O.S.J.J. Annual Report, 1873 by Museum of the Order of St John

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~--

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. I.

REPORT OF THE CHAPTER OF THE

ENGLAND

ON ST. JOlIN BAPTIST'S DAYA

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---

REPORT OF THE CHAPTER OF

~be

®rber of

~t. ~obll

of S{erttS3alem

in Qenglanll. ON ST. JOHN BAPTIST'S DAY, ] 873.

LONDON: HA.RRISON AND SONS, ST. MARTIN'S LANE, 1873.

~Itcration

'il' J OTTN

PIIIIJIPP.\Wl'.

~Iajor-( h'll.

I'ir

.T()n\"

in tfJe lExtcutibe

®ffi(c~+

to 1) -, Cl/ff!l (,('110 r. ,''I'. GE~)R(JE,

K.C.D., to l)c .A .<::.<;/.-lml1 Clwncel1oJ'.

@rDcr lJf ~t. cmlJ~n of ~rrnsH(cnt.

REPORT.

ADDITIONS TO THE ROLL OF

ME~IBEl{S

During the Year ended 24th June, 1873.

~fJtbaIter~ of IDu~ttce. GLASGOW, The Right Honble. George Frederick, Earl of, Kelbu?'ne House, AY'l'shire; Cupa1' P?'iory, Fife. DICK-LAUDER, Sir Thos. North, Bart., 45, Upper Br?ok St?'eet, (}-?'osveno?' Squa?'e; Fountain Hall, IIaddwgtonslw'e. LAjIB, Sir Archibald, Bart., 2nd Life Guards, lVindharn (,htb, St. James's Square, and Beaupo?'t, Battle, Sussex.

Entered 5th Nov .• 1 7'2.

6th Feb., 1873.

6th Feb .• 1873.

lEf5qufref5. ALOOOK-STA WELL, Jonas William, K?'lb?'1'ttain Castle,

('0 . 5th

OV .,

1872.

Cork.

O'MALLEY, Edward Loughlin, New Courrt, Temple. MoLEAN MoLEAN, Robert, Byculla Club, Bombay.

TIm ellal ter makes the follo"ring Report to the Aunual Gelleral A,'sembly :Admi.. ions to the Order, as detailed on the eparate sheet hcrClyith, haye taken place since the 24th June, 1872. Throl1gh the co-operation of Dr. Headland and in accordance witll a ,ch me Fmggestec1 by the Almoner, an arrangement has been made with the authorities of Charing Oross Hospital, under 'w hich a Rhort conI' 'e of met1ical and surgical training and hospital practice will be proyic1pd for non-professional gentlemen recommended by the Order. The details will shortly be publiNh (1. a)1(l the Chapter hope that the result will be satisfactory, as proyic1illg a number of gentlemen sufficiently trained to act not on1r as i1~fi]'mie}'s during war, but also in temporary mcrgellcic. in their own ncighbOlU'hood at all times. Thr> Almoner reports that the Physicians of Charing Cross and King\:l College Hospitn,ls continue to speak in approving term of our s)Ystem of i, ning diet, and that applications have been made from hOI pitals in the country for details of its organization. The following tabular for111 supplies the particulars of the diets i' u 1 during the year ;_

23rd June, 1873.

/ c,," / Di,~.

23n1 June, 1873

/'''. /Ib. / di~~~. ~g:, /Pi""f/ Meat.

Bread.

MURRAY, James 'Volfe, C?'ingletie, .V.B. WALKER, John, M.A., Westbourne I-Iou,se, Pittville, CheltPnlwm".

11!onorar)1

5th Nov .• 1872.

"" / pirits. '"

Scout.

Wine.

--1-

QCfjebaUerf5 of ($race.

Charing Cross IIospital

678

657

678

657

30:1.

516 154

King's College IIospital

469

434

126

6th May. 1873 .

<af5~octatef5.

RUMSEY, Heury Wyldebore, M.D., P?·ioTY House, Cheltenham. RUM:PFF, FraUlein Clementina Louisa, Mission I-Iouse,

5th

T OV .,

1872.

6th May, 1873.

Lar<gley Oldbury.

VIARTYN, Miss Ellen, The Hospital Rugeley. j

<l3rd Jun e, 1873.

To·r.A.L ..

IDonatf5. MITFORD, Mrs. Emily, 2, Cleveland Squa1'e, Hyde Parle,

5th Nov., 1872.

London.

HILL, Thomas Rowley, F.R.A.S., St. Cathe?'ine's Ifill,

5th Nov., 1 72.

fVorcester. ATLAY,

Miss Rarah, Collpr/e P?'ecincts, Wo?'cNde?'.

23rd .June, 1873.

../113 /1,14'1 /',126/',14'1 /','26/ '138/ 642/ 224

Number of cases died .. J um bel' of cases cancelled

Cllaring Cross, 1 5

King's College, 0 3

.. Total 1 .. ,,8

In London, 113 cases, 1.147 diets, averaging a little oyer 10 days' relief in each case. The Ahnoner desu:es to record the aid whieh he ha receiyec1 during the past year from the St. Giles' branch of the Charity Organization Society. . The Hanley Ca tIe C""T orce tcrshire) Commandcry has C011 tinued its Hospitaller work during the pa. t year, and has be 11 enabled to di pense diet to conyale. cent pati nt of"\ \ Ol'cestcr Di pensary, as shown by the follo-wlug returll 1'01' 1 72-73:-

Quarter ending

No. of Persons.

hl~\;~:~~

T?tal Diets.

Total wec!'-s' Cost per Rehef Diet. represented

I Rea~y Ii I f t

Patient.

June 24 .

546

Sept. 29 ,

427

Dec. 25

259

9~cl,

1873. March 25

700

IJd.

IHcl.

The diets have become more expensive, from tho increase in co t of pro,i ion~ of all kinds.

Many of these diets WE're not of the kind called "full diet ," hence a { c1ecrea e ill t he cost.

. I

Total, 84 cases, 1,932 diets, averaging a littl oyer 13 day. ' . relief in each case. The attention of the Commandery has of late been dcyotc(l to the establishment of a system of trained nul'S s for the benefit of the sick poor in Ol'cester and its llejghhourhood and it is hoped that a commencement may shortly be made: The only impediment up to the present tim.e has been the great scarcity of trained n1.U'ses, and the conse(luent difficulty in securing an experienced person who, whih:;t takillg a share in the nursing of the sick, might eventually become the head of a more extended organization. The Committee of the ,Vorcester Di. pensary have n,cknow~edge~ the services rendered by the Hanley Castle Commandery ~n theIr report for the preseilt year, from. whieh the following IS an extract :-

"Your con1mittee have again to express their grateful the Order of St. John of Jerusalem for their great kln(tness 111 continuing their dietaries to convalescent patients~ tl:a~ks t~

I t is imposRible to speak too highly of the benefits derived by the poor from this inestimable charity, expediting, as it does, their recovery, enabling them to return more speedily to their several oecnpations, and even in many cases giving a higher tone of h alth than they had previously enjoyed." Arrallgemellts have been made by the Council for carrying into GireC't the sugge.·tiollS contained in Dr. Headland's paper, read at the Annual Gen ral Assembly on St. John's Day, 1872. The Chapter dcsires to urge upon the attention of the Onler the papers which will be read to-day to the Assembly hy our HOllorary A, ' 'ociate', Dr. E. H, Sievekillg and Dr. II. ,\~. Humsey, upon the subject of the provision of NUl'ses for the sick poor, "rith a view to their sugge tions being f1.u,ther con, ic1cred, and, if pos ible, practically carried out. The establi. hmcnt anc1mailltenance of training institutions for m1rHe for the sick poor forms one of the especial objects of the Order, and at a time when the clifficulty of securing the sC1Tices of properly-trained nul' es is so \'ery generally felt, it ,ycmltl be de, 'irahle that we should take the initiative in dcyising the be t means of calling public attention to the subj ct. There is another subject which has from time to time occllpi 'c1 the attention of the Chapter for some years, and which has lately been more prominently brought before om' notice, which is the pos ible acquisition of a site within the 'wal1s of Jerusalem, the cradle of OlU' Order, with a view to the ultimate establishment of some such Hospitaller object as a. British IIospice, to which a Dispensary for the benefit of the natiye pOOl' might be added. Independently of the revival of the interesting associations, anc1 the real good which such an acquisition would bring about, we should be relieving our country from its present position of being the only Christian power unrepresented in the Holy City by such an establishment. The British Consul at Jerusalem has expressed himself very favourably to this project) and is willing to aid in proc1.U'illg a site. On the proposal of one of our chapla,ins, the R ev. 'lV. VV. Malet, who is intimatcly acquainted with Jerusalem, and is deeply interested in this object, a Committee was forme somed years ago for the purpose

6 of taking steps to secure. if possible, part of the ancient Hospital of !:;t. John. Almost contemporaneously with the formation of thi Committee, the greater portion of the site in question was given by the authorities at J eru alem to the Crown Prince of Pru sia for the Johann itel' Ord r; but even if there were no chance of the Engli. h Langue being able to obtain the remaining portion of this interesting site another may be seclU'ed at a moderate price should it be finally thought desirable to take steps in the matter. In the meanti.me, the Chapter would suggest the r e-appoilltlllent of the COlllmittee, with power to add to their numbers. (Signed)

THOUGHTS ON NURSINGn

ED lUND A. II. LECIIMERE, Sec/·etm·y.

A PAPEI{ BY

SIEVEKING M.D., F.R.C.P. EDWARD H. 1 , . Associate of the Orclero[St. John . . II R II the Pi'ince of Wales; Honora7Y, . Phy.l ician tn O)'dtrwry to

oj Jeru3alellt in

Eng~and.

READ AT THE ANNUA L GENERA.L ASSEMBLY Q'j' JOHN OF JERUSALE~1, HELD IN OF THE ORDER OF 0 • LONDON, ON ST. JOHN BAPTIST'S DAY 1873. BAltRISON AND

BON~ , PRINTERS IN ORD INART TO IlER MAJESTY, ST. lI ARTJP.'S LANE:

THOUGHTS ON NURSING OFFERED TO

Q0y.e (Qr'o.er .of .st. J(ogn .of ~.eru~ar.em in ®nglanb. "Certes si tuer les homme est un titre de gloire, les guerir, et cela souvent au peril de sa vie, merite bien l'estime et la reconnaissance." Dnnant, Un Souvenir de Solferino.

AN invitation from the Secretary of the Order, Sir EdmlUld Lechmcr , to reacl a pap r on some subj ct connected with the object' of the Order, coupled with the suggestion that I should offer a few remarks on Nm'ses and Nursing, so entirely harmonizes with one of the aims of my entu:e professional life, that I have not hesitated to respond to the call, I can have nothing new to say on a question that has engaged the attention of many of the best men and womell of the Chl'i tian era; but when we look al'ound us and see how far, even in the year 1873 the most advanced nations fall short of realizing the full scope of national hygiene, it appears to nle not lUlfitting that a society like that of the Order of St. John should unceasingly remind its contemporaries of what ought to be done, and, still better, enforce its views by example as well as precept. Few of us, who have gone through any serious illness, but have learned to appreciate the value of a good nurse. The nurse is an essential supplement to the medical man in the treatment of disease, and there are many cases in which good nm'sing may be l'egarded as more uTIportant even than medical advice alone. The physician or the surgeon gives the directions requisite to be carried out in each case, but who but a skilfulnlU'se, who is in constant attendance, can see that these directions are followed

4 out and minister to the numerous wants of the invalid which are beyond the immediate scope of the ordinances. There was a lamentable want of good nurse wh 11 I commenced my prof ssional career, and even now, although for many year,' pa t, numerous societies and individuals have ought to supply the want, there i till ample room for female ministers to the l::5i<.;];: in the shape of well-trained efficient, and gentle nlU' e . I wouhllay great stress upon the first epithet. IIowever kindhearted and fe eling the attendant may be, he i often worse than usde , unle s he has duly learnt what pm'taills to h l' function , and is willing entirely to subordinate her 'elf to the melli<.;al at t "lldallt. Amateur nursing on the part of charitable ladies or relative who have not gone through any kind of in truction i:-; often prejudicial to the patient. Such w ll-intelltioned people are apt to allow their feelings to prevail ov l' their judgment, and to Ullcl '1'mine or supersede the infiuence of the medicalmn,l1, who, jf ho knows his profes ion, deserves to be I' ganled:lR the highc"t anthority in the management of the ick room, ancl the sule rl'fer e in all case of doubt or clifficulty. Hut even among w ll-train ~ cl nurses there are many degrees of efficiency, and ther arc qualities which may be developed but can rarely be imparted hy professional education. These are qualities of the h 'tnt-tact, gentleness, consideration-qualities that eli tillgui 'h the true gentlewoman, and the cliffusion of which among all la c. of women render it so peculiarly desirable that ladies by birth, who feel a vocation and who e opportunities ::tHow them to obey its calls, should more frequently than is now done, charge themselves with the duties of a nurse; so that, posse sing the requisite knowledge, they may exercise with more power and authority that influence which they possess by virtue of station. N one of onr near l'elatives may be cast in the heroic mould w"tich enables the in clivi dual to brave public opinion for the sake of carrying out even the best matured plan of beneficent action; but there is great force in united endeavours, not only because of the necessarily increased power, but also through the moral influence exerted upon each worker by the sentiment of mutual support. It appears to me that there is a large sphere open in this direction for the ladies who belong to the Order of St. John, and that they might most beneficially contribute to the solution of one of the social problems of the present day, by promoting among their own sex one of the great objects of the Order, more efficient, more intelligent, more universal nursing; if they

5 would demonstrate by prece]?t and example that the attondance upon the sick is one of their highest duties and privilegeH. it i , however, not 0 much in reference to llID'sinO' the indi, b ~1~Ual th~t I, wi h to acldrc " you a, on the subject of nID' ing In It hyglClllC a pect , on nul' ing as a question of ~ 'tate medicine, and as a matter well ueserving the consideration of the l cgi lator. It if) only of late years that the health of the community has been heated a.' a qu stioH of paramount illLj!ortance, and as one not l)clow the dignity of Parliamentary consideration, It has forced it elf, '0 much into the foreground as to have been used yen as the ,Yar cry of a great party. At a great sacrifice, member ,of the medical profe. ion have e.-pecially ID'ged upon the publIc and upon the variou' custodians of executive pow 1', the duty of guarding against noxious influences which it was not po. ible for the individual to remove 01' to escape from, but which, re ulting from conditions inherent in Ollr . oci~ll relati~n', it behoved society collectively to wage war agalll t. 1 he re 'ult '0 far has been a diminished rate of mortality, and an increase in the average dID'ation of life. But when I reminl you tha,t even in OID' highly favolued land one-thinlof all deaths in the population occur durina' the first fiye year of life, and that the general average of Cllife varies ~roll1, 4.3 year and 8 month " as in RutlandsIDre, to 24: years, as ill LIV rpool nay that in clifferent districts of the same town there lllay be a difference of six. years in the ex.pectation of life at the agc of iO * you will agree with me that much yet remains to be done in order to eliminate all the removable eause of clisea e, prematID'e decay, and death. Improvidence and vicious habits have much to do with these lamentable results. The schoolmaster may exercise his influence beneficially in eountor-

* In the 15th Annual Report of the Registrar-General it was shown that the male expectation of life, in t. George's Parish London was 39 years and G months, while, in \Vhitecbapel at the sadte ao'e it wa 3~ years and 0months. The hcalthie,"t death rate ill Great bB~'itain Cis 11 pel' 1000; ill London, the average is 25 per 1000, or 8 more than that even now atta!Dable; and thero are tOWllS where, as in Liverpool, tl:e rate f)f mortality, dependent upon removable causes, is very much hlg~lCr. , J 0~1ll Graunt WllO wrote the first English work on the data, 011 1 whiCh hfe l~sur,an~e 1 founded, in the early part of the 17th century, states that 1Il Ius tIme, 7 pot' cent. of the population iu England lived to the age?f 70 ; w ho~'oas, the proportiou at the present day, accol',-ling' to ~he Carll Ie tables, 18 24 per cont., showing how much has been doue to Increase the val UP of life.

acting such causes, but unless he goes hand-in-hand with the physician, the intellectual training which he imparts is more likely to develop irregular and unwholesome growth than to issue in fruit goodly to behold and of fragrant and pleasant savolU'. Grand as are the occa ional achiev menta of mind over matter, and strenuou ly as each individual should seek to subject his material existence to th control of his spu'itual power, we cannot benefit the human race without having a due regard to the requirements ot the boely ill regard to h ealth; and, without entering into a di quisition as to whether or not the moral training of man may r ceiv a beneficial impulse from sickness, I maya 'ume that we all agr 0 as to the truth of the view that a h.ealthy mind require a h althy body for its best and highest manifestations. It follow that whatever affects the health of the community prejudicially, exercises a generally distressing effect upon its moral as well as upon its material well-being. Again, although we see that different classes and ranks of society have peculiar proclivities or idiosyncracies with regard to diseases, the clo e relation and inter-dependence of all is an admitted fact, and from mere selfinterest, as well as from the highest motives of Clu·i tian benevolence, the sanitary welfare of the whole body concerns ach individual. N ow my ideal nurse is one of the numerous agencies that we require in the warfare that has yet to be carried on against the many debilitating in£uences that undermine social health and vigolU' in the shape of disease. I would enlist her as one, and an essential one, of the army that works on the preventive system, quite as much as on the combative principle. For this purpose she must be endowed, not only with those moral qualities to which I have alluded, but she must have acquired a knowledge of sanitary laws which govern the health of the community. She must be willing, especially when her services are called into requisition in the smaller households of ither town or country population, to put a ide all fine ladyism, and to assist in the domestic duties; which, at all times heavy, fall with increasing weight upon the members of a family in which the p~esence of sickness already adds so much to the daily pecunIary burdens. Much has been justly said on the pauperising in£uences of gratuitous medical advice: as canied out at the present da.y. I should be the last to add to them. But, if my views are correct, that by an efficient system of National

Nursino- we improve national health, and enable the individual tn PI' lVb'llt and anticipate disease, we. shall, by enablin~ members of 'very cl~L 'S to obtain easily the aSSIstance of an effiCIent nUTse, in Tca,:e their self-d penelence, and dimini 'h rather than add to the pre, cut poor law budget. This is nO.t the ~lace to go into t 11 ' ddaiL' of a scheme calculated to reahze the Idea that I wiNh to submit to your notice; but I beg to state, di tinctly, that I am llot achrocatillg an eleemosynary system. The parochial authoriti 'S ought to flu'ni ·h the pari ·h doctor with a nm'se, whereYer he r 'quU'b' it gratuitou ly; but there are thousands of famili'l:) of th \ lower orders to whom it would be a great boon if th Y could obtain a tru t,yorthy and efficient nluse at a rnoclerat calc of remlUleration, provided they had once lcarlleu to appreciate the value of the aid that she might gIve. Anyone who has seen much of the houses of the poorer la,'s '8 know, how di 'proportionately ill health affects their w 'll-being. ~"epaTatioll of the 'ick from the healthy is imposiblc, aud th meallS of earning a livelihood are necessarily interf'red "rith if a parent or an older child is seized. If it be the father, he ·will often continue working long after his failing trength ju tifie his doing 0, and eventually the disease has aCtIuir 'cl ueh hold upon him as to make recovery, even under the mo t fl:\,Voluable circumstances, an impossibility; and when he i· pro trated, the mother' whole care being devoted to him, she i' I revented king out theu' means by work of her own. If sh hers If is the ulvalid, her hu band's comfort and heT children's welfare mu t suffer, apart from the actual los of her pos ible earnings. Again, if ono of the children is throl'"ln on the bed of sicknc's, the mother has little time to attend to the healthy, and dixectly and iudirectly the conuort and health of the rest of th family will be in jeopardy. It is in such cases that the nurse may, if she be a welltrained and well-intentioned active person, step in with so large a pro. pect of conforring great and enduring b nefit . Her presence may enable one or both parents to attend to their ordinary avocations, she may assist in checking the early inroads of disease, and in maintainulg in h ealth those who are not yet unler the depxossing in£uences of illness. vVithout being dictatorial, sho Inay become a sanitary t eacher, in influenculg those abont h er by precept and oxample ; by example, in regarcl to cleanliness, ventilation, and neatness, by demon-

strations of economical cooking, and the like, eyen more than by precept. For many y aI'S r labolU'eel with a number of oth r gentlemen to bring tIll matter L foro the publi. :ought to obtain the co-operation of the Poor La"\y Boarcl, mul "\ye "\Y'1' 0 far succe ful, that om years ago thiH authority i. Rll 'c1 a circular * recommending the qu tiull of nul'. lllg a, a Rallitary matter to the consideration of the Boanh.; of Guar<liaml throughout the kingdom. I fear the pradical re nIt was hut s111all, hut since then the subject has a umed a different ~u'pe·t ill as much as the public nllllel has been ducatocl generally tt) n.ppr _ ciate questions of hygielle, and to uncleI' ·talld that th ) gl'lleral health of the eutll'e social body can only result from tIl . yigour and health of the individual membcr. A ociety lik that of the order of St. John, numbering alllong its as.'~cia i S 1-;0 ll1UllY ladies and gentlem 11 of positioll and iniluence llmy llOW, taking advantage of the popular feeling prevailing all such iopie8,

hope to achieve a greater and more complete suocess, if it fairly r solves to carry out a general scheme, which i in accordanc with its proD R cd olJject. Each member may in his 10 'ality form a nuclcu , m'ounl wInch an abundant growth can be develop ed; whil , by a sy tem of association and org-anization, the iulividual worker will receive an amount of strength and support in hi. nl avours to labour at the good cause, which, llnaicl d, he might find hllnself l.mable to establish or to a(lvt1.n ·e. The condition of my pap r is, that it hould be short; I dare not ther fore, d w 11 longer on this fruitful topic, but before taking my I a\e of you, p nnit me to sunmlarize what I hav' saitl in th following propositions:1. Tho nlUSC i an sential aid to the medical man in the treatmcnt of eli, ·ease. 2. The nurse ought to be recognised as an essential element in the pI' 'v ntion of eli:; <1.1 e; she therefore requires tt) be taught. be. id . the ordinary duties of ick-nursing, the rudiments of sanitary.' 'i "nce. 3. By means of our parochial system nurses ought to be available throughout the COlUltry, and in carrying out any plan for 8 Cluing the neces, 'ary stair of nurses, special care should be had to make it solf- upporting.

Copy of a Lettel' addressed b!J the Poor Law Bo((rd to tlte POOl' L({ID Inspect07's, cOllcemz'ng the E17Iplo!Jllunt oj the Able-hodicd FemaLe Inmates of W07'khouses as lYU7"Ses.

POOR

LAW

BOAlW,

"\YIIITEIJALL,

l011t 111a./l, 1, ,) G. SIR,-Adverting to the Oircnla.r M mOral1l1UIll whidl tho Board addressed to you ill February ill It)55, ill referell80 to a propo!-\a,l IlHule by the Epidemiologieal Society for the tmitJing ill "\VOl'kho\l~'s of Nurses for the POOl', ~Ild to your remarks l:POll it, I am directeu by the P.oor Law Board t~ lllform you, tiJat thmr attention 11a:; h 'ell :lgain dIrected to the subJect, and that they thillk it desirable to COIllJl111IJieatc to you, for your guiuance, the views which they HOW nteriain re pectillg it. Th~ B?ard a:re of opinion that any [Lttempt on their part to establish authontatlvely 10 Workhouses a general system of trailliJlo' for. ur s wo~ld b.e .alike impracticable and inexpedient, alld they co~nmunicated th~lr OPUllO!! to the S~cretary to the Epi~lemi?logical. 'ociety ill J\Iarch, 18u5. At the same tIme the. Board ~hll1k It DOt Improbable that in large.workhouses where a paId nurse lS employed it may som 'times be practicable to adopt a system under which such of the Pernal Inmates ~ may betrustworth:f and competent for tl~e work, may be employed III t.he Infirmary and ?lCk vVards, not oIlly wILh the object of acting as asslstant.s to the Paid ~urses, but al~o with the view of their being taught by t.hem tlte dutles of a Nurse III such a manner as may subse quently enable them to support tbemselves by becomilJg Nurses on their own independent account. I~ is of courRe Ullllecessary for the Board to point out that thIS speclCs of employment must, however, be subject to the qualification that no persoll should be employed in attelldallce on infectious cases without her free consent. If 1:lUch a scheme were carried snecessfully

It is the interest of very person of education to a sist in making known the sanitary and economical principles involved into effect, it is thought that recourse would be frequently had to the "\Vorkholl es where it was in op ration for Nur es to attend the ick; and it is suggeRted that a register might be kept of the names and qualifications of these inmate who shall haye been thus taught, and who are fit for such att nelance. rrhe Board a1'e accordingly desirous that some such plan should be suggested by you to any Board of Guardians within your district in which the arrangements of the "\Vorkouse are, or may be made, such as to admit of its being' carried into practical effect. The Board further reque" t that, in bringing the subje8t under the notice of any Board of Guardians, you will not fail to state the strong sense which they eut rtain of the evils re ulting from the want of a sufficient number of trained and efficient Nur es for tbe Poor, and their confidence that the Guardians will be ready to concur in any plan by which, consi.'tently with a ound system of Poor Law Administration and with the laws regulating the expenditure of the Poor Rate, thei; Hnmber may be increased. I am, &c., (Signed) OOURTE AY, SeC?'eta1'Y' To Poor Law In pe tor.

10 in the supply of nUl'ses proportionate to the wants of the community; and it belongs especially to the nmctiol1s of the Order of St. John to sec that a large and vigorous cffort is ma.de to diffuse the principles, and to see that they arc brought iuto practical operation.

THE TRAINING OF NURSES.

A PAPER l1rn 'QRtilitate Jnmbutlu.

t·

HEN R Y

RUM S E Y,

M. D.,

Ho nomTY Associate of the Order of St. John of JerusalellL in England.

HABRlSON AND SONS, ~1UNTI!:HS l.1S OBDlNAIO' TO HER MAJIiSTY, .':IT. MARTIN'S J.ANE.

READ AT THE ANNUAL GENERAL ASSEMBLY OF THE ORDER OF ST. JOHN OF JERUSALEM, HELD IN LONDON ON ST. JOfu~ BAPTIST'S DAY, 1873.

THE TRAINING OF NURSES. My LORDS, LADIES, GENTLE~IE -HOSPITALLERS, ,V HY, let me ask, do soldiers . and women make the bestnurses ~ As to women, it may be replied that nursing is the natural function of the gentler ex. Yet there are some qualifications which they share with soldiers. In both, there is more or less separateness of life from the outer world. There is often, also, in both, a personal bond between the sufferer and the attendant, which more than supplies the measul'ed service of the hired employe, however honestly rendered . For the Wage question does not lie at the root of any service which, like nursing, can never be exactly calculable. In the case of the soldier there is pre-eminently the comrade's bond,-community of calling with the patient. Many a touching instance of brotherly care and sympathy has been seen in a military ho pital. "Vhen your grand predecessors, the early Knights Hospitallers, took charge not only of worn and failing pilgrims in the Holy Land, but aloof their sick and wounded fellow warriors, all were alike animated to effort and endul'ance by a lofty and generous, even if a mistaken, enthusiasm. ,Ve fail to sec'm"e this elementary motive among womennurses, unless we engender something of the old sentiment of confraternity; unless, in a word, the nurses belong to an Order. The members of such a community, whether soldiers or women, acquire the best of all qualifications, namely, habits of obedience. But neither enthusiasm or e :P'l-it de corps, nor the more valuable elements of obedience and subordination are to be expected in Nursing Institutions based simply on the commercial principle of ttU"ning out a useful article at a fair price. It is the absence of the h ~gher principle in the training of nurses, as well as in the theory and practice of nursing, which has led to the failure of many a nUl'sing scheme. It has been found that to take up the business of a nurse

after other occupations have failed-when, for example, the woman is tired of domestic service or no longer fit for it-is simply to fail in the vocation; that to degrade the nurse by requiring h er to do menial work (to scrub floors or clean, e utensils), is to quench all self respect and to deprive her of the regard and consideration of thos e for whom he labom"; and that, worst of all, to leave the care of the ick, in any grade, to ignorant charwomen, fit for no difficult or earne t work, and of doubtful habits, was to produce the" Prigs" and the" Gamps ' of what we may hop e, is now a pa t ra. But the impre., ,ion thus made on the public mind i not ea. y to remove. How often does the physician hear, in reply to his adyice that a professional nurse should be engaged,-" I will watch the uffer r night and day myself,-anything rather than a hir d nul', e in the house ~ " It was an economical fancy, about twenty years ago, that able-bodied female paupers might b turned into nnrRCS for workhous e infirmarie and for the out-door ick poor. The project was actually tested, but the material ,vas generally fonl1el to be too raw for sncce sful manufacture. The habit, a. Roc:iation, and notions of female pauperR, as a cIa. (for th re a1' xccptions of course) have proved to be snch a, to render th 111. mo. t unfit for an employment in which the hicte t dec ney, cleanliness, and morality, with some delicacy of feeling are essential to the welfare of the patient. :Moreover such a sy.·t 111 fails to provide for propel' technical training. The. ick ward of a workhouse does not supply a ufficient field for ob rvation, instruction and practice, and competent teachers are wanting. The employment of pauper nurses has, for these reasons, led to gTievous abuses, The Lancet Cornrni sion r eported in 18G5 that" very few indeed of the pauper nurses are qualifi d for their work," and that" theiT antecedents were such that the patients did not respect them." It is a great mistake to assume that the very poor ought to be nUTsed only by those equally low in habits and depressed in circumstanc s with themselves. Hours of sickness t en ded by superiors become hours of moral improvement as well as of physical restoration. I submit then that the n1u'sing profession should be treated as a distinct callin g, that early devotion to the service, a good elementary education, special training, habits of order and subjection to disciplin e, and lengthened probation, are necessary to make the perfect nurse.

Whatever may be the advantages of natural or congenital fitness for the work, I cannot say of the nurse, generically, as of the poet, "nascitur, non fit," because good nurses have sometimes been made out of very unpromising specimens of humanity. But the easy,luxm'ious habits of a modern domestic servant in a high-class family, are, perhaps, the worst pos ible pI' 'paration for that life of courageous and patient self-denial, which the true nul' e ought to embrace as her appointed lot. The proper field for the technical training of nurses is the IIo. 'pital, where ev ry improvement in subordinate therapeutics i hi d uuder . cicntific direction. The question then is, how to utilize the numerous hospitals of the kingdom so as to provide the greate t number of skilled nurs R? N ow, the managers of hospitals too often di play much l' luctance to open their institutions for any such purpose. I know of more than one Nm' ing Society which has been r end red comparativ ly useless, if not broken up, because the lIo. pital Board l' fu, cl to admit nm'se pupils. In one case, the I r jnc1i 'es of a lazy, puritanical Iatron, backed, unfortunately, by the lhaplaill and by an indifferent and autocratic House 'ul'geon, .ealed the fate of a u eful project. It i, quite U11n ce., ary that the nurse pupils should r eside in th ho pital, which, indeed, can rarely accommodate a sufficient number. A far mol' suitable home for them, if taken from the working clas es is that of a i terhood, where" industrial gu:ls" r eceive th ben fit of elelnentary education and imbibe good principle of action, and where their conduct is strictly superint nde 1 by kind and religiou superior. The house of the Si terhood ought to be n ' ar the hospital. No large town ought to be without such a comm1mity in connection with a nurse-training hospital. 'rhe girls when duly prepared, should attend daily at the hospital, working in cla ses under the dil'ection of skilled nurses, the more advanced pupils being drafted off for regular service in the wards, 01' as assistants in the homes of the ick poor. It is lTIOst llece ary to accustom the young nul' e to night-work, to sleepless watching, and to casual di hubances. In the preliminary training, beside elementary education, two Arts shoulu be taught, viz., Needlework and Cookin g. N eedlework, especially in mending clothes and linen and in mc.l,king under-garments an(l bandage. Cookery, at least in its primary principle, i .e., to make nub'it'io'Us food digestible, and practically in

6 preparing sick diets of all kinds, some of which t~ e specified

in the excellent scale of diets issued by the Order of St. John. These subjects of preliminary education might be taught at the house of the Sisterhood, proficiency in them earning promotion to hospital training. Is it then, Ladies and Gentlemen, possible to combine this orderly and t echnical education with the inculuation of a higher sense of duty, and of an earnest desire t o render loving service to the sick for Christ's sake ~ I believe this to be possible. All that we need is a resolute will to accompli hit. As regards those t aught, the first requisite is that ev ry candidate-nm'se should regard her vocation as special and pennanent, demanding the devotion of a life. I do not mean that she should be r equu'ed, or even encouraged, to take any irrevocable vow, but that she should be led, neither to look forward to other remunerative occupation, nor to use heT acquirements m rely as a step to some better position in life, but rather to H, pire to the reward of the Great Sentence-" Ina much a ye have done it unto one of the least of these, my breth'ren, ye have done it unto ftle." May not tills noble Order become one of the choice t agencies in Christendom for promoting a combination betw en the Scientific and what some would call the Sentim enta1 elements of the nursing qualification? I venture to r eply in the affirmative, and, a!:l a necessary first step to that end, I humbly suggest that the Members of this Order might beneficially exert themselves in their reE!pective n eighbolU'hoods ana counties to procure the utilization of Hospitals for the proper training of nurses, in connection with Sisterhoods of M rcy. 24th June, 1873.

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