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instructions of the medical officer must have authority to do so, and resistance to that authority must be treated as a breach of discipline.
To put this upon a right footing from the first, would be indispensable to success. The more a nurse does by influence, and kindly influence, the better; but dealing with the promiscuous inmates of a workhouse, the knowledge that there is authority in reserve to be exercised if necessary, prevents the necessity of resorting to it, and makes the patients duly appreciate the kindness which keeps it in reserve.
With regard to all such matters, a great deal will depend upon the good-will, the good sense, and good feeling of the Governor and Matron, but especially of the Governor. He can do much to promote or to mar the success of the experiment, and so can the medical men; but if they be men of sense and right feeling, they cannot fail to perceive how vast an addition to their own comfort the permanent establishment of such a system as you propose to introduce experimentally, must produce.
The position of a medical man dependent for the execution of his instructions upon nurses who are neither intelligent nor trustworthy, is very painful, and tends to deteriorate his own character, both as a man and as a practitioner, by rendering him callous to preventible suffering which he is denied the proper means of relieving, and by compelling him to forego the use of remedies which require intelligence and conscientious care in administering them. The house Governor, if he be a conscientious man, must be kept in continual anxiety about the conduct of ignorant, and often worthless pauper nurses in the hospital, and is driven at length to be satisfied with a low moral and intellectual standard in the nurses, and a corresponding standard of care and comfort in the hospital.
The Select Vestry took the subject into their serious consideration, and instituted most careful inquiries in various quarters. Among other steps, they called for
