kind of service the condition of holding the positions of direction. in the museum, is to invert the universal order of things; to create a show museum only, and to erase the name of our Academy from the roll of honor for the time to come. Yet such a proposition is gravely entertained by some of the members, and constitutes the Avernus to which the descent is just now particularly easy.

An organization such as is here indicated has been already in part adopted by the Academy and incorporated into the by-laws, but with such exceptions as to materially injure the practicability of the scheme. A temporary difficulty exists in the provision in the charter that the property, including museum, shall be under the management of four curators. This institution should give way to the larger number represented by the professors, or conservators, as they might be called. Sufficient reasons for such change have been already cited, but others may be added. Thus it is obvious that four persons cannot arrange or label a museum in a correct manner; they cannot be expected to perform what all the experts in the Academy combined could not succeed in at the present time. While this is a work of specialists alone, the board of curators is only partially composed of special scientists. As having charge of the property, it necessarily includes business men and financiers, so that to two of its members at most must be delegated the proper scientific arrangement and management of the museum. In the light of the functions of the Acaddemy this system is clearly impracticable, and in the light of experience it is proven to be insufficient. While the care of the property should remain in the hands of business men, the arrangement, and above all, the increase of the museum should be in the hands of experts, each in his proper department, as is the case in the institutions of the Old World. To employ one person and an assistant to arrange and label the entire museum is like employing a house-painter to furnish Madonnas and angels by the yard for the inside of a cathedral. And precisely similar results have followed this policy so far as it has been adopted by the Academy, of which it may become necessary to speak at a future time. The gradual concentration of the direction of the museum into the hands of two or three persons is simply choking the mill at the sluice, or the man at his wind-pipe. The class of gentlemen who pursue science as as an alternative to the business which sacrifices to the lares and penates, and those who adopt it as an occasional recreation, will doubtless welcome any

change of organization which will bring new material within their reach, or furnish a source of knowledge not otherwise accessible. Their own rights and privileges can be in no wise curtailed by the proposed creation of nine or ten conservators or professorships, but would remain where they are now. They would, indeed, be enhanced; for the present restriction of the management of the museum to four, or practically two persons, cannot offer the same facilities of introduction and access as in the case of a larger number.

The

Finally, this reorganization should be perfected at once. danger is that our city will be shorn of her strength in this field before many years have elapsed. Several institutions with sufficient endowments will be in working condition before long, if present prospects are realized. I may merely mention one projected in a neighboring Western city, with an endowment of $2,000,000, and others to the south of us. And none of the experts of the Academy could refuse offers from these quarters, if accompanied by salary and opportunities of procuring the materials and aids to original research. E. D. COPE.

ON THE TRAINING OF NURSES FOR THE SICK'

M

ISS NIGHTINGALE, in opening the preface to her "Notes on Hospitals," says: "It may seem a strange principle to enunciate, as the very first requirement in a hospital, that it should do the sick no harm." But she goes on to show that hospitals may be so defective in contrivance and management that their inmates are in many respects placed at a disadvantage in their struggle with disease, or even exposed to new sources of danger; thus being, as it were, betrayed by their own allies.

When, however, we consider the word "nursing," and all that it implies the host of kindly images it calls to mind-it may seem even more strange to say of this service that its first requisite is that it should do its recipient no harm. And those of us who have had the good fortune to find the evils of sickness mitigated by the tender care of skilful nurses, whether bound to them by ties of friendship

1 By John H. Packard, M. D., one of the Surgeons to the Episcopal Hospital, Philadelphia.

or kindred, or serving for wages, may be inclined to doubt the necessity of any further provision in this matter. Let me say here, that in the majority of cases of severe illness, the battle is fought mainly by the nurse. The ablest medical advice may be of no avail, even if carried out, unless gentleness, firmness, care in many details to be hereafter mentioned, tact and common sense, are possessed by the constant attendants of the sufferers. Men there are, as well as

women and children, who have such tenacity of constitution as to conquer even desperate disease, in spite of neglect and even bad treatment; but these are rare exceptions. In the main, the issues are determined in a great measure by faithful and skilful nursing, or the want of it.

Probably few persons have ever asked themselves the question— "How are the sick nursed?" The general answer would be "Oh, by their families, or their servants, or their friends." Fortunately, in many families there are servants who in cases of sickness assume the role of nurses as a matter of course. Their long-tried faithfulness, the reciprocation of kindly feelings and good offices, and the experience they have gained on like occasions, combine to make their services in this capacity both acceptable and efficient. Often, again, the members of a family will take this duty upon themselves, and become by the force of affection skilled in the work. Or a friend will give up all other engagements for such a labor of love, and fulfil the task well.

But there occur many cases in which these resources are wanting, or are exhausted by the demands on them, as in severe and longcontinued illness, or when several members of a household are stricken down at once. How are these to be supplied?

Under such circumstances, the physician, or some friend or acquaintance, is called upon to recommend a nurse. It may be that the choice made in the emergency happens to be a good one; a person of skill and experience is obtained, and all goes well. But it may be that experiment after experiment is tried; a succession of ignorant, noisy, conceited, careless, or even dishonest or intemperate characters come and go, the poor sufferer perhaps losing his life before any one worthy the name of a nurse appears upon the

scene.

This picture is not too strongly drawn. Let me quote from a high authority in England, where for a number of years organized

and earnest efforts have been made to establish a better order of things. The London Lancet, speaking of a report from the subcommittee of the National Nursing Association, says:

"This report shows in detail, and most truthfully, how many lives in all grades of society are annually sacrificed, because persons cannot be found to carry out skilfully and faithfully, as well as tenderly, the advice and directions of the physician. This want affects rich and poor alike. Many of those who live in palatial establishments, and are able to obtain anything and everything that money will buy, have experienced the sad fact that the lives of those nearest and dearest to them have been lost, because the careful conduct of the nursing was not properly provided for. And the same want exists in the homes of the poor.'

So urgently was this need felt in the city about forty years ago, that a nurse society was organized, which is still in active operation; but it is identified with a Lying-in Charity to such a degree as to make the furnishing of nurses, for other than cases of confinement, of necessity a subordinate feature. One or two extracts from its last report will, however, afford some additional evidence upon our present subject. The managers say, quoting from the Report for 1853, published in 1854:

"It is still true that The want of efficient nurses, not only in obstetrical cases, but in sickness generally, is widely felt in our community, and we have constantly been made acquainted with the great difficulty experienced in procuring good nurses, even by those who have the means to pay liberally for their services. The rapid increase of our city makes this want annually greater, and calls for a systematic arrangement by which this most useful occupation, so peculiarly within the sphere of women, shall be opened to such as are naturally adapted to its duties and responsibilities. To train such in the necessary acquirements, and introduce them favorably to notice when deserving, and to supply the demand for nurses, by establishing a communication between them and the public, is one object of our society.""

They say further, speaking of the preceding ten years' work:

"More than six thousand citizens have applied at the institution for nurses, of whom about four thousand have been supplied. The excess of applications for nurses beyond our capacity to supply them, has been a constant and unvarying feature since the founding of the nurse school, verifying the quotation given above from the Report for 1853."

It would be but wasting time to argue at greater length as to the

need of additional provision for the efficient nursing of the sick in all classes of the community. Let us proceed to consider what we want, and how to get it.

The remarks now to be made will have reference especially to the training of female nurses; for the reason that among women we find the best material for the discharge of these duties, and that it would be impossible, except in military organizations, to find such a demand for male nurses as would warrant the establishment of training schools for them. It is indeed extremely seldom that cases occur in civil life, requiring attendance which cannot be given by women; and when a male nurse has been needful, so far as my experience or observation has gone, there has never been any difficulty in obtaining one.

Permit me here to quote from Dr. O. W. Holmes a passage, the aptness of which will, I trust, be apparent, and which may recall to some of us characters that we have had the good fortune to know in real life:

"She had that genius of ministration which is the special province of certain women, marked even among their helpful sisters by a soft, low voice, a quiet foot-fall, a light hand, a cheering smile, and a ready self-surrender to the objects of their care, which such trifles as their own food, sleep, or habits of any kind never presume to interfere with."

As far as natural qualifications go, such a woman would make a perfect nurse; but there are many details which even she would be apt to overlook, unless she had had the benefit of instruction. Training is as needful for a nurse, as for a physician, a book-keeper, or any other skilled laborer.

Our sources of supply of nurses, so called, may be summed up as follows: Sisters of Charity, who, as I have been informed by one of their Superiors, a woman herself of large opportunities for knowledge, have no systematic instruction, but pick up what they can by serving in hospitals; other women who, having been employed as nurses in hospitals, have likewise acquired more or less experience in their duties; women who have taken up nursing in default of other occupation; and monthly nurses who have either temporarily or permanently taken to a more general line of business.

Many of these nurses do their work fairly well; but there is no standard of qualification. I have known one woman who had abundant employment in this city, and was considered an admirable