appreciate the odds against recovery when the severely ill are left to the tender but awkward mercies of their own flesh and blood. It is not too much to say that the treatment of typhoid fever, of a severe pneumonia, of a dozen other maladies, in a private house without a trained nurse is a calamity. At the best it is giving the enemy a long start." (An. Rep. St. Louis Training School for Nurses, 1894.)

EDUCATION AND GOOD HOME TRAINING NECESSARY.

Although it is well for the nurse to be in good health, it is not absolutely necessary that she be of a strong and robust constitution. It is far more important that she have received at least a full English education, and that she have some knowledge of the proprieties and amenities of social life. Without a good English education it would be impossible to appreciate the necessary instruction, and it can easily be conceived how injurious to the sick, in some instances, would be the abrupt and blunt expressions of a nurse with no delicacy of feeling, and how unwelcome would be such a person in a home of comfort and refinement, where the service of a trained nurse is most frequently demanded, and where she must necessarily come in contact with members of the family.

In communities where trained nurses have not been generally employed, the esteem in which their service is held when introduced, and the demand for such service, depend to a large extent upon whether the nurses first employed are well qualified for their work. If they have had good preliminary training and have been thoroughly instructed in the strictly professional details of their work, and especially if their usefulness is observed by the medical profession, the value of their service soon becomes known and the demand for trained nurses at once arises. But if nurses of inferior education and knowledge are introduced, they will rightly be considered of no more worth than industrious and careful servants. It is very important that officers having charge of the selection of candidates for positions in nurse training, especially in communities where they are just being introduced, exercise great care to accept only those who have good educational qualifications and have received good home training, and nurses should not be sent out into private families until they have received a full course of complete and systematic instruction.

THE MODEL TRAINING SCHOOL.

A majority of nurse-training schools are found in the large cities, in connection with the hospitals. In fact, proper instruction and practical experience can not be obtained elsewhere, except under many disadvantages. There are a few training schools where the students attend lectures and clinics just as medical students do, and pay a regular tuition fee, and receive some training in nursing private patients and in attendance upon free obstetrical cases. Such students are relieved from some of the disagreeable work of large hospitals, but it involves the loss of much valuable practical information, and it is doubtful whether they can ever become as skillful and efficient nurses as those who have served an apprenticeship in a hospital ward. The model training school seems to be one where the pupils serve as nurses in a large hospital where medical, surgical, and obstetrical cases are treated; where they receive regular instruction in anatomy, physiology, and obstetrics by lectures and recitations, with occasional examination on the instruction given; where the pupils reside in a nurses' home near to their place of work, but at the same time separate and distinct from the hospital, so that they have some change of scene and are not constantly in contact with the sick and afflicted, in whose presence mirth and gaiety would be both unseemly and difficult. Many of the larger schools have the arrangement here mentioned, except that but few hospitals can give the threefold instruction-medical, surgical, and obstetrical.

The New York City Training School for Nurses has a Nurses' Home on the south point of Blackwell's Island, from which the nurses go out daily or nightly to one of four different hospitals, the City, Maternity, Gouverneur, or Harlem hospitals. Each

of these hospitals has its own medical board, its own methods of nurse training, and a distinctive class of patients, so that pupils receive instruction in the nursing of patients with all kinds of diseases and injuries. The school has about 75 pupils, 4 supervising nurses, a superintendent, and an assistant superintendent. It received during the year 1893-94 400 applications for places as nurse pupils, accepted 40 as probationers, dropped 7 nurses from its roll for various reasons, and graduated 22. During the first six months the nurses are placed in the City Hospital, where there are large wards and many chronic cases, and where there are supervising and assistant supervising nurses to instruct them. Here they become acquainted with hospital life and learn the first principles of nursing. The nurse "may now be called upon to enter upon the duties of the maternity service, where, under the immediate charge of the supervising nurse of Maternity Hospital, she will gain experience peculiar to that service. Here, too, she will have charge of a small ward and learn something of hospital management.

"The Gouverneur and Harlem hospitals, situated in the northern and southern portions of the city, are emergency and reception hospitals. Two ambulances at each of these hospitals are constantly bringing in sick and wounded from the surrounding neighborhood, and here the nurses come in contact with a new order of things. To these hospitals the nurses are sent in their second year, and when they are well on in their senior course. Here again the system of graded responsibility in the management of the nursing is carried out, the supervising nurse responsible for all, the head nurse under her having charge of the operating room and the practical training of the nurses, the senior nurse and staff filling in their respective places. The six months a nurse spends in these hospitals give her experience in nursing all kinds of acute medical and surgical cases and in dealing with the emergencies which these hospitals continuously supply.

"The last six months of a nurse's time in the school are spent acting as head nurse in the large wards in City Hospital, in filling the position of head nurse in the Maternity, Gouverneur, or Harlem hospitals, or in taking care of operation cases where experienced nursing is specially required.

"The course of training thus pursued insures a thorough training in method, order, accuracy, and attention to detail principally gained during the first year in City Hospital; while during the second year the service in the outlying hospitals develops self-reliance, self-control, adaptability, quickness of observation, and gives a knowledge of the higher responsibilities of nursing.

"The Nurses' Home, which may be considered the heart of this system, is situated pleasantly on the south point of the island. Here the nurses reside, and go daily or nightly, as the case may be, to the hospitals where they are stationed on duty, and here they rest during the evening and when they have their weekly half day or second Sunday. The social ties here formed are one of the pleasant features of the school. Since its enlargement last year, the 'Home' has a capacity of forty-five bedrooms, four bathrooms, two dining rooms, two storerooms, cloakroom, linen room, trunk room, kitchen, and two pantries. It also has a large library or parlor, a class room, a study, and a private sitting room. We find the Home a very pleasant place to live in, situated as it is in its own grounds and removed from all immediate hospital surroundings."

WAGES OF NURSES.

As will be seen by an examination of the table of nurse-training schools,' the wages of nurses during their years of service are, during the first year, about $8 or $10 per month; during the second year, $12 to $14 per month-board and lodging always being furnished free. After graduation, when in attendance upon cases of sickness in private families, they usually receive $2.50 to $3.00 per day, or $15 to $25

The table giving statistics of nurse schools can be found in latter part of this volume.

per week, in addition to board and lodging. They are usually employed in homes of people of refinement and some means, and as might be expected in such cases, especially under circumstances of serious illness, they are treated with much kindness and courtesy. As to whether they can obtain work regularly depends to a large extent upon energy and efficiency, especially as recognized by members of the medical profession. The best nurses usually find all the work they desire.

The great usefulness of well-trained nurses can not be doubted for a moment when an examination is made of the course of training which they receive, involving in almost every school two years of careful and attentive work. The course is practically the same in all the schools, but some schools have much better facilities than others for giving instruction, and are more rigid in their requirements, and some now require courses of three years.

The instruction includes:

COURSE OF TRAINING.

1. The dressing of blisters, burns, sores, and wounds, the application of fomentations, poultices, cups, and leeches.

2. The administration of enemas and the use of the female catheter.

3. The management of appliances for uterine complaints.

4. The best method of friction to the body and extremities.

5. The management of helpless patients; making beds, moving, changing, giving baths in bed, preventing and dressing bedsores, and managing positions.

6. Bandaging, making bandages and rollers, lining of splints.

7. The preparing, cooking, and serving of delicacies for the sick.

The nurses will also be given instruction in the best practical methods of supplying fresh air, and of warming and ventilating sick rooms in a proper manner. They will be taught to take care of rooms and wards; to keep all utensils perfectly clean and disinfected; to make accurate observations and reports to the physician of the state of the secretions, expectorations, pulse, skin, appetite, temperature of the body, intelligence, as to delirium or stupor, breathing, sleep, condition of wounds, eruptions, formation of matter, effect of diet, or of stimulants, or of medicines; and to learn the management of convalescents.

The teaching will be given by physicians and surgeons, when practicable, at the bedside of the patients, and by the superintendent and head nurses. Lectures, recitations, and demonstrations will take place from time to time, and examinations at stated periods.

When the full term of two years is ended, the nurses thus trained will be at liberty to choose their own field of labor, whether in hospitals, in private families, or in district nursing among the poor. On leaving the school they will each, having passed an examination, receive a diploma under the seal of the hospital.

In addition to the practical experience obtained in the wards, there is a regular course of study, embracing the following subjects:

Anatomy, physiology, obstetrics, the nature and course of various diseases, the action and doses of those medicines in general use.

Monthly written examinations will be held by the superintendent, and the general standing of each pupil nurse recorded.

Diplomas will be granted to those nurses only who obtain a final rating of 75 per cent or over, this rating being fixed by the final examination and by the superintendent's record kept during the two years' course.

LIST OF LECTURES AND SUBJECTS.

A lecture is given to the training school, by a member of the medical or surgical staff, once a week between September 15 and June 15. The following are among the lectures given:

Fire. Surgical dressings: poultices, washes, fomentations, bandaging, splints, leeches and blisters, enemas, surgical hemorrhage, etc.

ED 94-63

Three. Theory of wounds: modes of healing, granulations, ulcers, cellulitis, suppuration, sloughs, erysipelas, pyæmia, gangrene, sepsis, etc.

Three. Bacteriology, brief history and general theory: micro-organisms, general distribution in air, water, etc.; elementary consideration of pathogenic and nonpathogenic micro-organisms; exhibition of apparatus and cultures; practical points for nurses.

Two. Theory of sepsis: aseptic treatment, different methods; dressings, with demonstrations and "quiz drill."

Two. Emergencies: hemorrhage, burns, sunstroke, fits or seizures, drowning, fractures, immediate treatment of wounds and injuries, foreign bodies in eye, nose, and ear; poisons, domestic emergencies, and practice of expedients.

Two. Surgical anatomy and landmarks, hemorrhages, etc.

One. Surgical operations: care of patient before, during, and after operations; anesthesia and recovery; accidents, hemorrhage, shock, especially as in private nursing.

One. Abdominal surgery: including ovariotomy, herniotomy, operations for abdominal injuries, etc.

One. Fractures: varieties; preparation and care of splints and apparatus for treatment; management of cases, etc.

Three. Medicines: avenues of taking; preparation and doses; classes of internal and external poisons; cautions; hospital formulæ.

One. Nursing in fevers: theory of fever, symptoms and course of, different plans of treatment, nurses' duties as to symptoms, bed, clothing, secretions, baths, food, and management of cases.

Two. Eruptive fevers, especially diphtheria and scarlet fever: symptoms and course of disease; complications; infection and contagion; management of patient, and surroundings; personal hygiene of nurse in attendance, etc.

Two. Symptomatology in disease: what and how to observe accurately; vital organs and special symptoms. The model sick room: temperature, light, ventilation, care of bed, bedding, and clothing; furniture, utensils, disinfectants, cleansing, dusting, etc.

One. Contagious fevers and epidemics: prevention of contagion; disinfection, care of habitation, etc.

Three. Care of children in health and disease: diet and clothing of infants and children; various infantile diseases.

Two. Physiology of pregnancy and labor: delivery, confinement nursing.

One. On gynæcological nursing: preparation of patient for examination or operation; operations after treatment, douches, use of catheter, etc. (Demonstrations to sections of senior nurses.)

One. Special nursing in nervous diseases, including the insane.

Two. Special nursing in skin diseases and syphilis in the infant and adult.

One. Special nursing in diseases of the eye. Anatomy and physiology of the eye, and general care in health and disease.

One. Special nursing in diseases of the ear, its care in health and disease; nurses' duties at operations and continued treatment in disease.

One. Special nursing in croup, laryngitis, tracheotomy, intubation, etc.

One. Urine: characteristics, properties, including taking notes on same, and brief analysis. Drill in laboratory by classes in sections.

One. Massage: its history, theory, and modes of application.

Two. Visceral anatomy: demonstrations by post-mortems; care of the dead, etc.

LAW SCHOOLS.

The table giving the statistics of law schools includes the names of 67 schools, and there were 2 others from which information was not received in time for tabulation, namely, the law school of the American Temperance University Harriman,

Tenn. (opened January 22, 1894), and the law school of Indiana Central Normal College.

According to President Henry Wade Rogers, of Evanston, Ill., “Harvard is the oldest of existing law schools in this country. It has made its way slowly. Founded in 1817, the largest number of students it had before 1829 was 18, and its average attendance at that time had been 8. The Yale Law School was established in 1824, and that of the University of Virginia in 1825. The Cincinnati Law School was established in 1833 by lawyers who had been educated at the Litchfield school. It was the first law school established west of the Alleghany Mountains."

The number of students enrolled in 1893-94 in the 67 law schools tabulated was 7,311, an increase of 533 over the enrollment in 1892-93. The number graduating was 2,454, an increase of 54. In the city of New York there were 1,186 students of law; in Washington, D. C., there were 739.

Although we hear much now and then of the right of women to practice law in different States, they do not seem to be fast availing themselves of their opportunities. Of the 7,311 students of law registered in 1893-94, only 54 were women. And it seems that many of those who study law do not practice it afterwards, for by the census of 1890 there were only 208 women classed among lawyers.

Although law schools are helping greatly in raising the standard of legal education in the United States, especially among the younger members of the profession, there still remains much to be done. Hundreds of young men are being admitted to the bar in the various States, many of whom can never become properly qualified on account of lack of elementary education, to say nothing of the large number who expect to qualify themselves in law after admission to the bar. The legal profession must learn a lesson from what the medical associations did a few years ago, when the standard of medical education was elevated so materially.

While some States have regulations sufficiently restrictive to shut out the incompetent and unprepared, in other States there are practically no restrictions. The constitution of Indiana expressly states that any man can practice law who is a voter and of good moral character. In some other States, where the inferior courts are allowed to admit candidates, the requirements are exceedingly lax.

Prof. John D. Lawson, of the University of Missouri, has related an instance which shows not only how little is required for admission under present laws, but also what results sometimes follow. "There was an old negro preacher in St. Louis who conceived the idea that if he were only able to hold himself out as a lawyer as well as a preacher he would do a flourishing trade among his flock. He applied for admission in St. Louis and was examined in open court. He had spelled his way through a few hundred pages of Blackstone, of some obsolete law dictionary, and the statutes of the State. Without an idea of any single sentence he had read, his examination was of course a comedy of errors, but though rejected, he was not dismayed. In a few weeks he turned up again, the happy possessor of a certificate of admission to the circuit court in one of the interior counties, and thus entitled to be enrolled in any and every other court in the State. The first client he obtained was a poor negro charged with murder. Though the prisoner was afterwards found to have acted under circumstances of justifiable self-defense, the management of the case resulted in a verdict of murder in the first degree and sentence of death. Then the poor prisoner became frightened and retained a lawyer. It was a rather difficult case to appeal; there were no points reserved; there were no errors which could be taken advantage of, and the only possible chance was to ask for a new trial on the ground of the ignorance, imbecility, and incompetency of the attorney."

Many practical business men would prefer to fall into the hands of the Philistines and be robbed outright rather than get into the meshes of the law, where they must spend weeks of care and anxiety, vexatious postponements, and fruitless efforts, and at last come out probably with heavy loss, whether for the gain of Peter or Paul they care not.

1 Proceedings of the American Bar Association, 1894, p. 78.