vi. I do not overlook the fact that honest certificates, especially if

annually renewed, might give the matrons some perplexity, from reasons which need not be enlarged upon. Still, it seems to me, it would be well worth trying.

IV. RULES TO BE FOLLOWED IN GIVING ASSISTANCE.

Lastly. With regard to rules to be followed in giving assistance of whatever kind.

[Sidenote: Need of Advice with a view above all to Security.]

It seems to me most important that we should obtain the opinions both of hospital authorities and of a few able men of business, before laying down rules. The whole matter is so essentially mixed up with the tangible point of securing that the savings of these poor women should avail them in their age, that it is urgent to have sound practical advice as to letting nothing else imperil this. Security seems the cardinal point of the whole, and that is a question for men of business to answer.

[Sidenote: Suggestions in detail.]

The following suggestions toward obtaining it are offered.

1. Security of invested savings to be the first and main thing to be secured. Every other object should be subordinate to this.

2. If we decide upon aiding their savings, let the security of this aid be the main point. Invest all donations, annual or not; unless, should any hospitals contribute annually, it might be fairly considered that those contributions should be annually used.

3. The aim should be to enable all hospital nurses, of good character, to provide annuities for themselves, whether with or without assistance. I think assistance will be necessary.

4. Also to enable private and monthly nurses, and midwives, to do the same, but without requiring the certificate of character, which, not to be a mockery, ought to be an effectual one; and these persons are not under a fixed superior.

5. The pensions should, if it be possible, range from £13 or £15 a-year to £50 a-year: say £13, £20, £30, £40, £50.

6. Each hospital nurse to produce, before being allowed to join the Fund, a certificate from her matron of chastity, general good conduct, and a statement as to her being unmarried, married, or a widow, also of her having served in one hospital not less than a year. Also her marriage certificate, if a wife, and, if a widow, that and the certificate of her husband’s death. In the event of her marriage or re-marriage afterwards, the marriage-certificate to be produced, and her altered name and the fact of her marriage duly recorded in the Fund-book. (All this is important: aliases and fictitious marriages are sadly common, in this class).

7. If possible the certificate to be produced once a-year, and, on its failure, the contributor to cease to have a title to assistance. _Assistance_ in the form of an addition to the annuity may be made _contingent_; the annuity which the premiums provide must be absolute: most of the vices tend to shorten life, that is, to diminish the number of annual payments, so that the fund would not be likely to incur losses through them.

8. Private and monthly nurses, and midwives, to produce, before being allowed to join the Fund, a certificate from the Clergyman of the parish, stating his belief that the subscriber is a respectable woman, unmarried, married, or a widow; and in the latter cases, marriage and death certificates. On any after-marriage or re-marriage, certificate to be produced and altered name registered, on pain of expulsion from the Fund. I should not attempt an annual certificate for this migratory and “independent” class.

9. Each nurse, before being allowed to join the Fund, to undergo whatever examination is undergone by women before they are allowed to effect Life Insurances, as to her being, at the date of joining, a healthy woman. (Physicians ought to advise here as to inserting provisions technical enough to be effective).

10. Payments to be made weekly, monthly, quarterly, or annually, as shall be advised. Amounts to run from 6_d._ or 1_s._ a week upwards. For the plan to work, it ought to allow small payments on an ascending scale.

Many will only be able to make very small payments.

Few will be able to make other than small payments.

11. Payments made by a subscriber dying before attaining pension to be devisable by will, and in case of intestacy, divided among next of kin.

12. All possible safe curtailment of office expenses.

13. Treasurers, or equivalent civil chiefs, of all hospitals that subscribe, to be on the committee or council, or by whatever name the equivalent may be termed.

V. PROSPECTS OF EVENTUAL SUPPORT.

[Sidenote: Support by the Nurses themselves.]

1. I believe that many head-nurses would thoroughly appreciate and thankfully avail themselves of such a Fund.

2. I think that many nurses would do the same, and, in time, many more. Many cannot contribute to it; many will not.

[Sidenote: Support from the Hospitals.]

3. What aid the hospitals might be disposed to give I do not know. I rather think none at first. If the thing works and works well, I think they would probably contribute. But it must never be forgotten that, excepting the endowed hospitals (the financial position of St. George’s I do not know) the London hospitals find their income scarcely sufficient, often not sufficient, to meet their expenditure. They cannot be expected, nor would they perhaps be justified, to curtail the number of the sick they relieve, in order to provide for the superannuated nurses of those sick. It is true, however, that it might enable them to get better nurses, which is surely economy.

[Sidenote: Support from the Public in general.]

4. I do not think that much lasting public interest is likely to attend the Fund. The interest the public has, for the last few years, taken in hospitals has been fictitious and almost mischievous. The public can never really know what hospitals are, nor is it feasible or desirable that it should. What eventual good may be done in them must be done quietly and with great patience. What good may be done among the nurses must be done by infusing, if it may be, a higher and truer spirit of duty, by increased discipline and protection, and by ameliorating, in some material points, among which the aim contemplated by the Fund ranks very high, a condition which, to the end of time, must remain severe, rough, dangerous, and in all senses trying. In the details of all these things, most especially in all that concerns discipline, which involves protection, the public, with the best intentions, will only be an obstacle, and John Bull is sadly prone to pull up anything he plants or anything he waters, to see how it grows.

I think anything like appeals to or solicited support from the public might, in various ways, seriously embarrass the Superintendent of a very difficult and a very important though, at the same time, a very humble branch of Her Majesty’s Service. I should be very anxious to avoid this: it would be perpetuating the evils of publicity, and sacrificing the greater good for the lesser.

[Sidenote: Necessity of Advice.]

5. In conclusion I again submit that it would be desirable to ascertain from the hospital authorities above mentioned, and if possible from three or four able and honest men accustomed to business, their opinion as to the scope and details of this plan. In matters of spirit and of discipline we should probably rely on other judgment; but these are matters of business; and in which, without binding ourselves to follow, it seems most important to obtain and to weigh, the opinions of men long conversant with business.

_January 23, 1858._

NOTE AS TO THE NUMBER OF WOMEN EMPLOYED AS NURSES IN GREAT BRITAIN.

To show the importance of an Institute for Nurses, it must be stated that 25,466 were returned, at the census of 1851, as nurses by profession, exclusive of 39,139 nurses in domestic service,[24] and 2,882 midwives. The numbers of different ages are shown in table A, and in table B their distribution over Great Britain.

To increase the efficiency of this class, and to make as many of them as possible the disciples of the true doctrines of health, would be a great national work.

TABLES OF AGE AND DISTRIBUTION.

TABLE A.

GREAT BRITAIN.

AGES.

| NURSES. | Nurse (not | Nurse | |Domestic Servant)|(Domestic Servant)| +--------------+-----------------+------------------+ | All Ages. | 25,466 | 39,139 | +--------------+-----------------+------------------+ |Under 5 Years.| ... | ... | +--------------+-----------------+------------------+ | 5 — | ... | 508 | +--------------+-----------------+------------------+ | 10 — | ... | 7259 | +--------------+-----------------+------------------+ | 15 — | ... | 10,355 | +--------------+-----------------+------------------+ | 20 — | 624 | 6537 | +--------------+-----------------+------------------+ | 25 — | 817 | 4174 | +--------------+-----------------+------------------+ | 30 — | 1118 | 2495 | +--------------+-----------------+------------------+ | 35 — | 1359 | 1681 | +--------------+-----------------+------------------+ | 40 — | 2223 | 1468 | +--------------+-----------------+------------------+ | 45 — | 2748 | 1206 | +--------------+-----------------+------------------+ | 50 — | 3982 | 1196 | +--------------+-----------------+------------------+ | 55 — | 3456 | 833 | +--------------+-----------------+------------------+ | 60 — | 3825 | 712 | +--------------+-----------------+------------------+ | 65 — | 2542 | 369 | +--------------+-----------------+------------------+ | 70 — | 1568 | 204 | +--------------+-----------------+------------------+ | 75 — | 746 | 101 | +--------------+-----------------+------------------+ | 80 — | 311 | 25 | +--------------+-----------------+------------------+ |85 and Upwards| 147 | 16 |

TABLE B.

AGED 20 YEARS OF AGE, AND UPWARDS.

| | Nurse | Nurse | | | (not | | | | Domestic |(Domestic | | | Servant) | Servant) | +----------------------------+----------+----------+ |Great Britain and Islands in| | | | the British Seas. | 25,466 | 21,017 | +----------------------------+----------+----------+ | | | | |England and Wales. | 23,751 | 18,945 | +----------------------------+----------+----------+ | | | | |Scotland. | 1543 | 1922 | +----------------------------+----------+----------+ | | | | |Islands in the British Seas. 172 | 150 | +----------------------------+----------+----------+ |1st Division. | | | | London. | 7807 | 5061 | +----------------------------+----------+----------+ |2nd Division. | | | | South Eastern. | 2878 | 2514 | +----------------------------+----------+----------+ |3rd Division. | | | | South Midland. | 2286 | 1252 | +----------------------------+----------+----------+ |4th Division. | | | | Eastern Counties. | 2408 | 959 | +----------------------------+----------+----------+ |5th Division. | | | | South Western Counties. | 3055 | 1737 | +----------------------------+----------+----------+ |6th Division. | | | | West Midland Counties. | 1225 | 2283 | +----------------------------+----------+----------+ |7th Division. | | | | North Midland Counties. | 1303 | 957 | +----------------------------+----------+----------+ |8th Division. | | | | North Western Counties. | 970 | 2135 | +----------------------------+----------+----------+ |9th Division. | | | | Yorkshire. | 1074 | 1023 | +----------------------------+----------+----------+ |10th Division. | | | | Northern Counties. | 402 | 410 | +----------------------------+----------+----------+ |11th Division. | | | | Monmouth and Wales. | 343 | 614 |

NOTE AS TO TEACHING NURSING.

There is, at Madras, an Institution called the Military Female Orphan Asylum, which trains 200 orphan girls, daughters of European soldiers. They enter in infancy, and, as they attain a proper age, they are married to soldiers or others. There is always an abundance of applicants for them, and every endeavour is made to train them to be useful soldiers’ wives. Dr. MacPherson, the excellent Principal Medical Officer of the Turkish Contingent, when at Kertch, who is now in charge of this Asylum, was the person, I believe, who introduced amongst the senior girls, a system of training, to enable them to officiate as nurses, an all-important element in their education. Below is a syllabus of the theoretical branches taught, a practical knowledge being acquired in the Hospital attached to the Institution. It would be well if all women underwent a similar training.

_Course of Instruction for the Class of Sick Nurses, at the Military Female Orphan Asylum._

Popular and Regional Anatomy and Physiology.

A general knowledge of the human body, its various organs, and their uses.

Sanitation.

To be made acquainted with every subject relating to health, viz.: Food--Exercise--Clothing--Cleanliness--Ventilation, &c.

Sick-room Management.

Administration of Medicines, Application of Leeches, Lotions, Fomentations, &c. Cleanliness, Darkening of the Apartment, Quietness, &c. Cooking for the Sick. Diet for Infants.

Household Medicine and Surgery.

To be taught how to act in emergencies, viz.: in cases of Fainting--Hysterics--Convulsions of Children--Burns--Stings of Insects--Wounds, &c.; and the simplest mode of treating the diseases most commonly met with in India, viz.:

External Inflammation, Cholera, Fever, Dysentery, Sore Eyes, Bowel Complaints, Cutaneous Eruptions.

How to prepare Poultices, Fomentations, and Lotions. ″ dress Wounds, Sores, and Blisters. ″ apply Bandages.

FOOTNOTES:

[21] If the sisters and nurses, as a rule, were fed as well as lodged at all the Hospitals, &c., the class of women would, in a very short time, be entirely changed; this kind of employment would not then, with the reduced money payment, be so much an object of desire to widows with families, particularly if compelled to subscribe to a pension fund, which should be compulsory.

[22] At first it would be unwise to attempt too much. If extended to Her Majesty’s dominions or private nurses, it would be almost impossible to control abuses.

[23] Every institution ought to provide for its nurses during illness, but in fact it is not done.

[24] A curious fact will be shown by Table A, viz., that 18,122 out of 39,139, or nearly one-half of all the Nurses, in domestic service, are between 5 and 20 years of age.