order of St Vincent de Paul, founded in 1633 for the express purpose, is still the largest nursing organization in the world. Even in Protestant England, where purely secular training schools have reached their highest development, the generic title of Sister, alike prized by its holders and honoured by the public, remains the popular and professional synonym for head nurse, and perpetuates the old association. Nursing, as a popular or fashionable occupation, is not a modern invention. Sir Henry Burdett quotes an order, dated 30th May 1578, directing the master and the prior of the Hôtel Dieu “not to receive henceforth any novices without speaking of it to the company, because there are an excessive number of nuns and novices, who cause great expense to the said Hôtel Dieu.” In Protestant countries a secular nursing system came in with the Reformation. The staff appointed for St Bartholomew's, on its re-establishment by Henry VIII. in 1544, consisted of a matron and twelve nurses, who were engaged in domestic occupations when off duty. Thus nursing became a menial office and an inferior means of livelihood, adopted by women of the lower orders without any training or special skill; and so it continued down to the middle of the 19th century, when a new movement began which was destined to revolutionize the status of the nurse.
Its distinctive feature was the systematic training of nurses for their vocation. Previously a certain amount of regular instruction had no doubt been given here and there by individual physicians and surgeons; lectures to nurses were delivered in the New York Hospital as early as 1790. But these were isolated efforts. Such skill as nurses possessed was picked up in the wards. No qualifications were required, nor indeed would they have been forthcoming, so low had the calling sunk in public estimation. The credit of inaugurating the new order of things belongs to Germany, and here again the religious influence came into play. The beginning of the modern system dates from the foundation of the institute for training deaconesses at Kaiserswerth by Pastor Fliedner in 1836. It is true that state training schools for male nurses had previously existed in Prussia, the oldest having been founded at Magdeburg in 1799; but the employment of men in hospital wards is a feature of the German system which has not been copied by other advanced countries, and seems to be in process of abandonment in Germany. It is a heritage from the middle ages, when the Knights Hospitallers undertook for men the duties discharged in female institutions by the nuns. The male schools, therefore, stand somewhat apart, though they mark a stage in the evolution of nursing as the earliest regular training establishments. The Kaiserswerth Institute, on the contrary, had a far-reaching and lasting influence, and may fairly claim to be the mother of the modern system. England, in particular, owes much to it, for there Florence Nightingale acquired the practical knowledge which enabled her afterwards to turn her remarkable gift of organization to such brilliant account. The example of Kaiserswerth was soon followed, and not in Germany only. In 1838 the Society of Friends founded a nursing organization in Philadelphia, and in 1840 Mrs Fry, a member of the same community, started the Institution of Nursing Sisters in London. In 1857 the nurses attached to it numbered ninety. They received their practical training at Guy's and St Thomas's Hospitals. On the continent institutes for nursing deaconesses were founded at Strassburg, Utrecht, Berlin, Breslau, Königsberg and Carlsruhe between 1842 and 1851. In London a Church of England training institution (St John's House) was opened in 1848. There were three classes—(1) sisters, (2) probationers, (3) nurses. The nursing at King's College Hospital was for many years undertaken by this society, whose members were trained at the hospital.
The training system, thus inaugurated on a semi-religious basis, received a new impetus from the Crimean War, which was further emphasized by the Civil War in America and the subsequent great conflicts on the continent. The despatch of Florence Nightingale with a staff of trained nurses, to superintend the administration of the military hospitals was the direct result of the publicity given to the details of the Crimean War by The Times, and it formed a new departure which riveted the eyes of the civilized world. The work undertaken and accomplished by this lady was far more important than the mere nursing of sick and wounded soldiers. She had grasped the principles of hygiene, which were then beginning to be understood, and she applied them to the reform of the hospital administration. In civil life it had a marked effect in stimulating the training movement and raising the status of the nurse; but substantial results were only obtained by degrees. It was not until 1860 that the modern hospital school system was definitely inaugurated by the opening of the Nightingale Fund School at St Thomas's Hospital, founded with the money subscribed by the British public in recognition of Miss Nightingale's national services, and worked on principles laid down by her. In the meantime several nursing societies, in addition to those previously mentioned, had been founded in England, and elsewhere. Among them the Baden Ladies' Society, founded in 1859 by the Grand Duchess Luise, deserves mention. In the same year the first district nurse began work in Liverpool; and in 1865 the reform of the much-neglected workhouse nursing was inaugurated by Miss Agnes Jones and twelve nurses from St Thomas's, who took up the work in Liverpool. At this time England took a decided lead, which she has never lost. Other countries gradually followed. In Germany the Albert Nursing Society was founded by Queen Carola of Saxony, and the Alice Society by the Grand Duchess Alice of Hesse, both in 1867. In France, where the nursing was comparatively well performed by the religious orders, no change was made until 1877, when a training school was opened in Paris by the municipality, and two others by the Assistance Publique, in connexion with the Salpêtrière and Bicêtre Hospitals. In the United States schools were opened in New York, New Haven and Boston in 1873. The British colonies, Austria, and other European countries followed some years later.
It remained for the third influence to complete the work begun and to develop systematic nursing to its present dimensions. Since 1880 the increasing demands of medical knowledge have well-nigh revolutionized the craft in the home, the hospital and the workhouse. A large part of the change may be summed up in the words “scientific cleanliness.” The outcome has been to raise the dignity of the calling, to induce persons of a superior class to adopt it in increasing numbers, to enlarge the demand for their services, and to multiply the means of educating them.
Nursing does not appear to be regulated by law in any country, though attempts in this direction had been made in Training and organization. England.[1] Its organization is voluntary, and even in state or municipal institutions is dependent on the direction of the administration. In Great Britain nearly all the general and special hospitals and many of the poor-law infirmaries offer systematic professional training to nurses. The provisions differ considerably in detail, but in the larger schools the system is uniform in all important respects. Candidates must be between 23 (sometimes 21 or 22) and 35 years of age, and must produce satisfactory evidence of character, education, health and physique; after a personal interview and one, two or three months' trial they are admitted for three years' training. During this period they receive regular instruction in theoretical and practical knowledge, and have to pass periodical examinations. At the end of it they are granted certificates and may serve as staff nurses. They pay no premium, and generally receive a salary of £8 to £12 in the first year, rising annually to £30 or £35 as staff nurse, and subsequently to £40 or £50 as sister or head nurse. They live in a home attached to the institution, under a matron, and in the most modern establishments each nurse has a separate bedroom, with common dining and recreation rooms. Private nursing staffs are attached to several of the hospitals; they are recruited from the staff nurses and probationers on completion of their course, and supply nurses to private patients. In the special
- ↑ In 1902 an act was passed to establish a Central Midwives Board and regulated the training and employment of midwives.
