Buffalo Township (part 6 of 6)

Note. - As the work of the settlement lias become known among nurses, two similar groups have been established; one in Orange, N. J., and the other in Richmond, Va. Both are centers of district nursing and social work and of an interest in civic improvement which gives them much influence. - [Ed.]

Honnor Morten

There is no daily medical inspection of primary schools in England, though the spread of both major and minor infections amongst school children is fully recognized. So, while the state and municipal authorities are deciding what they shall do with regard to arresting this spread of disease, private individuals have been sending nurses to some of the schools in London, Liverpool, and elsewhere and doing the work quietly as a charity. It was on this line that the London School Nurses' Society was founded in 1898 with the vice-chairman of the London School Board as its chairman of committee. The staff of nurses has always been small, never more than five, though the elementary schools of London numbers over 500, and the nurses have only been able to visit the very poorest schools and touch the mere finger of the evil. But they are getting a slow recognition by the authorities, a rapid regard from scholars, teachers and parents.

" The School Management Committee give their consent to a nurse from the London School Nurses' Society attending each morning for one hour and a half to dress the eyes and sores of the children in those schools where the divisional members consider it desirable, and make 'the necessary arrangements, provided that the board shall not be liable for any of the cost thereof ; and in any case where a school is visited by a nurse of the society the board provide a basin and kettle for the use of a nurse at a cost of 3s. for the two articles."

Her Majesty's Inspector, in his report of April 19, 1900, on Laxon Street School, says : " The visits of a nurse to this very large infants' school have proved most beneficial to the health of the children, so much so that it could be wished that the School Board might make such visits universal in their schools in poor localities."

Then in June of this year (1900) the School Board cautiously appointed one nurse of its own as an experiment, especially to deal with a virulent form of ringworm that is very prevalent. This nurse is not now at work, but the fact remains that for the first time the public school authority in England has made such an appointment.

The work done by the voluntary nurses consists in weekly or, if necessary, daily visitation of the schools, seeing the children sent to her by the teachers, dressing small sores, cleaning dirty heads, and bathing sore eyes. Where necessary the teacher is advised to exclude a child, or a bad case is followed to its home, or the mother sent for to be seen at the school. It is found that pediculi and mild ophthalmia form the large majority of the cases ; in some girls' schools as many as 90 per cent, of the scholars were found to be suffering from pediculi. After six months' regular visiting these " head and eye chronics " become cured and a higher standard of cleanliness reigns in the school and the nurse's visits are less frequent and often very brief.

The ideal would be for some six school nurses in a district to visit daily, under a doctor, reporting to him where major infections - such as diphtheria - were found and medical help wanted, while they attended to the enormous number of cases of minor infections. Towards such an ideal we are slowly but surely tending and then the School Nurses' Society will gladly dissolve and hand over its charitable voluntary work into the hands of the school authorities.

i\Hss Mclsaac : I like to tell of the Crerar Fund of Chicago on every opportunity, that possibly the idea may be taken up by others. Several years ago a philanthropist of Chicago, Mr. John Crerar, left $50,000 to the Illinois Training School. Tlie women managers of the school decided that as this money was not actually needed for the support of the school, it should be devoted to providing trained nurses for the middle classes.

The income of the fund is used in the following manner: The nurse receives $20 per week for her services, $25 being the average rate for private duty in Chicago. The patient pays from $7 to $10 a week for the nurse's services, according to his income. These receipts are added to the yearly income from the fund. We send nurses only within the city limits, and only to acute cases, and maternity cases. There is no work in Chicago more appreciated or that has done more good than this, which we call the " Crerar Nursing." I have repeatedly heard nurses say that if they had money to give to anything it should be to the Crerar Fund.

Miss Walker: I would like to thank Miss Wald for the suggestion that in district nursing we not only help the people but that the people help us. There was so much to me in those few words that I think she ought to be thanked for them.

Unannounced : I think nurses as inspectors of schools would do better work than the doctors, for the doctor does not treat the school child. He simply sends it home. We are trained to recognize symptoms, although we are not to make diagnoses. But the nurse can take the child to a dispensary or show the mother what to do, and thus have a more practical influence on lessening the spread of contagion.

[The complete system would undoubtedly be for the doctor and nurse to work together in school inspection - the doctor to examine and give directions, the nurse to visit the mothers, instruct them, and apply dressings and treatment. - Ed.]

Friday Afternoon

The President : If there are any resolutions to come from the body of the house the chair would request that they be sent up at once in writing.

Our next paper is on an entirely new subject. I have the very great pleasure of introducing Mrs. Kinney, who is at the head of the United States Army Nursing Corps.

Dita H. Kinney

The origin and subsequent history of army nursing is so well known that in view of the limited time alloted for the presentation of the subject such a retrospect may be omitted.

No occasion, however, should be allowed to pass unnoticed which offers an opportunity for a tribute to her who is the professional mother of us all, or to him to whom the United States Army Nurse Corps owes its existence. Just as soldiers, be they officers or privates, salute in passing their superiors, do we army nurses metaphorically rise to our feet and stand at attention as we recall for a moment

Ever since the days of the Revolution, Congress has from time to time authorized the employment of women in army hospitals. An act dated July 27, 1775, provides for a matron " to superintend the nurses, [query - were these too women?] the bedding, etc." A similar act, April 7, 1777, provides for a matron " who shall take care that the provisions are properly prepared, that the utensils are kept in order, and that the utmost economy be observed in her department."

In 1814 provision was made for female attendants known as " matrons." At the present day one of these is allowed at each post, but she is simply and solely a laundress, and never by any chance has anything to do with the care of the sick.

The incidents of the war of the Crimea demonstrated to the medical department of the English army the value of female nurses in army hospitals, and since that time they have formed a part of the military establishment of that country. The Lancet in its issue of April 27, 1901, says: "Without skilled female nurses, the proper care of the sick cannot be accomplished, and it will probably be necessary, even under ordinary conditions, to increase the existing establishment. It will certainly be so in the event of war on any large scale."

There is in England a finely organized school where graduate nurses who desire to enter the army must take a course before being permanently assigned to that work. English army nurses have in addition to their pay an allowance for clothing and servant hire, and after retirement are pensioned.

In France and Germany, by arrangement with certain religious and secular nursing orders, a limited number of women are employed to care for the sick of the respective armies in time of peace, with a provision for a suitable increase in event of war, but neither country has an organized nursing service such as exists in our own land and in Great Britain.

Previous to the year 1887 the nursing of the sick of the United States Army was done by soldiers specially detailed for that duty. They were selected with no special regard for their qualifications, and were entitled to twenty cents extra duty pay, as this sum was called. Eventually this was discontinued, and in that same year Congress authorized the establishing of a body of well-qualified men who should be permanently attached to the hospital in the various capacities demanded by such service. The authority thus given resulted in the organization of the hospital corps as it now stands.

Up to the time of the Spanish-American war, the navy had no such body. Today its hospital corps is a vigorous organization, giving large promise of efficiency and offering special inducements to young men for advancement. Its highest rank is not open to civilians, but is to be filled by promotions from the lower grades. These pharmacists, as they are called, are not enlisted men, but '* warrant officers." Their positions are tenable up to the retiring age, after which they receive a pension and such other benefits as belong to their rank.

During the happy and uneventful period in our country's history between 1887 and the Spanish-American war, the hospital corps proved itself amply sufficient for the care of the sick of a small army of twenty-five thousand men. At this time the corps numbered about six hundred, and after the addition of what was deemed a sufficient number to meet the emergency, it was thought to be unlikely that the services of female nurses would be required.

which had been recently added to the corps, and at the request of the Surgeon-General of the Army Congress, in April, 1898, authorized the employment of female nurses.

Even before the call to arms had sounded through our land hundreds of patriotic women, trained and untrained, had offered their services as nurses in the event of war. The tremendous rush of work thrown upon the War Department made it impossible to investigate the qualifications of these, and so all such communications had, with the courtesy which distinguishes all official procedure, been replied to, filed, and buried.

The genius of Dr. Anita Newcomb McGee at this point saw the opportunity and seized it. She formulated a plan whereby the Society of the Daughters of the American Revolution were to become an Examining Board for all nurses who wished to enter the service of the government. The Daughters promised their hearty cooperation, and she at once called upon the Surgeons-General of the Army and Navy, and submitted her project for their approval, with the result that they gladly availed themselves of the proffered services.

What followed - her achievements - her untiring devotion to the work - is too w-ell known to need more than passing mention. It may, however, be stated that she took in bulk from the War Department all the accumulated applications, and so far as was possible investigated the references and qualifications of each one, and from these made a list of those who could be available at a moment's notice. Neither she nor they had long to wait.

It may be both interesting and profitable just here to pause for a moment to compare conditions at this time with those which existed at the outbreak of the Civil War. We find that trained nursing as we know it today had no existence then, and though Congress in August, 1861. authorized the employment of women as nurses, these were chosen more on account of their matronly age and manners than because of any special qualification for their work. Miss Dorothea Lynde Dix held the position of superintendent of these nurses, althoug-h that appointment carried with it no definite official status. Indeed, a notable proportion of the nursing during the Civil War was done by women who were never officially appointed or paid.

On May 10 (nineteen days after the formal declaration of war) the Surgeon-General of the Army ordered four nurses to Key West, Fla., and by July 15 forty-seven nurses had entered into contract with the government and had been assigned to different general hospitals.

About this time an epidemic of yellow fever offered an opportunity for the employment of immune nurses. The Surgeon-General detailed Mrs. Curtis, the wife of the superintendent of the Freedman's Hospital of Washington, D. C, to go South to secure these. No distinction of color or sex was made, and most of those selected were untrained.

Following close upon this epidemic of yellow fever came one of typhoid in the large camp hospitals where the recruits were in training, and Dr. McGee thus describes the existing conditions at that time : " It became evident that these camp hospitals had lost their transitory character and become stationary, consequently the objection to the employment of women as nurses in them had practically ceased, and the demand for trained female nurses grew to an entirely unexpected proportion."

The roll of army nurses numbered at this time about one thousand names. Not only did they go to general and field hospitals, but wherever the surgeon in charge of a division or post hospital so requested nurses were assigned to duty under him. During the fall it was not uncommon for regiments or larger divisions of troops, when they moved to southern camps or to Cuba, to take with them the nurses attached to their hospitals, and no inconvenience or difficulty has been reported as having ensued.

It is needless to refer to the great value of the work done by these trained assistants to the medical department of the army, since surgeons, patients, and the public at large have been most enthusiastic in their expressions of appreciation. There was scarcely a training school in the United

States which did not send some of its best representatives for this work, and the women adapted themselves to camp conditions in a manner which quite altered many a preconceived opinion.

The Sisters of Charity merit prominent mention in this connection, as they furnished from their order two hundred sisters, many of whom had had a large hospital experience. A few of the sisters from four other Roman Catholic orders and from one Protestant Episcopal sisterhood served for a time.

Auxiliary No. 3 to the American National Red Cross Society Relief Committee of New York was unique in the work of furnishing money for the transportation of many nurses, also for their comfort while awaiting orders in New York and while serving at certain army hospitals.

There was much difficulty in the time of the greatest stress in securing enough suitable applicants to meet the demands. At some of the more important points the chief surgeons were authorized to secure help without regard to training, and thus a few undesirable appointees were enrolled. Temporary assistance was also accepted from women not connected with the medical department. Such irregular nurses were not subject to the same control and discipline as those on regular duty, and here again was an opening through which some who proved to be undesirable gained admission to the corps.

The beginning of the year 1899 found the work of substituting trained for untrained immune nurses well begun. From this point the evolution of the Army Nurse Corps, from an experiment to an effective working organization, was a matter of steady and uninterrupted development, and while it is at the present time on a comparatively satisfactory basis there are yet many points which must be readjusted before it can be said to have attained to its greatest possibilities. It must also be remembered that there is naturally a wide divergence of opinion as to what is really to be desired for it - between the point of view of the lawmakers on the one hand and others most deeply interested on the other.

When Section 19 of the Army Reorganization Bill was first drawn up, though its details were most carefully considered, the most vitally important was to secure for it a place upon the statute ; the finer work of fitting and adjusting it to meet existing conditions could well be left for the future. With the signing of the bill by the President (February 2, 1901), this great achievement was accomplished, and the Nurse Corps became a part of the medical department of the United States Army. While this new dignity involves the corps in some temporary complications, it will eventually result to its great advantage.

1. The Judge Advocate General has recently rendered a decision that the members of the Nurse Corps must be regarded as a component part of the army of the United States, and he adds: "There is considerable ground for belief that they are subject to the articles of war and are triable by courts-martial."

2. Provision was made for the appointment of a trained nurse as superintendent, who under the Surgeon- General should have charge of the administrative work of the corps. Mrs. Dita H. Kinney was appointed by the Secretary of War to fill this position March 15, 1901.

The important work of drafting the new regulations has been a matter of many months. As these stand, provision is made for certain examinations to test the mental, moral, physical, and professional qualifications of each applicant. And just here I beg to make a most heartfelt and sincere acknowledgment to the superintendents of the various training schools for their valuable and valued assistance in this regard. Had it not been for this cooperation it is not too much to say that the most important and difficult work of selecting suitable and proper nurses from among the large number of applicants could not have been accomplished. Each of these has been and is today accepted or rejected in accordance with the recommendation of the superintendent of nurses under whom she was trained.

After appointment a nurse is required to give a term of service of at least four months in the United States before being assigned to foreign duty. The term of service has been increased from one year to three, the tour of foreign duty from one year to two.

The records of the corps are most accurate and complete. Those referring to the efficiency of the nurses with their papers of application and recommendation are filed in the office of the corps. Other documents which bear upon their places of service, change of status, and official orders are carded and filed with other official papers in the record room of the Surgeon-General's office, where they are easily accessible when needed.

Efficiency reports are prepared quarterly by each chief nurse and forwarded by the commanding officer of each hospital, who endorses thereon his approval or disapproval of the ratings. In the same way (by endorsement) he reports upon the efficiency of the chief nurse. Special efficiency reports are required whenever a nurse changes her station or upon her discharge from the service. In all cases the text of these reports, by whom made, with the dates of leaves, illness, payments, and all other data concerning each nurse, are noted upon a card and alphabetically filed. By this arrangement it is possible to have at a moment's notice all information connected with every case. Monthly returns are prepared by the commanding officer. On these appear all changes, i. e., gains or losses by transfer, with the date of the last payment of each nurse. All papers are forwarded through the chief surgeon of the division or department, and endorsed by him as approved or otherwise.

During the present year the medical department has deemed it advisable to abandon the use of the Red Cross, and has adopted in place of it the cross of the department in its own color, - i. e., green. The white brassard worn by the privates of the hospital corps is replaced by this, and the badge of the Army Nurse Corps will hereafter be in green instead of red enamel. The red Greek cross on a white field will still be used on hospital flags, hospital ships, and ambulances authorized and required by the Geneva treaty.

There have been approximately eight thousand applications since the first one was made to the War Department. Of these sixteen hundred and eighty have been employed by the government. The largest number serving at any one somewhat less than at this time last year. In 1900 there were two hundred and ten against one hundred and seventysix in 1901. Twenty-eight appointments were made in the latter year. Of these thirteen had given previous satisfactory service, fifteen were new. Sixty-two have been discharged ; of these ten are doing private work in the Philippines, one has accepted a teacher's position in the same place, four have requested discharge to be married. The rest have left the service for various reasons, such as long term of service, family conditions, and impaired health.

There have been but fifteen deaths among the members of the corps since the beginning of the Spanish-American war. Most of these were from typhoid fever and some from which existed . before the nurse entered the service.

On September 1, the distribution of nurses was as follows : United States - San Francisco, thirty-six ; Fort Bayard, nine ; Cuba, six ; Philippines, ninety-three ; transports, eleven; awaiting discharge, seven.

Under ordinary conditions the Surgeon-General does not approve the placing of nurses at small post hospitals, chiefiy because of the difficulty of securing suitable accommodations for them. A commanding officer is at liberty, however, to request the temporary assignment of female nurses in any emergency. Under this provision nurses were recently sent to Fort Sam Houston, Texas, and to Eenicia Barracks, California.

For a time there were nurses in both China and Japan, but the need for hospitals in those places no longer exists, and they have been closed.

The employment of nurses in the schools of instruction - for the hospital corps has been a most gratifying success. Beginning as dietists, their work was at first confined to teaching the preparation of food for the sick and the adaptation of the rather unpromising " ration " to this use. In some places the work has been extended to include a course in general nursing, bed-making, the changing of bed and body-clothing of a patient in bed, the preparation of the ordinary antiseptics and disinfectants, with a glimpse into the germ theory and the rigorous requirements of aseptic surgery. These subjects are fully and most carefully covered by the lectures of the doctors in charge, the practical demonstrations being given by these nurse teachers.

The question of the rank of the nurses is an interesting one, but by no means of as great importance as may at first appear. One who is a lady will never be denied that which belongs to a lady and what is due her as such. Indeed, if all nurses had always been ladies and had always conducted themselves as such, the question would never have been brought up at all ! This is only one more exemplification of the truth so often observed, that the many must often sufifer for the mistakes of the few. It is a noteworthy fact, however, that in the examinations of candidates for admission to the nursing service of the English army one of the questions asked of a referee is, " Has the applicant the birth, breeding, and, education to make her an acceptable member of a profession which is made up of ladies?" The regard in which our English army nurse sisters are held was finely exemplified by the attentions paid a party of American nurses at Malta. The transport on which they were on duty was temporarily detained in that harbor. During this time, a ball was given by the English officers and their wives to which the officers on board ship and the nurses were invited. Nothing could have exceeded the charming cordiality and hospitality of this occasion. I am sure the solution of this whole matter, as well as of many others of far greater importance, lies in the hands of the nurses themselves. As they sow, so shall they reap. If they have this fact ever before their minds, it must only be a question of time when they will be unquestioningly accorded the position which cultivation and good breeding may always claim, and to which as members of a high and noble profession they are entitled.

But there is yet another aspect to the situation which must not be forgotten. The Nurse Corps is yet in its infancy, and the present nurses are in reality pioneers in the work. They must decide whether as such they are willing to put up with temporarily unpleasant things for the sake of the work itself and for the sake of those who will follow and reap the rewards of their forbearance. Few of those whose feet are breaking new paths find the walking pleasant or easy, and the recognition of such service is more often delayed than promptly accorded. But the " patient waiter is no loser," and the reward will surely come to the Army Nurse Corps even if those who made sacrifices are no longer members of it.

A recommendation looking towards an amelioration of many misatisfactor)^ conditions is now before the Surgeon- General, who never turns a deaf ear where the interests of his nurses are concerned.

2. When frequent visits of inspection of the nursing service will be possible, thus keeping headquarters in close touch with the nursing staff of each and every hospital.

3. When the Quartermaster's Department will carry the materials for the nurses' uniforms, so that these may be tmiform in fact as well as in name. And, best of all,

4. When^ after faithful service, old and otherwise incapacitated nurses will be " retired " with suitable provision for their declining years. This is not too much, we think,

Perhaps the most important detail connected with the administration of the Nurse Corps remains yet to be mentioned. I refer to the reserve list. Only those who have given at least six months of entirely satisfactory service are eligible for a place on this roll of honor. When a nurse is offered a place on this list she is allowed to indicate whether she is willing to re-enter the service at any time when she may be needed, or only in case of war or national calamity.

A nurse is dropped from the reserve on attaining the age of forty-five, or if she ceases to practice her profession for a continuous period of five years, or for cause : though in the latter case she is always given a hearing.

A place on this list is the highest distinction an army nurse can achieve, and we look forward to the time when to know a nurse is an " army reserve " will be considered a sufficient recommendation without further endorsement.

The objections which were at first offered to the admission of women as nurses in army hospitals have been gradually overcome. They have been found to meet privation cheerfully, and to adapt themselves readily to the varying conditions incident to army service, particularly in new fields.

In a report to the Surgeon-General a chief-surgeon says : " The female nurses have done excellent service here. Their influence on both the sick and the well has been a good one, and they have, as a rule, been discreet in conduct, amenable to discipline, and possessed of professional attainments of a high order."

On the other hand it is most gratifying to note the unmistakable evidences given by the nurses of their love for and their deep interest in their work. One who was a veritable pioneer writes : " It is very hard for me to see the others starting for foreign duty and be obliged to stay behind. But I know I have had more interesting work than any who go now can ever have. I can never forget some of my army hospital experiences. The memory of the old dirty wards, with their filthy corners and the half-fed patients, will always remain with me. When I think that it has been my privilege to lend a hand in improving- all this, I feel very sure that there is no profession on earth which so fully repays all labors as our own. Then too a woman's influence means so much in the strange foreign lands - it may be for good, or it may be for evil. Do let us try to send nothing but the best."

And so she goes on through a long letter. That there have been a few in the corps whose influence has not been for all that was highest and best we recall with all humiliation and regret, because there is no getting away from the fact that the disgrace of one of our members is the disgrace of all. All things considered, however, it seems little less than miraculous that such records have been so exceptional. As a profession we have good reason to be proud of the achievements of the Army Nurse Corps as a body, and of the work of its members as individuals.

I beg in closing to bespeak for it in future the interest and the cooperation of all trained nurses. Its work concerns deeply every training school in the country, and its efficiency and fair name must in the very nature of things be a source of solicitude, just as its successes must be a matter of pride to every individual representative of these.

And, finally, all will agree that the very best service which her loyal daughters can furnish is not too much for us, as a profession, to place at the disposal of our beloved country.

M. Eugenie Hibbard

Member of the American Society of Superintendents of Training Schools for Nurses, and Superintendent of the Santa Isabel Hospital, Matanzas, Cuba.

With the United States mihtary occupation of the island of Cuba, a countr}' so crossed and barred by events in its previous history, began a new regime, difificult for the people of tropical climes to appreciate, and possibly more difficult for them to imitate and sustain.

The conditions were such in 1898 that vigorous efforts were imperative to make the island habitable for those who were forced or chose to remain in Cuba, aside from the population whose heritage it is.

At once energetic minds set to work to evolve order out of chaos, and enforce a sanitary administration that would eventually and effectually relieve the country of filth, disease and the dread scourge yellow fever, which limited the ingress of foreigners, enforcing quarantine laws extremely trying to travelers and proving a serious menace to the business interests and development of the island.

In Cuba, as in most countries that have been dominated by strong religious views and where the government has been practically led b}- the Church, a condition existed that prevented women from taking an active part in philanthropic work, outside the religious orders of Sisters of Charity or members of the various communities recognized by the Church. These Sisters, among whom there are always some excellent women, had charge of the nursing and domestic departments to the various state institutions, such as hospitals, orphan asylums and asylums for the poor and destitute, and were considered the legitimate persons to carry on such work.

Unfortunately their vows restricted them in the performance of duties that are considered an important essential in the care of hospital patients, and which duties were delegated to persons of inferior position and ability to perform.

The strides that the medical profession has made in the line of progress during the last twenty-five years has demanded an evolution in the ranks of the so-called nurse, and in countries where the religious orders do not rule the graduate nurse is the result.

A similar one we hope shortly to produce here - educated and trained on lines that will command the respect of the older sisters in the service of nursing.

As inheritors of customs and prejudices, founded on Moorish habits, we find the women of Cuba an affectionate, emotional and irresponsible people, without much moral, mental or physical force, incapable of sustained effort, and most to be deplored, without ideals or standards that excel, but with an innate sense of refinement and a disposition to be led through their affections which is most gratifying if properly directed.

Out of this material (with the optimistic view predominating) we hope to evolve the traditional calm, self-poised, intelligent, industrious and ambitious graduate nurse of the twentieth century.

Therefore upon whosoever the duty falls of introducing new ways, imperceptibly though radically changing social customs, facing the traditions of the country, and to a certain extent the opposition of the Church, an exquisite tact is required, which should be controlled by common sense, good judgment and a strong desire, for the moment, to work in harmony with existing conditions, with the end in view of creating a picture of life and its possibilities, for women, that will both entice and charm, and be a factor strong enough to overcome scruples that at present prevent women of education and refinement from taking an active part in a life savoring of publicity.

With the passing of the religious to the secular regime, and the subsequent v\athdrawal of the "Sisters'' from the various hospitals, the establishment of schools for nurses became an absolute necessity to provide for the inmiediate care of the sick.

The first school for nurses in Cuba was started by Dr. Raimundo Menocal in connection with the Sanitarium " Havana." in the city of Havana. It was opened in January. 1899. with twenty-two pupils, under the charge and theoretical instruction of Dr. \'idal Sotolongo. The sanitarium was closed in the month of May, the same year. The permanent establishment of the schools for nurses, however, is due to the interest and influence of Dr. C. L. Furbush and General Ludlow, assisted ably by Drs. Emilano Nuney and Raimundo Menocal. The first school for nurses was officially established and opened August. 1899. :\Iiss Mary O'Donnell, graduate of Bellevue Hospital. New York City, was appointed superintendent.

(which is under the general supervision of the Department of State and Government), schools for nurses were established in connection with the following- hospitals named in chronological order:

Making a total of seven. Changes have taken place in the supervision of some of the schools, but the names given were the first superintendents appointed.

On the retirement of Major E. St. J. Greble from the position of Superintendent of the Department of Charities, Major J. R. Kean received the appointment and the subsequent success of the schools is due largely to his personal interest and keen appreciation of the actual requirements at this stage of the schools' existence. Shortly after assuming office, in July, 1901, the following order was issued :

By authority of the Military Governor, a Board will be convened to meet in the office of the Superintendent of Charities, Havana, Cuba, at twelve o'clock, July 22, 1901, or as soon thereafter as practicable, to draw up a system of regulations for the Training Schools for Nurses in Cuba. They will also fix the course and duration of instruction, the requirements for admission, the standard to be required before graduation, and make recommendations with regard to salaries and allowances. The Board will also recommend a suitable manual for use in the nurses' schools and in the hospitals under state control.

The meetings, several in number, were well attended, and at the end of the month of August, 1901, a " Plan of General Regulations for the Schools for Nurses of the Island of Cuba was submitted for the approbation of the Central Board of Charities of the Island of Cuba."

Later in the month of October, 1901. these were made more comprehensive, and somewhat modified, and again submitted for approval. Eventually on January 3, 1902, the plan was approved of in its entirety by the Military Governor of the Island of Cuba, General Wood.

Regulations For The Schools For Nurses In Cuba

The aim and fixed intention of those interested in organizing- Schools for Nurses in Cuba was to put them at once on the highest plane attainable, giving the result of similar work in other countries as sufficient reason to establish a standard tliat would at once command the respect of the people and the self-respect of the accepted student, defining emphatically a position for the nurse in a country, until recently, ignorant of her existence. To start with a high standard is a more effectual way of securing success than in placidly allowing conditions to evolve.

The science of nursing has passed the pioneer stage and has now a foundation firm as a rock. Hand in hand with the medical profession (as hand maiden of it) it claims respect for the assistance it gives to suiifering humanity and to the advance of medical research. To those who have so earnestly and so wisely encouraged the work of nursing in Cuba, the profession owes a heavy debt of gratitude, for without the assistance, interest and concentrated effort of men of influence and prestige and the hearty support of the Cuban doctors of reputation and influence, the work that has been accomplished in Cuba could never have given to the world the history of its existence. Today the number of pupils in training exceeds 150, with at least 37 instructors - American graduates.

The Military Governor of Cuba, upon the recommendation of the Superintendent, Department of Charities, directs the publication of the following Regulations for the Schools for Nurses of the Island of Cuba :

I. The Schools for Nurses are created in the Island of Cuba with power to issue diplomas to the crraduate, showingtheir fitness to practice their profession.

II. The Schools for Nurses will be classified as State institutions and will be under the immediate supervision of the Department of Charities.

III. The rules and regulations published herewith will govern the establishment and management of the Schools for Nurses, and all special regulations enacted by the Boards of Alanagers for the interior administration of hospitals to which such schools may be annexed will conform to these rules.

The object of these schools shall be, first, to further the best interests of the nursing profession by establishing and maintaining a universal standard for instruction and providing students with the proper means of education in the practical care of the sick ; second, to secure for the students upon graduation a degree or title which will be a protection in practicing their profession and be a recognized means of securing employment ; third, to provide hospitals and institutions in the island with skilled service in the nursingdepartment and proper number of graded assistants, thus conferring a benefit to the mass of sufifering humanity.

Tlie Schools for Nurses are State institutions, attached to hospitals for mutual benefit, but under the direct control of the Department of Charities. The director of the hospital shall be the immediate representative of the Department in the school, and the treasurer of the hospital shall be also the treasurer of the school. Separate estimates for the schools shall be prepared and signed by the director and the treasurer.