position on the part of nurses and attendants to ignore the finer lines of diet and to feed the house as one great mass. We know, moreover, that the medical profession is coming to an era in which the diet is of vastly more importance than medication. We cannot put mal-nutrition cases in one part of the house where they will all be fed alike, and diabetics in another, so that it becomes necessary to not only maintain rigid rules for the feeding of patients, but also a complete individualism in the preparation and distributing of meals. I regard this as one of the most irksome, expensive and important phases of hospital administration. One of the largest special practitioners in Chicago said to me not long since that he had never been able to get a restricted diet consistently through any case he had ever had in any hospital. I wondered whether this was due to one particular man's extraordinary demands, or whether the profession at large felt equally helpless in the hospitals of the country. I made some rather wide observations on the subject among the specialists in internal medicine, and I found that it was the common feeling among them that they could not be sure that a consistent dietary could be carried out in a hospital. Do you not regard this as a commentary on hospital administration methods? With the stimulus of this broad arraignment, we have planned in our own institution a rigorous individual dietary, in which every meal for every special diet case is individually prepared and indivdually dstrbuted to the patient. The work of preparation in these cases is not left to the hospital kitchen, but is confined to the diet kitchen under the direction of a graduated trained nurse, who has specialized in dietetics. Such a plan as this can only be carried out when the extraordinary cost is ignored. Fortunately, in our own institution the kitchens are directly and separately connnected with each ward by means of an elaborate system of electric dumb waiters, and whereas the trays for the private rooms, as well as for the wards where the patients are on ordinary diet, are made up by the nurses in serving rooms adjacent to their particular point of distribution, the trays for all special diet cases are made up in the diet kitchen and sent to the patient labeled for the patient by name. This system has increased our cost of feeding by about twenty per cent, but we believe the results will justify the expenditure.

237

"TRAINED HOUSEKEEPERS."

MISS M. U. WATSON,

Director Home Economics Department, Macdonald Institute, Guelph, Canada. (By Invitation.)

Numbers of capable mature women are to-day asking for training which will fit them for hospital housekeeping, and hospital boards are gradually waking to the fact that a well-trained housekeeper greatly increases the efficiency of a hospital. Therefore, the trained housekeeper has come to stay. You will remember there was a time when training for the doctor's profession, for the nurse's profession, for the librarian's profession, was looked at askance, when such training was crude, when the product of the training was much farther from perfection than at present. Just so, hospital housekeeping as a profession is now passing through its initial stages.

Five years ago the college which I represent had not the slightest intention of training housekeepers, but when Macdonald Institute opened, certain women sought such training. We hesitated, but finally promised to do what we could, and have been doing it ever since.

Five years of keenly interesting work have developed in my mind an ideal hospital housekeeper. Let me present her to you, with a running commentary upon her qualifications. This woman of my dreams will enter upon her special training with several important possessions. Chief among them will be that high standard of morals which is necessary to guide her own conduct and her dealings with superiors, fellow-officers and subordinates. She will have the discriminating mind which makes for discretion and sanity of judgment. She will be notable for executive ability; not everybody has it, and the people born without executive tendencies should choose another profession. She will be old

enough for stable opinions and settled habits, but not so mature as to be "set in her ways." She will have had a good elementary education and used it to such purpose that she is mentally alert and able to study. She will have had considerable practical experience of household affairs. Finally, she will have that great essential, sound health—a body which attacks all work with springy capacity and with nerves of steel. Such will be the foundation of the ideal hospital housekeeper. Her special training will give her much practical instruction and experience in laundry, cleaning and cooking, in order that she may acquire correct standards in these matters through personal experience. She will study chemistry, biology, bacteriology, physiology and sanitation, in order that she may better understand the principles governing the practical work, and have intelligent reasons for applying them to hospital conditions. She will study the chemical physical and physiological value of the common foodstuffs before approaching the subject of dietetics. She will study the food question as a problem of hospital economics: the purchase of food in large quantities, vastly different from family marketing; the control of quality in large orders; the storage and care of foodstuffs; the distribution and careful service of cooked foods; and the control of waste, that vexed question in many institutions. She will learn systematic methods of accounting for the cost, reception and distribution of foods and equipment; for laundry operations; for making equipment inventories, and what is more difficult, for checking and posting them. She will study the institution housekeeper's relation to her employees: her responsibility as a personal influence upon their lives; the value of attractive quarters; the wisdom of demanding careful and explicit contracts with all employees; the wisdom of sifting out the inefficient, the lazy, the unthrifty, and the quarrelsome; the supervision which is necessary for the best of employees; the instruction of employees by careful distribution of work, clear definition of duties, and special training if necessary. She will study the art of making reports; this is a weak point with the average housekeeper, and those of you who have suffered muddled reports will appreciate the item. She will be able to present a clear, definite statement when information is wanted by

superintendent or board; her appeal for needed improvements will be buttressed by facts and figures presenting their value in cold dollars and cents, a process eminently convincing; and her opinions for or against proposed changes will be respected because she will present them with clear reasons. Lastly, her special training will afford a certain amount of supervised practical experience and observation in a well-conducted hospital under its efficient housekeeper. There will be no fear of friction with this ideal housekeeper, because she will recognize clearly what measure of authority is hers, will never overstep the bounds, and will be loyal to the board, staff, nurses, patients and her own employees.

This ideal is certain to appeal to you superintendents and members of hospital boards when you realize the value of such a woman to the institution each represents. There are three factors to be considered in securing such housekeepers: first, the women who want training; second, the hospitals which need trained housekeepers; and third, the places which offer more or less of the necessary special training.

The number of women who want to become housekeepers is increasing steadily, and there is plenty of good material in this country and yours. There are many women keeping house for relatives who pay them with board and lodging and a few clothes, who have developed this executive ability because they had little to work with. There are many experienced nurses desirous of leaving the field of private nursing for a settled life, who are turning inquring eyes to this new departure in hospital service. There are also the capable young women with discernment enough to say, "Here is a new field which is bound to develop rapidly; I will be among the pioneers." There is no lack of good material. Presently when the women are ready to seek positions there will be no difficulty in placing them. I say nothing of salary, because that will take care of itself; when the women appear they will be so sought after that competition will make the salary satisfactory. If I had a room full next door, there would be a stampede in their direction. When you secure one, you will be glad to rank her high in the staff. A recent questionaire which covered a large number of Canadian hospitals shows that very few hospitals employ a

housekeeper with any special training. You have more hospitals on your side of the line, but the percentage employing trained women is probably very little larger. The percentage in both countries which employ trained superintendents of nursing is, as you know, very large. Why such discrepancy? Why should that department of hospital service which includes the food of every person in it and the cleanliness of a large part of it, as outlined by the last speaker— why should that work be in the hands of untrained people? Their ignorance may easily undo much of the good done by the nursing. Many hospitals expect the superintendent to undertake the training of the nurses and the housekeeping also. The board demands good training for the nursing work, but apparently trusts that Providence has trained her for housekeeping. The small hospital doubtless must require the same person to fill several offices, but that individual should have training for all. The large hospital should not ask any one woman to superintend both nurse training and housekeeping. One or both branches are bound to suffer. Again, why should the head of a large hospital employ an untrained woman for a housekeeper? It means that the head is pestered with innumerable details which should never come to his notice. These heads have enough worries to contend with. When they realize the possibility of relief they will quickly shift their housekeeping worries to the shoulders of a woman trained to deal with them. She will pacify Paddy, who wants potatoes three times a day, and sweetly reason with Jane, who wants impossible privileges. She will accomplish better housekeeping at a lower price than the untrained, and will double the efficiency of her department.

What about the training places? That is another story, as Kipling says. There are schools in your country and in mine which can give a certain amount of the necessary training. There is no school to my knowledge giving complete training. The women who are doing the best hospital housekeeping now got part of their training here, part there, and the rest at the expense of the hospital willing to let them work it up. This is satisfactory as far as it goes, but it is too slow, the demand is increasing too rapidly. The question is how to lessen the time necessary and how to secure uniformity in the training which will prevent an