming.   Their
efficiency depends  upon nurse agents.
                   173 
      NURSES  FOR  OUR NEIGHBORS
  Last  but not least is the need of nurses
specially trained for social service, the latest
flower of organized philanthropy, for which,
in its particular application to the  hospital
and dispensary world, we owe a great debt to
Dr. Richard C. Cabot, of Boston. He saw the
need, as did many others. But he also saw the
way to  enlist in this service willing workers,
who under  the inspiration of his high purpose
succeeded in doing so much good that hospi-
tals everywhere are following the example of
the social service department of the Massa-
chusetts General Hospital.
  For this social service of every kind so much
special training is needed that few nurses have
yet undertaken it.  And some famous  social
workers go so far as to say that women are
unfitted by a nurse's training for this work.
This is by all odds the severest condemnation
yet made of the training schools.  It is not,
however, altogether true. And, at any rate,
it should be obvious, on the contrary, that a
proper training in nursing would be  of great
advantage to the social worker.  For although
                    174 
  SHORTCOMINGS  OF  MODERN  NURSES
her work is not so directly for the physically
helpless as it is to relieve and prevent every
other kind of helplessness, nevertheless there
is no sharp dividing line between helplessness
due to disease, whether of body or of mind, and
that due to moral or other causes. Any attempt
so to  separate the proper fields  of social ser-
vice for nurses  and for lay workers will be
futile.  In recognizing, in understanding, and
in relieving physical helplessness the visiting
nurse has the great advantage  over  the lay
worker.  Moreover, her uniform admits her
to the very center of the home,  whereas only
the parlor in many a house would be open to
the friendly caller in her street dress.  In other
words,  for one acquainted with all forms of
disease, while searching for the causes  and
ways of relief, it is easier to pass from the
physical into other realms, such as the moral
and economic, than it is for any one without
this knowledge to make the necessary allow-
ances for purely physical causes of whatever
helplessness is encountered.
  From this sketch of the various departments
                    175 
NURSES  FOR  OUR NEIGHBORS
of modern nursing it must be apparent how
great is the need of better training schools for
nurses.  Our only  hope of getting them is by
changing the present widespread dissatisfac-
tion into an effective public demand for their
improvement. 
CHAPTER VIII
   HOW TO GET BETTER NURSING SCHOOLS
   In the previous chapter I have told how far
 short the present training schools fall in fit-
 ting nurses for the many different kinds  of
 nursing needed.  That their pupil nurses are
 indispensable to the hospitals, and that after
 their graduation they  are excellent hospital
 nurses, does not save these schools from very
 low rating if judged by educational standards.
 It  is,  therefore,  no wonder that ambitious
 young women, — college graduates,  for  in-
 stance, — in search of professional education,
 hesitate to take up nursing, and instead choose
 other professions that have real schools, but
 in which  they have  to compete with men.
 Regardless of the great need of better nurses,
 even if only to furnish proper educational op-
 portunities for young women in lines of work
where their sex is an advantage, better nurs-
 ing schools should be provided. How this great
                    177 
NURSES  FOR OUR NEIGHBORS
improvement might be effected I now propose
to show.
  With even slight knowledge of the subject
it is evident that the development of training
schools  for nurses depends mainly upon the
kind of relationship  between the schools and
the hospitals with which they are connected.
There are three principal  kinds of such rela-
tionship.
  First,  where the  educational  institution
owns and manages the hospital; second, where
the hospital owns  and manages the school;
and, third, where the two institutions are under
separate management, but more or less closely
affiliated.
  (i)  To the first class belong the hospitals
and  schools  of the  Protestant  deaconesses
and the Roman Catholic sisterhoods.  Some
of them are  very old  and famous. In  this
scientific age, however, it is generally believed
that such connection between the hospital and
Church has been outgrown.  But these insti-
tutions have a tremendous  economical advan-
tage over other hospitals, and it is not at all
                    178 
 HOW TO GET BETTER NURSING SCHOOLS
 unlikely that we shall yet see a great revival
 of  the Church hospital  and training school,
 as we have lately seen in this country a great
 development of Church day schools.
   (2) In America the hospital ownership of
 its training school is nearly universal.  The
 wonderful increase in the number of training
 schools during the last  quarter-century has
 been primarily due, as we have seen, not to
 a wide-spread educational movement for the
 benefit of young  women, in  order to fit them
 in the best possible  manner for the subse-
 quent practice of nursing, but rather to the
 recognition on the part of hospitals that stu-
 dent nurse service is better and cheaper than
 any other nursing service available.  Owing
 largely to this economic discovery the number
 of hospitals in the country has increased ten-
 fold within the past twenty years, and nearly
 every one of them now owns  a training school.
Hospital nursing meanwhile has  been revo-
lutionized. Too much cannot be said in praise
of its present efficiency.
  Although many of the hindrances to nursing
                   179 
NURSES FOR OUR  NEIGHBORS
advance are due to this subservience of the
educational to the eleemosynary institution,
nevertheless, so firmly is this custom intrenched
that even those who recognize its great dis-
advantages  still accept the  arrangement as
inevitable.
  It is surely well for those who are interested
in the education of nurses to look squarely at
all the obstacles thereto.  We can then plan
to surmount them. Almost all of our hospitals
are governed by trustees, who are elected or
appointed solely for the efficient and economi-
cal management of the hospitals. The nurses'
training schools belonging to these hospitals
are merely  side issues. Whatever interest in
them the hospital trustees may have is due
primarily to their anxiety for most efficient
and economical nursing service. The resident
physician or medical superintendent of the
hospital is  merely the salaried agent of the
tmstees. It is his first business to suit them,
and the matron of the hospital and superin-
tendent of the training school is only one of
his assistants.
                    180 
HOW TO GET BETTER NURSING SCHOOLS
  Of course, as we all know, some hospital
tmstees and some hospital superintendents
are also interested in the higher education
of their nurses beyond the hospital's imme-
diate advantage, but to  such men this is a
secondary  and not a primary interest.  In
point of fact, it is seldom even that much;
for there  are very few hospital  trustees in
this country who  make the management of
their hospitals  a  matter  of  first interest.
What, then,  can be expected of them in ad-
vancing the profession of nursing? It would
be just as sensible to expect hospitals to man-
age medical schools to the advantage of the
profession of medicine as it is to  expect any
advantage to the  nursing  profession from
the hospital's ownership and management of
the training  school.  The hospital depends
upon practically gratuitous nursing and medi-
cal  service from students of  nursing and of
medicine who are glad of the opportunity
for  practice that such service affords.  The
medical students who serve as internes must
have had  previous education in the medical
                   181 
      NURSES  FOR  OUR NEIGHBORS
schools,  and student  nurses  ought also to
have preliminary and  preparatory education
before being given practice in the wards. And
why, it may well be asked, should it be ex-
pected that young women  must learn their
anatomy and physiology, for  instance, while
hard at work, when their brothers in the medi-
cal school are allowed all of their time for these
studies ? The unfairness of this discrimination
against the nursing profession is not lessened
by the fact that a shorter course of preparatory
education is needed for the student nurse be-
fore  she begins  the actual practice of nursing
than is needed by the medical student before
he is given practice even in out-patient assist-
antships.
  All medical schools offer opportunities for
this  preparatory education.  Why do not all
training schools do likewise?  There is  but
one  answer.  The hospitals which own  the
training schools think they cannot afford the
expense of preparatory  courses.  And  yet
many of these same hospitals pay to their
student nurses  in small monthly stipends as
                   182 
HOW TO GET BETTER NURSING SCHOOLS
much  as  proper preparatory  courses would
cost.
  The cause of this and also of other glaring
anomalies  in  the present regime  is easily
found  in examining its development. Before
their training schools were started, the hos-
pitals  depended for  their  nursing service
upon hired servants often of the lowest class.
When these toughened women were displaced
by student nurses, the same wages were paid
and  too many other of the same conditions
remained in force. It is very true that many
of these hardships have been ameliorated, but
the fact remains that hospital  student nurses
do not yet have anything like a fair chance for
acquiring  such an education and  training as
will best fit them for future usefulness.
  The defenders and advocates of the present
system of hospital owned  training schools
maintain that the only education needed by
nurses can be acquired in the  actual nursing
of a  great many cases. We need not stop to
discuss this proposition, further than to point
out the fact that only a  certain  amount of
                   183 
NURSES FOR OUR  NEIGHBORS
nursing service can be given by any one nurse
and, therefore,  it matters not by how many
hundred or thousand other cases she is mean-
while surrounded.  For even if it be admitted
that a nurse's proper  education is provided
for in the  opportunity to see and to nurse a
great number of patients, it surely cannot be
gainsaid that the variety of cases thus avail-
able is at least of equal importance.
  In a great general hospital the medical in-
ternes, it  is true, have the chance of seeing
many rare diseases,  and very many cases of
the common diseases.  To a  less extent the
student nurses also have this advantage.  But
inasmuch  as hospitals admit only  certain
forms of  human helplessness, it necessarily
follows that the hospitals afford their nurses
correspondingly  restricted oppportunities for
their education.  Thus, in one hospital there
are no contagious cases, in another, no obstet-
rical cases, and so on.   Worse than this, the
special hospitals that  receive only  women
patients, or children, or only mental or nerv-
ous cases,  all have their training schools.
                    184 
 HOW TO GET BETTER NURSING SCHOOLS
   Some few hospitals have lately tried to ar-
 range for  their student nurses exchanges of
 service, but this movement, which is of great
 educational promise, is beset with difficulties.
 The  interests of the different hospitals clash,
 and even where they are virtually under the
 same management this exchange of service,
 after having been proved most desirable from
 the educational point of view, has been dis-
 continued.  Such arrangements for the broader
 education of nurses, however, can very easily
 and naturally be  made by the independent
 schools.
   But, even with all the possible advantages
 of service in several different hospitals, there
 is still lacking in hospital training schools the
 opportunity of learning how to care for the
 common everyday ailments and invalidisms
 and helplessnesses, which are never admitted,
 or, if by accident admitted, are never allowed
 to remain in hospitals. And yet in the  actual
practice of both physicians and nurses by far
the larger service is to just such patients.
  Not only are nurses whose training has been
                    185 
     NURSES FOR OUR  NEIGHBORS
solely in hospital wards under the disadvantage
of never having even seen many of the common
forms of human helplessness, but they go out
to private practice under the still more serious
disadvantage of never having learned to take
care of patients in their own homes, surrounded
by their families.  This is  the chief cause of
the dissatisfaction on the part of the medical
profession and the laity with modem nurses.
When the patient is acutely sick,  and espe-
cially when  a serious surgical operation is
necessary, then the modern nurse is recognized
as a blessing. She is then in her own element,
for  success  depends upon transforming the
home into a hospital.  But, when the success-
ful treatment of the patient as well as the hap-
piness of the patient's family depends, as in
nine cases out of ten it does depend, upon keep-
ing the  home from being  turned into a hos-
pital, then the modern nurse is not so sure of
being thought an  angel. For it is one thing to
be able  to take excellent care of a  dozen pa-
tients in a hospital ward, where all materials
are at hand, and where no thought need  be
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HOW TO GET BETTER NURSING SCHOOLS
given to the domestic arrangements, and it is
quite another thing to take good care of a sin-
gle patient in her own home, where no proper
appliances  are available and where the whole
household machinery is easily upset.
  Of course this very different kind of nursing
can be afterwards learned by graduates of the
hospital schools.  As we all know, many such
become excellent  private nurses.  But such
ability is gained not where it should be gained,
during  the nurse's  studentship, but  in her
subsequent practice, where the nurse is paid
maximum fees. This serious educational dis-
advantage in the hospital schools is fast being
recognized  by all teachers of nursing, and
many hospital schools are arranging for the in-
struction of their student nurses in district
visiting nursing. What, then,prevents the gen-
eral adoption of this improvement? Again the
same answer—the hospitals cannot afford  it,
they cannot spare their student nurses.
  Here we  have the  underlying disadvantage
in the hospital ownership of its training school.
In such subordination of educational  ideals
                    187 
NURSES FOR OUR  NEIGHBORS
to utilitarian ends no real professional advance
can be expected. Even in the manual training
schools, where pupils are fitted only for trades,
the product of the pupil's endeavors is of only
secondary consequence.  The pupil's education
and training is the  sole purpose of  these
schools. But in the hospital nursing schools,
on the contrary, the usefulness to the hospi-
tal  of  the  student nurse's work is the only
consideration. Even her health is of  minor
consequence.
  (3) Before considering the advantages  of
affiliation between separately  governed nurs-
ing schools  and hospitals we may well bring
into view the kind of training  school required
by our present ideals of nursing.
  As regards the department of hospital nurs-
ing,  little need be said.  In that respect the
training schools of the present day are most
proficient.  That, as we have seen, is because
the schools exist for the primary benefit of the
hospitals, and because they are so entirely con-
trolled by hospital tmstees. Were the training
schools controlled,  as  are  all other schools,
                    188 
HOW TO GET BETTER NURSING SCHOOLS
by educational boards, whose primary pur-
pose is the education of their students for their
highest future usefulness, there can be  no
doubt that at least  equal opportunity would
be afforded in the training schools for educa-
tion and training in  the other departments of
nursing.
   For instance, proper preparation for private
family nursing includes  thorough education
and practice  in  all branches of housekeep-
ing.  In  wealthy households the nurse, it is
tme, may not need such knowledge, but in
the  average family, and especially when the
mother is the patient, a nurse who  is not a
proficient housekeeper is worse than useless.
   And again  in the departments of visiting
nursing and school inspecting, where trained
service is now in rapidly  increasing demand,
proper preparation  requires special courses
of instruction  and full opportunity for prac-
tice under teachers who have mastered these
specialties of nursing. Further instances need
not be specified in support of our main con-
tention that the ideal training school must
                    189 
NURSES  FOR OUR NEIGHBORS
prepare nurses for the kind of service the pub-
lic demands.  And is it not self-evident that
such training schools can be inaugurated and
maintained only under the management of
educational boards?
  Inasmuch as  more than nine tenths of our
nurses are  women, it is certainly fitting that
the majority of the educational boards in
charge of training  schools should be women.
And so fast as  possible  these  boards  should
include in their membership graduate nurses
who have become permanent residents in the
neighborhood.  In the case of many  of the
smaller hospitals, their boards of  managers
fulfil these requirements, and might naturally
be thought perfectly competent to manage the
training school as well as the hospital. If so,
it  still is important that there shall  be two
separate organizations, even of the same peo-
ple, as managers of the two very different in-
stitutions — the hospital and the school.
  But it is of far greater importance than the
composition of the board of tmstees that the
direct management of the nursing school shall
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HOW TO GET BETTER NURSING SCHOOLS
be vested in a faculty of teachers.  This re-
quirement is a sine qua non.  No real school
can possibly be otherwise managed.  Without
schools so managed no profession can advance.
  If this ideal  of the nursing  school be ac-
cepted — that it shall be managed by a faculty
of teachers responsible only to a board of tms-
tees, a majority of  whom shall be women —
then the advantage of an organization sepa-
rate from that  of the hospital  becomes very
plain, at least so far as the interests of the
school are concerned.  And our inquiry now
should be directed to the effect  upon the hos-
pital of such a separation.
  Those who believe in continuing the cus-
tomary subordination of the  school to the
hospital  are  always urging the necessity of
having one responsible chief, who as the su-
perintendent of the hospital shall have abso-
lute control of every person on  the premises.
That is all very well. No one will dispute that.
But why should such a chief have any more
control of the school that furnishes the nurses
than he has over the school that furnishes the
                    191 
     NURSES FOR  OUR NEIGHBORS
medical and surgical internes? The student
nurses  who are sent to the hospital for their
training must, of course, while in such service
be absolutely obedient to the hospital organi-
zation.  Failure in this respect should in their
case, as in the case of the internes, involve their
instant dismissal from the hospital's service.
Moreover, it may well be provided that the
matron of the hospital and her permanent as-
sistants should also be members of the faculty
of the nursing school. This would inure to the
benefit of both institutions.
  One  great advantage  of having separate
organizations for the school and the hospital
comes in the relief that such separation gives
to the hospital management.  As a member of
the faculty the hospital matron can well afford
to give her advice and assistance to the school.
In that faculty she is in charge of the depart-
ment of hospital training. But she  is relieved
of the overwhelming responsibility now resting
upon most hospital matrons of managing also
the preparatory and  all other departments of
the training school. If it works well in the best
                    192 
HOW TO GET BETTER  NURSING SCHOOLS
private hospitals, instead of maintaining train-
ing schools of their own, to employ only stu-
dent nurses from other hospitals which have
their schools, why should it not work equally
well in all hospitals to  employ only  student
nurses from independently organized schools ?
The answer is that wherever tried this kind of
affiliation between school  and hospital does
work well for both organizations.
  If the  scheme  be considered  only  from
the financial viewpoint, the  arguments  are
wholly in its favor.  There  is no reason why
hospitals, supported by charity, whether pub-
lic or private,  should pay more for  nursing
service than for medical  service. The perma-
nent officers of the hospital, both nursing and
medical, must, of course, be paid salaries; but
the constantly shifting force, both of  student
nurses and of medical internes, if given board
and lodging,  is sufficiently paid in the oppor-
tunity thus  afforded for acquiring practice
in their professions. Were this principle more
generally recognized, the hospitals would feel
more free to maintain  an adequate  nursing
                    193 
NURSES FOR OUR  NEIGHBORS
force, and the student nurses would be eman-
cipated from many of their  inherited  servile
hardships.
  Against the separation of  school and  hos-
pital may be  urged the impossibility  of the
nurse's serving two masters.   Such objection
entirely misses the mark.  For it is the nurse's
business first,  last, and all the time to serve
her patients in absolute obedience to medical
direction. This is also the business of the whole
hospital organization  of which the nurse is a
part.  The only purpose of the nursing school
is to fit her for this service, and, therefore, in
perfect loyalty both to her school and to her
hospital there can be no conflict. Her duty to
the one involves her duty to the other.
  When once this indispensable independence
is  gained  for  the  training schools, for their
further development  we have only to follow
steps  already  taken for  the  advancement of
other new professions, which, like that of nurs-
ing, are really special   departments of   the
grand profession of medicine.  Take dentistry
for example. The dentists, scarcely fifty years
                    194 
HOW TO GET BETTER NURSING  SCHOOLS
ago, were either self-educated or they picked
up what they knew by apprenticeship. Then
schools  of dentistry were established for the
pecuniary advantage of their promoters. Such,
indeed, was also the sole purpose of many med-
ical schools that only lately have been driven
out of existence. Then, as the public awakened
to the importance of better dentistry, there
came the demand for truly educational schools,
which our universities at last heard and an-
swered.
  Even our domestic  animals have had the
same good fortune. Veterinaries were formerly
self-educated.  Then came schools which sold
diplomas for the profit of those who signed
them.  This would not do. And, again in re-
sponse  to public demand, the universities
added another department.  For  our teeth,
our horses and dogs, when ailing, we can now
have doctors of dental or of veterinary medi-
cine who have been properly educated for the
practice of these professions.  Why, then, for
our nurses should we be content with schools
under no real educational direction, however
                    195 
NURSES  FOR OUR NEIGHBORS
profitable they may be to their hospital pro-
prietors?  Or rather why is not our discontent
voiced so loud that it shall reach the univer-
sities ?
  The state universities  have latterly made
great strides  in practical  education.  Sup-
ported as they are by direct  taxation, they
have found it necessary to furnish what  the
people want.   Purely  academical education
was not enough. The arts and sciences must
all have university support.  Even the trades
must likewise  be helped.  These universities
should also be asked to undertake the educa-
tion of nurses. There can be no doubt that such
a request, if popular, would receive favorable
answer.
  The older universities, and some  of  the
newer that  have been established by great
gifts and bequests, would not be able, perhaps,
to add a school or department of nursing  un-
less  additional endowments for that  special
purpose should be given them.  And the hope
of such endowments depends  upon  a more
general knowledge both of the need and of  the
                   196 
HOW TO GET BETTER NURSING SCHOOLS
feasibility of nursing schools under university
control.
  In providing intelligent educational direc-
tion for any professional school  what other
way is open?  How else  can the schools of
nursing be wrested from their present hospital
proprietors?  For it is too much to hope that
they will ever be able to  look further ahead
to the interests  either of  graduate nurses or
of those who afterwards will be dependent on
their services. Indeed, it is more probable that
these tmstees will always feel obliged to get
their nursing service at the lowest price. And
if they could not be shown,  as I believe they
can be shown, that by the university adoption
of nursing education they would have better
nurses for their hospitals and at no higher cost,
every movement for such schools would en-
counter their opposition.
  As regards the need of better nursing schools
I hope I have made that clear. And now, in
order to show the feasibility of the adoption
of such schools by universities, I offer the fol-
lowing considerations.
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NURSES FOR OUR NEIGHBORS
  In the first place, only the universities afford
the best security for proper financial care of
educational endowments.  Without this se-
curity no great gifts or bequests for the ad-
vancement of nursing ought to be expected.
And, what is still more important, university
acceptance of special educational endowments
insures the proper use of such means for the
purpose intended.
  The immediate direction of  every profes-
sional school must be left, of course, to a faculty
of teachers, chosen by the university govern-
ing board and under  its general supervision.
Upon their wisdom and influence the char-
acter  and usefulness of the school depends.
The composition of  such faculties is therefore
the question of greatest moment.
  Were nursing a separate science, or even an
independent profession, it would be plain that
the faculty of a school of nursing should be
made up  only of nurses.  But such is  not
the case.  Nursing is  not so much a  science
as it  is an art;  and,  moreover, it is  not an
independent profession, for nurses must al-
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HOW TO GET BETTER NURSING SCHOOLS
ways work under medical direction. A school
for the education of nurses should, therefore,
be a department of the medical school, which
implies that  its faculty must include physi-
cians.
  The teaching of such science as is essential
in the education of nurses has generally been
left to physicians, who have given courses of
lectures and perhaps some smattering of labor-
atory instruction.  But these medical teachers
have had almost no voice in the management
of the training  school, which is  one of  the
reasons why  nurses and  physicians have  not
pulled better together. Unfortunately the sex
question  has contributed too largely to this
estrangement.  Many of the leaders of  the
nursing profession have been fierce for "wo-
man's rights."   In their estimation nurses
should manage their own affairs.   And inas-
much as the great majority of the medical pro-
fession are still of the male  persuasion, any
efforts by physicians for  the  improvement of
nursing have been regarded by these women
as intrusive.  This is folly. For, in spite of the
                    199 
NURSES  FOR OUR NEIGHBORS
fact that nursing is preeminently a womanly
vocation, men are often excellent nurses, and
some  of them excellent teachers of nursing.
And inasmuch as nurses,  after all,  are only
agents for carrying out medical orders, it is
plain  that physicians ought to have a large
share in their education and training in order
to insure beneficent cooperation.
  A well-chosen  faculty of first-rate  teachers,
some of them physicians to teach the sciences
underlying the art of nursing, and the others
nurses who as masters of the art shall teach it,
would soon have a school  worthy of its high
purpose.  For all that then would be wanting
would be suitable pupils, and for such oppor-
tunity thousands are waiting.  Many of them
have  already applied to the present schools
for information, hundreds  here and hundreds
there; but when they have found out the edu-
cational poverty and the  many other disad-
vantages of what is now  offered, they have
reluctantly turned away to other employments.
Not a few have been advised to do so by phy-
sicians and nurses, who know only too well the
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HOW TO GET BETTER NURSING SCHOOLS
hardships and disappointments pupil nurses
now have to bear.
  It is not unusual in the annual reports of the
hospital training schools to find that ten times
as many young women have applied as there
were vacancies, and yet that there is increas-
ing difficulty in enlisting enough probationers.
What a commentary this \
  The usual  criticisms, however, that deter
women from entering training schools are not
what I have already made: it is not their
great failure to fit nurses for subsequent prac-
tice that is generally charged against them.
Perhaps  the  most common deterrent is the
sacrifice  of health  and strength  that pupil
nurses too often suffer.  There is no denying
that nursing is arduous work and that a shame-
ful extra strain  is put upon pupil nurses in
having to acquire their theoretical education
and pass their  examinations therein, while
working to the very limit of their strength in
the wards, and often while short of sleep.  But,
on  the  other hand, it is  tme  that  young
women of excellent physique, who vigorously
                   201 
     NURSES  FOR OUR  NEIGHBORS
deny  themselves  every fatiguing  diversion,
and instead avail  themselves of every chance
to rest, generally finish their course of training
without physical  detriment. Some few, pro-
fiting by more regular regime and plainer food,
even improve in health.  No school, especially
a school for young women, ought to be al-
lowed  existence where  such  results are ex-
ceptional.  Were  there  any need of  this too
common sacrifice of health in  the course of
training, it would  not be so intolerable. There
is none.
  In  King's College Hospital  I once asked
Miss Monk how  she secured such fine pupil
nurses,  so gentle and  delicate and perfect
seemed to me their service.  She replied, "I
take those whose health has broken  down in
other hospitals, for  I  have found that the
sensitive, high-spirited,  self-sacrificing proba-
tioners who are first to  break down in health
make the best nurses if only properly guided
and guarded."  She preferred the curb to the
whip and spur.
  The danger of damage to health, however, is
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HOW TO GET BETTER NURSING SCHOOLS
a more weighty consideration with their older
advisers than with the young women them-
selves. What they most fear is any needless
sacrifice of their independence.  And there is
no  gainsaying that in the training schools
there is still far too much of that.
  The discipline necessary in a well-ordered
hospital bears heavily upon young women who
before have had their own way.  The few*who
complain of that, however, have yet to learn
the  essence of service, and the sooner they
fly away to more flowery fields the better for
all concerned.   No, it is not that they must
sink their individuality for the good working
of the corps, it is not that they must evince
soldier-like obedience to every order however
curt, but rather it is that they must be judged
without fair trial by a single despotic chief,
from whose condemnation there is no appeal.
This it is that rightly frightens women of proper
spirit from entering training schools. Of course,
where the matron or superintendent or prin-
cipal, however the despot  be named, is a fine
woman, as she often is, impartial  and kind-
                   203 
     NURSES FOR OUR NEIGHBORS
hearted, her pupil nurses may have no just
ground for complaint against her decisions.
But they cannot even then be content under
such governance. Their real objection, whether
aware of it or not, is to service under one who
holds two very different offices.  When they
meet her, which ft not often, they cannot tell
whether she comes as matron of the hospital,
on official tour of inspection, interested only
to see that the work goes on well at any cost,
or whether she comes as their helpful teacher,
interested mainly in their individual progress
and welfare. Willing enough they would be to
work under martinets if only they might some-
where find their teachers.
  Where,  on the other hand, the chief, how-
ever named, has her pets and her pet aversions,
or where she successfully conceals every evi-
dence of kindly interest in her pupil nurses,
their life may  be almost unendurable.  The
long and short of it is that the present auto-
cratic organization of hospital training schools
is an un-American anachronism.  And that it
is so regarded by young women of discernment,
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HOW TO GET BETTER NURSING SCHOOLS
who for this among other reasons,  although
desirous of being nurses, shrink from the train-
ing, would soon be shown by the number that
would enter a school of nursing where their
education would be in the charge of a faculty
of teachers. But such a  faculty, and the di-
plomas they give, must have university stand-
ing. Diplomas signed by a hospital chairman
and some equally unknown superintendent of
nurses are pitifully valueless, even if accom-
panied by gold breastpins engraved with the
date of the founding of the hospital.
  The proper organization  of  a university
school of nursing, although a new departure,
involves no great difficulty. Having given the
subject much thought I cannot  resist offering
a plan, which  by  happy chance may  help
others to formulate their  own ideas  of what
such a school should be.
  We must first agree as to what  shall be
taught. Fortunately that is easy as regards the
two essentials of elementary science and of
thorough drill in hospital service. For the first
of these a full year's work is indispensable be-
                    205 
NURSES FOR OUR NEIGHBORS
fore the pupil nurses are given actual nursing;
and for the hospital drill between one and two
years further are needed. Besides these essen-
tials, there are two others, regarding which as-
sent from nurses need not be expected.  One of
these is housekeeping:  for nursing includes
that, however vigorously modem nurses may
object to the fact. The other essential is de-
votion to the helpless, not only as individuals
but as members of families, — domestic nurs-
ing it might well be called, in distinction from
hospital nursing.  With these four essentials
before us of what shall be taught, we are ready
for the questions of where and how and when
this teaching shall be given.
  The scientific foundation of nursing, which
usually has  been  taught in some fashion by
physicians, ought to be and would be taught
much better by medical teachers employed
and paid by the university. There would then
be hope of more sensible methods and of more
suitable textbooks. In anatomy, for instance,
instead of burdening the pupils  with  names
which most physicians have forgotten, they
                    206 
HOW TO GET BETTER NURSING SCHOOLS
would be taught mainly on the living model
what nurses ought to know. The general prin-
ciples of physiology,  rather  than finespun
theories, would be emphasized.  And so in
chemistry and in bacteriology, it surely is pos-
sible  to  give an intelligent understanding of
vital processes, and of harmful germs, without
burdening nurses with so much useless infor-
mation as now is thrown at them in haphazard
fashion.   Their trouble has been that their
teachers have not taken enough pains to select
what ought to be taught them.  Physicians are
not alone at fault in this matter; for nurse au-
thors also have put forth ridiculously unsuit-
able textbooks.  Some of these compendiums
have undertaken to give all the sciences nurses
need, and descriptions of all diseases with di-
rections for the treatment needed, with reci-
pes for invalid cookery and tables of weights
and measures in the appendix.  If confined
to a single subject, as for instance materia
medica, as much is given as would fit a drug-
gist for his license and more than any nurse or
even physician needs to know.
                   207 
     NURSES FOR OUR NEIGHBORS
  This scientific education should all be ac-
quired by pupil nurses in their first year, before
actual nursing is required of them.  Just as
medical  students must  have this scientific
foundation before they even see the hospital
wards, and much before they have opportun-
ity to assist in the care of patients, so pupil
nurses ought to  be taught beforehand.  But
as good nursing  depends so much more  than
does the modern practice of medicine upon
technical skill and tenderness of touch, train-
ing in this direction must be given to pupil
nurses simultaneously  with  their scientific
education.  All teachers of nursing agree upon
this necessity. But it is not necessary to give
this training in  the wards, as is customary,
at the expense of the sick and suffering.  For
it can be taught and learned better, first on
healthy models,  and then in the care of those
whose helplessness is  due not to sickness or
accident but rather to infancy or old age.
  Another essential of nursing education, pro-
ficiency in domestic science as nowadays it is
called, can likewise be given during the first
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HOW TO GET BETTER NURSING SCHOOLS
year of pupilage.  Nursing, after all, is largely
housekeeping for the sick. No one can do that
who has not first learned how to do it for well
folks so that it has become a second instinct.
This comes only by  happy  combination of
theoretical  knowledge  and  thorough  drill.
Just as at West Point soldiers are taught the
housekeeping of their camps and then, by long
practice  under  their teachers,  acquire  the
instinct of perfect orderliness, so nurses  can
likewise be taught this essential efficiency by
doing all of the housework of their school home
under teaching supervision.   Drudgery  this
may be considered; and so it is if not done
with enthusiasm and with consciousness of its
import.
  When Florence Nightingale appealed from
Fliedner's verdict that she was too fine a lady
to  undertake the nurse's training, he  said,
"You would not want to scrub that corridor
floor?"  "Give me the chance," she answered.
And at it she went.  A hard job it was, too, as
she herself told me.  But she did it, and many
another equally dirty task. Her first hours in
                   209 
     NURSES FOR OUR NEIGHBORS
the Scutari hospital  were spent in  cleaning
one room, that she and her nurses might have
a clean floor to sleep on.  The next day they
succeeded in ridding the barracks of corpses.
Before the second month had passed, the four
miles of hospital wards were clean and vermin
free, every patient and every bed was clean,
and every man well fed. That certainly was a
triumph of housekeeping.  And yet before she
went  to  Kaiserswerth  she had  never done
housework.  Nor would she there have gone
down on her knees, with scrubbing-brush and
soap and sand, had she not with the  intelli-
gence of her high purpose recognized the mean-
ing of it all.
  Fifty years ago girls were taught housekeep-
ing in their own homes.  Now they are not.
And because they have not been taught  it
in the training schools, they have not been
able, as nurses, to take proper care of private
patients, especially where the patient was the
homemaker.  Even where there are cooks and
maids, nurses who are ignorant of housekeep-
ing make no end  of trouble. And where there
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HOW TO GET BETTER NURSING  SCHOOLS
are no servants to wait on them such nurses
are almost helpless. As hospital matrons they
also often fail for the same reason.  It is usu-
ally the housekeeping, homemaking part of
the hospital that, from the economical as well
as from every other point of view, is worst
managed.
  From the  foregoing specifications of what
pupil nurses should be taught during their first
or probation year,  it will be  seen that they
must live  together in a  school-home, where
they shall be taught and  drilled in domestic
science  and where they shall also have class
room and laboratory instmction in  the other
fundamental sciences.  The only remaining
need for this first year is provision for teach-
ing the  art of caring for helpless individuals,
infants  and old people, or convalescents who
no longer  need actual  nursing  yet are not
fully able to take care of  themselves. There
never will be any lack of such opportunities.
The  visiting nurses  in any community would
be thankful for such successors;  the societies
for following up patients discharged from the
                   211 
      NURSES  FOR OUR NEIGHBORS
hospitals, the infant asylums and day nurseries,
the homes for the aged and the poorhouses, all
will  rejoice over such  kindly aid as the pro-
bationers can give.  For this branch the best
teachers are needed.  Closest attention must
be given to each probationer, in showing her
the  loveliness  of  such  personal service, in
stimulating her enthusiasm,  in teaching her
how to bring her best  heart impulses into ef-
fective  action.  The teacher  and  probationer
together should make the first of these visits
to the  helpless.  And afterwards, when the
visits are made by the probationer alone, the
teacher should follow her to find out what she
has done. Of truly helpful visits evidence may
always be found.
  If only such a year's work as I have thus out-
lined could be provided  in university schools
of nursing, the benefit would,  indeed, be great.
After such education and training, the pupil
nurses, it is easy to see, would be far more ready
for hospital service than the probationers now
accepted. The hospitals would be relieved of
the cost and trouble of the preliminary teach-
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HOW TO GET BETTER NURSING SCHOOLS
ing and training now so imperfectly given in
their schools.  This, however, is not enough.
For  no university  school  could be content
with giving a merely preparatory course. But
before outlining the subsequent education and
training of the pupil nurses until they are fit
for university graduation, we may well stop
to consider the cost of this preparatory year.
  Given suitable housing, the main expenses
would be for the teachers' salaries and for the
housekeeping. During the three following years
of the course there would be sufficient income
from the pupil nurses' services to meet the
whole cost of these years.  But for  the first
year there  would  be  no income from this
source.   They would  at best  only partially
earn their board and lodging by the housework
necessary for  their training  in this branch.
Therefore the whole cost would have to be
met by income from endowment, by tuition
fees, or by the income from both these sources.
As regards the possibility of tuition fees there
is no reason why such  a charge should not be
made as in other professional schools. But in
                    213 
NURSES  FOR OUR NEIGHBORS
consideration of the large number of young
women, in every way desirable, who have to
earn their living, scholarships should be liber-
ally provided.
  The cost of the preparatory year, supposing
the class to number fifty, and judging from the
experience of  the  Waltham training school
which  for twenty  years has  maintained a
similar  preparatory course, would  be  one
dollar per day for  the living of each pupil.
For forty weeks this amounts to $14,000. The
principal of  the school should  have a salary
of $2000. Two physician teachers should have
$500 each;  the domestic science teacher  and
the assistant principal, $1200 each.  For six
additional nurse teachers $5000 more would
be needed, making the salary  cost $10,400.
Incidental expenses would amount  at least
to $600, which makes the total cost $25,000,
that is, $500 for each pupil. A tuition fee of
half  this amount would be reasonable,  and
this would make necessary for such a prepara-
tory year the  income of an endowment of
$300,000.  The cost of suitable buildings for
                    214 
HOW TO GET BETTER NURSING SCHOOLS
the first year and also for the years following,
with  provision for their upkeep,  would  be
$200,000 more.  Besides this half-million dol-
lars  needed for  the  establishment of a uni-
versity school of nursing, it would be highly
desirable if not absolutely essential that there
also  should be in the medical school an  en-
dowed professorship  of nursing which would
provide for a director of this department.
  This may seem a  huge outlay.  But what
other investment would bring such grand re-
turns! Each year for succeeding generations
young women would have as fine an opportun-
ity to prepare for noble life work as now their
brothers have in the medical and theological
schools that have been so generously endowed;
and each year twoscore or more would go forth
perfectly fitted for the highest  kind of altru-
istic service.   Other  university schools, after
one successful demonstration, would soon be
established.   The art of nursing  would  be
redeemed.
  So far only the first or preparatory year of
our model school has been considered.  The
                    215 
      NURSES FOR OUR NEIGHBORS
 hospital part of the course needs less attention.
 For that, as I have said, is in most respects
 already excellent.  Only small changes would
 be necessary and  these can be quickly sum-
 marized.
   In return for the gratuitous service of the
 pupil nurses,  the  hospitals might easily be
 persuaded to take better care of their health
 and strength by demanding shorter hours of
 service, by providing a separate room for each
 nurse, and, most important of all, by employ-
 ing a sufficient number of first-rate teaching
 supervisors.  Under such  conditions,  if the
 pupil nurses, as fast as they have become pro-
 ficient, should be  changed from one kind of
 service to another, less time than is now con-
 sidered necessary need be devoted  to hospital
 service. The thorough preparation the pupil
 nurses would  have previously received, and
the larger provision  for their instruction in
the wards, would facilitate this quicker inter-
change and shortening of their term of service.
At any rate, after one full year of such instruc-
 tion, the pupil nurses should be taken  out of
                    216 
HOW TO GET  BETTER  NURSING SCHOOLS
the wards for training in  other  equally im-
portant branches.
  At least six months should be given to visit-
ing nursing, school nursing, and social service.
All of this must be under  constant teaching
supervision, to  insure that  in actual practice
the lessons learned shall be  carried into  effect.
Here may always be found the best opportuni-
ties for the  development of the nurse's char-
acter.  Her self reliance, her ingenuity in mak-
ing the best of makeshift  material, her tact,
her ability to change all surrounding influences
of family and neighbors from disturbing into
helpful factors, for the patient's comfort and
relief,  all these essentials  of nursing can be
taught and learned in the patients' homes far
better than  is ever possible in hospital wards.
  Such services should be gratuitously given;
but  the associations thus  profiting by addi-
tional workers should bear the expense of their
board  and  lodging and of  the  extra teachers
needed.
  After  this  outside  experience  the  pupil
nurses should return to the hospitals for further
                    217 
NURSES FOR OUR  NEIGHBORS
training. They will then have a wider horizon
of the nursing field. They will then be able to
see the individual souls and social needs of the
patients, as well  as the diseases from which
they suffer.  In meeting these human needs
they will henceforth be able to do more in
minutes than before this experience they could
do in hours. They will find that this extra ser-
vice is the  great essential, and that it can be
given far more naturally and efficiently during
the actual nursing, which  before was wrongly
thought to be the great essential, than it can
ever be given apart from such personal service.
In short, they will  have learned the deeper
meaning, the tme spirit, of nursing.  Hence-
forth as head nurses they will be able to incul-
cate this spirit in their juniors; and, only as
they do this, will what they have learned be
ingrained in their characters.
  The  duration of this second part of the
nurses'  training  should depend upon what
branch of nursing they expect to follow after
graduation. If they elect hospital nursing for
their vocation, the term  of such  service, of
                    218 
HOW TO GET BETTER NURSING  SCHOOLS
course, should be longer, perhaps a year and
a half.  If, on the other hand, they have dis-
covered greater aptitude and liking for domes-
tic nursing, social service or visiting nursing
of any sort, this second term of hospital nurs-
ing ought not to be more than half so long,
and  the time thus gained should be given in-
stead to such form of outside nursing service
as they may elect.
  It is much to be  hoped that many of those
first privileged to acquire real education and
training in an ideal school will feel and heed
the call to be themselves  teachers of nursing.
The teaching art is quite independent of abil-
ity to practice. Only occasionally is it found.
For  it special education is necessary; and five
years, as Miss Nightingale says,  are needed.
Plainly, then, one of the especial services of a
university school of nursing will be as a normal
school; for the immediate need of better teach-
ers of nursing is tremendous. However general
university adoption of this kind of professional
education may become, there will always be
for every such school scores of others without
                    219 
NURSES FOR OUR  NEIGHBORS
university  affiliation.   And for many  long
years it is mainly as a leavening and a stan-
dardizing of the profession  that the greatest
good will result.
  Returning now to the vital question of the
faculty's make-up, all the teachers in all the
different branches should be included.  For
only so can these different interests be weighed
and  their  relative  educational  values  esti-
mated.  The service of the pupil nurses will be
none the less satisfactory when their education
is thus made of first importance.  Besides the
general  direction of the whole course, particu-
lar attention must also be given by the faculty
to the best development of each individual
pupil. This can effectively be done by assign-
ing each of the probationers as they enter to
some one teacher, who throughout the  course
shall be charged with her guidance  and so be
able at  every faculty conference to represent
her individual interests.
  Wearisome details are these, I fear,  to the
general  reader. All I hope from it is that those
responsible for the education and training of
                    220 
HOW TO GET BETTER NURSING SCHOOLS
our future nurses shall have a larger, deeper
sense of their responsibilities.  The vital point
is that  the time has come for taking away
this  responsibility from the hospitals. Great
opposition to so radical a change must be ex-
pected.   Vested interests are not easily dis-
lodged, nor will our modem nurses give much
help in the reform.  And our only hope of it
lies in an awakened public interest. 
CHAPTER IX
 AMATEUR NURSING  AND NEIGHBOR HELPING
  Few of those who may have read thus far
will probably ever be able to take active part
in improving the training schools. And before
we shall have a sufficient supply of excellent
nurses for all the varied needs of the commun-
ity it will at best be many a long day. Mean-
while much that ought to be done for our help-
less neighbors will  go by default  unless all
whose hearts move  them towards fellow-ser-
vice  follow their impulses.   Each must first
study the surrounding field and then begin
where the need seems plainest.
  Every one can do something in the way of
personal  service, which is  the thing always
needed. That it is not easy  to begin has to be
admitted. Self-distrust stops, and morbid self-
consciousness spoils, many a well-meant kind-
ness.  Moreover, much of the "charity" work,
wherever  found, is  disheartening because so
                    222 
AMATEUR NURSING
cold and lifeless.  New members of such or-
ganizations  cannot  escape  discouragement.
And yet if these same young enthusiasts start
new associations, without the guidance of ex-
perienced workers, the chances of miscarriage
of purpose are at least ten to one.
  Let me tell this story by way of illustration.
Years ago a club of school-girls eager to do
something for others were advised to arrange a
system of visits to the helpless, — to the aged,
the blind, and the bedridden.  The girls were
to read or sing or tell stories to them; in some
way or other they were to entertain them.
They were  to give personal service,  but no
money or materials. For a year or two this
scheme worked well: at any rate, the girls im-
proved.  But as new members  joined the club
somehow its purpose and character changed.
Every month meetings were held to sew for the
poor, which soon became gossipy  afternoons
with tea and confectionery. But the next year
a fair, and  then a dance, had to be given to
raise money for material for the sewing-bees.
The visiting to the helpless was delegated to a
                    223 
NURSES FOR OUR  NEIGHBORS
committee, which soon had time only for in-
vestigating the relative poverty and affliction
of those who now began to appeal for warm
clothing.  Finally even this kind  of visiting
was dropped, and the last possible chance of
personal service disappeared. The society still
exists, but a few badly cut and poorly made
nightgowns, not very wisely distributed, figure
as the sum total of its service to the helpless.
  I suppose somewhat similar histories belong
to most  communities.    Relief associations
formed by those who are personally acquainted
with the poor and suffering succeed for a time
in bridging the chasm between those who can
give and those who need help. But this bridge
is at best  a frail one, built as it is only of con-
tinuous personal service. When that fails the
relief association soon becomes a mere social
club, whose dances and private theatricals may
possibly bring in some surplus above expenses
for the club's pet charity.
  Material help, of course, must be provided
for all kinds of charitable institutions.   And
let all praise be given to the social clubs and
                    224 
AMATEUR NURSING
hard-working aid societies that raise the where-
withal for hospitals and other relief organ-
izations.   Far be it from my purpose to say
aught  in  detraction of their invaluable ser-
vice.  I desire only to emphasize the fact that
the impersonal gift of material, of food or
clothing or money, is not enough. Real neigh-
borliness means much more than that.  The
good Samaritan, it is tme, gave money; but
he gave more. So must we.
  Take the flower mission, for example. When
it began there was a novel pleasure in gather-
ing the wild flowers, tying them up in bunches,
packing the baskets and sending them in to the
city. Soon it became a rather stupid task. No
one's  imagination  of  what joy the  flowers
might  give to the sick was vivid enough to
create  any enthusiasm among us.  Nor was
there, as I afterwards saw, any particular plea-
sure in the hospital wards where the flowers
were distributed.   There  was no direct com-
munication between the rosy-cheeked children
who searched hillside and meadow for colum-
bines and marigolds and the wan and wasted
                   225 
NURSES  FOR  OUR NEIGHBORS'
patients to whom the flowers were sent.  And
it is no wonder that the flower mission has
languished.  For flowers in themselves, how-
ever choice and lovely, are not what the help-
less most crave. What they really want is the
freight of human sympathy that flowers may
so easily carry.
  One early morning I happened to meet at
the hospital door three little girls with their
aprons full of daisies and buttercups. Timidly
they asked if "the sick  folks in there would
like these."  I  told them to come in and see.
So back to the wards we went, and without a
word the shy little maids handed to each pa-
tient a few of their flowers. The effect was like
a burst of  sunshine  after  a gloomy siege of
weather. No costly roses or priceless orchids
sent by  express could have wrought that spell.
The magic of it was in the personal touch.
  Every physician is accustomed to the ques-
tion from would-be helpers if he can tell of any
sick and suffering people for them to visit. His
usual negative  answer must seem strange and
discouraging.  The fact,  of course, is that he
                    226 
AMATEUR NURSING
knows many such, but he doubts if they would
be helped by beginners.  Probably he is wrong
in not oftener taking the risk of that; for some
will be helped, and at any rate some of the
helpers will acquire skill and tact and the power
of bringing their hearts into effective action.
Fortunate, indeed, is the physician who has at
his call such a staff of experienced helpers, and
richly is he repaid for whatever trouble he has
taken to teach them what the helpless really
need.
5  For the  same reason hospital and  asylum
managers often seem unwilling to accept offers
of friendly visits. The tmth is such visits are
generally disappointing.  Tactlessness is usu-
ally due to lack of sympathy, and any sign of
that in the visitor defeats the whole purpose of
the visit. For instance, I have known a volun-
teer  choir,  after walking through the corridor
laughing and joking as if on the way to a circus,
when finally  in the ward, stare curiously at
the patients,  and then, having made a try at
the pitch, dole out only the most melancholy
hymns.  The effect of it was not unlike that
                    227 
     NURSES FOR OUR  NEIGHBORS
produced when from the undertaker's wagon
there is unloaded at the hospital a mass of half-
wilted flowers, many  of them wire-stemmed
and banked in pillows or other emblems of con-
solation. Had these singers reversed their pro-
cedure,  and,  after quiet passage through the
corridors, given forth their jollity in lightsome
song, they would then have brightened and
cheered the wards. For music has  such power
of charm to divert us from our woes that it is of
immense therapeutic value.  And yet in our
hospitals and asylums music of any kind is but
seldom heard.
  The monotony of helplessness is one of its
greatest terrors. Any relief from that is, indeed,
a blessing.  Reading aloud  to those who no
longer  can read for themselves  offers large
chances for giving this relief. One would sup-
pose such friendly service  would be freely of-
fered. As a matter of fact, acceptable readers
to the sick are seldom available. For one rea-
son reading aloud is not nowadays  such a com-
mon accomplishment as when the  privilege of
sitting next the tallow-dip carried with it the
                    228 
AMATEUR NURSING
obligation of sharing the book with the assem-
bled family.  The need, however, is not for
elocutionists but for ordinary readers. Simple,
distinct, low-voiced reading is what is wanted;
and any one who really tries soon learns how
to read acceptably. I know of no better way
for girls to begin helping the helpless. Even
those whose daily tasks and social duties seem
to claim every hour, if they really want to do
so, can squeeze  in engagements for this ser-
vice. I have seen great comfort so given, and in
the readers themselves large growth in power
of friendliness.
  Years ago a young clergyman's bride offered
at the hospital any kind of service for an hour
or so a day. She had not begun her own
housekeeping, and wanted, as she said, some
escape from  boarding-house  vanities. She
longed to be helpful,  and she was taken di-
rectly to the bedside of a Swede who was dis-
couraged over his long-delayed recovery from
a  severe accident.  She soon found he was
ambitious for education and began giving him
lessons, in English one day, in algebra  the
                   229 
     NURSES FOR OUR  NEIGHBORS
next, and so on.  The weeks for that poor fel-
low flew by. His recovery undoubtedly was
hastened. He  was thereafter better able  to
earn his living. And she?  I cannot testify to
any change in her character from this particu-
lar episode; but when a year or so afterwards
she was  suffering woman's  most  poignant
sorrow,  having lost her newborn child, her
steadiness was remarkable. The habit of sym-
pathy, of living in the lives of others, takes us
out of ourselves, which, after all, is what more
than anything else most of us need.
  To experienced friendly visitors the hospitals
afford endless opportunity for the rescue  of
souls. So long as health holds out it is rarely
possible to persuade the reckless to turn from
the slippery downward path. But when they
bring up on their backs, tortured by pain and
remorse, then  it is that they will  clutch at a
helping hand.  For  such work, especially  in
the rescue of wayward girls, more wisdom and
patience, truer sympathy and higher courage,
are needed than in any other branch of social
service.  From the nurses the most that can be
                   230 
           AMATEUR NURSING
expected is the melting through of the poor
girl's  defensive  brazenry. The nurses have
not time for more. And this entrance when
won by their sisterly sympathy  must imme-
diately be utilized by new friends who, joyful
over her turning from darkness  towards  the
light,  will henceforth help her up the steep
climb of reinstatement.  I  have seen both
brilliant successes and also ghastly failures in
this kind of fellow service.  And I now  be-
lieve  that  the failures  have often been due
to lack of loving sympathy. Once in the ether-
izing room, as I was saying a word of cheer to
a girl about to undergo a serious operation, I
was startled by  her whispered wish that she
might not survive. The day before I thought
she had found new hope and courage.  "Why
this change?" I asked.  And then she told me
she had overheard the head nurse say that
"the hospital was not for the likes of her."
On the  other hand, many times have I seen
the recovery of self-respect come with the con-
valescence, thus  richly rewarding the com-
bined efforts of  nurses  and  friendly visitors.
                    231 
     NURSES FOR OUR NEIGHBORS
In such cases personal service is indispensable.
Moralizing is  worse  than useless. It is in
shampooing and  manicuring, then in cleans-
ing and neatly repairing the poor girl's cloth-
ing, and in making over her tawdry hat, that
her new-found friends have their best chances
to help her regain her self-respect. This, of
course, is only the beginning. Ultimate  re-
storation of character depends upon long-con-
tinued care,  upon  change  of  environment,
upon new friendships. Contrary to customary
opinion, I believe in the greater  usefulness of
male friends in the rescue of women. In the
rescue of men we all  know the greater influ-
ence of women.
  The most pathetic form of human helpless-
ness is that of  the deserted girl and  her illegi-
timate child. And yet very few there are who
stand ready to help them.  If possible, even
their existence is ignored.  In  country towns
the almshouse or the hospital of the county
jail is their only refuge, and more degrading
surroundings for mother and child cannot be
imagined.  In the cities there are more or less
                    232 
AMATEUR NURSING
well-conducted maternity hospitals; there are
also free shelters of various kinds for expec-
tant mothers; and only the absolutely friend-
less have to go to the large almshouse hospi-
tals. Naturally many drift from the country
to the city, where they can escape observa-
tion, but where also they have no friends; for
in the  hospitals, to the medical students and
nurses, they are  simply cases.
   In one of  the  shelter homes I was  once
shown the dainty dining-room for the matron
and visiting clergyman and  lady  directors.
The tea-set was of delicate china; there were
flowers, too, and ferns. Across the hall was
the dining-room for the inmates of the home,
with bare plank tables, thick crockery, and no
flowers. Religious services  were held  there
with great regularity.  And yet, as the ma-
tron complained, only rarely could they feel
any hope of a girl's redemption.  What won-
der!
   In my time not even the  flower mission
visited the Boston  Lying-in  Hospital. But
when I began my service  as house physician
                    233 
     NURSES FOR OUR NEIGHBORS
there I was told that, in any case of special dis-
tress, either of those whose time for discharge
had come, or among the sad applicants for ad-
mission, there were just two women in the
city upon whom I might call for assistance at
any hour of the night or day. Miss Mary Park-
man and  Miss Elizabeth  C. Putnam were
the names given  me. It was not long before
occasion arose for so calling.  When told she
was well enough  for discharge from the hos-
pital, a poor weeping  mother said she had no
money and no home to go to nor cradle for her
baby. To beg in the streets would be her only
resource. I telephoned  for Miss Putnam.
Her answer was,  "I will come at once." Her
solution of the  problem was  masterful. A
temporary home was found where mother and
daughter would be  kindly cared for, until, as
the woman recovered strength for work, more
permanent arrangements could be made for
them. Thirty years afterwards Miss Putnam
asked me  if I remembered the woman, and
then told  me of  the  happy children of that
baby girl.  During all the years she had kept
                    234 
AMATEUR NURSING
track of the family,  encouraging,  advising,
loving them. This was but one of  hundreds
and hundreds whom she has thus befriended.
Yes, and she remembers them all.
  Why should not there be such friends for
every forsaken girl, and for every fatherless
child? Is it not plain that lives would then
be saved which now are lost? "What is done
for the illegitimate babies in your  city, Mr.
Mayor?" I once heard the Countess of Aber-
deen  ask.  "We have none," was his brazen
answer.  "Ah," she rejoined, "this certainly
is a remarkable exception.  I shall investigate
further." And  with her unerring instinct for
lifesaving,  aided by long experience, she soon
found out what was  done in that city for
such babies.  They were sent from the private
maternity  retreats to so-called infant homes
where, in case the baby should live less than
one week,  five  weeks' board would have to be
paid. When these homes  were raided, a few
desperately sick babies found  there were  re-
moved to a hospital, where, in spite of every
care, all died.  The autopsies disclosed the
                   235 
NURSES  FOR OUR NEIGHBORS
cause:  the  babies had been fed with  pow-
dered glass.
  I do  not know if such awful conditions now
exist, for it is ten years since I have made any
investigations of the subject. I then found in
the public hospital of one of our largest cities
a babies' ward so far separated from where
their mothers  were that  I asked in surprise
how the babies were fed. "Oh, we never let
the girls nurse their babies," was the answer.
When I found the formula for the milk-modi-
fication employed for all, the frightful emacia-
tion of those babies was accounted for.  They
were being starved.  Few  of them, I was told,
went out of the hospital alive. " It was just as
well so," the matron said; "for such children
are better dead, and as for  the mothers they
never could take care of them even if they
wanted to do so." Yet in these wards medical
students were learning to  be family physicians
and young women were being trained for ma-
ternity nursing!
   Such heartlessness  seems impossible, and
would  be so if  motherly women recognized
                  v236 
AMATEUR NURSING
their duty  to visit the hospitals and mater-
nity homes of their  neighborhoods.  Official
inspection of them is not enough. For that
insures only that such places shall not be too
glaringly shameful. And the standard of the
average city  in these respects  is very low.
Where the whole subject of illegitimacy is
ignored, it means that the babies so born are
soon buried,  and that their mothers, freed
from the responsibility and deprived of the
redeeming  influences of  motherhood,  soon
plunge downwards. Thus more than life is at
stake.  Surely it is the duty of every commun-
ity, and so of every family in it, either to take
into their own homes these homeless unfor-
tunates or  to provide homelike accommoda-
tions for them.
  Late one stormy evening a young woman of
good family and education told me this story.
She had come from far and had found house-
work, but when her pregnancy was  discov-
ered she had been at once discharged. Now
her money was gone and her room-rent over-
due. She was hungry as well as wet and cold.
                   237 
     NURSES FOR OUR NEIGHBORS
She had gone to the river-bank, as she thought
unobserved, intending there to end her misery.
But a policeman happened to see her. In her
confusion she could not explain why she was
there;  and  he,  recognizing  her condition,
brought her to my office. What could be done
for her?  Some weeks later when she would
need medical and  nursing care, the hospital
would receive her.  But what for the mean-
time?  Luckily I  remembered a call  some
weeks  earlier from the new Presbyterian
minister and his wife who said  they would
gladly  help in any cases  of distress.  So,
though it was very late, I took the girl there.
The  lights  were out, and only by repeated
ringing of the doorbell did I waken them. The
parson came to the door. I told  him my er-
rand.  He would ask his wife, he said.  Soon
the door was flung wide open.  " Come in, come
in,"  was the  noble woman's answer.  She
threw her  arms around the shivering girl  as
she would around her own sister if lost and
found.
  However they managed it I know not.  I
                    238 
AMATEUR NURSING
 only know that the girl stayed there both be-
 fore and after her hospital term, and that her
 new-found  friends, although having  several
 children of their own, kept for her and finally
 adopted her baby. When I afterwards under-
 took to thank them for helping me out, they
 insisted instead upon thanking  me for bring-
 ing them their opportunity.
   The usefulness of friendly  visits to hospital
 patients is threefold, — to the patients, to the
 hospital nurses, and to the visitors themselves.
 The patients  are  encouraged and comforted
 in realizing, however  separated from kith and
 kin they may be, that they still are children of
 the great human  family  with kind brothers
 and sisters eager to give them a helping hand.
 The nurses recognize  their function as agents
 of  the kind-heartedness of  the community;
 their patients become individuals instead  of
 cases.  The  visitors learn  to  see further into
 the complications of life; that is, to see things
 as they are.
  There is a still larger field  for usefulness  in
following up with  friendly visits the patients
                    239 
      NURSES FOR OUR  NEIGHBORS
after  their discharge from the hospital.  Be-
tween the day when discharged as recovered
and the day when really able to resume work
there  is usually a discouraging period, often
much extended by worry and by lack of care
and of proper food.  Not seldom patients suf-
fer serious setbacks by resuming work too soon.
The loveliest charity  I have ever seen  has
been shown by families who have taken in as
one of the  household some convalescent who
when  discharged  from the hospital had no
home  to go to.  Not every family can afford
to give so much.  And yet the obligation rest-
ing upon every neighborhood to help the help-
less would seem to require  either taking these
homeless convalescents into  our  own  homes
or providing some home for them until they
regain their ability to earn their own  living.
Some  hospitals and some communities do
recognize this obligation and have provided
convalescent homes. It would be simpler and
better as well as less expensive to arrange for
their board and lodging with families who need
in some such way to augment their incomes.
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            AMATEUR NURSING
But the main need is for such friendly visiting
of all these discharged patients as will insure
for every one of them just the encouragement
needed for their reinstatement as serviceable
members of the community.
  We must include in this class all patients
who have been served by the district visiting
nurses, but who no longer need actual nursing
care. Any one willing and yet not knowing
how or where to begin  helping the helpless has
only to ask the  nearest visiting nurse for the
names and addresses of patients she no longer
has to visit regularly, but who are not yet fully
able  to resume their regular  work. There
need be then no fear of intmding. The intro-
duction the visiting nurse has given, in telling
about the  patients  she  has  served, is  quite
sufficient warrant  for  the offer of neighborly
interest and friendly service.
  Thus far in our survey of the field for per-
sonal service in  helping the helpless we have
considered  only  ways of supplementing what
trained nurses are doing or have done for their
patients in  the  hospitals or  in  the districts.
                    241 
NURSES FOR OUR NEIGHBORS
And we have ignored the tremendous fact
that for the majority  no trained nursing is
available either by securing admission to the
hospitals or by procuring such service in their
own homes.
  In previous chapters I have told how neigh-
bors used to help families in the nursing of
their sick and helpless ones; and how in later
times the old-fashioned nurses could be hired
for very small wages. I have also called at-
tention  to the fact that the disappearance of
both these forms of relief has been coincident
with  the  establishment  of  modem  trained
nursing.
  It remains for us now to consider what can
be done by neighbors for the relief of the help-
less where modem nursing is out of the ques-
tion. Many attempts have been made to solve
this problem, but thus far no adequate solu-
tion has been found.  In some small cities hav-
ing  large training schools, which teach their
pupil nurses home nursing, all the needs of the
community are thus provided for. In some of
the  larger cities associations have been estab-
                    242 
AMATEUR NURSING
lished to train attendants who take care of the
sick at a half or even a third of the cost of
trained nurses.  While both of these methods
are admirable and worthy of extensive imita-
tion, the fact nevertheless remains that  in
neither of these ways will it ever be possible
to cover the whole field.
  As may easily be seen the problem is two-
fold, as considered from the professional  or
economic standpoints. On  the one hand it is
plain that the old custom of neighbor nursing
has  gone forever: modern scientific require-
ments could not possibly be satisfied by a suc-
cession of untrained night watchers. And yet,
on the other hand, unless the generosity  of
kind neighbors be accepted, the ordinary fam-
ily when sickness occurs is liable to suffer last-
ing damage. Before the patient recovers the
others of the family, worn out with the nurs-
ing and housework, are very likely to fall sick;
and even when the patient is not the principal
breadwinner, the extra expense of sickness and
the inevitable interference with the ability  of
the wage-earners threatens them with bank-
                   243 
NURSES FOR OUR  NEIGHBORS
ruptcy. If absolute pauperism is escaped, it is
too probable that the family will emerge from
the stress of sickness only under an overload
of debt, which is almost as bad.
  The only practicable way, so far as I can
see, of supplying adequate assistance in cases
of sickness in the homes of the great majority
of our population is for neighbors to help the
family to do their  own nursing.  By relieving
them of their usual labor, by helping  them
with their housework, we can save them from
exhaustion and so make it possible for them to
devote their whole strength to the nursing of
their own sick.
   I have already spoken of the great useful-
ness of district visiting nurses in teaching fam-
ilies how to do the nursing required in their
own homes. This educational service ought
to be far more widely available. In every com-
munity it ought to be as possible for a family
to have visits from a nurse,  who will  teach
them how to carry out the medical orders, as
it is to secure a physician to give these orders.
The visiting nurse  associations might well
                    244 
AMATEUR NURSING
undertake to provide these teachers of family
nursing, but it must be borne in mind that the
teaching art is very different from the ability
to practice nursing.
  Even without expert teachers,  families of
ordinary intelligence can often take as good
nursing care of their  loved ones  as  trained
nurses could. Sometimes family  nursing  is
better than professional. In some cases, it is
true, the anxiety of those nearest and dearest
endangers not only them but the patient also.
For the sick often are abnormally sensitive to
the emotions of those standing by, however
well concealed. And even where there  is no
hope of recovery, and where death is felt by all
to be only a merciful release, if the nursing is
left to the family,  there is always  the danger
that some one of them ever after will feel that
had this been done, or had that not been done,
the end would not have come so soon.  The
responsibility of deciding  questions of detail
as well as the  larger questions of treatment
rests,  of  course, upon  the physician.  But he
has become accustomed to leaving to the nurse
                    245 
NURSES FOR OUR  NEIGHBORS
all such details, and so where there is no nurse
he is often careless in not saving the  family
from the necessity of deciding these matters.
Generally it is not so important how the de-
tails of treatment shall be decided, as it is that
there shall be some decision. This, of course,
cannot be appreciated by those most anxiously
awaiting the issue, whether it be life's renewal or
death: their greatest comfort comes in carrying
out in minutest detail the treatment ordered.
  Few nurses know enough to appreciate the
relief it is to aching hearts to allow the  chil-
dren, for instance, — yes, and to show them
just how, —  to do the last little services for
their dying  mother.  Too often  the modem
nurse does not know enough  to  keep  in the
background  on  such occasions and, instead,
stands  by,  officiously  counting the  failing
pulse  or in some other equally  useless  way
exhibiting her professional accomplishments.
Friendly neighbors at such times  are far more
likely to be of real assistance,  for they natur-
ally take the proper nursing attitude of help-
ers to the family. But this is a digression.
                    246 
AMATEUR NURSING
  Having admitted that in some exceptional
cases the intense anxiety of the family is detri-
mental to their nursing usefulness, in the great
majority of cases we can just as truly claim
the great advantages of such nursing. Who
for himself would not prefer it?  Is it not, in-
deed, the highest praise any nurse can have to
be told her nursing is motherly? And what
else is nursing but mothering? For in the de-
gree we need nursing we have gone back to
the helplessness  of childhood until at the last
our dependence upon others is that of the new-
bom. How fitting it is, too, for a perfect nurse
to be called "Sister"! I wish that when our
training  schools began  we had adopted the
titles  as well  as the general scheme of the
Nightingale School.
  Nor is it only on the mother and sister side
of the  house that  family  nursing is often
admirable. I have seen rough, hard-handed
laborers take such loving, gentle care of their
dying mother or wife or child as might make
any  nurse envious. And under the inspira-
tion of her heart's  devotion  I  have seen a
                    247 
     NURSES FOR OUR  NEIGHBORS
young girl's exquisite care of her father raise
my previous ideals of perfect nursing.  He was
slowly dying of cancer of the stomach; that is,
he was starving to death rather than endure
the nausea and agony caused by taking food.
No one else, not even his wife, could persuade
him to eat or drink anything. If he did so, it
was at once vomited. And yet  this daughter
to our great surprise could feed him, and what
was more marvelous could save him from the
subsequent ill effects. How  could she?  I  will
let her  tell her story, as after my repeated
questionings she told it to me.  "Yes, I know
he will  take  food for me and keep it down,
when he will  not for others; but the only rea-
son is because I make him think of something
else. Oh, it is just nothing, and will never bear
telling.  But you see Daddy every spring used
to take us children out to hunt for wild flow-
ers, and he would give prizes for the first daisy,
buttercup, or violet. Thus we  learned where
the different flowers can earliest be found. So
before my day's work began, as soon as ever it
was light I have been going out after first one
                    248 
           AMATEUR  NURSING
wild flower and then another, and sometimes
I have been miles to where as a child I had
won a prize. If I found no flower I would
bring home the plant and in warm water get
the reluctant buds to open. Daddy, you know,
is  very fond of wild flowers.  And he likes
lovely china, too. So I have been fixing his
tray in this way; I  would use only our most
precious teacups; in one I put cracked ice, in
the other the beef juice he so dislikes, and in
the prettiest wineglass  I could find I put my
wild flower.  That I carry so he has to see it
first.  And when he asks where  I  found  it, I
just tell him to look straight at it and to open
his mouth.  Then I give him a bit of ice, which
is the only thing he is always willing to take,
and tell him not to speak, but to open his
mouth when  the ice is melted.  Then I  give
him the cupful of beef juice, with a tiny bit of
ice in each teaspoonful.  Meanwhile I tell him
how and where I found the flower and make
him remember how  he used to take us flower
hunting. And so he just does n't  have  a
chance to refuse the beef juice."
                   249 
NURSES FOR OUR  NEIGHBORS
  Similar instances of excellent amateur nurs-
ing will doubtless recur in every reader's mem-
ory.  And such successes would  be far  more
frequent instead of less so than in former years,
if the essential advantages of old-time nursing
customs had been retained  or could now be
revived.
  In every community this  revival is practi-
cable.  Two moves must be made.  First, it is
necessary to start a visiting nurse association,
or to secure affiliation with  some near-by as-
sociation, which shall furnish nurses for actual
service where there are no relatives or friends
who  can be taught  how  to do the nursing
needed, and also nurse teachers who shall give
this instruction in  every home where there is
willingness to receive it.  Second, there  must
be an organization of neighbor helpers, to back
up families where there is sickness so that they
can nurse their own without  sacrifice of health
or financial independence.
  As  regards  visiting nursing,  although  in
years past  I have traveled thousands of miles
and  given  days and  nights, and  sometimes
                   250 
AMATEUR NURSING
weeks at a time, to pleading for its establish-
ment, I now feel the even greater importance
of neighbor-helping organizations.
   In small towns  and  in  country districts
where every family knows all  about every
other, and where cases of distress are sure to
be discussed at the village store, or on Sun-
days at the meeting-house, it is unlikely that
any  family needing help will not receive it.  In
such communities there may be no need of
organizing the willing helpers. And so even
in our largest cities, where the sick member
of the family is well known and widely be-
loved, friendly aid is offered in abundance.
But  for the vast majority of families, not well
known and having no claim to prominence,
the surrounding crowds of strangers make the
city  more  lonesome than the forests.  When
sickness invades their homes no helping neigh-
bors  call.  This is not for lack of willingness
to help, but for lack of general information.
  The objection is sometimes made  to this
necessary  work of  investigation, to the card-
cataloguing of the  community's woes, that it
                    251 
NURSES FOR OUR NEIGHBORS
is too scientific and cold-blooded.  And so it
may very easily be if tactless, heartless agents
are employed.
   One of my saddest memories is of a call I
made on the family of a man who, thrown out
of the watch factory by the panic of 1893, was
tramping from town to town in search of work.
His house, in one  of the best quarters of the
city, seemed singularly bare of furniture. But
at first  I did not understand that, any more
than I did the ghastly pallor of his wife and
children. It was  hard to believe  that they
were starving, but such was the terrible fact.
For the mother, relief came too late. She died
within  easy reach of  neighbors who  after-
wards admitted that their curiosity had been
aroused  by never  seeing milkman or grocer
call, but instead, many a time after nightfall
seeing the poor woman carry away a chair or
other piece of furniture.
  To prevent such tragedies there  is need in
every city of some agency for  searching out.
And however diligent inquiry be made, there
will be  found on  the  most faithful agent's
                    252 
AMATEUR NURSING
records only a small amount of information
compared with what would be the common
talk regarding the same family when living at
the country cross-roads.   In either locality,
when the motive is neighborly, there  can be
no valid objection to the investigation. And
in each situation adequate neighborly relief de-
pends upon the discovery and making known
of the exact character and extent of the fam-
ily's distress.
  This is the work of the Associated Chari-
ties, which may be found in active operation
in most of our cities.  As information is ac-
quired by friendly visitors,  cases  of distress
are referred to appropriate agencies, or where
the urgency does  not allow sufficient time for
this, immediate relief is  given. The work is
altogether  admirable,  and  the gratitude of
thousands belongs to the founder of the first
of these organizations, the late Robert Treat
Paine of Boston.
  Inasmuch, however, as any one  trained in
the larger field of the Associated Charities will
have had to do with all forms of poverty and
                    253 
      NURSES FOR OUR  NEIGHBORS
misery, while we are considering more particu-
larly relief measures for physical helplessness,
where circumspection in helping is far less
important, we should  rather  have for our
agency some one, trained if possible in the so-
cial service department of a hospital, who has
been more accustomed to the relief of necessi-
ties  caused by  disease.  Such  an agent, by
acquainting those able to help with the cases
of helplessness as found, takes the place of the
country common knowledge of other families
which precedes and inspires all movements for
neighborly relief. But in the city, instead of
depending upon  each one's knowing  what
others are doing, and upon all heartily cooper-
ating, the effectiveness of relief work depends
upon efficient organization of helpers.
  The best organization I  know of this kind
is the Mutual Aid Association of Brattleboro,
Vermont. There at the central agency is kept
a list of all who stand ready for any kind of ser-
vice by the hour or longer, as helpers in cook-
ing, cleaning, laundering, or any other house-
hold work. Where the moderate fees charged
                   254 
AMATEUR NURSING
for these services can be paid by the family,
they are so collected by the association; and,
where  not, the workers are paid from funds
contributed for  this purpose. There is thus
the double economic benefit in this scheme of
giving,  on the one hand, profitable employ-
ment to those who have a few spare hours and
need to increase their family income, and, on
the other hand, of providing at moderate cost
all the extra help families need to make it pos-
sible for them to do their own nursing.
   To Richards M. Bradley belongs the credit
of originating this admirable scheme. As trus-
tee of  a large charity fund left to his  native
town he has sought most diligently for effec-
tive methods of relieving, without pauperiz-
ing, distressed families  and individuals. To
this task, besides  his legal and business  acu-
men, he has devoted his large heart without
stint or measure.
   Where charity  funds  are  available, or
where  it is not too hard to raise sufficient in-
come from annual subscriptions, perhaps  it
may not be possible to improve upon the Brat-
                    255 
      NURSES  FOR  OUR NEIGHBORS
tleboro plan. For, by charging the  regular
fees to families  able to pay for the services of
the helpers, the danger of pauperizing, what-
ever it may amount to, is guarded against; and
for families unable to pay, adequate succor is
provided at the expense of those able and will-
ing to give money.
   In  average communities where there is no
large  charity fund to fall back upon, and where
it is difficult to raise  money except for the
relief  of some particularly appealing case,  it
would be well to supplement the Brattleboro
plan by having  an additional list of voluntary
household helpers, who shall stand ready to
give, instead of  money, personal service in the
relief  of families  unable  to hire the  regular
helpers. With this amendment of the method
we should  not  so much  miss  the essential
loveliness of old-time New England neighbor
helping where  there was  no fee table for
friendly service  and yet no pauperizing. But
why was there in olden times this exemption ?
For one reason, every family aided would in
turn hasten to  help  others in distress. This,
                    256 
AMATEUR NURSING
of course, was merely exchanging credits in-
stead of money.  Another reason is to be found
in  the homogeneousness  of  the  colonists.
Neighbors  as they were at home, they were
doubly so  in exile. Moreover,  as their chil-
dren intermarried, families were so extended
that nearly every one was related to every-
body else.  Why should they not hurry to the
rescue  of  their relations? Furthermore, in
the new settlements the strength and health
of every family and of  every individual was
well known to  be of vital consequence.  But
the strongest reason for the old-time family
acceptance of neighborly help,  when  under
distress of  sickness, without any sacrifice of
independence, is that in simpler conditions of
living it is  easier to be done for as one would
do  unto others. Only as life becomes  more
complicated is it easier to give than to receive.
  At a nurses' home with which  I am  well
acquainted they not seldom have  had appli-
cations of this  sort: a laborer rings the door
bell furiously and calls out, "I want a nurse;
my woman is sick; it's time for her."  "Well,
                   257 
      NURSES FOR OUR  NEIGHBORS
has she made any engagement here?"  "No."
"Can you pay for a nurse?" "No, sure we
have nothing, and I am out of a job, but what
can we do except we have a nurse?"  Out of
his simple, honest heart he has given  a suffi-
cient reason why a nurse should go back with
him to help his poor wife in her labor.  It will
in no wise pauperize that family to be helped
through this time of their helplessness. What
will they not do  afterwards for others  in
distress ?
  Let me tell one of many stories I should like
to tell of how some of the honest, generous-
hearted laborers I have known have by turns
both received  and given. When  Martin left
his young wife and child in their little Irish
hovel, where dire poverty was their only pros-
pect, she, having in every other way failed to
dissuade  him from emigrating, as  a last resort
taunted him with "Yes, goodbye it is and for-
ever."  "Why  so?" "Sure  you'll soon  be
finding another woman in Ameriky."  Under
that sting Martin pulled himself together —
"Did I not marry you?" "Yes."  "An'are ye
                   258 
AMATEUR NURSING
not  my  wife?" "Yes."  "Then  hold  yer
tongue."  This  was their parting.  Letters
would not help them, for neither could read
or write.  But before the year was gone they
were again together in a wretched tenement,
yet in a country far better for laborers.  Had it
not been for sickness they would have thriven
from the first. But for the year following her
next confinement Martin's wife was  insane.
There was nothing for him to do except to
stay at home, caring for her and the little ones
as best he could. Had it not been for generous
neighborly help, the family would have per-
ished.  This  help was  gratefully  and  simply
accepted. What else could they do?  Years
after, when their children were grown  up and
they owned their little home, Martin came to
me to ask what was  to become of a family
where  the mother  had lately  died,  leaving
twins a few  hours old, besides several little
children, for her thirteen-year-old daughter to
rear as best she could. " How long is the nurse
to stay there," he asked, "and how much does
the nurse cost?" When I told him she would
                    259 
NURSES  FOR OUR NEIGHBORS
stay a few weeks and could be kept longer at a
dollar a day, he gave me fifty dollars, more
than a  month  of his earnings, saying, "Let
that go as long as it will to keep some woman
there to open the door for him when he comes
back from his day's work."  "Is he any rela-
tive of yours, Martin?"  "No, neither he nor
she is belonging to me, but I know all about
them."
  Were there more simple-hearted Martins,
ready to receive, and, according to circum-
stances, quick to give,  there would be less need
than there is now of organizations for neighbor
helping.  But hearty giving even of money is
not a common habit,  and the habit of giving
personal service to helpless  neighbors is far
rarer. Therefore, to insure that all who are in
need shall be supplied, it is necessary to organ-
ize those in the community who are able  and
willing to give for this purpose either of their
means or of their time.
  But what of the supposed present danger of
pauperizing by neighbor helping?  Let us  see.
We all agree, of course, that common pmdence
                   260 
AMATEUR NURSING
 and a decent amount of self-respect require in
 every family provision against adversity. And
 we know that as a people, in comparison with
 many other nations, we are thriftless, extrava-
 gant, and wasteful. And yet a large propor-
 tion of our day laborers are saving enough of
 their wages  to be buying their own homes. If,
 instead of the present exorbitant expense, the
 cost of ordinary sickness had continued to be
 moderate, we might  reasonably expect that
 such families would be able unaided to meet
 these common exigencies. The fact, however,
 is that sufficient provision for family rainy
 days is uncommon. And unless for neighbor
 aid in times of sickness many a family  would
 lose their home by mortgage foreclosure.
   Industrial insurance companies, sick-benefit
 associations, and fraternal orders that furnish
 free medical attendance  are doing much for
 moderate wage-earners to mitigate the  heavy
 expenses of sickness. In Germany, and now in
 England, such insurance, aided and controlled
by the Government, is obligatory.  The time
may come when associations will provide, for
                   261 
      NURSES FOR OUR  NEIGHBORS
 families  insured, nursing as well  as the medi-
 cal service needed.  Indeed, so far as visiting
 nursing is needed by their employees, that is
 already provided for them by many shops and
 factories. As  the economical advantage of
 such  humanitarian  provision becomes more
 widely known, this  kind of service doubtless
 will be largely increased. By further extension
 of these protective agencies and associations it
 would be possible to provide both the nursing
 care and the  household assistance needed in
 every case of helplessness in the families of the
 wage-earners.  And by accumulation of charity
 funds, aided perhaps by socialistic civic appro-
 priations, it also would be possible to provide
 for the homeless sick and all helpless strangers
 within our gates. But even with such possible
 completeness of insurance relief, which is not
 yet within sight, the friendly service of neigh-
 bors would still be just as much needed; for the
 essential quality of neighborliness can never
 be supplied by official agents in any commun-
 ity where the yearnings of the  helpless for
more than mere material aid are ignored.
                    262 
AMATEUR NURSING
  Whatever we may consider as the proper
precautionary measures against the helpless-
ness of any member of the family, we may be
sure both that such measures will not always
have been taken, and also that these pre-
cautions,  even when taken, will often prove .
insufficient.  In times of general disaster, by
fire or flood or famine, cities and states and
nations rush to each other's assistance, with-
out too close  inquiry what precautions have
been taken or omitted. The question of pos-
sible pauperizing does  not arise.  Why, then,
need  it do so when  a single family  is over-
whelmed?
  It may be questioned if the modern promi-
nence of this phantom is not due at least as
much to the fear on the part of the givers of
never-ending   if not  of increasing demands
upon their time and purses, as it is to the fear
of harming the recipients.  Such, it may be
suspected, is sometimes the compelling motive
of anonymous subscribers  to charity: they
withhold their names, not so much from mod-
est  unwillingness to  give with their  money
                   263 
NURSES FOR OUR NEIGHBORS
their personal indorsement, as from not un-
justifiable fear of being made a target for all
other beggars.
  Before leaving this  moot  question of the
danger of pauperizing by revival of the old cus-
tom of neighbor helping, in order that families
may have the time and strength for taking the
nursing care of their own helpless  ones, the
difference in effect should be noted between
impersonal  gifts  of materials and  personal
gifts of service: material help is easier to give,
and to receive; personal service, while far less
likely to harm the recipient, is much surer to
enrich the giver.
  Where any are ready and yet do not know
just how to band together for more efficient
neighbor helping, it may be well for them to
bear in mind  the fact that  associations for
giving only personal service  need not be so
formal as they must be for the proper handling
of money or other material.  Indeed, in many
ways the more informal  the  personal service
clubs are, so much the better.  If possible it is a
good plan to attach them as junior auxiliaries
                    264 
           AMATEUR NURSING
to existing organizations, such as hospital cor-
porations, hospital  aid societies, and visiting
nursing associations. For one of the common
faults of our charitable  organizations is the
high average age of their membership. They
were young enough once when they formed
their  associations  for high endeavor,  but,
without provision for age retirement, or even
for the rotation of their officers, many of these
associations have lost their enthusiasm. They
need rejuvenation.  And  this can be best pro-
vided for by electing into membership every
year the officers of their junior auxiliaries. On
the other hand, for the juniors there is in such
affiliations the great advantage of experienced
leadership and of well-blazed paths. Where
there seems to be no chance for such affiliation
small groups of  neighbor helpers must  find
their own way, consulting with each other and
working together, not forgetting to keep inter-
esting others so that young  members may be
added yearly.  And even  earlier, before groups
or clubs can be formed,  those willing to help
their helpless neighbors,  instead of waiting to
                    265 
NURSES  FOR  OUR NEIGHBORS
join with others for this work, must begin it
even if single-handed.
  Many residents of Cambridge and Harvard
students of forty years  ago remember Miss
Watson, who with her mother lived in the old
home of Morrill Wyman, the beloved physi-
cian.  In the hard winter following the gold
panic there was  much  distress  among the
wage-earners, because of lack of work. In so
many cases where he was summoned the old
doctor found  there was  need of  food rather
than of medicine that he referred more of his
patients to Miss Watson than to the dmggist.
For she kept the beef tea hot and ready.  Her
work  became well known.  One night, when
answering the  doorbell, she asked the gaunt
and half-crazed man if he must have the doc-
tor.  "No," he said, "it is food and help I
want, for my wife is dying of hunger." Off she
went with him, beef tea in hand, through lone-
some  streets,  up  several flights in the dark
hallway, and into his cold attic of horror. His
wife, sure enough, was almost dead. But she
and the little  children were  saved;  and  his
                   266 
AMATEUR NURSING
reason was saved,  too;  for, by  asking  her
friends to give him their furniture repairing,
Miss Watson found work for him at his trade.
Her friends helped her with the housework
there, making daily visits in turn till the poor
starved mother regained her strength. After
the awful crisis of that night, the family pros-
pered. Miss Watson saved them.  Had  she
waited for daylight,  it would have been too
late.  And  had she not kept on helping the
family until they were well on their feet, their
misery would only have been prolonged.
  The world needs more Miss Watsons.
THE  end 
CAMBRIDGE . MASSACHUSETTS



          U . S .  A 
 
 
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JUN 1 0 1914 
WY 100 W919na 1914




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