theory, and what practical methods are we really responsible for teaching"? yet, I confess that the answering of that question alone, is not likely to be entirely successful, unless we make up our minds to break away from old habits, and eliminate the great majority of medical lecturers. In saying this, I wish it understood that no possible disrespect for the medical profession is intended, nor does this remark imply any lack of appreciation of the debt the hospital school owes to physicians. Neither should it be construed to mean that I think all medical instructors should be eliminated. It is mainly the too-muchness of a good thing which I am condemning, and the system in general which divides a nursing course up into so many pieces that the result can never be a well-constructed sound practical, systematic affair. So long as we plan for and allow 24 medical instructors to come in with a hundred medical lectures approximately, just so long will we have an excess of medical instruction to deal with. I am firmly of the opinion that the efficiency of the nursing service will be increased by having more teaching done at the bedside and less in the classroom; that the entire first year's course should be kept in the hands of the resident corps of teachers, with perhaps one or two paid instructors; that teaching from the from the textbooks should be adhered to, and lectures and study from haphazard notes abolished; that a better, more systematic and thorough course will be given, if not more than three, or at most four outside medical instructors are concerned in the teaching of theory.

If it be true that the quality of the nurses, the matter and manner in which they are taught is a strong factor in determining the degree of hospital efficiency, it is also true that training school laws have a decided bearing on that question. One tendency of recent years that has seemed to me to seriously imperil the efficiency of the nursing service in hospitals, is legislation requiring a high school standard for graduate nurses who desire recognition by the state. Before taking up this point I wish to state that I am a firm believer in the justice of the principle of state registration for nurses. I believe that our hospital trained nurses who have served faithfully and courageously meeting all the requirements, through a space of two or three years, deserve if they desire it, some mark that will distinguish them from

the products of spurious schools, and from the great army of untrained women who are endeavoring to earn a living by caring for the sick. But I wish always that legislative enactments might be based on a wide and thorough knowledge of conditions and needs that may affect the supply of candidates and may vitally affect hospitals. If we are ready to cease to depend on the training school for the care of the sick, and to keep in our wards a sufficient supply of permanent graduate nurses to meet all the needs, this objection need not be considered, but so long as we expect the bulk of the nursing to be done by pupils, anything that affects the supply, becomes an intensely important matter. That legislation does affect this point cannot be overlooked. Probably we are all willing to admit that good legislation is a good thing. But when we have admitted this, we must also admit that foolish legislation is a foolish thing, and unjust legislation an unjust thing, and that there are possibilities in all three directions. From the requirements of one state board I quote the following provisions headed "Conditions for admission to training schools." "All applicants for admission to training schools for registered nurses must file credentials as follows: First, satisfactory evidence of good moral character. Second, a certificate showing completion of Grammar School course. After July 1st, 1910, a High School course will be required, or in the absence of such certificate, the applicant shall pass a satisfactory examination thereto, such examination to be conducted under the supervision of the Principal of an accredited High School. An applicant failing in one or more branches in such examination may be conditioned for one year, at which time such deficiency must be removed." This registration bill states that "After July 1st, 1910, no training school shall be accredited by the state board as a school of recognized standing which is not attached to a general hospital and which does not have a course of study of at least three years." I might state that though this bill is somewhat exceptional in some of its methods, it is not exceptional in the substance of its provisions. Now, if we did not need a definite number of nurses in our training schools to properly take care of our sick, I would not object to these rulings, but, because I believe the care of the sick is the hospital's supreme duty, and because that duty cannot be set aside to carry out any

theory, nor to reach after any ideal, because these provisions seem to me to strike at the very foundations of hospital efficiency, I do now and here emphatically protest against these and similar rulings. I have quoted before and I beg leave to again call attention to a statement made in an article in Charities, by a student of social conditions, who says: "It is an indisputable fact that about 90 per cent of the pupils in the public schools leave before the high school stage. Perhaps two-thirds of this number fail to complete the grammar grades;" and to another statement made by a prominent educator that less than 5 per cent of the pupils in rural districts get any education other than that received in rural schools. I do not wish to underestimate the value of education to nurses, nor the manifest desirability of having only well-educated nurses in the training school, but I do not believe that we have yet reached the Utopian stage of civilization when we can afford to risk the applying of such measures in a wholesale manner. I have no hesitation in saying that even when the supply of nurse candidates was proportionately much greater than it is at present, I could never have complied with such requirements without crippling the hospital.

It may be stated that these rigid requirements are not being enforced, and I believe, that, to a degree, this is true, but I fail to see the wisdom or the justice of forcing hospital authorities into the position of lawbreakers, in order to reach after a purely theoretical ideal. I covet for every training school superintendent the right to exercise her own best judgment in selecting candidates, and the fullest opportunity to make a careful selection from the rank and file. I covet for every hospital the right to secure the best all-round women as nurses, free from such rigid legal limitations as to eligibility.

I need not call to your attention the combination of heart qualities, the personal, the human qualities, that have made thousands of nurses valuable caretakers of the sick, and a blessing to the world, though they had never reached the high school stage in general education. Who will take the places of these women when we have barred them out of our schools by legislation? I cannot permit the heart qualities, the splendid natural abilities, the dogged faithfulness displayed by nurses whom I have known who have never

had high school advantages, to be discounted without a strong protest. No hospital that has to run without enough nurses to properly care for its sick, can ever do its best work, however elevated its educational ideals may be. In all the conditions of life we are obliged to stop short of our ideals, and accept the best that can be done under the circumstances.

We are living in an age when there exists a craze for legislation. The remedy for every social ill is a legal enactment. Statute books are crowded with unworkable laws, or laws that have become a dead letter. While believing in British and American justice for nurses I believe just as strongly in British and American justice for hospitals. The two are not necessarily incompatible if the matter is approached in a reasonable way. It has been stated that training schools should be endowed so that they can afford to carry a large staff of paid permanent workers and more nearly approach collegiate methods in regard to pupils. But stating that fact does not alter the situation. Training schools, as a rule, are not endowed. It is a condition, not a theory, we have to deal with. For this reason, under present conditions, with the demands on hospitals increasing every year, with the cost of supplies soaring higher and yet higher, with annual deficits embarrassing a large number of hospitals, with the supply of candidates already inadequate to the needs, it seems to me that legal panaceas for training school defects should be formulated with exceeding great caution, in the next few years, if the hospitals are to carry on without embarrassment, the work for which they were brought into existence. The nurses ought to have their distinctive mark, but they can, and they ought to get it, without creating embarrassing and impossible conditions for hospitals. The relation of training school laws to hospital efficiency is a subject that is worthy of the fullest and most impartial consideration in any campaign for legislation. Enthusiasm for reform should never blind us to the whole issues involved, and the possible and probable results of proposed laws. If the object of legislation is the protection of the nurse by giving her a distinctive mark, then that protection is quite as fully secured with moderate, as with extreme or impossible requirements. If the object of legislation is to limit the supply of graduates so that more

advantageous conditions will result for those already in the field, then that fact should be fully understood.

The ruling quoted that " No training school shall be accredited by the State Board as a school of recognized standing which is not attached to a general hospital, and which does not have a course of study of at least three years," must be regarded by most fair-minded, well-informed persons as unjust. We represent in this association hospitals of very diverse characters, each with its own special problems which have to be met, as the work goes on, and patiently worked out. However strongly we may believe in the desirability of a three-year term for our own institution, we should hesitate long before forcing it on all the other hospitals of a state, irrespective of conditions, as we do when we crystallize those sentiments into law. There are a great many hospitals that can give a valuable training for two years, a training that will make the right kind of candidate an intelligent, resourceful, capable nurse, but they have neither the patients nor the facilities to make the third year valuable, and affiliation cannot be forced, nor effected at will or by law. There are other institutions whose authorities believe in the wisdom, justice, and adequacy of a twoyear term, as fully as they believe in the articles of their religious creed. It has yet to be proven by practical results and tests, that they are not justified in their position. There are other institutions that have been, and still others who will be, forced to lessen the term, and make the entrance requirements less exacting in order to secure a sufficient. nursing force. I claim for all these classes of institutions the right, within reasonable limits, to use their judgment as to what is best for their school, the right to independence of choice, between a two and a three-year term. I claim that any law that would debar such hospitals from recognition as training schools is a distinct menace to hospital efficiency, and calculated to defeat the very objects to which this association stands committed. Let any hospital that is equipped to make a third year valuable, and finds nurses who want the third year of training, adhere to the longer term, and even add to it if they wish, but let us be moderate and sensible in our legislative requirements for hospitals in general. Let us not run the risk of crippling the little hospital in a country town, or a mining region, or any general hos