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while, on the other hand, a courageous, devoted well-trained body of nurses, can wrest success from very poor conditions." There is no gainsaying the truth of these remarks. The quality of the nurses and the way in which they are trained, does affect materially the efficiency of any hospital.

In many respects the hospital training school occupies a unique position in the educational field. Nursing, so far as the science of it is conecrned, is a combination of many other sciences. The nurse needs an elementary knowledge of anatomy and physiology if she is to intelligently care for the human body, but she has no use for a great deal that is taught on those subjects to medical students. She must have some knowledge of the properties and uses of the common drugs, since she is constantly handling and administering them, but a comparatively short course in materia medica should be sufficient to teach her the facts about drugs which it is essential for her to know. She must understand dietetics and invalid cookery to a certain extent, but has no need for an extended or elaborate course in the chemistry of foods, or domestic science. She needs a general understanding of the principles of hygiene and household sanitation, but the ordinary nurse need not go very deeply into architectural problems, or sanitary science, in order to efficiently practice the art of nursing. While at first glance the field of study that properly belongs to the hospital training school may seem very circumscribed, it is not so in reality. The real essence of nursing must always be personal service to the sick or helpless. The first duty of the hospital must be the same thing. The nurse is at liberty to draw to a certain extent from many sciences, and to use for the relief of suffering and the prevention of disease, any of the discoveries made in other fields of science, but she cannot go far into any of these sciences, as a nurse, before she becomes a trespasser on other provinces. Into whatever field she may go gleaning for knowledge she is certain to soon be recalled, to have the truth again emphasized that her chief work and the crowning achievements of nursing, must not be along intellectual lines; that advancement in nursing must come by improved methods of practical service. This is a truth, which today needs to be especially emphasized. It is a truth which many training schools have yet to learn.

Within recent years there has arisen a chorus of complaint against the introduction of so much medical instruction into the nursing course. It is claimed that it is an unnecessary and useless tax on the strength of the nurse; that it detracts from the interest in ward work; that it does not make for thoroughness in practice, and is, in various ways, a hindrance to the best results. ' That this condition exists is recognized and admitted by people of different classes, who hold widely antagonistic views regarding training school methods and management. Just how much this is affecting the efficiency of hospitals in general, is a matter that is difficult to determine. That it is vastly adding to training school problems, and is felt as an increasing burden already grievous to be borne by many institutions, is freely admitted by large numbers of persons who are familiar with the general situation. In justice, it must be said that there are numbers of institutions that are keeping to a safe, creditable, middle ground, that are constantly studying how to make the whole course thorough and of practical value. There are many superintendents who have for years labored to eliminate non-essential instruction from their courselabored with the odds against them, and with varying degrees of success or failure. There are others who have yielded to the tendencies of the times and not only permitted, but planned and insisted on a great deal of instruction being given which is in no way calculated to benefit their hospital work or nursing.

Without making any attempt to procure data to show the truth of this latter statement, I find among the periodicals and material of various kinds that has come to hand unsought, and in a perfectly natural way, plenty of material for illustration regarding this point. In the prospectus of one school, a small school of about twenty nurses, I find the names of no less than twenty-four medical lecturers, besides the superintendent, the chief nurse and teachers of massage and dietetics. In short, from a perusal of a great many announcements, I find that from twenty to thirty medical instructors are considered a necessity to the proper instruction of the twentieth century nurse. Twenty-four is probably a fair average. In the school mentioned, twelve of these medical instructors are scheduled to lecture to probationers, and the list of subjects to be covered, I should judge, might

profitably occupy the entire time of a medical student for one whole year. According to the program, the first instruction the probationer is to receive after she arrives at the hospital, is regarding embryology. After the topics of ninety-two lectures to be delivered by twenty-four medical instructors have been enumerated I find the comforting assurance stated in a space of less than two lines, that "classes in practical nursing will be held." I further gather from the printed program that the whole subject of weights and measures, including the metric system, dosage, and administration of medicines, is supposed to be taught in one hour, and the next class hour for the junior nurses is to be devoted to the giving of anesthetics.

Another school, a large school, announces that its probationers will be required to spend 24 class periods in a pathological laboratory making a careful study of the more common pathogenic organisms, such as the tubercle bacillus, the pneumococci and gonococci, and the germs of typhoid fever, diphtheria, and tetanus. The same school announces that 24 class periods during the probation term are also to be devoted to the study of chemistry, as a preparation for the study of physiology and dietetics, while throughout the entire course, eight lectures only, on medical nursing are scheduled. Another striking feature of this course is that exactly the same number of lectures--eight-are devoted to diseases of the eye, as are scheduled for the entire field of medical nursing

Another school announces a course of 66 lectures on anatomy, physiology and hygiene, for its probationers. Sixty-six!

Another school devotes one lesson only for its probationers to hygiene and sanitation. In that one lesson it announces that air, water, ice, milk, utensils, soil, drainage, personal hygiene, habitation, and hygiene of the hospital ward will all be discussed and disposed of. This remarkable lesson is immediately followed by a course of five lectures on the responsibilities of nurses to boards of health,

A graduate nurse, who was evidently very enthusiastic about these modern innovations in training schools, writes thus of her probation period: "For our practical work in anatomy and physiology, besides our classes and demonstrations with mannikins and specimens, the professors and intructors of the medical school demonstrated to us with the microscope and quizzed us as we dissected dogs, cats, and other specimens.” It is unnecessary to take time to give many more illustrations of this character though they are easily found; but from the cases I have cited, one thing seems to be clear. Whatever omissions may appear later on in the nursing course, the poor probationer of modern times is not suffering from lack of medical instruction in great many American training schools. Farther on in the course in one school such subjects as indicanuria and glycosuria have been scheduled as though they were of equal importance with the nursing care of patients after operation. One school requires its pupils to spend five class periods in studying diseases of the ear. Another devotes four class periods to the study of chiropody. One State Board of Examiners requires that all pupil nurses shall have a course of five lectures on medical jurisprudence. From one set of examination papers published in a recent magazine, presumably taken from subject matter which the nurses of a certain hospital have been engaged in studying this past year, I quote the following:

"How large are bacteria ?
"Where is the bicipital groove?

"Where is the latissimus dorsi, the levator labii superioris alaequae nasi, risorious, platysma myoides?

"Describe a uriniferous tubule and its blood supply.
"What route does metastasis take in carcinoma ?
“What route does sarcoma take?"

In justice to all I wish to say that though the tendency to plan for, and advertise this kind of instruction has been most marked within the past five or six years, it has existed to some extent from the beginning of training schools. The difference is that formerly it was, apparently, accidental; now it is planned for, insisted on, added to, and heralded as a sign of progress. Many superintendents, medical teachers, and nurses, seem to honestly believe that the nearer they can make the nursing course approach the medical course, the better it must be, and the higher their standards.

In the earlier training school days the instructors were necessarily doctors, and as they had nothing to guide them, they apparently selected out of the great field of medical knowledge, whatever they were most interested in or familiar with. Each man who taught, in large measure, blazed his way through the wilderness of scientific knowledge available and led or tried to lead the nurses after him. From an old note book which dates back to my own probation period, I find that'I was taught that "Protoplasm was the living substance of the cell, and was made up of two substances, one of which appears in the form of network called the reticulum or spongioplasm, and the substance occupying the meshes, the enchylema or hyaloplasm.” I was also instructed regarding chromoplasm, karyokinesis, the endothelium, the blastodermic membrane, the development of the hair, nails, sweat ducts, and so on.

Before passing on, I desire to submit a few questions. Is the kind of instruction I have mentioned of any real use to a nurse? What effect is the policy of taking nurses out of the wards to attend these multitudinous classes, likely to have on the care of the sick? Is it not true when so many class periods are taken up in dealing with these theoretical subjects, that thorough teaching in practical methods is apt to be crowded out, or slighted. There is a limit to the number of hours that can be spent in class work. Is it any wonder that it takes three four years to train a nurse when the curriculum is padded with this kind of stuff? Is it any wonder that when such a formidable array of subjects supposedly to be studied, is announced to prospective candidates, a great many say to themselves: “Who is sufficient for these things?" "Who can measure up to these demands, in addition to from eight to twelve hours of duty per day. It might also be profitable to call to your attention some statements made by a prominent member of a state board of examiners who says, that nurses are being sent out from hospitals who have not been taught the first principles of practical hand disinfection; that bandaging is becoming a lost art; that "many a school is turning out nurses who do not understand how to give a dose of castor oil properly, non how to make an oyster stew, and it is not the poor schools either.” I desire to respectfully ask if the time has not arrived for this association to do something toward improving these conditions ?

While I believe that at the very bottom of the problem is the question which has never yet been answered: “What are the essentials of a nursing education ?" How much

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