as there are in the homeopathic, the ratio to male students is much smaller. In the regular schools the number of women is 902, which is only 5.1 per cent of the whole number; but in the homeopathic schools there are 351, or 21.1 per cent of the whole number; while in the eclectic schools there are 86, or 10.7 per cent. In all the medical schools there are 1,419 women, or 6.5 per cent of the whole number.

In dentistry, pharmacy, and law the number of women is much smaller; dentistry, 88, or 2.1 per cent; pharmacy, 88, or 2.4 per cent; and law, 54, or seven-tenths of 1 per

cent.

DIAGRAM 7.-Proportion of women in medical schools in 1893–94.

A diagram has been made to show what proportion of the whole number of students in law, medicine, theology, dentistry, and pharmacy were allowed to graduate at the end of the year; in other words, to show approximately what amount of preparation is required of students in each of these pursuits before they are considered qualified to enter upon their work.

Judging from the results there given and from the usages followed in these vocations, it is concluded that, on the whole, medical students at the present time are required to have a better preliminary training, are required to spend a longer time in the study of their profession, and must undergo severer final examinations than students in the other professions, law, theology, dentistry, and pharmacy. If we take these elements of preparation singly, the result might be different; for instance, it might be claimed that law students begin the study of law with better education than medical students; but when we consider all three of the items mentioned, it will be found that the result is probably as stated, namely, that medical students are required to make better preparation for their work than any other class of students. This was not the case only a few years ago.

DIAGRAM 8.-Proportion of students graduating.

Theological-19%.

Dental-21%.

Medical--24%.

Pharmaceutical-27%.

Law-34%.

The proportion of law students graduating at the end of the year was 34 per cent, a larger percentago than in any of the other classes. This was probably the result of the short course in law schools, 7 law schools requiring but one year of study before graduation, 47 requiring two years, and only 13 requiring three years, while of the 152 medical schools only 3 have courses of two years, the others having three years, except 19 schools, which have courses of four years. Large numbers of law students serve as clerks for a few months in the office of some attorney, are admitted to the practice of law, and then devote their leisure time to real preparation for their profession.

Of students in pharmacy, 27 per cent completed the course at the end of the year, and of dental students 21 per cent. While these percentages show that students must devote considerable time to preparation in these callings, it is well known that many licensed druggists never attend a school of pharmacy at all, and the requirements of dental practitioners are also lax.

In theology, of the 7,658 students only 19 per cent completed the course during the year, while of the 21,802 students in medicine 24 per cent graduated at the end of the year. The course in theological schools, too, is usually three years, while several schools have courses of four years. It is evident, therefore, that students in theological seminaries receive full preparation for their work.

But why is it that with about one-fourth more physicians than clergymen in the United States there are about three times as many students of medicine as there are theological? And why is it that while one denomination may have four times as many members as another, the number of theological students in the two denominations is about the same? It is evidently because a large number of ministers never attend a regular seminary course at all, but receive only private instruction from some clerical brother, or else jump full-fledged from some other calling into the ministerial ranks. This is well known to be true, especially in some important denominations.

If we consider the interests involved, it would seem to be only proper that the education of physicians should rank especially high. While the legal profession frequently consider questions involving largo estates or large funds, these can not

be considered so important as those cases where health and life are at stake, and to secure which surrender of every possession would willingly be made.

It seems also that the physician needs a better preparation for his work than the theological student, although the latter will aim to direct the spiritual welfare of his fellow-men, a calling which of course ranks in importance above all others. But in order that one may succeed in turning men from ways of vice and wickedness to godliness and holiness, it is not so necessary that he shall have unraveled all the nice distinctions of doctrine which set up one denomination against another, and which cause much waste of effort, but it is very important that the teacher of righteousness shall himself be righteous, and that he be able to illustrate his precepts by his example. The history of early Methodism is convincing proof of what can be accomplished by earnest, consecrated workers, with but little previous training for the work. Many of those who have received full theological instruction are themselves opposed to a strict requirement of a long theological course under all circumstances.

In the study of medicine the previous instruction of even a well-educated person gives him but little knowledge of those things which he must learn before beginning a practice of medicine. His previous training will simply enable him to grasp more quickly and fully the new ideas presented, and accelerate his progress along paths untrodden by him before. It is therefore absolutely necessary not only that he be capable of properly receiving instruction, but that he also devote much time to receiving it, and that he give clear evidence of his medical knowedge before receiving a license.

NURSE TRAINING.

The nurse-training table mentions the names of 66 schools, with 2,710 nurses receiving instruction. The number of instructors was not given in the table for several reasons. In the first place, in answer to the question as to the number of instructors, quite a number of schools invariably reply, "Instruction is given by the hospital staff of physicians and surgeons." Some schools mention only four or five instructors who deliver special lectures regularly to the nurses as to their duties, omitting entirely the regular hospital staff. Another school will probably give the number of the entire staff in two or three hospitals where the nurses serve. As a result one school will be reported as having 5 instructors and another as having 150, while in reality they may have about the same number. It is doubtful which can be said to have reported correctly, the school giving only the number of actual lecturers on nursing, or the school which included every member of the hospital staff. In reality the nurse receives the larger and more important part of her training in the hospital ward, where she constantly gets many gentle hints as to what she should do, and where she learns to know by doing. In the operating room she sees an amputation made by a skillful surgeon assisted by the resident physicians and nurses. In the fever ward she sees the physician examining the typhoid patient, note the pulse, take the temperature, and give a cold bath. In the afternoon she hears a lecture to the nurses on the condition of the skin. How many instructors were there? Fifteen, three, or one, or nineteen? Evidently none of these answers would be correct. Her instruction could no more be determined in that way than by the number of windows to the ward.

The first regular and systematic instruction in nurse training in this country is said to have been given in 1873, although some efforts to establish such schools were made previous to that time. In the annual report of the Bureau of Education for 1874 only two nurse-training schools were mentioned, the Bellevue Hospital NurseTraining School and the one at New Haven, Conn. These schools found much difficulty in securing candidates for instruction who possessed good health and sufficient education. The secretary of the New York Association, in his report for 1874, said: "We were at first disappointed at the few desirable applicants who presented themselves to be trained, but as the knowledge of our school gradually spread over

the country we received, either through personal interview with the superintendent or by letter, many applications from women offering themselves as probationists. Some were entirely unfitted by incapacity, physical weakness, or because, belonging to the ignorant and uneducated class, they fell below our standard of admission. DIAGRAM 9.—Showing nurses and students and graduates in dentistry and pharmacy,

Pharm, grad.

NOTE.-Course of three years first required.

But the majority were unwilling to devote two years to gaining a career, seeming to care little for really perfecting themselves in their profession.

"The scarcity of such professionally trained nurses throughout the country was perceived in the effort to find women capable of acting as head nurses. Advertisements,

1893-4

4300

applications to doctors, and in fact all available means only brought us four, one of whom we were soon forced to discharge for inefficiency."

At the present time, however, there is no scarcity of applicants wherever schools have been established long enough to make known the value of such service. Whenever a number of nurses, possessing a full English education, so that they are entirely competent to receive instruction and to adopt it in practice, have once found employment in any city, the great value of their service is at once recognized, and thereafter they are always in demand in case of sickness. It is soon found that their value does not consist at all in the amount of menial service which they per form, this being incidental and expletive, but that they render valuable professional service of the same kind that the medical attendant bestows, differing only in degree. The value of the trained nurse increases just in proportion to her ability to acquire this professional knowledge, and decreases just as her measure of usefulness depends only on the amount of menial work she discharges.

Her work, however, does not conflict with that of the physician, but supplements it. As a rule, the more competent and better educated the nurse, the more friendly and congenial will be her relations with the physician, for even if their ideas of proper treatment should differ, the well-educated nurse will always remember that she is merely to assist the physician and carry out his directions, and not to conduct the case, and if she should consider it advisable to make any suggestion to the physician, it would be done at a time and in a manner not objectionable. An ignorant woman as nurse, and with only the little training such an one can receive, might easily imagine she understood the whole case, and would be liable to discharge for impertinent interference.

As the successful physician usually has a number of patients to visit and as he must have time to study up current medical literature, without doing which he would soon lose both professional knowledge and interest and consequently professional standing, he must necessarily confine his visits to each patient to a short length of time, simply ascertaining the condition of the patient and making the necessary prescriptions. He then intrusts the patient to the nurse until his next visit. The skillful nurse administers the medicine or performs any other duty which the physician may have directed, notes the progress of the case, the pulse, respiration, condition of the skin, and nervous symptoms, and if she discovers any special change for the worse, and it is particularly important that she be able to recognize any change, sends immediately for the physician again, to whom she is able to give a minute and accurate account of the course during the interval. He is then able to diagnose the condition at once and without doubt, directs the proper treatment, and the patient is soon convalescent, and the physician's reputation is again strengthened instead of being clouded by a death; the patient and her friends bear many feelings of gratitude and kindness to the nurse, upon whose careful attention and good judgment they have depended in the intervals of the physician's visits, and to the physician who has given wise and skillful treatment and who recognizes the valuable assistance he has received.

"Schools for training nurses have done much to make clear the evils of untrained nursing. Intelligent people see that the best results are to be expected only when the directions of the trusted physician are implicitly followed, and that the modern treatment of disease demands the continuous, thoughtful attention of a trained expert. The intelligent family is no longer content to trust a fight, whose loss means saddest bereavement and years of hidden pain, to the sole direction of a commander who is on the field of battle only half an hour in the twenty-four. He must have a lieutenant, an executive officer who will see his orders carried ont, who will call him to the spot if an emergency arises, and who can be trusted to act wisely in those crises where the right thing must be done at once.

"There are now, happily, many who know by experience the relief given and the confidence inspired by the presence of a trained nurse at the bedside. But it is the doctor who can best bear witness to her usefulness. No one but a phasician can