only those know who, as heads of training schools, have been obliged to do this year after year. There is no escape from it, and I know of no school which is exempt from this necessity.

Although the larger and more prominent schools, where more ample opportunities and advantages are offered, do naturally attract the larger number of desirable pupils, yet question any one of these, and I think you will be assured that there are never nearly enough really good candidates, and that the needs of the hospital must always be met by including the less worthy. And if this is true of the large schools, what might we naturally expect of the smaller, where the opportunities for suitable teaching and training are in various ways inadequate? I think you will find that here the problem presses much more closely. The standard of requirements for admission here must usually be lowered in every particular, and sometimes to all practical purposes it passes out of sight altogether, and "not one survives to tell the tale." Repeatedly during the past ten years have superintendents of the smaller hospitals and training schools told me of their difficulties in attracting the right kind of women into their schools, and repeatedly have they written to me, as I presume to others, asking me to refer to them those who failed to meet our higher requirements, although the material out of which a good nurse can be made is about the same, whether the process be carried on in a large or a small school, and no large school that I know rejects any candidate who by any process known to it can be made into a good nurse. Quite recently, in talking with the superintendent of a hospital in a small town, I was told that it is next to impossible in some places to get any applicants at all. Of the few that do apply, many are so uneducated that such. a matter as giving out medicines becomes a serious problem, owing to their difficulty in reading correctly the labels on the medicine bottles.

This lack of good applicants for admission to some training schools, while a matter not only of present discomfort or distress, is of grave import. It seems ominous to those who, familiar with the training school problem as it presses daily, can see no way out of the bewildering and complicated state of affairs. Yet it may not be an unmixed evil if it induces us to give serious and unprejudiced study to the situa

tion, and get down, if we can, to the root of the matter. When we can be quite certain of the cause or causes (for there may be several), we can then discuss the remedy intelligently and profitably. Before such a careful study is made, we ought not, in justice to both hospital and school, to attempt any radical changes. The fact that there were over 21,000 pupil nurses in our training schools two years ago shows the very great requirements of our hospitals; that number would, of course, be much larger at the present date.

The rapid increase in the demand for pupils for hospital work has practically doubled within a few years, owing to the great activity in the line of hospital building. Two years ago the number of pupils in our training schools was equal to the total enrollment of regular students in several of the great universities of this country-Harvard, Yale, Princeton, Columbia and three others combined. This does not seem to suggest any falling away in students as such. What we need to observe is that, notwithstanding this very large number of pupils in the schools, there are still not enough to meet the needs of the hospitals.

One might also point out here that when nursing as a vocation for women first appeared upon the horizon there were few large hospitals, and consequently few schools for a good many years. In 1880 there were but fifteen such schools; the demand for students was small, and many more women applied than could be admitted. Even ten years later, in 1890, there were but thirty-five schools, but during the following decade, the tremendous onward sweep in hospital building brought with it the establishment of nearly four hundred training schools (423, in fact, are recorded in 1900), while the subsequent six years have more than doubled that number. It is perhaps not surprising that there has been a lack of enough candidates for admission to training schools to correspond with any such rapid development.

It might also be borne in mind that the past twenty-five years have been in few ways more wonderful than in the opportunities they have created for women. The two fields of teaching and nursing have opened out on the one hand into special work in the kindergarten, in domestic science, domestic art, manual training and nature study; and, on the other side, the many lines of institutional work, which includes the very attractive fields occupied by philanthropic

and charitable, social and settlement workers, into which so many of our brightest and best women are venturing. Added to this are the librarians, welfare and social and other secretaries, and workers in business and professional offices. Meanwhile the colleges for women have grown and multiplied. Vassar with her 1,200 students, Wellesley with 1,500, and Smith with, I believe, a larger enrollment, could perhaps enlighten us as to where to look for the woman who twenty or twenty-five years ago might have stood at the training school door asking admittance. The greater prosperity of the people of this country has made it easy for women to enter college today whose sisters of twenty-five years ago might have been glad to get for little or no expense what the training school offered. It is possible that the colleges might serve as a means of enlightenment in other ways. They might, it is conceivable, point to the long list of waiting candidates for entrance each year, and say that there is apparently no lack of good women seeking education, and that if we cannot find them-or, rather, they will not find us-it may be true that we are not offering them conditions which attract them to us. In other words, they like what the colleges offer, and will not have what the training school offers. We have here the interesting spectacle of women entering the college for four years of hard study, and paying a considerable sum each year for it; and, on the other hand, the hospital training school offering a professional course of three years of hard work at no cost to the pupil (as a rule), with board, lodging, laundry, uniforms and text-books provided, or, in default of such provision, a frank payment of money to the pupil. Yet one would suppose that nursing. would be just the work to attract the thoughtful, healthyminded, educated woman, and especially where the training for it could be obtained free of all cost. One is inclined to remember the saying that people do not value what they do not have to pay for.

One might dwell upon other aspects of this matter, but enough perhaps has been brought forward to show that the needs of the hospital do control the school in its most important function, that of determining what kind of woman shall enter the training school and become later the professional nurse, charged with the gravest of responsibilities, and supplied with powers and opportunities which, if un

wisely or improperly used, may make her a harmful member of society. Public opinion has not dealt gently with the trained nurse, and a few at least of its severe criticisms have been well founded. A general recognition of the necessities in the hospital which so largely control the selection of pupils might perhaps temper this criticism, or give it another direction.

There is still another and quite different way in which the status of the school may be affected, and that is when the accommodation for pupils is insufficient for the number required to do the work in the hospitals. Here we have a defect which cuts both ways, and affects, and seriously, the welfare of both hospital and school. Hospitals have a way of outgrowing with extraordinary rapidity the provisions made for nurses, and of adding department after department of new work, without at the same time realizing always that each new development of hospital work calls for some corresponding increase in the nursing staff. Hence we find in many schools the superintendent of nurses calling attention to lack of quarters for pupils, and asking for more, stating that her pupils are overworked daily because she has not room for as many as the hospital needs. This is a very common complaint, but no assurance is needed as to the seriousness of it. It affects steadily and disadvantageously the character of the pupil's work. It usually eliminates all possibility of study, and tends ultimately to produce the disheartened and discouraged worker. And to those physical and nervous breakdowns among pupils which, in addition to the loss of just so much human efficiency, stand particularly to the discredit of the training school, which above all places should set standards of healthy and well-ordered living. Such conditions often militate strongly against the school in its ability to attract desirable applicants. "I will not send my daughter to that school; they will work her to death," is the not uncommon criticism of certain schools where there is a failure on the part of the hospital to provide abundant and suitable quarters for its workers, a condition which must invariably result either in neglected patients and badly-done work, or in long hours and overworked pupils. When such a situation continues, the place loses all characteristics of a school. The overcrowded student can never profit even by the best teaching: she cannot study; frequently

she cannot even listen intelligently. To all intents and purposes the school has for her ceased to be a school. She is no pupil; she is a worker, whether efficient or inefficient. For not only do I refer to formal instruction, such as classes, lectures and recitations, but to that most important and valuable of all teaching-that given in the ward and at the bedside, the whole forming that course of study and training in return for which the pupil gives the just equivalent in her services. With such a shortage of pupils, brought about by insufficient quarters, or by any other cause, the effort of the entire staff is concentrated upon the work-to get it done. Thus the health, welfare and instruction of the pupils is here seen to depend upon the hospital; and since the conviction is held, and strongly, that all pupils must live in the quarters provided for them, usually within the hospital precincts, and under its control, no remedy for this state of affairs seems likely to come from any other quarter. The pupil, even if she lives in the same city in a comfortable home, cannot live there and go to her school daily, as is customary in other educational institutions (?), but must occupy the space in the nurses' quarters which would at least provide room for one more worker for the force. There seems lack of true economy in this method, but it is of course so greatly for the advantage of the hospital, and so apparently essential for its smooth running, that any other system will not easily find favor.

In discussing this phase of our subject, I am not unmindful of the number of large, comfortable and even luxurious homes for nurses which of recent years have been built in connection with several of our best known hospitals, but these form a comparatively small number among the 1,000 or more training schools which we are considering.

It is when we approach the actual education of our pupil and attempt to carry out the promises which have been made to her, that the resisting power of the hospital becomes more and more strongly felt, and the enormous difficulty with which it meets even the least of its obligations in this respect is clearly seen. There is no place in its strenuous scheme of life for the machinery of a school. All the space, the effort, the means which the hospital can provide are needed to carry out its immediate purpose, which is the care of the sick, and any scheme of education must of necessity take a