and thus the first English training school for nurses was started in June, 1860. Accounts of this great reform, which spread in England from year to year, reached this country more or less vaguely, but were without result until, in 1872, the men and women belonging to that branch of the State Charities Aid Association which visited the sick in Bellevue Hospital felt that they could not do any good or lasting work until the existing system, or want of system, should be entirely changed. The nurses were too few in number, nearly all illiterate, some immoral, and others intemperate, and had sought their places simply as a means of livelihood, and not because they had any aptitude for, or knowledge of, their profession. The members of the Bellevue Association therefore applied to the Commissioners of Charities and Correction for permission to establish a school for nurses at Bellevue Hospital, pledging themselves to pay the additional salaries and all other expenses of a better class of women and to put two more nurses in each ward. The consent of the Medical Board of the hospital, to whom the Commissioners referred this appeal, having finally been given to what many physicians considered a doubtful experiment, the Bellevue Training School for Nurses was started on May 1, 1873, with a superintendent and five nurses, having five wards under their care. In 1890 the school has 62 pupils and has graduated 345, while as a direct outgrowth of that modest beginning there are three other great schools in New York alone. These are the New York City, which has 64 pupils and has graduted 263; the New York Hospital, with 48 pupils and 192 graduates; and Mount Sinai, with 50 pupils and 111 graduates. There are also smaller schools in the city, but, great or small, Bellevue must always be honored as the pioneer. Her graduates are at the head of most of the important schools and hospitals in the country, and have even gone so far afield as England, Italy, and China. The next school to be established was the New York City, which was started by the Commissioners of Charities and Correction in 1877, and is entirely sup ported by the City. Until last year it was known as the Charity Hospital School, because it began there, but as it grew its work spread until the old name was misleading and had to be changed. It is now the largest and in some respects the most important of all the schools, as it nurses five different hospitals-Charity and Maternity on Blackwell's Island, the Infants' Hospital on Randall's Island, Gouverneur at Gouverneur Slip, and Harlem, at the foot of East 120th Street, the two last being accident or emergency hospitals, while at Charity the cases are largely chronic. Besides the pupils of the school, there are thirty-two permanent trained nurses at Charity and Randall's Island, making nearly a hundred in all, for whom the superintendent is directly responsible, and over whom she has full authority. The other schools in the city are supported from the funds of the hospitals which they nurse. I have said that nursing is a trade or profession, for it is really both-being a trade, in that it exacts manual skill and dexterity, and a profession because it requires mental ability, judgment, and progressive knowledge. The hospital is therefore at once a workshop and a college, with this essential difference, however, that its scholars exist because it has need of them, not they of it. So much talk has been made about nursing as a noble "vocation" that it is easy to lose sight of the fact that hospital training schools are run first of all because hospital patients must be taken care of. When Florence Nightingale led her little band of workers out of England it was not in order that women should have a new vocation, but because men were dying like flies in the hospitals at Scutari, and the women who started the Bellevue School did so because they found the hospital could be well nursed in no other way. In most of the schools the nurses receive each $10 a month during the first year of their service, and $15 the second, and at the present time there is some discussion as to whether they should be paid at all, or should give their time in return for their professional training, as the house physicians do. This seems reasonable enough to an outsider, but in the first place much of a nurse's work is of a routine kind, repeated far oftener than is necessary for her education, and such as a doctor is rarely called upon to do, and in the second, the most desirable pupils are those who could be self-supporting outside the schools, and will not be a burden on their families while in them. In this country there is a large class of conscientious and industrious women whose education and early associations lead them to look for some higher and more thoughtful labor than household service or work in shops, who have received the good education of our common schools, and who are dependent on their own exertions for support. These women can be trained to make the best possible nurses, and it is the unanimous opinion of the superintendents of the large schools that it would be false economy to seek to deprive such pupils of the small salary which now keeps them independent during two years of very hard work. We will suppose that a woman of this kind has decided to go into one of the large schools, and has applied to the superintendent for information. She receives in return a circular giving the rules, requirements, and course of study, and in due time finds herself with other candidates waiting for examination in the superintendent's office. When her turn comes, and if her credentials are satisfactory, the superintendent usually talks to her a little while in order to find out what grade of nurse she is likely to make; for candidates are admitted only on their own merits, and where there are more applicants than vacancies it is important to secure the best. A short examination in spelling, dictation, and simple arithmetic follows, and also in reading aloud, but this is often passed over if the candidate is evidently too nervous to do herself justice. Various experiments have been tried as to Examining Boards, but the best result is always gained by choosing a good superintendent, and then leaving her free to select her own nurses, without fear or favor, from those who present themselves, as she must train, discipline, and live with them for two years, and has therefore every reason to take only those who are likely to do her credit. Apart from articles in professional journals, much that has been written about hospital life is apt to strike one familiar with it as somewhat vague and sentimental, and there may therefore be some interest in the following sketches, by pupils now in the New York City Training School. The first gives a general outline of the work. "We each begin our duty in the hospital as probationers on a month's trial. That beginning is very new to most of us; quite unlike anything in our previous lives. Before entering the school, some of us may have imagined that we had a peculiar fitness for nursing, even if we did not consider ourselves born nurses. We may have made up our minds that we knew how to make a poultice, and to care for the sick by being kind to them and ventilating their rooms. We may possibly have read Miss Nightingale's "Notes" and so are quite sure that we know something of nursing; but that the hospital training will give us a sort of standing, and therefore it will be a desirable thing to have. As we proceed with our training we discover that we did not know how to make a poultice, nor how best to care for a sick person. Some of us, again, know nothing at all about nursing, but we are not required to know anything. A head nurse prefers to train the raw material, so to speak, in her own way. What is required is that the probationer be receptive, that she be intelligent and, above all, active; and in case she has any knowledge of nursing, or ideas, or opinions, if she is discriminating she will keep them to herself. We have no dreaming time; there is no place for sentiment, and very little for sympathy in the ordinary sense of the word. Were we to sympathize with all the woes that we see we should be used up, we should die. A probationer enters the ward for the first time, and is introduced to her head nurse. She is then probably set to do some simple piece of work, such as arranging a closet or folding clothes and the like. On the next day she will have her regular duties to learn. As the afternoon goes on she may find herself looking at the clock watching for 5.30 P.M. to come so that she may go off duty, and she has, probably, a bad headache. There is a hospital atmosphere, produced by the smell of drugs and other unavoidable odors, perceptible to a fresh nose; there are strange sights and sounds which, combined, give a sort of shock for the first day. The new nurse may not be able to sleep that night, and by the end of the week she may find herself crying in bed, with pain in her feet and legs. These little ailments she keeps to herself. She is anxious to give satisfaction, and she has to do unquestioningly all that she is directed to do. A head nurse is nearly always considerate, if necessary helping her through with her work and encouraging her. Time goes on and the probationer becomes a junior, a senior, and finally a head nurse, and as we proceed with our training, each day, if we will, we can learn something; we gain confidence in ourselves and others gain confidence in us. I suppose we are rather an ordinary class of young women. We never talk of ideals; we may not even think of them; perhaps we have not any. We are essentially matter of fact; we have to deal with human beings and with facts. Our two years' service to most of us is a means to an end, and that a material one, viz.: the earning of money. Some one told us at our commencement that we had done well to have chosen a profession which would not go out of fashion and which could not be done by machinery. That is a good start anyway. I am speaking of us as a whole; in the school we are told we cease to be individuals. That does not mean that we become automatic, for, I suppose there is no calling for women which needs more personality, more individuality. Whatever may have been the rush, monotony, or otherwise of our day (and there are some days in which everything seems out of joint), when our time to be relieved comes, we go away from the hospital, and if we choose we need not give it another thought for the next twelve hours. Out of the hospital we have not a care, unless it is for ourselves; we know how to appreciate our leisure; we are cheerful and apparently happy, and sometimes frivolous; in fact, we are quite sisterly, as behooves all good nurses to be. Our training is divided into what we call "services." We have so many months' training in the different services. They are medical, surgical, maternity, gynecological, eye, skin and throat, and the care of infants. About six months of our time is spent on night duty, spread over the two years in periods of about six weeks' duration. The large wards of Charity Hospital have each four nurses two juniors, one senior, and a head nurse. In the emergency hospitals a nurse has usually the charge of a ward by herself, with a supervising nurse over all. There are also "special cases," the patient having a room to himself, and a day and a night nurse appointed in charge. We each have our preferences and our dislikes, which are of no account as far as the distribution of the services is concerned; it makes something to talk of, but we are under discipline; we go where we are sent. us We begin our duties in a large ward of Charity Hospital. The probationer will have charge of one side of the ward, with the care of from ten to fifteen patients and all belonging to them. The head or senior nurse will go round with her and work in with her for the first time. She is shown how to make the beds, to change all soiled linen; how to remove a very sick patient from one bed to another; how to cover a patient and save her from fatigue while sitting up to have her bed made; the best way for her to get in and out of bed; to keep an eye on the beds that the patients are able to make themselves, and so on throughout the details of the morning's work. The latter part of the day is taken up with waiting on the patients and keeping her side in order all the time. The probation month is especially a time of learning something new; a good deal has to be got into that month; afterward things come more by degrees. Should the probationer be accepted, she becomes a junior nurse and has the same kind of work for about three months. She then goes on night duty; she is on the landing" as we call it, that is, has charge of the two or three of the wards opening on to that landing. The junior nurse is feeling somewhat independent and consequential by this time. She does not have to act by herself; there is always an experienced nurse on the top floor to whom she can refer in case of emergency or otherwise. awful night duty," "that dreadful night duty." Here is where a nurse's mettle comes in. She has long hours-fourteen, and besides the care of the patients she has the real "ward work" to get done before eight o'clock in the morning. The patients in this hospital are very sick; there are no "chronics," the nurse A nurse may never have been up all has critical cases to watch, and upon her night in her life before, so the first night devotion and judgment the life of the is rather exciting and anxious; she is patient may depend. Here the doctors very wide awake until about two or three are hard worked both day and night, o'clock in the morning when the effort and the nurse, if she is considerate, is to keep awake is really painful. A very reluctant to call the doctor, and so night nurse does not sleep, that goes often has an anxious time. Some of without saying, and should she doze the cases that come in during the night when all is quiet she has always one ear are truly heart-rending. The burnt open. Imagine a rather young nurse cases are the worst; if they are not too peering around the large ward with the badly hurt their sensibility is acute and aid of an antiquated lantern. Shall I they suffer dreadful agony. At about ever forget that lantern? It would five o'clock the nurse begins to feel throw all shadow and the least possible rather badly. She has to brace herself ray of light and anywhere but where it up and put on a big spurt to get through was wanted. Sometimes its miserable the morning's work, and perhaps at eight little light would go out and the wick o'clock she will go to bed without her have to be pricked up and relit, then breakfast. it would spit and splutter as though it meant to burn well, but somehow it never would, and the gas burnt low on the landing. When I think of that lantern I can go all through my night duty over again. We have a helper to fetch and carry for us, and she can be very useful in many ways. She may be as 66 good as a nurse" or she may have a fancy for gossiping with her friends during the day and so prefer to sleep at night, and such a "lady" is rather a trial. 66 The patients have a way of dying at night, in spite of the very best efforts of the nurse to keep them alive until morning. Some helpers never could go anigh a dead body," but they "don't mind fetching the things and standing outside of the screen. It requires considerable nerve on the part of the nurse to "lay out " a patient in the small hours of the morning; when the wards are silent and gloomy there is something uncanny about it; there is not much of the "beauty of death" in these cases, but we get used to it after a time. When we become more experienced we have our emergency hospital night duty. We occasionally speak of this in rather strong language; we call it "that A senior nurse's duties are somewhat different from those of the juniors. To begin with, she feels herself of some importance; she has charge of liren closets; she sees to the giving out of the food and gives out the medicines; when the doctors make rounds, if there is time she accompanies the head nurse; she makes herself acquainted with the state of the patients, and often has to be in charge of the ward. To anyone not initiated into the ways of medical men, "giving out the medicines" might mean a spoonful of something in a little water. A medicine list is an appalling undertaking at first: there may be thirty names on the list, some patients having as many as five or six different medicines; in fact, it practically amounts to one-dose prescriptions. Different quantities are given-drops, drachms, ounces, and so on. With some practice and with someone to take the medicines around quickly a nurse can get through the list accurately in a remarkably short time, say fifteen to twenty minutes, but this is not often done; we usually take our time. (A nurse has learnt something of the properties and doses of the medicines in her class.) When a nurse has charge of a ward, or becomes a head nurse, any notions she may have had of her importance as a senior disappear. She feels herself responsible, and is responsible for the condition of the ward, the care of the patients, the instruction of the nurses, in fact for whatever is done or neglected. The doctors rely upon her for the faithful carrying out of their orders, and altogether she needs a good deal of judgment and tact. After receiving the notes of the night nurse and seeing that all the work is going on well, the head nurse goes round, note-book in hand, and inquires into the state of each patient; she questions them and listens to what they have to say; she also makes her own observations. In this way the nurse becomes acquainted with her patients, while she reports everything of note to the doctors. There is an etiquette observed in the wards, but it is not very oppressive; the nurses on duty are subordinate to the doctors for the time being, and everything goes on with order and decorum. This may sound stiff and formal, but it is not so; it is only the fitness of things. We usually all work well together and there is seldom any friction. The patients in Charity Hospital are the very poor of the city; some of them are only morally sick and needing a home; they puzzle the doctors to make a diagnosis. Most of their sickness, as we nurses know, has been brought on by over-work, poverty, drunkenness, laziness, and the like, but some are worthy and deserving persons. Often when a patient comes into the hospital she enters a moral atmosphere which is new to her. She is cleaned and made fairly comfortable; she has to drop many of her old habits of speech, and be a decent member of the hospital for the time being. If she is not too degraded she can see what is expected of her at once. We seldom have any trouble with the patients and rarely hear an improper word. A nurse never need submit to insubordination; on her complaint the patient is dismissed, but a very sick patient is seldom beyond endurance. They are often very witty, and if we are in the mood we can get lots of fun out of them. They are also very reli gious. They thank God for everything; everything is the will of God-their sickness, their troubles, their death; it never seems to occur to them that they might have a will of their own. In one way they have not much variety; they usually object to soap and water. As a rule the nurses are as good to the patients as they can be. Many of them remain in the hospital for a long time, and a nurse has the opportunity of showing them small kindnesses, perhaps writing a letter or giving them a garment or a few cents to pay their car fare. In those tedious cases of phthisis where the treatment is only palliative a nurse can be much to the patient. The patients in the emergency hospitals are somewhat different; they are mostly of the mechanic class, and usually quite sick. That means business and getting them well, and they pass on. They are not so poor; they can even offer us money, either by way of bribe or reward. I heard of a nurse having the handsome sum of ten dollars offered to her, and I once came near having a pair of diamond ear-rings, only the patient changed his mind and would not undergo the operation." The "helpers" spoken of in this sketch are women sentenced to the workhouse on Blackwell's Island for terms varying from three days to six months, and for such offences as drunkenness, vagrancy, and fighting in the streets. From the workhouse they are sent to do the scrubbing, laundry work, etc., in the institutions controlled by the Commissioners of Charities and Correction, who are obliged by law to use their labor. Most of them are the sodden, frowsy creatures who huddle into the prison van after the laconic "ten days" of the police justice, but they are "all ages of bad eggs," as one of them once said to me, and taken together they form a curious class. They are most punctilious in always speaking of each other as "ladies," and the much-abused word is somewhat amusing when applied to a stout virago with a variegated eye. Drunkenness, their common vice, and the cause of all their woe, is delicately alluded to as a "weakness" or a “failing," and some of them seem rather |