sixty years ago, by the poor-house authorities; for thirty years it was an almshouse, and since then it has been used exclusively for hospital purposes. So unenlightened was the general view of the obligations of a city toward its sick and injured in those days, that for years the only nursing was done by convicts of the Female Penitentiary. The profanity, drunkenness, theft, and profligacy of these attendants were soon too scandalous to be ignored, and in 1848 this system was abolished, and "hired nurses, selected from among poor women of reputable character and decent habits," were employed in all the wards.* The advance from no nursing to poor nursing told sensibly on the death-rate, which, however, owing to poor hospital supplies, bad ventilation and beds, defects of heating and cleanliness, and the general indifference to the welfare of the patients, still continued large; the best medical skill was useless against incompetence and neglect.

So matters continued until the year 1872, when the attention of the Local Visiting Committee of the New York State Charities Aid Association was called to Bellevue. This committee was composed of sixty members, chiefly ladies of high social position and intelligence, two visitors being assigned to each ward. Their duties were to visit the hospital weekly, and to report its actual condition to the Association. They found in the building nine hundred patients, most of them in want, many in positive distress. The men's wards were so crowded that three patients would have to sleep on two beds and five on three. Others were forced to sleep on the floor without blankets or pillows, as there was no supply of extra clothing, except what could be obtained from the stock belonging to deceased patients. A few of the "hired nurses" were still there, and they seemed to have learned nothing by experience, save indifference to suffering. There were no night nurses, and only three night watchmen for six hundred patients. They sometimes drugged the patients with morphine to keep them quiet, and drank the stimulants that had been prescribed. In the kitchen it was ascertained that tea and soup were frequently made in the same boiler; the coffee was nauseous, and the beef dry and hard. "Special diet" existed only in name, and, even if ordered and provided, it had little chance of reaching the patients or even the nurses, being confiscated on the way up from the kitchen by the work-house women, who had been committed for drunkenness or dis

orderly conduct, and had been transferred to Bellevue as "helpers."

Judging from these inspections, the committee became convinced that no improvement could be hoped for in the management of the hospital until a complete reform of the nursing should be effected; and, inspired by the example and success of similar work in England by Florence Nightingale, the founder of the modern system of nursing, they set themselves to this task with resolution, tact, and intelligence. At first they met with little encouragement from the medical profession, but now their stanchest supporters are found within it. One distinguished physician said, "I do not believe in the success of a training-school for nurses at Bellevue. The patients are of a class so difficult to deal with, and the service is so laborious, that the conscientious, intelligent women you are looking for will lose heart and hope long before the two years of training are over."* A clergyman well acquainted with the hospital echoed this opinion, and thought it was "not a proper place for ladies to visit." One or two physicians thought the lives of such people not worth saving. Other grades of opposition or indifference presented themselves-political, social and professional. The experiment was a new one, and the theory on which it was undertaken ran counter to the traditions of those employed in the hospital. Before such obstacles, stout hearts might well have hesitated, but the courageous and intelligent managers were only thereby the more firmly convinced of the necessity of patient and persistent effort.

The first step was to learn how to organize the school in the best way, and for this end Dr. W. Gill Wylie, of New York, volunteered to go to Europe at his own expense, to study the foreign systems. Upon his return he brought a cordial letter from Miss Nightingale, in which she set forth the principles upon which the management of the school has been based. Chief of these is the entire subordination of the nursing corps to the medical staff, the nurses being under the discipline of a superintendent, or matron, whose duty it is to see that the work is performed to the satisfaction of the physicians. To her report the head-nurses, who have a surveillance of both the day and night nurses. The position assigned to the matron, by which she is made solely responsible for the effi

Address of Dr. Reese.

of Management.

ciency of the nursing corps, is one of the most important features. The tact and judgment displayed by the training-school managers in the practical application of these sensible ideas of the function of nursing, have saved a vast amount of friction, and won for the school the friendship of many physicians who were naturally prejudiced against it, and might easily have been forced into opposition by any encroachment upon their rights.

The boundaries of the nurses' duties having been laid down with circumspection, voluntary subscriptions were called for and made to the amount of $23,000, and a house was rented near the hospital, in which the nurses should lodge and board.

To find a person capable of taking charge of such an institution proved a difficult task. Miss Bowden, otherwise known as "Sister Helen, of All Saints," then of Baltimore, but formerly of the well-known school at University College, London, was finally selected. Equal difficulty was experienced in procuring assistants for her. Advertisements were inserted in the journals, and physicians were applied to; but such was the scarcity of educated nurses in this country at that time, that, after a search of many months, and after the most liberal offers, only four were found who were in any wise capable, one of whom proved inefficient. Later on, Sister Helen, compelled to return to England, was succeeded by Miss Perkins, of Norwich, Conn., under whose management the school has continued to increase in numbers and usefulness. At first but six pupils were obtained. The scheme adopted that developed by Miss Nightingale-demanded in the applicant a combination of requisites the mere enumeration of which appalled many who had been encouraged to seek admission to the school. These are: Good education, strong constitution, freedom from physical defects, including those of sight and hearing, and unexceptionable references. The course of training consists in dressing wounds, applying fomentations, bathing and care of helpless patients, making beds, and managing positions. Then follow the preparation and application of bandages, making rollers and linings of splints. The nurse must also learn how to prepare, cook, and serve delicacies for the invalid. Instruction is given in the best practical methods of supplying fresh air, and of warming and ventilating the sick-room. In order to remain through the two years' course and obtain a diploma, still more is required, viz.: Exemplary deportment, patience, industry, and obedience. The first year's experience was far from satisfactory. Among seventy-three applicants, hailing from the various States, only twenty-nine were found

that gave promise of ability to fulfill the conditions. Of these, ten were dismissed for various causes before the expiration of the first nine months. To serve medicine to the patients in the wards of a great public hospital smacks not a little of novelty and of romance, and goes far, at first, to compensate for a hospital's unpleasant surroundings and its odor of disinfectants; but a short period of wounddressing and night-watching is sufficient to dispel such illusions. Every year, young women whose abilities warranted their admittance at the commencement of the course have been permitted to depart before its completion, owing to an evident distaste on their part for the duties imposed upon them. But the managers, though surprised at the result of their first efforts, were not discouraged. As time went by, the number of applicants increased, and, though the high standard first established was not departed from, the proportion of those capable of fulfilling the requirements multiplied. Some applicants, who did not seem especially adapted to the work, proved most efficient, and on this topic the managers say that, after their long experience, they have found that the fitness of an applicant can be determined only by absolute trial.

The nurses at the Bellevue school may be divided into two classes: those who study the art of nursing with a view to gaining a livelihood or supporting their families, and those who look forward to a life of usefulness among the poor sick. All are lodged and boarded free of charge during the two years' course, and are paid a small sum monthly, while in the school, to defray their actual necessary expenses, and, in order to avoid all distinction between rich and poor, every nurse is expected to receive this pay.

The "Nurses' Home," the head-quarters of the school, is No.426 East Twenty-sixth street, a large and handsome building, erected for the purpose and given to the school by Mrs. W. H. Osborn. From the outside of this building the tastefully arranged curtains and polished panes of its several chambers present a striking contrast to the somber, frowning walls of the great charity hospital opposite. Besides studying from text-books, and attending a systematic course of lectures, the pupils are occupied by the care of the patients in the hospital, and in the general management of the wards. The nurses are taught how to make accurate observations and reports of symptoms for the physicians' use, such as state of pulse, temperature, appetite, intelligence, delirium or stupor, breathing, sleep, condition of wounds, effect of diet, medicine, or stimulant. This instruction is given by the visiting and resident physicians and surgeons of Bellevue, at the bedside

except the want of money, why this system should not be extended to the entire hospital. Look in at the male surgical ward. These young women in white caps and aprons and blue-and-white striped seersucker dresses seem to have had something of the training of the soldier added to that of the nurse. There is little talking and no laughing. When they do speak, it is in subdued tones. Each seems to understand her duties. One of the house physicians enters, and, beckoning to a nurse, gives her directions regarding a particular patient recently visited. She listens attentively makes no reply, and turns at once to obey. A soldier, pausing in his rounds, presenting arms to his superior officer and listening respectfully for orders, would not have exhibited a more perfect discipline. On either hand the patients lie on their cots, in the various stages of relapse or recovery. As a rule, these are hard-featured, ill-favored men. Some are only waiting here until the healing of their wounds to be tried for felonious assault, housebreaking, or murder. One is a bar-keeper, brought in the previous night in an ambulance, VOL. XXV.-5.

easily upon the strap-support. On the opposite side of the ward, stretched upon a cot near the door, is a workman who has been injured by falling from a scaffold. He has a careworn, anxious expression, that proceeds not from physical, but mental troubles. He has just told the nurse that his wife is very ill, and that there is no one to look after her and the children. He does not know, but will soon learn, that another young woman with even more experience than the one sitting near him, is already on her way to his wife, the number of his house having been ascertained from the hospital entry-book on the ground floor. In another division of this ward are gathered the most complicated cases. The labors of the nurse must here be unremitting; yet little medicine is required. Some of these poor fellows who lie in rows are, doubtless, yond the influence of that, but the worlds still sweet to them, and the spark of life that fitfully lights up their wan, colorless faces may, if carefully tended, still be kept aglow. One patient is undergoing an operation, though not a dangerous one. The nurse stands by,

Training-School, and after passing a satisfactory examination, the nurses, furnished with diplomas, signed by the managers and the examining board of the hospital, begin their several careers. Some are called to superintend state and city hospitals, a continually increasing number seek private practice, or rather are sought by it, while not a few, as has already been said, devote themselves to the sick among the poor. The value of the service performed by these noble women cannot be adequately estimated

tages of a nurse's training, would fail signally where she would succeed. For the mere attendance on the invalid is not the whole of the service performed by the visiting nurse. She sweeps and cleans the rooms, cooks the food, does the washing, if necessary, goes upon errands-in short, takes the place of the mother, if she be ill. All this has been learned at the training-school. Neither illness nor death itself can appall her she has served a long novitiate in nursing the one, and the other has long since lost its terrors.

without visiting the tenement-house district wherein it is performed. They lodge in a house provided for the purpose by the Woman's Branch of the City Missions, by which they are supported, and are to New York what the "District Nurses" are to London. From early morning until evening they endure fatigue, heat, cold, and storm, in their efforts to relieve the distressed. Neither the gruff responses, nor the ingratitude of those for whom they toil, have, in a single known instance, forced them to cease their work. An equally zealous person, without the advan

Here is the substance of an account given by one of these charitable women, of a typical day's work.

"I heard that a young man was dying of consumption in a tenement-house on the east side. After searching for some time, I found the house, squeezed in between two larger and equally dilapidated structures, in the rear of those facing the street. It had no door, and, like such houses generally, was so dark, even in broad daylight, that I had to grope my way to the upper chambers by aid of the stairrail. A woman in the yard told me that the