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pecuniary value. But the opinion of the eminent surgeon' is by no means peculiar. Once upon a time, another surgeon expressed his satisfaction that his hospital sent to his private patients probationers from its wards, when the institution was applied to for thoroughly trained nurses; and the best commentary upon his satisfaction was that, in consequence of the results which followed his operations, he was known amongst the students as “the Shadow of Death.'
It involves a fact of the greatest importance for the public that nursing has 'emerged into a science.' Because it implies that medicine, surgery, and obstetrics, whose handmaiden nursing is, sciences, and that, instead of the 'tomahawk,' knowledge now affords other equally true and unerring remedies for sickness. It is the immense advances which have been made during the last forty years, in the discovery of the causes and conditions of disease, by the microscope
and other modern instruments of precision ; in the prevention of illness associated with the antiseptic system ; and in the prevention of suffering associated with anesthesia, which have so greatly enhanced the value and the success of medical efforts.
But as medical skill and knowledge increased, it was seen clearly that there was an important link missing, that it was not sufficient for the most able directions to be given for the treatment of disease unless those directions were faithfully and precisely followed and carried out. It was manifestly impossible for the busy doctor with many patients to devote his whole time to one. Sairey Gamp could neither comprehend, nor could she be trusted to execute, instructions involving the use of the thermometer and other instruments, the administration to the patient-and not to herself—of stimulants, or even of medicines, in exact doses upon which life may often depend. Thus the laws of evolution called into existence a nurse trained to carry out with efficiency the many methods employed in the modern treatment of disease. And then, knowledge still advancing, the doctor realised more keenly the need of knowing the condition of his patient between his visits, of an accurate and scientific description of symptoms which would appear probably quite unimportant to those who only possessed the mere instinct of domestic love and duty,' and so would either not be reported to him at all, or else would be recounted in so garbled a manner as to be valueless for his guidance. The skilled practitioner now knows that his treatment must be adapted to meet the ever-varying phases of disease, and that symptoms occur in most patients which are veritable danger-signals, which require knowledge and experience to discriminate and observe correctly, and the early recognition of which may mean, especially in children and in surgical cases, all the difference between recovery and death. So it requires no prophetic instinct to foretell that, as medical men grow more and more acquainted with the mysteries of disease, and therefore with the measures necessary for the restoration to health of those who are sick, they will require, and will demand more and more emphatically, that the assistant to whom they entrust the execution of their instructions, and to whom they look for information concerning the effects produced by their remedies, and as to the symptoms which arise during their absence from the bedside of their patients, shall be qualified by most careful training and experience to fulfil those duties and to afford that assistance with the utmost possible efficiency.
In brief, then, it may be said that the wide technical training now given in the leading nurse-training schools has gradually been developed to meet the increasing demands made upon nurses by medical men and the public, and that therefore the extent of their education must inevitably tend to grow as medical knowledge increases. There are a few medical men who are not aware of this fact and they express the views of Lady Priestley's friend. Several have said to me in similar strain that they 'got on very well without nurses formerly.' So did typhoid fever. In 1863 a case was admitted into a convent. Fifty-six nuns were struck down within three months. Even at the present day there are gentlemen who 'object to newfangled notions,' and who are prepared to adopt the role of Dame Partington and attempt to stem the irresistible advance of our times' in nursing, as in all other directions, by ridiculous little brooms. They stand in ignoble contrast with the position assumed by scientists of such superlative worth as the late Sir William Savory, who at a Mansion House meeting, held some five years ago, voiced the opinions of men like himself as follows:
The subject comes home to every man, woman, and child, for all may
suffer from disease and injury. Nursing is not only the oldest of all occupations, for it must have existed ever since the creation of women, but in none has there bee more signal progress within recent times. The great change which has taken place in nursing might be aptly described as a revolution. Formerly the charge of nursing devolved upon any one ; now it is everywhere recognised that not only are the qualities with which all good women are endowed necessary—such as tenderness, faithfulness, and devotion to duty—but skill and knowledge also, which can be gained only by a term of practical instruction and training. Nursing has attained to the grade of skilled labour. It is understood that no amount of goodwill or willingness can compensate for ignorance; and though it is sometimes objected that our nurses know too much, those who urge this objection are usually those who know too little.
There is good reason to believe that the public are becoming quite aware of this aspect of the case; that they realise that a doctor who is skilled in his profession, and who is desirous that his patients should recover speedily, will wish that his instructions should be carried out most correctly. In other words, he will in all dangerous cases obtain, if possible, the services of a well-trained
On the other hand, if there be any medical men who know too little 'of modern methods of treatment, and who therefore have no definite instructions for the patient's care to entrust to the nurse, it would be comprehensible, and not altogether unnatural, that they should denounce her education as 'unnecessary' and regard her presence in the sick-room as a perpetual reminder of their own shortcomings.
The first point, then, which it is desirable to make is that the thoroughly trained nurse, who has been carefully schooled in habits of obedience, discipline, and good order, as well as in the technical details of her work, is obviously not the sort of woman whom Lady Priestley describes as having no respect for privacy, silence, or obedience, and with whom discipline is conspicuous only by its absence.' She is not a woman to whom the description of frivolous, • flippant,' and 'flighty' can be applied; and so I have no hesitation in saying that this is a most unjust accusation to have scattered broadcast against a whole class of working women, the great majority of whom are devoted to their calling and admirable servants of the sick.
But it has been said that the article in question will probably be very valuable to trained nurses as a class. The explanation of the apparent paradox is very simple. For some years the leading nurses have been striving to protect their profession against the very women whom Lady Priestley has described, and who, they know very well, are not trained nurses at all. These women may be seen in full uniform, wheeling the scions of the Beerage in perambulators though Kensington Gardens, or in attendance on malades imaginaires, who seek fresh air and sympathy in places of public resort. They pervade provincial towns as travelling agents for the sale of infants' foods, babies' bottles, and patent medicines. They infest every night the public thoroughfares of London and other cities, bringing the deepest disgrace upon the uniform they wear; while the titles they adopt in connection with the massage establishments alluded to by Lady Priestley reflect equally unmerited discredit on the name. But it is almost incredible that either Lady Priestley or anybody else can for one moment believe that those women are really nurses. Probably not one in a hundred of such women has ever had a single day's training. Things are bad enough as it is, but not so bad as that. How trained nurses are disgraced and how the sick are victimised was explained in guarded language in a letter which appeared in the London daily papers just five years ago, and which, if I remember right, was signed by Sir William Priestley, amongst others, as follows:
At present any woman, although she may be destitute of knowledge, or of moral character, or of both, can without let or hindrance term herself a trained nurse, can obtain employment in that capacity, and bring much danger to the sick and discredit upon the vocation of nursing.
The law requires no public record or register, as in the case of other skilled professions, of women who have been certified as qualified nurses by responsible
authorities; and consequently hospital certificates can be, and have been, forged or stolen and used to obtain positions of great trust, to the manifest disparagement of genuine certificates, to the discredit of hospitals, and to the danger of the public.
That indictment describes the Nurses à la mode, whom Lady Priestley, like others, has confounded with trained nurses; and it is valuable for the latter class to have the impostors exposed in so telling a fashion. They can afford to let a little more temporary discredit be cast upon their calling, in the earnest hope that such revelations may incite the public to demand adequate protection against a class of women who are dangerous to the sick. I, from a wider experience, could throw a more lurid light upon this matter than Lady Priestley has done. I could tell of women who stole or forged hospital certificates, who obtained admission into one institution after another on the strength of such testimonials, and who disappeared from each with money and jewelry; of others who gained admission into private houses, and not only neglected to carry out the orders of the doctor-in several cases to the danger of the patient—but who left each house with a certain amount of portable property; who were caught at last, sentenced to imprisonment, and on their release from gaol repeated their previous exploits. There are many more startling cases which could be told, were it necessary ; but, for the present, Lady Priestley's stories are sufficient to prove that the inability to discriminate between trained and untrained nurses is a matter of grave public concern.
It is even more serious that the facts which have appealed so strongly to Lady Priestley's mind are as nothing to the actual danger which untrained nurses are causing every day to the sick and the suffering. But it may very naturally be asked, what are those who are acquainted with the facts doing? If they know of the facts, how are they seeking to remedy them ? And the answer is simple. Nine years ago public attention was called to this matter, and the Royal British Nurses' Association was formed to cope with the evil. We proposed that a Register of Trained Nurses should be forthwith published Kan alphabetical list of names and addresses of women who had satisfied a Board of medical men and nurses that they had passed through a three years' training in hospitals, and that they were possessed of professional knowledge and unimpeachable personal character. We proposed that the name of any nurse who proved unworthy of trust should be removed from that register, and that the volume should be published annually, so that the public should be able to distinguish those who were, from those who were not, properly trained and trustworthy nurses.
The proposal was simple enough in all conscience, but it met with the keenest and most bitter opposition from institutions which sent out nurses to the public, and even from leading hospitals which were engaged in the same commercial occupation; but the Register VOL. XLI-No. 240
was started as a voluntary measure, and within three years the Privy Council, after an exhaustive inquiry, recognised the public value of the movement and recommended her Majesty to grant the association a Royal Charter. To a large extent the work has been successful, and there are many medical men at the present day who will only employ registered nurses. There are unhappily others who do not yet recognise the importance of having their subordinates under the professional control which a system of registration affords; and a considerable section of the public are still unaware of the grave abuses which exist, of the innumerable parasites which cling around the nursing profession and are a disgrace to the calling and a continual danger to the sick. The suggestion which is strongly advocated is that an Act of Parliament should be passed forming a Nursing Council composed of medical men and trained nurses, to which should be confided supervision over the education of nurses, over their registration, and therefore over their subsequent work-control similar to that which prevails in the medical profession. By such means, and by the publication of a general Register of Nurses, the public would be enabled to distinguish a trained from an untrained nurse; and by the disciplinary powers of the Nursing Council any nurse who proved herself to be unworthy of trust could be removed from the recognised ranks of the calling. Then, and then only, would the Nurse à la mode disappear from the scene which she at present disgraces; and it is to be hoped that public opinion will be sufficiently awakened to the actual dangers she produces, that the Government may be persuaded to undertake the necessary legislation in this direction. It is certain to come sooner or later, but the earlier it comes the better will it be for the safety and welfare of the sick and for the credit of well-trained nurses.
Incidentally, Lady Priestley has touched upon a matter which has occupied the earnest consideration of the Committee of the Registered Nurses' Society—the great problem of how to provide thoroughly trained nurses for middle-class families, at a reasonable rate. This matter is one of very great importance, and I am not without hope that the Society may shortly be enabled to suggest and carry out a scheme which would prove of almost national benefit.
ETHEL GORDON FENWICK.