Buffalo Township (part 2 of 6)

The positions which I have been fortunate in occupying as a hospital superintendent, covering- a period of nearly fourteen years, include three dififerent hospitals. My training was in a large hospital in Boston and I do not hesitate to say that the administration of that hospital was honest, the physicians were honest, and the patients were well taken care of.

My first experience as a superintendent was in organizing a little hospital of only ten beds in a small manufacturing city in the southwestern part of Massachussets. I repeat that same statement as to the administration and honesty of that hospital.

yiy next experience took me to \\'ashington where our administration was very much influenced by politics. The hospital there, and the administration of its affairs was conducted by a board composed of men and women who were certainly sincerely honest and uncorrupt in their methods of administration.

In the last hospital which I have until recently had the honor to preside over, in the neighboring city of Rochester, we had a very complete system of bookkeeping. It was in existence before I went there and had been carefully worked out by some very successful and able business men. and I could call on my bookkeeper for a report for the detail of expense of any department of that institution, and have it in five minutes ; what it was costing to heat the building, to light the building, or any other one item.

I would like to say one word in regard to the point which was brought up in the last paper with reference to the position of superintendent being held by nurses. I think the difficulty most superintendents have to contend with at the present time in our hospitals, is the difference in the attitude of the public towards men in that position, and women in the same position. The public is not accustomed to give to a woman the same privileges it gives to a man.

It expects a man to have his family with him and to lead a social life. It looks upon him as a citizen. The woman is always expected to be there, day and night.

She must attend herself to every item of domestic detail from the highest to the lowest. She must see every patient in the hospital personally and all of their friends. She is never off duty, and is unable to take the relaxation which men are accustomed to allow themselves.

The President : The papers are now open to general discussion and we shall be very glad to hear from anyone who has anything to say upon the subject.

Aliss Davis : I can only endorse the secretary in her paper, as I have been in the same locality and I have met with quite the same difficulties and the same experiences as those she has met with. I have also been trained with the last speaker in Boston in a well trained, honest, straightforward Puritan hospital.

Banfield and Miss Palmer that, as Miss Banfield said, there are two sides to the question. Miss Palmer has been happy. Any one who has had charge of a hospital in Massachussets ought to be happy, but I am sure that any one who has had experiences in eastern hospitals can hardly be allowed to judge of hospitals that have no tradition. In Boston hospitals people enter and fall into line and walk along with the procession, so to speak, without ever doing anything out of line. Take the hospitals in the far West; everybody has opinions of their own and they are allowed to express them and live up to them. I had the experience of working under a man who dyed and curled feathers all his life ; that was all he had ever done ; after he was made superintendent I was asked to look after the nurses, and I do not think Miss Banfield has touched the situation. The superintendent who followed him after a certain length of time was a French officer of the Franco-Prussian War; a most admirable gentleman so far as courtesy was concerned, but he had never been in a hospital in his life. One day

I was passing- through the corridor and he said to me, " Come here, come here, come here !" I rushed to the window and looked out on a large square and there were three of my nurses standing on the g-reen playing ball. He said, " Is that not scandalous?" I said, " No." He said, " For young women to make such a spectacle of themselves," and I said. "Why ?" I did not go further; they were recalled and forbidden to play ball on the grass.

I could tell you things which you would not believe. Visitors were allowed to enter the building, no one to receive them, no one to show them about the place. They simply entered and went where they wished. They stayed as long as they wanted to; they came at six o'clock in the morning and stayed until ten o'clock at night. There were as many as they pleased. They came in droves and went when they got ready.

I had two large signs printed in gold and stood them at each side of the door and directed the nurses to tell visitors that the hours for visiting were as printed on that sign. The visitors at once complained, and I was summoned to the office and reprimanded. The first morning I was in power I was summoned to the room of a patient whom I had a short time before seen in the bed with his clothes, shoes and hat on. I had directed that he get up. A short time after I was summoned to the room by the visiting physician and instructed that we were not to interfere with the patients doing as they pleased, and that patient afterwards got into bed with his clothes, shoes and hat on. I think I have said enough to substantiate Miss Banfield, that there is another side to the question.

Dr. Hughes, (Boston) : I quite hope that our foreign delegates will not go home with the idea that we are still in the stage of the American Indian. In some of the Western cities we still find hospitals that are not all that we might wish. We have in this country, of course, more politics in one way than in England ; in another way not any more. But all our politics are not bad. I know of a board that is composed of two Democrats and two Republicans and the fifth one is, as they say, the one who sits on the fence. The medical officer is appointed by those poHticians and he had remained in that capacity for twenty years because of his ability.

In this country we find many men taking a hospital management course, and although there are a few boards who try to get a larger number of beds and alter the figures so as to get larger appropriations I think they are in the main honest and sincere.

Miss Durkee : I have had little experience, but would like to speak a word for an honest management under a board of women managers. These women, who were responsible for the maintenance and efficiency of the training school, worked in the greatest harmony with the superintendent of the hospital, a medical man appointed by a board of men.

Personal views were always put aside for the good of the patients and the work generally. They looked upon the superintendent of nurses as a specialist and expected her to supply the knowledge and experience which they did not possess.

Miss Banfield : In speaking of the way that hospital administration is carried on, I thought I had to speak of things as I found them - not as I thought they ought to be, or as it seemed desirable they should appear to visitors. I really did not think of the visitors at all. I have no doubt they have troubles of their own. But as I told you, I found no uniform system to dilate upon, statistics so rarely reliable that no comparisons could be made, and so on. Nearly every speaker has used the words " honest - sincere." You will observe that I never once used these words, except where I specifically stated that these inaccuracies were of course not due to personal dishonesty. I added, however, that such methods would inevitably land all concerned in unpleasant places if pursued in business matters ; that the administration of public business and the spending- of public money should be of the same moment to us as the care we bestow on our own affairs. This I think may be considered incontrovertible. Frankly, I am g-lad that you disapprove of the facts I have stated. I would only remind you that I did not make these conditions. I only related them. Denying^ facts does not do away with them, or I would deny them all most cheerfully, and at once. But as it is, I cannot take back one word I have said. I could add many more.

I should like, however, to mention that, obviously - or it seems obvious to me - I was by no means calling upon my own personal experiences, although I do speak from personal knowledge of every point I have touched upon. Naturally if the conditions I have spoken of prevailed in the hospital with which I have the honor to be connected, I either should not be there, or I should not say a word about it. I am happy to say that my personal relations with trustees, physicians, and fellow workers of all degrees, have been, and are, all that the most exacting could require ; and for this I feel a deep sense of personal gratitude and appreciation. But it never occurred to me that my own personal experiences would be of interest of this Congress, especially as I regard myself as unusually fortunate. It was hospital government in general which, since we say we prepare students at Teachers' College to take part in it as superintendents of hospitals, it seemed not unreasonable we should look into. I really did not like what I found any better than you do, but that did not seem to me any reason for suppressing it.

As for politics, Washington may be " the hot bed of politics " in one sense, but not in the sense of the ward boss and city politician - politics affecting the admission of patients, the police force, and city government. For Washington is the one city in the States which has no city politics, but is governed by direct grant of Congress, and independently of either Democratic or Republican party changes. Its citizens have no vote. It is often said to be the best governed city in the States. The ordinary wnre pulling of influential people I suppose exists everywhere, and Washington may perhaps be unduly well ofif in that respect ; but ward or city politics it is spared. Possibly it requires some one who lives in Pennsylvania to appreciate all that it escapes.

In conclusion, I may say that the reason I did not give instances of every point I brought up, and cite page and name of hospital reports, was because I have no wish to hold up any particular institution or medical or other body of men as " bad examples." It is by drawing attention to it that I hope to mend it. I have given sufificient data to enable any of you who wish to look the matter up for yourselves.

Mary M. Riddle

As the interests of any hospital and its training school are closely interwoven, no argument is needed to confirm the statement that they are mutually dependent. That which militates for the advantage of one reacts for the good of the other and vice versa that which is to the detriment of the one is also an evil to the other.

Since they are so closely allied and participate so nearly equally in the results accruing from their collaboration, the proper adjustment of their relationship seems a simple matter. But, many systems are in vogue and it is only by careful consideration of circumstances and the needs of the time, together with a just estimate of the value of each to the other that a satisfactory solution is possible.

It is a self-evident fact that in every hospital some form of government is necessary, and if it be that which provides for the efficient management and preservation of the common interests, promotes the general welfare, and establishes a permanent happy state, it accomplishes its purpose and no individual or class of individuals is at liberty to interfere with its administration, lest it be weakened, and the end to be attained frustrated. Organized training schools for nurses are of comparatively recent date and their modes of growth have been that of evolution from the simpler and less complex organizations of the beginning, on and on to the

When these schools were in the simplicity of the beginning it was no uncommon thing to find them managed by boards in no way connected with the hospital. This was especially true of those hospitals which employed religious orders to care for their sick. Such nursing bodies did efficient work, and paved the way for their more scientific, though possibly less devoted followers. They were, from the highest religious motives, most devoted to the relief of human suffering, and were responsible only to the head of their order, regarding the hospital as the means whereby they were allowed to fulfill their vows and to exercise those functions and attributes which made them indeed " Sisters of Charity."

Other schools there are, governed by superintendents who have no voice in the executive affairs of the hospital, but whose interest is concentrated in furnishing to the school clinical advantages for study and observation. This relationship of school and hospital may have items in its favor, but there are evident disadvantages, prominent among which is the effect upon the nurses themselves. It is possible and altogether probable that by a training thus given, nurses may be produced who fail to consider that the welfare and comfort of the patient is of primary importance. His welfare may receive due consideration, but his comfort and happiness are of secondary value. He is the means to the end that they be educated and they unconsciously drift into the belief that all patients were created for their benefit, whereas the reverse is the fact, viz., that nurses are created for patients.

Again the training school may be governed by a superintendent who with the school is employed by the hospital to do the nursing therein. Hospitals and training schools thus associated have been known to flourish and go on to success, and to send out graduates who take and maintain positions in the front ranks of the profession. Furthermore, this association of school and hospital has been one method of solving the problem of political control or rather of keeping the school free from political influence when the hospital is under its domination. It has also been a method of securing greater freedom for the school, in that it allows the accomplishment for the hospital of what is reasonable rather than the exaction of what is desirable, with the result that the possibilities for the preservation of the health and strength of the nursing body are greatly increased.

Another form of relationship between training school and hospital is exemplified when both are under one administration. Then do we have a form of government which may more nearly meet the necessity for any government, viz., to promote the general welfare, but there are some apparent disadvantages to the school arising from this form of relationship ; first, the ability of the board of trustees to at any time abolish the training school and conclude to have the nursing- service performed in some other way ; second, it seldom calls for a " Ladies' Board," unless it may be that such a body constitutes part of an advisory board.

That training school which has no Ladies' Board doubtless loses many of the influences which tend to stimulate it in the search for high ideals and correct motives. Personal contact with women of a wider and more varied life cannot fail to make strong impressions upon nurses, and when the spoken words convey the knowledge of experience they carry with them a conviction that supplements the teaching of the school.

The superintendent of the hospital is the nominal head of the training school, under authority of a board of trustees. He, in turn, delegates his authority to a superintendent of nurses, superintendent of training school, principal of training school, or a directress of nurses ; one title implies the same meaning, suggests the same routine of duty and the same burden of responsibility as another, and is at the same time representative of some distinctive idea when given. Great power is gained by this combination of offices.

extended influence than the average superintendent of nurses, for by reason of his professional and business relations he comes in more immediate contact with men of afifairs and is constantly informed of the public pulse.

In matters of discipline he is the court of appeals and from his position as head of the training school on the outside of the actual work he should be able to form unbiased opinions and render judgment without prejudice.

If he is the power to whom appeal may be made for direction and discipline, the training school committee of the board of trustees is the final tribunal or supreme court.

He is an adviser not only in matters of discipline, but is to be consulted on those that are educational or that otherwise pertain to the progress of the nursing work. The superintendent of nurses, from her more intimate knowledge of the requirements of the training school, gained by her experience while in training, and her contact while superintending, should formulate and carry into execution plans for the advancement and betterment of the nursing service within the hospital, as well as the elevation and maintenance of standards among pupils who must soon represent the training school in the great world outside, where they will be judged by the efficiency and spirit which characterize their work. In all this the superintendent will advise and consult and he will doubtless eventually place his seal upon the results ; but if he is wise and unselfish he will permit the superintendent of nurses to proceed within limitations that are not narrowed and restricted by his conceptions of expediency, but by those which, after full and free consultation, they together conclude will most surely promote the general welfare.

Another element of power in this combination of offices, subject to one authority, is found when the relationship between the training school and other departments is scrutinized. It is impossible for a matron or housekeeper who is an untrained nurse to duly appreciate the necessities of the hospital from the standpoint of the nursing service, and therefore the progress of the work is frequently impeded by friction which is the outg^rowth of ignorance. But when all departments are subject to the one control, there can be no division of interests, and consequently no friction to overcome.

The benefits resulting to the hospital and its administration in every department by this unity of government may be augmented by placing at heads of all departments of the domestic service, women trained and educated in the art of nursing. Success to the whole is thus lured by every inducement of sympathy and interest.

Here, too, is an opportunity for the development of those ethical traits in a nurse which count for much in making up the estimate of the individual as well as the professional body. Here loyalty may grow, flourish and bring forth fruit which shall rebound to the well-being of the training school, the hospital, and ultimately the whole profession.

The matter of placing trained nurses at the heads of departments has seldom been carried to complete success. Alany existing theories have thrown their w-eight in the scales to overbalance the success of the scheme when tried. There is a sentiment noticeably prominent among nurses that by taking any other line of w^ork than the actual bedside care of patients, or instruction in the art, they forfeit their place, their self-esteem and the esteem of their neighbors.

Is the rejection of these branches of work by our best nurses the result of their training, or a deficiency in their training, or a fault of their earlier education, or is it due to the influence which heads of hospitals and heads of training schools have permitted to surround these forms of hospital work ; or, is it due to the fact that other than nursing forms of work in the hospital have been consigned to the list of menial occupations? But, do they really belong there? Do they not rather represent the business element in the hospital world, and is it not now the common belief that the higher education best fits one for business and the conduct of vast affairs, and if true, then does not the higher education in the hospital best fit for places therein? Moreover, is not the successful management of vast business enterprises receiving the homage of the world today, and are not these special lines receiving the attention of instructors in the course of nurses at Teachers' College?

Then let not the training school despise the offices of any other department, but rather broaden out to include preparation for them in its curriculum. Instruction in the duties of matron, housekeeper or purveyor might well form one branch of training for the third year, with the result that the trained nurse would be better able to meet the responsibilities of the combination of all ofBces when called upon to do so in assuming the management of a small hospital. Then would she not be completely overcome by the problems which demand, for correct solution, a knowledge of the various subsistence supplies, their value to the hospital, their cost, their necessity, the amount required, and the manner of preserving them and preparing them for use. She would also have a knowledge, gained by instruction, observation and experience, which would enable her to demand the proper amount of domestic service within a given time and for a given recompense.

Whether the relations between the hospital and training school are those that naturally arise when under one administration or whether they are those due to the contract which binds them together, there are certain duties and responsibilities of the hospital to the training school and vice versa of the training school to the hospital. When the relationship is by contract its terms doubtless define these duties and responsibilities and each member of the compact sees to it that the other renders that which was agreed upon, - there responsibilities cease.

When a hospital issues to the world its prospectus setting forth the advantages of its particular school, and a young woman is induced thereby to undertake its course of training, to the end that she may become useful and self- siipportinq-, the hospital assumes toward that young woman certain moral responsibilities as well as those enumerated in its agreement with her. She has doubtless come from a sphere in life where knowledge of hospitals and training schools is very limited ; she knows nothing of the many phases of the work which may be to her advantage or otherwise, therefore she must be protected, and this is one duty of the hospital to the individual nurse, - her interests must be preserved and this cannot be done if obstacles are placed in her pathway toward success. She looks forward to the time when she shall be suf^ciently equipped to take her place in the world and earn a competence. The time arrives, but she finds she is superseded, possibly by undergraduates from her own school, who because they are undergraduates and are supported by the school, underbid her services to such an extent that she must withdraw from the field, wondering how her hospital could have held out such inducements to her when they evidently do not exist.

This is the prevailing condition in those communities where are located the hospitals having training schools that send their nurses out to private duty. In these days of progress we frequently hear the argument advanced that it is only a part of the new plan for university education of nurses, and so it may be in those schools where the nursing service is rendered at the same rate as to the poor in our hospitals. Let the poor and others be given the nursing care required and let no remuneration be exacted, then will become perfectly visible the plan for university education of the nurses. And lest these patients become pauperized, let them be given to understand that the obligation is wholly on the part of the hospital. Possibly a circular to that efifect might be substituted for or accompany that which is now sent inquiring as to the merits of the nurse.

The idea of obligation may not suggest a happy state and it may be wise to charge a nominal fee, but if it were no more than the actual cost to the hospital of the nurse while engaged with the patient, surely all moral and ethical requirements would be met and the value to that training school of university education for its nurses could be determined by the amount of service thus given for which there was no visible increase in its treasury.

Other responsibilities of the hospital to its school under the same administration may be enumerated, - as, provision of home and sustenance, fulfillment of contracts, provision of necessary educational advantages, etc. In return the training school as a whole and nurses as individuals will give unstintedly of those qualities which furnish the best service, as, loyalty, unselfishness and devotion to principle. They will abide by their contracts and will guard against the purely scientific work, forgetting not sympathy and womanly nursing virtues and attributes which sometimes seem almost out of fashion and can only be seen in the dim distance of the past, but will be ever present with the nurse who heeds the admonition of one well fitted to furnish it, that " the ideal nurse must maintain a strength of character upon which a sick world may lean."

Notwithstanding much has been said to the contrary, there is a growing sentiment of appreciation for training schools and their work, among hospital governors and administrators. The school is no longer thought an expensive luxury of the hospital or even a pecuniary benefit, but it is placed where it belongs, among the educational institutions of the world. Material evidence of this change of opinion of the hospital for its school is found in the provisions made for their comfort, for their culture and for refining influences which surround them in the beautiful home that almost every hospital is ambitious to furnish its nurses.

An editor of a prominent medical journal who is closely observant of the trend of events says, " It is becoming more and more obvious that the efficiency of a hospital of any sort depends in a great measure upon the services of the nursing staff. It would, we sometimes think, be possible to get on, for a time, at least, without physicians, but to be deprived of nurses would mean the abolition of the modern hospital. The external recognition of this fact lies in the ample pro-

Time and experience are the surest tests by which the real value of any form of relationship between school and hospital may be estimated ; but all departments cannot fail to find in the united means and efforts, greater strength, greater resource and eventually greater results, - unity of purpose is the main prop of success.

Isabel Hampton Robb

Late Superintendent of Nursing Johns Hopkins and Illinois Training Schools, Member Board of Women Managers Lakeside Hospital, Cleveland ; Member of American Society Superintendents of Training Schools, Lecturer on Hospital Economics, Teachers' College.

So much has already been said about the advantages and disadvantages of putting the administration of hospitals in the hands of boards composed of women as well as men, that at first sight any additional remarks would hardly seem to be required. Nevertheless, the whole subject is one about which nurses, whether they be superintendents or others occupied inside or outside of hospitals, should take pains carefully to inform themselves, for opportunities come to many of us when the right kind of knowledge would be of much value in helping either the individual or the public to reach correct conclusions concerning this and other questions in which similar principles are involved. For these reasons, this brief paper that I have had the honor to prepare for the Congress, is devoted to the consideration of our attitude of mind as a profession towards the appointment of women on hospital boards, and an endeavor has been made to place a true value upon woman's services in such work, to consider some of the ways in which a proper selection may be made, and some of the methods of organizing her work by which the most effective service may be rendered while harmony is preserved. In taking an honest vote of our position towards the subject, judging from opinions freely expressed in private and from, our negative attitude in reference to it in public, it is safe to say that in all probability^ 80 .

superintendents would be almost unanimously in favor of workint^ in hospitals where women are not represented on the managinq- boards. This feeling is partly due simply to the traditional belief in woman's incompatibility to work with women - and we know how slowly all fixed traditions die - and partly to the fact that in some instances this incompatibility has been a matter of personal experience, which has been swiftly carried from one to another, and has not failed to leave a prejudice in the minds of every hearer. For less reason the feeling is usually shared in by the stafif of hospital nurses, being founded not so much upon any special comments they may have heard passed upon lady managers, or upon any particular reasoning on their own part, but being the natural outcome of a certain unsympathetic tone respecting the matter that pervades the hospital, fostered, it may be, by the unspoken but negative attitude on the part of the superintendent, and occasionally by the thoughtless remarks of inexperienced, unthinking members of the hospital staff, who regard with suspicion the possibility of outside interference in their own particular province. This conception might be expressed in words somewhat as follows : " Visiting ladies are apt to be interfering, opinionated in affairs they cannot know very much about, busy-bodies and stirrers up of trouble. They are therefore to be regarded with suspicion and treated with scant or only forced courtesy." That some such feeling pervaded hospitals twenty years ago I can testify, and it seems but yesterday that I recall with what transparent toleration the ladies' visits were received in the wards by the nurses. In my own particular case nothing but good to myself came from the only occasion on which, as a pupil, I encountered one of the lady members of the board. She came behind the screen where I was busy in caring for a patient, and after taking in some of the details, abruptly put the question, " Can you comb a patient's hair so that it doesn't pull and hurt the patient all the time ? There is not one nurse in a hundred Avho knows how to comb a patient's hair properly." She passed on, leaving with me the determination to excel in at least that one point in nursing so that after that time I never arranged a patient's hair without givine special thought to her comfort. As regards superintendents, the true source of their objection lies in the dread that their own ideas and ways may be interfered with or hampered, or that they may be disturbed by constant and untimely visits and by unnecessary solicitations for patients from individual members, or by the board as a whole. To always do our work in our own way may be very pleasant, but where this work has to do so vitally with so many people, both well and ill, and where it is a public trust, the surest sign that we are broadening out with growth in years and experience is evidenced by an ever increasing readiness to give up prejudices and to welcome any arrangement that will help the work on. To do the subject justice, we must in the first place take an absolutely impartial and impersonal view of it. To eliminate the personal equation is very difihcult, but this must be done, and only the thought of the benefit that such boards are likely to be to the hospital should be allowed to influence us. In nursing as in any other work the more self is kept in the background, and the more the work and its best interests are made the first thought and consideration, the happier the worker, and the greater the success obtained, for the reason that over-sensitiveness and friction will seldom interfere. Were I to allow the personal sentiment to predominate I should take the side against the election of women to serve on hospital boards, as I did at a time in my hospital career when I certainly was not a fit judge on so important a matter, since I had not yet made a trial of both ways of working. Increasing experience, however, coupled with an unswerving determination to make the best interests of the hospital my first consideration, have led me to alter my former opinion, and I can hardly express myself too strongly in favor of their appointment. This decision is the result of personal experience obtained from various sources. For some years I worked in two of the largest hospitals in the country, where the administration of the hospital and training school in each case was quite distinct, the former being entirely in the hands of men, and the latter in those of women. In a third hospital, the trustees of which are all men, the women formed an auxiliary board, and although giving lavishly of their time and means to procure materials and necessaries generally for the hospital, were not accorded even the right to demand an account of the disposition of the abundant supplies provided by them. In another large hospital, in which I was superintendent of nurses, everything in and about the place was administered and controlled entirely by a board of men trustees. Finally, it has been my privilege to act as a member of a board of women managers in a hospital administered by both men and women, the former serving in the capacity of trustees, and the women as a board of managers. In addition to this personal experience after watching with keen interest the administration in all sorts and conditions of hospitals, both in this country and abroad, it has become my firm conviction that women are needed in the administration of all such institutions, not just because they are women, or for any " Women's Rights " reasons, but because unbiased observation has demonstrated their usefulness, and the influence and part they have taken in establishing and improving hospitals all over the world have become matters of history.

Msitors to a modern well equipped hospital often express surprise when they are told that there are still many people who prefer to struggle through a sickness in the squalor of a tenement house rather than enter the wards where every attention can be paid to them by trained nurses and skilful physicians. Nor do all refuse to accept these advantages from mere blind prejudice, for there is another and a still stronger reason. Despite all the care that is given the patients, there is often something lacking in some of our most noted hospitals which the meanest hovel still ofifers - an atmosphere of home. " Men may work from sun to sun but woman's work is never done." The former are occupied in the so-called larger fields of the world, but the woman's main occupation is in the home, where she has to deal with men, women and children, at their best and worst, and must be ready to manao^e intelligently a thousand and one details, if she is to succeed in making a happy home for herself and those around her. As the bread-winner the man must to a large extent devote himself to external matters, and in the matter of home details he becomes accustomed to depend upon the women for carrying out successfully the very many duties with which he is necessarily unfamiliar. It is clear that the same holds good in hospital management. In order to insure the greatest success attainable, the best work of men and women is essential, the former attending to the financial part, and to such afifairs as come more strictly within a man's experience, the women looking after the details and the housekeeping part and those afifairs belonging to home-life with which they are more conversant. But if we cannot have both then I should without hesitation be in favor of retaining the women and letting the men go, for women have proven themselves to be no mean financiers or planners, where the whole responsibility has rested upon them, and from the standpoint of careful administration and economy they are undoubtedly far ahead of men trustees. One prominent example of which I can speak with knowledge is that of the Illinois Training School for Nurses, Chicago, organized by a few women for the purpose of bringing relief to the city's sick poor by introducing women nurses into the wards of the city and county hospital. This organization has made for itself a name as being the largest school in the country ; it provides for the nursing in two of the largest hospitals, and has steadily increased its plant as the need arose. Moreover, it has not only kept itself free from indebtedness and is practically self-supporting, but for years has been able to make to the public an annual contribution of the income derived from a gift of $50,000, which has been set apart as a special fund and is utilized in supplementing the remuneration of competent trained nurses, who by this means are enabled to take care of the patients of moderate income at reduced charges.

The pnpil nurses are well cared for and the school affords an object lesson, teachin.e^ the people the duty of providing healthful surroundings for those who care for the sick, and who are sent out to teach by individual example all the possibilities of prophylactic hygienic measures. All this has been accomplished by a board of twenty-four women, and I think we may be well proud of the fact that the duties of superintendent have for years been efificiently carried out by Miss Mclsaac, our honorable president.

But it may be asked : Do not the hospital nurses as women represent the home element in these institutions? They undoubtedly do, but it must be remembered that their supervision is restricted chiefly to the wards, and the superintendent is usually the only nurse who has access to all parts of the hospital. If she combines the position of matron with that of superintendent of nurses, she has undoubtedly greater opportunities, but the matron is clever indeed who in herself possesses all the experience and wisdom needed to cope with all the details of the various departments as thoroughly, carefully, economically and perfectly as they should be managed. Besides why tax and over-work one woman when by a little management and system she ma> be assisted or relieved of an unnecessary amount of detail by the willing co-operation of a number of other women? I have heard it stated by superintendents on various occasions that these ladies make more work and trouble than they save. But when this is the case, is it not possible that the fault lies more with the superintendent than with the board of managers? Naturally the latter cannot expect to know all the ins and outs of hospital life, but with proper organization and especially with co-operation on the part of the superintendent of nurses they grasp the situation in a surprisingly short time, and hardly ever fail to contribute many good and practical suggestions concerned not only with their own particular duties but with the good of the whole institution.

of managers ; (2) proper organization and strictly defined duties ; and (3) hearty co-operation on the part of the superintendent of nurses. Of these three the last is the most essential, since a house divided against itself must inevitably fall, whereas a united body of workers, even though they may be of no extraordinary individual ability, can accomplish much. The same mind should dwell in all who have anything to do with the hospital, and its best interest and greatest good should always be paramount to private likes and dislikes. The desire to have the opinions of single individuals prevail should always be repressed, and each should determine to take a broad point of view, and accept cheerfully and carry out faithfully any well considered decision of the majority.

In the formation of a board of women managers many things have to be taken into consideration, and it is quite possible that the superintendent of nurses may not always be able to appreciate the various interests to be consulted, so that in some instances it may puzzle her to know why certain women are chosen as members of such a board. The reason governing the selection may vary according to the sources from which the institution is supported. Some hospitals, as we know, are carried on by religious denominations; others are richly endowed by private bequests; in the case of the municipal hospital the cost is provided for out of the city treasury, while others depend for support solely upon public contributions. To this last class belong the greater number. At the same time no matter how securely endowed, or how independent a hospital may be of its public, it is always well to have a number of people in the community who take a personal interest in it, and who are jealous of its good name, who will stand loyally by it if it is unjustly criticized, who will use their infiucnce to make friends for it, and who will see to it that it remains worthy of the favor and confidence of all who may seek its shelter and aid. In these respects the assistance of woman is farreaching. Again, the active co-operation of well-known women, whose names stand for integrity and what is best in the communily, at once lifts any institution with which their names are associated above reproach, and strengthens the hands of the officials in their endeavors at every turn. Moreover, in order that the benefits of the hospital may be made as far-reaching- as possible, it is well to have among its supporters those who can serve it not only philanthropically, but also financially, and who can influence others to give. Thus the society woman, the woman who is known for her indefatigable good work, the practical economical housekeper and the business woman can all find a fitting place on hospital boards.

A proper selection having been made, thorough organization is of vital importance. Each member should be chosen for a definite reason, and her sphere of usefulness having been once recognized, her duties, privileges and restrictions should be defined. Thus a board divided into suitable committees, with an executive committee composed of the heads of these various committees, may be useful in many ways, and will represent and forward all the various interests connected with the institution, of which I need not speak in detail here. Perhaps, however, I may be pardoned for pointing out a few ways in which women members of the board can supplement the work of caring for the sick. For want of time and for absorption in the strictly practical part of their work nurses are apt to forget that there are other factors besides medicines and the routine nursing that act as tonics and aids to the restoration of health, and that convalescence will inevitably be retarded should the patient fall into an indifferent listless attitude of mind. What brightens up the sick more than the sight of a new face, a few fresh fiowers, a bright entertaining story or the magazine pictures, a quiet game of some sort, or perhaps some light work for the fingers? All of such things can be supplied by the ward visitor provided the nurses will co-operate far enough to keep her in touch with the patient's needs. Such helps are sources of real economy and great good, for they undoubtedly hasten convalescence so that places are sooner open for others who need the care more.

Again, a practical, far-seeing superintendent, who is in hearty accord with her committee on hospital and household supplies, can hold their interest to such an extent that many items will be provided, with a consequent distinct saving to the hospital finances. Again, the individual nurse will find it of great advantage to her when she leaves the hospital to have a certain number of women in the community who are conversant with her ability and her ambitions to further district nursing, visiting nursing or whatever form her future work may take.

In the brief time allotted I have given but imperfectly a few of the many reasons why women are in place on hospital boards, and I beg to close by repeating that it lies in the power of the superintendent of nurses, if she be a capable, experienced executive officer, to utilize these extraneous aids in order to develop more and more the good work done by such boards. Our hospitals of today, although far ahead of those of twenty years ago, in some respects still lack the full measure of the home atmosphere that makes patients forget they are within the walls of an institution, and which can only exist where the presence of woman and her aid is appreciated and utilized to the utmost extent possible.

The President : The chair will call on Miss Gilmour, superintendent of nurses. New York City Hospital, to open the discussion on Mrs. Robb's paper.

Miss Gilmour : There seems to be such a diversity of opinions as to the usefulness or helpfulness of women on hospital boards that it is a difficult matter to know where to begin.

People in general connected with hospitals feel that as a rule these women are not practical. They give too much attention to petty detail and not enough to the great object for which the work is going on, - the saving of human life - so that a misplaced chair or rug is in their eyes of greater moment and will excite keener criticism than the cause of the disorder, which may have been speed necessary to do something of vital importance to a patient. And no amount of explanation can convince the visiting lady that she is unjust in her severe condemnation. As a nurse was heard to remark : " There is no use trying to explain. Her mind is already made up. Appearances are against me."

On the other hand, people outside of hospitals are of the opinion that women on these boards are an absolute necessity, that they supply the lack which is so apparent where only professionals are banded together, that doctors and nurses are so absorbed in their work that anything which has not a direct bearing on the case in which they are interested is of little moment to them. Therefore it often happens that while one may find the immediate surroundings of a patient in immaculate condition, beyond that things are quite the opposite and disorder reigns supreme, and scant consideration is shown to any one who is not a " case," or necessary to the " case."

To attempt then to control these two such opposite factions and dovetail their work so as to make a harmonious whole of it is no easy task and when it is accomplished the result is a very strong combination hard to break and ideal conditions for discipline and progress are created.

One such board working harmoniously wath its institution is brought to remembrance today as an example of what such a board can do. This board was called into existence by one of our number since gone to her reward, the late lamented Miss Darche. This lady, called upon to undertake the duties of a superintendent in a school where men, politicians at that, held sway, found there one woman, a society lady of wealth and culture, whose advice was often taken on important matters connected with the school - indeed who had been the means of securing Miss Darche's own appointment. This woman among her other many accomplishments was thoroughly practical, thus rendering her aid invaluable.

This lady, a committee of one, kept in very close touch with the school, as she said, to find the superintendent's limitations and to help there. In this way many of the reforms originated by Miss Darche were talked over and where Miss Darche reached her limit this lady took up her work and in every case put the reform through.

By reforms I do not mean matters relating to the internal administration of the school which a superintendent should be able to handle herself. In regard to nursing, there Miss Darche was always supreme, because she had no superior in her profession and that fact was soon recognized ; but where money was needed, where influence was needed, or where people were needed to help on the w^ork, there the committee of one was always ready and after suflficient questioning to understand the subject, her share was cheerfully taken up in every case and nearly always carried through. This lady, like all intelligent women, had her political views. She was a Democrat and as long as Democrats were in power she was unassailable. The possibility of a Republican board over the school, the possibility of any board of politicians over the school and no committee of one to interview in its interests kept looming up in the future, for life is very uncertain, and Miss Darche began to look to this possibility wath the result that a committee was formed chiefly of w^omen, called " The Advisory Board of the New York Training School for Nurses."

This board, wide in its aims, interests and politics, is united in holding up the hands of the superintendent, on all matters pertaining to the discipline and progress of the school. The committee of one became its chairman and nobly has she fulfilled her oflfice. In describing the board not long ago she said. " We are here to act as a buffer between the commissioner and the school, just as railroad cars are furnished to lessen or relieve the jar, should they come together with unusual violence." Her advice to another anxious board is worth quoting : " Choose first your superintendent on her merits and of course you will choose the best you can ; then let her alone. When she needs help she will let you know, and then help her."

The advisory board makes monthly visits, goes over the hospital and home, hears the superintendent's monthly report, talks over new business, and gives any necessary assistance.

Some of the work done by the board is as follows : All recommendations for increase of numbers on the staff of the Training School, or increase of salaries are endorsed by them; all special calls for lecture funds, etc., are met by them, and in any emergencies connected with the nurses of the Training School where financial help is necessary, it has been freely given. All disputed points requiring arbitration are turned over to them.

Where work is carried on in this way by a Board of Lady Managers, good results must be achieved and the work of the superintendent cannot be otherwise than lightened, while the moral and disciplinary effect must be to strengthen her hands and uphold her authority over her subordinates.

The President : I have the honor of calling upon IMiss Louisa Stevenson, member of the Board of Managers, Royal Infirmary, Edinburgh, delegate from the National Council of Women of England.

Miss Stevenson : I desire that my first words to this Congress should be to convey to you an expression of profound sympathy from the president, the vice-president and all the members of the National Union of Women Workers of Great Britain and Ireland, which I have the honor to represent today, upon the tragic sorrow which is now weighing down this great nation. I can assure you that these are no mere words. I thank you. Madam President, for permission to give expression to them.

the presence of women managers. For many years I was of opinion that there was a great deal of work in hospitals which would be left undone were there no women to attend to it.

About six years ago I was elected a member of the Board of Managers of the Infirmary. This year I am ofT the board, as no one can serve more than five years in succession, and so am able to attend this Congress, where I came to learn and not to teach. I believe there is a great deal of work done in America from which we may learn much. I think also there may be some things which you might learn from us ; that must be left for you to decide when you visit our country and our hospitals. After my five years experience on the board - and for the first year I was alone with twenty men ; the second year another woman was appointed - I have no hesitation in saying that our work is acceptable to every one concerned. I have, at this present moment, no warmer friends in the world than the men on that board. We discussed many subjects, which I brought before them, which would otherwise not have been considered at all. My experience is that there need absolutely be no friction whatever between men and women working together. I was on the most friendly terms with the managers, medical stafif, nurses and every one connected with the hospital.

I confess that I have not so much confidence in Boards of Lady Managers working apart from the general committee. I believe that the best work can be done by the women and men working together, and I believe that a large amount of friction is caused by women not having it in their power to carry out their own recommendations and resolutions. There is nothing more irritating than to have to make recommendations in a sub-committee which one knows one has no power to carry into effect. I do not know how it is with you in America, but with us I have always found that there is not such a superabundance of administrative power among the men of our country that we can afTord to do without the perception possessed l)y the women. I do not think this question should be discussed as to the differences between men and women ; if a man or woman has the administrative power and understands what good work is then that man and that woman are the right persons to be put upon a board of managers. I think for all public work there must be a certain amount of definite training. No one can do efficient work until they learn just how to do it. I do hope from what I have seen in other countries, from what I have seen in the hospitals under the supervision of boards composed or partly composed of women, that those who know of this work will realize its value and be converted to having women on the boards. There are many small matters which do not occur to men, yet which are really important for the best interests of the institution, and it is important to have women on the board to express their views on matters of which from experience they have a more intimate knowledge than men.

Now I really must not detain you longer, beyond assuring you that I am fully convinced there is work to be done on these boards, which will be left undone unless the women take it up.

Miss Dolliver: Of the many valuable and interesting points in the papers read this morning, I ask attention for a moment to the consideration of the hospital patient as an individual. Too often is the zeal for the mere routine w^ork of the day. The pupil nurse at least does not realize that she should first establish the right relations between herself and her patient, in order to gain his confidence. She should make him feel, though not necessarily in w^ords, that during his stay in the hospital she has sincere interest in him, and is constantly mindful of his needs, both of mind and of body. The nurse who does this will convince him and all who know her that the nurse is indeed created for the patient.

Wednesday Afternoon Diana C. Kimber

This society known popularly to doctors and nurses in London as the " Co," or the " Co-op," was formally started in 1891, and was registered under the name of the "Nurses' Co-operation," June 5th, 1894. It is, in common with so many English institutions under royal patronage, the Princess Louise, sister of the King, being its patroness ; whilst a titled lady, Alice, Countess of Strafiford, is its president.

3. (a) To purchase, lease, hire or otherwise acquire real and personal property ; (b) to erect, construct, maintain and alter any houses necessary for the purposes of the society; (c) to sell, lease, mortgage, or otherwise deal with

The society consists of the members who signed the memorandum of association (chartered members) and of members who pay annual subscriptions of £1 Is. (about $5.00) or of £5 5s. (about $25.00) to the funds of the society - such members being proposed for membership by two or more members, and elected by the committee of management. The society numbers only twenty-five members, seven of whom are the chartered members who signed the articles of association. Of these twenty-five members, eleven are men, and fourteen women.

The management of the society is in the hands of a committee, the committee of management - which consists of not less than twelve, nor more than fourteen persons, six being elected from the members of the association, and not more than eight, nor less than six, being elected annually in general meeting as representatives of the nurses. All the business of the society is managed by this committee of management, and all the power lies in their hands.

They formulate and circulate among the nurses of the society such regulations as they think fit for enabling such nurses from time to time to hold meetings for the election of their representatives on the committee of management.

The idea of the Nurses' Co-operation originated with a trained nurse, a Miss Mary Belcher, who desired to enable private nurses to co-operate for their mutual advantage and benefit. Miss Honnor Morten gave assistance in formulating a workable scheme, and considerable time and trouble was given to making this scheme practical in every detail. The promised support of a suflficient number of doctors was secured. A standard of qualification was determined so that doctors of repute might feel perfectly secure in recommending and employing the nurses ; and rules for the nurses, for their instruction, guidance and protection, were drawn up.

When the scheme was ready two gentlemen and four nurses came forward with financial aid to the amount of $2,500.00: (of this sum the $1,500.00 advanced by the two men was later made a gift to the institution, while the $100.00 advanced by the nurses was repaid in 1892). An office was taken at 8 New Cavendish St., London, W., and on February 1st, 1891, the Co-operation started with thirty nurses on its books.

The society thus founded in 1891 was registered in 1894, the memorandum and articles of association being signed by Sir Henry Burdett, editor of the Hospital ; Herbert P. Hawkins, physician ; Mary M. Belcher and Mary N. Napper, nurses ; P. Michelli, secretary, or as we should say warden, of a hospital in London ; Chas. Weston and W. Capel Slaughter, solicitors.

The signatures were witnessed by Miss V. Honnor Morten. From the beginning the Nurses' Co-operation seems to have been a success, for we read that at the end of the first year, i. e., in December, 1891, there were already 158 nurses on the staflf, and that 1,127 calls for the services of the nurses had been received by the association. These numbers have steadily increased, and the report for the year ending December 31st, 1900, states that at that date there were 509 nurses on the staflf, and that during the year a total of 7,130 calls had been received and filled. During the same year the nurses' gross earnings amounted 'to

£43,696 4s, or approximately $218,480.00. Again, in this report the nurses are congratulated on the completion of a residential home, which provides them with a restaurant, club rooms, and many separate bedrooms. And no charge is made for the use of a sick room by nurses belonging to the club, whose admission is recommended by the medical officers of the society.

Each nurse received her earnings, less 71/3%. She pays an annual subscription of $1.20 to the Howard de Walden Club. She boards and lodges herself as she pleases.

To an outsider, on reading this and similar reports all seems well, but recent events have shown that for some time there has been considerable latent discontent among the nurses of the stafif, and with the resignation of the late superintendent, Miss Amy Hughes, this discontent found expression. It would appear that the control of the association has been drifting further and further from the nurses of the staflf, and into the hands of those members of the society who are most constantly present at the monthly meetings of the committee of management. And the reason of this is not far to seek - the nurses finding it difficult to attend the meetings regularly on account of the nature of their work have grown careless ; possibly also they have not realized the importance of their position on the committee as representatives of the staff, and those members of the society who have been constantly present at all the meetings, finding the power in their hands, have grown accustomed to using it, and have possibly unconsciously come to believe that they are the only persons qualified to manage the business of the association.

But to return to facts. In consequence of the growth of the society, and consequent increase of its work, it became necessary in 1895 for the committee of management to employ a paid secretary. Up to this date the office had been an honorary one, and had been held by Miss Honnor

These nurse representatives do not necessarily represent the nurses, and as a matter of fact the present chairman, who sits as one of the nurse representatives, so far fails to represent their opinions that 95% of the nurses signed a formal protest against his actions. Four only of the nurse representatives now on the committee are nurses on the staff, and they on account of their work are often obliged to be absent.

Sinte the general meeting in June of this year, when the nurses met to voice their complaints, the committee of management have issued a circular letter to the nurses of the Co-operation, in which, to meet this difiliculty of inadequate nurse representation, they say :

" The committee are quite aware of the difficulty nurses find in attending the monthly meetings regularly, owing to their frequent absence from town (i. e. London) and this makes the question of the nurses' representatives a difficult one. The committee are now considering how the articles of association can be improved, and due time and attention will be given thereto, with a view to the nurses having, if possible, (the italics are our own) a larger representation secured to them.

" They also intend to take steps to acquaint the nurses more fully than heretofore with such resolutions as affect the whole work of the Co-operation."

It seems to us that the steps the nurses have to take is to make the committee understand that it must he made possible for them to have such representation on the committee as will enable them to have a controlling voice in its management. Unless the nurses have this voice the society cannot properly be called the " Nurses' Co-operation ;" having such a voice they can have no reason for complaint, if the disabilities under which they may be suffering are not rectified.

From the point of view of an American it seems somewhat incongruous that a body of women seeking to manage their own affairs should accept donations and patronage.

In England acceptance of patronage is so common that it does not occur to us to look at it in this light, but we venture to think that the English nurses who wish to stand upon their own feet, and manage their own organizations, will have to learn to face the fact that they cannot accept help from others without losing a certain amount of independence. -A,/ .

Sophia Cartwright

Ladies, - As you have already had described to you the basis of organization in the Nurses' Co-operation, which is identical with that of the Registered Nurses' Society, in securing to members the whole of their earnings less a small percentage for office expenses, I do not propose to enlarge upon this point, but briefly to give you some account of the distinctive features of the society which I have the honor to represent.

It was in 1894, after the Royal British Nurses' Association had been incorporated by Royal Charter, that Mrs. Bedford Fenwick felt that something should be done to secure to trained and certificated nurses, who were registered under the charter, remunerative work as private nurses, which work was largely in the hands of uncertificated and inefficient women, or was manipulated by institutions which paid the nurses a fee and retained the profits. If the nurses had the management the margin of profit would be theirs. On the other hand, Mrs. Fenwick urged that the Chartered Association had a professional duty to the public, and should define a definite standard of education and training for private nurses.

It was decided that the association could not initiate such a scheme, but eventually some of the medical and nursing members formed a committee, at Mrs. Fenwick's re-

Through the organization of this society nurse members of the Royal British Nurses' Association were provided with a medium through which they could obtain private nursing work. But after the new by-laws were thrust upon the association many of the early members felt compelled to resign their membership, and the Registered Nurses' Society adopted a standard of its own, and continued its work for nurses and the public entirely apart from the Royal British Nurses' Association.

(2) It requires, in addition, adequate training in specialties, such as maternity nursing, midwifery, mental nursing, massage, fever nursing, etc., of members undertaking nursing in these special branches.

(3) It inculcates and encourages in the members a sense of their direct responsibility for the wellbeing of the society, and of the duty which they owe to the public in maintaining an efificient standard of nursing education for private nurses.

Maintaining as it does a standard of education and government somewhat in advance of its age, and being in no way dependent upon social patronage, the Registered Nurses' Society must necessarily grow slowly and surely in public favor, as it is doing.

The society is not satisfied that nurses should become members merely to obtain the commercial benefits which it confers upon them, but its object has been also an educational one.

The society has further cultivated a broad outlook by affiliating with the National Council of Women, and also by sending delegates to various congresses and meetings at which questions affecting the interest of the nursing profession are discussed.

I believe I am right in saying it is the only society of private nurses in Great Britain which has, at its own expense, selected and sent a delegate to this great congress, and I consider this a typical instance of the good which must result from encouraging nurses to take an interest in their own affairs.

I must further mention that members of the Registered Nurses' Society are encouraged to keep themselves acquainted with the contemporaneous history of their profession at large, to which I ascribe the fact that many of the members of the society are keenly interested in nursing politics and appreciative of progressive movements.

It has been well said that "we may divide society into those who are assisting the progress of civilization, those who are driving it backward towards barbarism, and those who, being inert and stationary, are an impediment to the efforts of others. We must choose to which of these classes we will belong, for to one or other it is evident we must belong. If we are vicious, or even ignorant and prejudiced, so that in our intercourse with society we foster old errors, and resist the improvements of the age, we must rank with those who are either impeding the prosperity of the country or forcing it back to barbarism. But if we think, speak, and act up to the moral lights of our time, assisting more or less to maintain or forward improvement, we have then a right to rank with the benefactors of mankind. Our positive influence may be greater or less, without either merit or fault of our own, but we have joined the right cause. Each soldier has a share in the honor of the victory."

advancement, for a definite and efificient standard of nursing education, for self-government and discipline, the Registered Nurses' Society has "joined the right cause." We have proved also that it is possible to combine a high standard of profesisonal responsibility with commercial success, and last, but not least, that if nurses are permitted a share in the management of their own afifairs, they appreciate the dignity and responsibility of this trust, and perform their part conscientiously and with ability.

Miss Hughes : I am asked to say a few words upon the subject of Nurses' Co-operative Societies. Until last June, I had the privilege of being in charge of a very large association of private nurses working on the same lines as the one of which you have just heard. The principle of co-operation amongst private nurses has proved so successful that it is becoming very general with us. Not only do the nurses secure the full fees for their services, but by each one contributing a fixed percentage towards working expenses, the business of placing them in communication with doctors, helping to enforce the payment of their fees for services rendered, etc., is carried on without delay and loss of time to the nurse concerned. The office becomes the calling place of doctors and patients' friends, and many difficulties can be cleared away, and things made easier on both sides by this common ground of meeting. I would plead that those who join such societies should try to eliminate the feeling that the work is only undertaken because of the higher remuneration it secures, and because of the greater freedom of the life. Private nurses represent the profession to the general public and if they lower the standard it reacts unfavorably on us all. It rests with each individual woman to create and maintain a favorable impression or the reverse in every household she enters. Selfishness or want of tact in a very small degree create a wider distrust and prejudice than the nurse ever realizes. These associations exist for the benefit of all, and on each rests the responsibility of not only making- a good record for herself, but also for her association, and thus in a very direct manner for her fellow nurses working in that society, and in addition for the nursing world at large.

The private nurse of all others can least afford to work in an isolated way, for herself alone - her responsibility to the whole community is too great.

Regarding ways and means of keeping up an interest in their work among the nurses ; a great deal is done by our Alumnae Associations and the courses of study they have from time to time suggested. It would be well if more individual members of our Alumnae xA.ssociations could attend these conventions ; but it would take a long time to give them, individually, the stimulus to be gained here, since few of the associations are entitled to more than four delegates to each annual convention.

In Boston we have organized the Boston Nurses' Club, which is maintained and supported entirely by its membership composed wholly of nurses. Each winter a series of ten or twelve lectures is given upon the various subjects pertaining to the nurses' practical work. In this way interest is maintained. Occasionally we have a lecture upon some subject not wholly within the nurses' province, but one upon which they should be informed, - such as some sociological subject ; we also have demonstrations in nursing work from time to time, and by the courtesy of many of the hospitals and hospital staffs we are, under certain liberal regulations, allowed the privilege of attendance at clinics and at operations in the hospitals.

We do not altogether neglect the social side of the nurses' nature, for we have set apart an afternoon of each week, when some of the nurses are at home to all the other members and act as hostesses at the afternoon tea served from three to five o'clock on that day. These teas are served in the club rooms, are well attended and apparently much enjoyed. The hostesses either offer their services or are appointed by the committee on entertainment.

We have established and maintain a registry* which is growing in favor with the public from year to year. Doubtless many nurses become members of the club for the advantages to be gained from the registry alone; this single motive is, however, constantly discouraged by the more thoughtful members who aim to have permanently established a club which shall advance the nursing profession by educational and other means ; which shall provide a place for social and business purposes of nurses ; which shall aid in all kinds of charitable work, and which shall assist nurses in securing employment.

As an organization we are young, being in the third year of our existence. But, we have met with such success as to lead us to conclude that we are a necessity to the public as well as to the great body of nurses in Boston.

*The " registry " of American nurses is the same as the business office of the co-operative societies of the English nurses. Our word "registry" is not always understood abroad. Nur;^es supporting their own "registry" appoint and pay their agent, provide her with office and telephone, and make their own rules. In America we have never had the system of private nurses being employed on salaries by institutions. - [Ed.]

Emilie M. Waind

It will, I think, be of interest to you to know that our League of St. Bartholomew's Nurses is connected with one of the oldest hospitals in England, founded as it was in the year 1123 by a monk named Rahere, whose tomb may be seen in the beautiful church of St. Bartholomew the Great, just outside the gates of the present hospital buildings.

Passing through the many and varied vicissitudes which befell the religious and charitable institutions of early times and receiving royal support in the reign of King Henry VIII, who refounded the hospital, it gradually became what it is at the present time ; one of the first schools of medicine in the Kingdom, and, what is of more importance to us today, one of the great training schools for English nurses.

If imitation be the sincerest form of flattery, the alumnse associations in this country may feel duly flattered, for it was, I think, the knowledge of their existence which, to some extent at least, suggested to our founder and president. Miss Isla Stewart, the possibility of the formation of an association which would ofler similar advantages to its members.

No definite bond exists between them and the many friends and companions of their old school with whom the difficulties and the pleasures of hospital life had been shared. True, the bond of memory was the possession of all who might desire it, but it was neither a substantial nor a very satisfactory one.

Letters and meetings might be arranged between individuals, but such a busy body of workers found everincreasing difficulty in keeping up with old friends and their doings.

A visit to the hospital was equally unsatisfactory; to be greeted as a stranger, almost as an interloper, by the new generation of workers, was the occasional experience of any who ventured to revisit the familiar scenes.

This is but one aspect of the need which indicated the necessity of an association to unite old friends and new in perpetuity. In connection with our profession, there arise from time to time, many points of great and vital importance to us as a whole.

An opportunity of mutual discussion and a friendly interchange of opinion is an advantage of no small moment. With the possibility of offering these and other advantages. Miss Isla Stewart, with her usual spirit of enterprise and esprit de corps, called a provisional committee to discuss the formation of an association similar to those in this country.

Warmly supported by the members of this committee, who hailed her suggestion wath much eagerness, invitations were issued to all nurses holding the hospital certificate or diploma, to join a league for their mutual help, support and pleasure. With gratifying alacrity applications for membership poured in from all parts of the Kingdom or wherever St. Bartholomew's nurses were working or residing.

In due course an executive committee was formed ; by-laws were drawn up ; a badge was suggested and a design for the same prepared and accepted; a benevolent scheme was outlined, biennial meetings were arranged providing

It was also arranged that the doings of league members, together with their names and addresses, should be duly chronicled in a small half yearly issue to be entitled the League News. Each number contains an interesting editorial touching on current events of general interest, in addition to papers on special subjects, and as comprehensive a list as possible of the honors achieved by any members of the league. Our first general meeting took place in the Great Hall of St. Bartholomew's Hospital in May, 1900. It was an enthusiastic and representative gathering and Miss Stewart was justly proud of the fulfillment of her long cherished scheme. We now number nearly 400 members, increasing steadily as each six months produces more nurses eligible for membership. Amongst these we are proud to claim no fewer than five members who are working in this country at the present moment.

Miss Hay : I am sorry that I must speak from a limited knowledge only - that of my own alumnae association. This we find extremely helpful to every nurse who interests herself in it. We have monthly meetings at which we discuss current topics and various questions calculated to instruct and entertain ; and by this interchange of opinions and social intercourse we are much better enabled to keep out of the " ruts " and to carry to our work a fresh interest and an increased knowledge. I think nurses are too liable to regard their organization work as exceedingly irksome. In our alumnae association we hope fo avert this tendency so far as may be by making our meetings attractive and by interesting our nurses in them. Another important work of our alumnae association is caring for its sick. A room at the Presbyterian Hospital, Chicago, endowed by the generosity of a friend, enables us to provide for any sick member residing in the city hospital care and attendance. For those outside the city, or any unable to go to the hospi- tal for any reason, a weekly allowance is made during- the nurse's illness - a benefit that, never regarded as a charity, is oftentimes the most opportune and which for all of us is a pleasing assurance against the exigencies of sickness and misfortune.

Miss Stewart : I am very much struck with the amount of work you do in your alumnae associations. Indeed they appear to be forming for this more than for merely giving pleasure to their members. The League of St. Bartholomew's Hospital Nurses was instituted more on social lines than any of the associations I have heard of in this country. We merely do what business is necessary and give the social side as much prominence as is possible. I am a profound believer in the developing efifect of pleasure in a busy life. There is nothing makes a nurse do her work with such " snap " as having a " real good time " at not too frequently recurring intervals.

We have only one business meeting, which takes place about the end of June, and another meeting in December, which is wholly social. The members take great pride in the association, and have much pleasure in the meetings, indeed no amusement is provided. Music is almost unheard, and certainly unattended to in the noise of many tongues as one friend meets and greets another. I fear you would think us a terribly frivolous community.

We issue a paper twice yearly. It is entirely devoted to the doings of past and present nurses of St. Bartholomew's Hospital and of all who are connected with it in any way. There is an editorial on some popular topic, some letters from nurses in foreign lands, notices of the appointments any member may have obtained, notices of births, marriages and deaths ; any of the last have not as yet been recorded we rejoice to say. The bi-annual examinations are recorded, and at the end a full list of members with their present address. The price is Is. annually.

them that we are frivolous too, sometimes. I agree with Miss Stewart that one of the orreat needs of nurses is more recreation. Our own ahimnse association has one Httle custom which we have found very pleasant and that is to come together on our graduating day and have an alumnae banquet at which the graduating nurses are our guests.

Miss Walton : May I ask, is there a possibility or probability of other schools following the example of St. Bartholomew's nurses in organizing in this way?

The President : We now have the interesting subject of organization in distant countries, and it is with much pleasure I introduce Miss McGahey to this Congress.

Several months previous to the granting of federation to the Australian Colonies, an association of nurses was founded in New South Wales, named after the colony in which it was inaugurated. The objects of the association are:

" 4. To initiate and control schemes that will afford to nurses a means of providing an allowance during incapacity for work, caused by sickness, accident, age, or other necessitous circumstances."

Although the association was not established until 1899, it must not be considered that the Australian nurses were inactive during the years that preceded its inauguration, for as early as 1892 a meeting of medical men and nurses was held in Sydney in order to consider what steps could be taken to form an association of trained nurses in that city. Nothing was accomplished then owing to a diversity of opinion as to what constituted a trained nurse. Since then attempts have been made to form an association of nurses in Victoria and New South Wales with no better results than on the previous occasion, but no doubt all these efforts paved the way to the culminating point which was reached when the present association was formed.

The Australasian Trained Nurses' Association is managed by a council consisting of a president, a vicepresident, honorable treasurer, two honorable secretaries and seventeen members (of whom five are duly qualified medical practitioners, five matrons and superintendents of nurses, live sisters and nurses, and two honorable members).

Difficulties arose Avhen registration began, but these have all been overcome and the association is now firmly established. Early in its history the council realized that a grave injustice was being done by excluding from membership a certain section of the nursing profession who were not fortunate enough to have received their training when a three years course was compulsory. In order that no one should be excluded who had a claim to be registered a concessional clause was drawn up and passed by a large majority, consisting chiefiy of nurses who held certificates covering a period of three years training in hospitals. To all those who were eligible to register under this clause a period of three months was granted, during which time they were at liberty to make application. Those desirous of registering were required to produce proof that they had been employed for not less than three years in the bona fide work of medical and surgical nursing, either in hospitals or in private work. Such candidates had to- furnish certificates of competency and good conduct from three reputable medical practitioners as to their qualifications, etc. The council retained the power to examine applicants concerning whose qualifications doubts were entertained. This course had to be resorted to in a few cases, the majority of whom satisfied the examiners.

A register has been published in which the qualifications of each nurse appear, except in the case of those who were admitted under the concessional clause, then instead of the qualifications the words : " Admitted by the council under the provisions of Rule XXI " are inserted. In the beginning of the register the constitution is printed and Rule XXI explains the conditions under which such candidates were accepted.

" (b) That they have been engaged for four years in a country, district, or suburban hospital recognized by the council and containing not less than 20 beds, and have been trained at that hospital under a matron or nurse who holds a certificate from a training school for nurses recognized by the council of this association ; or

" (c) That they have been engaged for five years in a private, country, district, or suburban hospital recognized by the council and containing not less than 10 beds, and have been trained at that hospital under a matron or nurse who holds a certificate from a training school for nurses recognized by the council of this association.

" Furthermore, all candidates must give reference as to their moral character, produce certificates of competency from the hospitals in which they have been engaged, and account for any interval of time in their nursing career when not engaged in hospitals or nursing associations."

The membership of registered nurses has increased considerably : at present 406 are enrolled, besides these 64 medical practitioners have joined the association, amongst whom are the leading physicians and surgeons of Sydney. The nursing profession in New South Wales is deeply indebted to the members of the medical profession who have helped the association since its inception, some of whom have given much of their valuable time to further its interests in a variety of ways.

In March, 1901, a circular letter was sent to several of the leading members of the medical profession and nurses in the Australian States and New Zealand, asking them to take steps to call meetings with a view to the formation of branches of the association throughout Australasia. As already stated many nurses residing outside New South Wales have been registered, of these there are seventeen in Victoria, eighteen in Queensland, four in Tasmania, three in South Australia. No doubt branches in several of the states will soon be formed, as the nurse members in many of these states are anxious to have local centers established.

An auxiliary of the midwifery nurses in connection with the association was formed during the latter part of 1900, and up to the present date fifty members have been enrolled. These midwifery nurses have a separate register and are entitled to attend at the general meeting of the association to elect one of their members to represent them on the council of the association. In our country a large majority of midwifery nurses have not had any general training before taking up this specialty. During the past few years many more general nurses have studied this branch of nursing than was customary previously. The qualification for membership is a certificate proving that the candidate has received six months' instruction in practical and systematic training at one of the maternity hospitals in Australia, recognized by the council of the A. T. N. A. Furthermore, the candidate is required to have passed a satisfactory examination before a competent board of examiners. Candidates trained in European or American maternity hospitals

A schedule, setting forth the minimum amount of training which will be accepted by the council of the association, has been sent to each of the hospitals in Australasia, and those not prepared to adopt it, or whose number of beds does not fulfill the requirements laid down by the association, cannot be recognized. Moreover, the matrons are required to be qualified nurses, capable of instructing pupils placed under them. Matrons registered under the concessional clause are not considered sufficiently qualified to hold such positions and the hospitals with which they are connected have not been recognized.

The council in its efforts to protect the interests of trained nurses by refusing to recognize hospitals where trained matrons are not appointed is receiving considerable support from the government medical officer in Sydney, who is about to issue a circular letter to each of the county hospitals subsidized by the government, requesting them to inform him when any change is to be made in their matron and before any appointment to that position is effected to submit to him the name of the nurse together with her qualifications. It is only fair and just to nurses who spend five years in hospitals acquiring a knowledge of their profession, that vacancies for matrons should be filled up from their ranks, rather than from those who have had little or no training.

In July, 1900, a benevolent fund was established and although the sum subscribed is small yet hopes are entertained that it will be increased. Already one of the members of the association has received a small amount from the fund to enable her to take a holiday after a protracted illness.

Three of the members of the association who have private hospitals have each put a bed at the disposal of the council for any nurse members who may require medical or surgical treatment.

Soon after the inauguration of the A. T. N. Association, a society of nurses was formed in connection with the Prince Alfred Hospital training school, Sydney. This society was named the Prince Alfred Hospital Trained Nurses' Reunion, the greater number of whose members are also on the register of the association. The certificate of the hospital is sufficient qualification for membership. Several meetings were held during the year, at which papers were read which were both interesting and instructive.

The conditions under which the nurses work have much improved, modern hospitals have been erected and nurses' quarters replete with all the necessary comforts are now established in connection with most of the leading hospitals. The daily average off duty for pupils and nurses is three hours ; in some hospitals two days' holiday in the month is given besides. The annual holiday is two or three weeks. An eight hour day for nurses has not yet been introduced in any of the hospitals in the Australian states, but in a few of the New Zealand ones this system has been in force for some time.

The course of training in the larger schools is for three years ; at the Prince Alfred Hospital and Sydney Hospital, Sydney, the period has been extended to four years.

The curricula vary in the different schools ; in some the course of instruction has been considerably increased. At Prince Alfred Hospital midwifery nursing, dispensing, and housekeeping have been added and it is proposed to deal with those subjects during the fourth year of training. Practical and theoretical examinations are held at the end of each year. To the practical examination a much more important place has been given than was customary some years ago.

The non-payment system does not exist to any extent in the AustraHan training schools; in a few a premium is required to be paid by the pupils on entrance, but the majority give some remuneration to the pupils during their period of training.

It is hoped soon to see a preliminary training school established in connection with one of the large hospitals. This preliminary education would be a distinct improvement on the system now in force. According to existing arrangements selected candidates are taken into the hospitals on trial and their services are retained if found suitable after a reasonable period of probation. This system has had its disadvantages but the preliminary training school would rectify many of these. Some of the advantages of such a school would be :

2. The inefficient and incapable pupils would be dispensed with before gaining admission to the wards, and the constant changes amongst pupils of the first year would to a certain extent be minimized.

expense which it would entail. At present the income in many of the hospitals is barely sufficient to meet current expenses, but no doubt this great difficulty will soon be overcome and those desirous of seeing this improvement in the training of nurses will have their wishes gratified before the Australian Commonwealth has celebrated many of its anniversaries.

The President: We were so delayed in opening this afternoon that we will be obliged to dispense with the discussion upon this last paper which is regretted by us all.