lying ideas to accomplishments, it will be of interest to review briefly the methods and practical results of the nurses' work to-day. Nineteen district nurses and one head nurse are now at work, the force having been increased by three within the last year.

Below One Hundred and Twenty-fifth Street the city is divided into districts varying in size as the demands of the neighborhood are light or heavy. About half the nurses live in the outlying districts, either in settlements or in the branch house of the Nurses' Settlement on Seventy-eighth Street. The other nurses occupy the house at 299 Henry Street, and all have their headquarters in the front basement room at 265 Henry Street. It was of this room, with its well-stocked cupboards full of medical and surgical supplies of all sorts, that a Johns Hopkins medical graduate once said to me, "It is as beautiful in its way as a Hopkins ward." From this room the nurses start out in the morning on their various rounds, equipped each with a bag made especially for the purpose, and a model of lightness and capaciousness. It contains, in small compass, a supply of cleansing solutions, disinfectants, cathartics, and stimulants, together with such specific tablets, ointments, etc., as may have been ordered by the physician for the patients to be visited during the day; some eight different materials for use in bandaging and dressing wounds; soap, nail-brush, and towels for the nurse's use; a half-dozen instruments, spatula, surgical shears, and three thermometers, together with stationery, bedside notes to be filled out for the doctors, pencil,

etc.

These bags are kept constantly replenished from the general store, which also includes a large variety of special appliances, such as ice-bags, bed-rests, roller chairs, and rubber goods of all kinds, and a stock of sheets, wrappers, baby clothing, etc., some to be loaned and some to be given away.

What has this corps of nurses, thus equipped, accomplished during the past year?

In the first place, during 1904, 4,501 different patients were visited. Of these cases, 2,108, or 46 per cent., were

brought to the attention of the nurses by members of the family of the sick person; 1,160, or over 25.7 per cent., were referred to them by physicians; 603 were brought to their attention by the Good Samaritan Dispensary, and 630 by charitable agencies. In connection with these 4,501 cases, 35,035 nursing visits were paid and 3,524 convalescent visits-visits, that is, made after the termination of a case, in order to keep in touch with the family or to give needed advice and encouragement. In addition, 21,869 so-called 66 first aid " treatments were given-mostly minor surgical dressings, for which patients come to the "first aid " room at the Settlement, where one nurse spends her entire time in this work, or to the headquarters of the nurses in the outlying districts, who carry on indoor as well as outdoor work.

Of special interest to members of the medical profession is the classification of cases according to diagnosis. For 1904 it stands as follows: Unclassified medical....

Pneumonia..

surgical.

Gynecological. Typhoid. Burns.. Contagious.. Rheumatism. Meningitis.

Tuberculosis.

Cardiac.

1,393

548

809

193

174

175

178

177

123

78

160

Figures as to the final disposition of cases are no less interesting. Of the 4,501 cases, 2,375 were dismissed as cured; 609 were placed in hospitals; 502 were turned over to the dispensaries for treatment; 128 were given into the care of special nurses, and 95 were referred to the Board of Health; 361 cases were not taken up, 250 patients died, and 181 unfinished cases were carried over into 1905. Mention should be made, in this connection, of the convalescent home in the country maintained by the

Settlement, which has aided to final recovery many of the patients cared for by the district nurses.

The administration of the nurses' work has been reduced to a system which for completeness and simplicity compares favorably with that of an up-to-date business office. A card catalogue of all cases is kept, the cases under treatment and those which have been dismissed being separately filed. On each card is recorded, first of all, the patient's name (the file being arranged alphabetically on this basis), then his address, his age and occupation, the dates of the first and of the last visits paid him, the diagnosis of the case and the result, the name of the person who reported the case, the name of the physician in charge and that of the attending nurse. The catalogue thus evidently serves two ends-it is the quickest possible means of practical reference whereby the entire history of the case can be looked up in a few moments, and it is a valuable storehouse of statistical data.

The information given on the cards is supplemented by fuller details on the daily record sheets, made out at the close of each day from the records kept by the various nurses in their individual field note-books. On these sheets are entered, in separate columns, in the order visited, the names and addresses of all patients attended during the day, with the time spent in caring for each, and, briefly summarized, a statement of the condition of the patient and of the work done as "complete alcohol bath given," "ulcers dressed," or the like. It is thus evident that to trace the complete history of any case it is necessary to know only the patient's name; for the date of the first visit can be obtained from the record card, and the account of each visit thereafter made looked up in the daily reports of the attending nurse.

A study of these daily reports will assure any one, however little technical knowledge he may bring to the examination, of at least one characteristic of the nurses' work-its thoroughness. Nurses spend frequently an hour and a half and upwards on a single visit; recurrent visits, always two, sometimes three in a day, are made in serious cases;

and while night nursing is never undertaken by the visiting nurses on account of obvious limitations of physical strength, the services of other nurses are frequently secured where needs are imperative. In such cases, as for the regular visits of the district nurse, patients are encouraged to pay a small fee where they are financially able to do so; otherwise, the Settlement funds meet all expenses, except where nurses volunteer their services on special occasions.

Certain distinctions between the different classes of patients treated should perhaps be made somewhat clearer. The families visited are by no means all of the same economic grade. There are, of course, the very poor, who cannot afford to pay either doctor or nurse; but there is also a large class who have a membership in some lodge or benefit society, which entitles them to the services of a private physician; and there are others who can afford to pay for a physician and possibly a night nurse, but cannot meet the expense of a fulltime trained nurse. Members of these two last-named classes are glad to secure the services of a visiting nurse by paying a fee of from ten to twenty-five cents per visit; only patients of the first class are, strictly speaking, charitable cases.

Other and more indirect results, of great value to the tenement dwellers of the city, have followed upon Miss Wald's experiment. Of these may be mentioned the department of nursing established within the last few years by the Board of Health, including the nursing of contagious cases and the nursing of public school children, both of which undertakings are under the direction of a nurse formerly connected with the Nurses' Settlement. The first of these now relieves the Nurses' Settlement of one class of cases with which it used to deal, for the Board of Health has at work a corps of nurses who respond to calls for assistance in any family where there is contagious disease-there being separate" scarlet fever nurses," "typhoid nurses, "measles nurses," etc. The second undertaking has been the means of greatly regularizing school attendance among the children of the poor; for whereas the verdict of an examining

physician that a school child was afflicted with a communicable disease- -as of the eyes or scalp-formerly meant that such a child would be indefinitely excluded from school, without assuring to it any medical or nursing care, or preventing it from associating with other children. after school hours, such a verdict now means that the child will be visited in its home by a nurse, who will administer proper treatment and continue her oversight until the child can safely return to school.

Two other points may well be touched upon in closing. The first is the significance of the Nurses' Settlement as a partial solution of the vast problems confronting the administrators of medical charities in our large cities. The overcrowded condition of New York hospitals, resulting from inadequate funds, and inevitably leading to unsatisfactory treatment of patients, has been much dwelt upon during the past year. Reference has already been made in this article to Miss Wald's conviction that many cases of illness among the poor which now go to hospitals can be as successfully treated in the home, where the physician's efforts are supplemented by those of a visiting This proposition the work of the Nurses' Settlement may fairly be said to have proved. It is, therefore, Miss Wald believes, by the development of the work of district nursing that the hospitals may best be relieved of the excessive demands now made upon them. To what extent

nurse.

A

this would prove to be the case only the most careful study of comparative statistics a study hardly possible for the layman-can reveal. On its face it appears a reasonable view, and one which certainly deserves investigation.

The second point which I wish to dwell upon relates to the general social, as distinguished from the professional, side of the Settlement's work-or, better, to the relation between the two, which constitutes a feature peculiar to this Settlement and distinguishing it sharply from most other settlements with which I am acquainted. The residents have here what settlement residents generally most sadly lack-a definite organic relation to the life of the neighborhood in which they live. They are known first of all as professional nurses, with duties of a perfectly definite and tangible character, regularly and systematically performed. Their other work as club leaders, teachers, or social entertainers is a natural outgrowth of these professional relations, is free from the suspicion of condescension, and rests upon a sound basis of neighborhood ties. The democratic social ideal which so many earnest people are nowadays striving after sometimes seems hopelessly out of reach; but if it is ever attained, it will surely be by developing common interests to a point where the effort involved in bringing into social relations longsundered groups will no longer be obvious to either.

is apt to show later on—that is, how the American girl student becomes a woman, and whether, from the effective, glittering thing she is trained to be, she will be able to be made into a woman, as the sweet tradition of ages would suggest and the swiftly moving times seem to place in doubt, humble, noble, and subdued. For woman's mission is not to be proud herself, but rather to make others proud of her. It is all right to see a girl independent, energetic, buoyant, determined. But this is not all

that we need, and that the Nation needs. There is more call for the traditional than for the advanced feminine type in this busy, teeming world of ours, which needs assuredly more of a restful than of a stimulating influence. It cries out, in the daily tumult and turmoil of life, to the soft-hearted woman rather than to the clear-minded; it craves the firm but merciful influence of the one whose lips open freely in sweet words and smiles, and do not work as a patent lock with an aggressive snap. Now, the intellectual atmosphere which is provided for girls in this country too often seems to steer an opposite course. There is in the life of the present American girl student, who is the American woman of to-morrow, too much missionary work of both intellectual and religious character, too much so-called Christian work, too much useless excitement over humanitarian pursuits which are apt to make distant molehills look like mountains and vice versa, so that minding the business of the heathen Chinee becomes far more attractive to many women than minding their own. Working for distant aims and raising an interest in the affairs of the antipodes is harmless enough theoretically, but is worse than absurd, culpable in practice, while the first duty of woman is to the men, women, and children of her own nation—that is, to those of her immediate circle. Of thousands and millions of such circles the nation is made, and no good woman ought to feel the desire of overstepping the really magic circle of humanity which is inclosed by a wedding-ring. That is why the greatness of nations has been said so many times to depend on women. And although the women of America may, indeed do, claim as theirs the greatness of their Nation, let us remember that America's present greatness is due to her men.

Young American womanhood is too often led to believe that the acme of woman's happiness, and woman's duty even, lies in what is called "to be in touch with the outside world." So that many girls, even when they would rather have stayed at home and been "merely girls," have felt it their moral duty to go to college, get an education and raise an

interest in a lot of things which are at best to the true woman only an acquired taste; and through a false sense of duty are developed into the artificial flower of the amaranthus rather than into the natural flower of the clover. The average atmosphere of such education tends too much to impress upon women the fact that they, merely because they are American women, are able to do everything in the world better than any one else to run the paper better than the editor, the ship better than the captain, the engine better than the engineer; the Nation, forsooth, better than the President. Everything, subtly and unconsciously perhaps, tends to foster conceit, pride, superiority, while for woman the mot d'ordre ought to be submission, devotion, self-effacement. It seems as if the whole intellectual feminine world were crying out to the girls that they are too good for the men-the very men who make themselves slaves to make them queens-that an interest in art, in mission work, in the school-house, in social problems, in bacteriology or the Eastern problem, in anything and everything but the right thing, is the best to be had in life and the highest to which they may aspire to be called. We all remember how some years ago the public parks and the woods were flooded with women who had suddenly evinced some overwhelming interest in birds. The birds are there still now; where is the interest? Truly, the intellectual fad is one of the most dangerous and absurd results of this false intellectual life, which proceeds from the general superficiality of woman's culture, and the gregarious and analytical tendency of her mind. And while this mistaken intellectuality is deplorably small and inconclusive when viewed by the light of the intellectual world at large and its achievements, the American woman's reliance in the excellence of her own achievements is too great. The trouble is with the teachers no less than with the students, if so much second-rate, second-hand, and superficial scholarship obtains here. While we see primary or high school teachers, women without a degree and without any brilliant original work to back them, push into college positions, and get advance

ments on the strength of "having been there so many years," we cannot indulge in fond hopes re public education throughout the country. Let more men and fewer women into the girls' college faculties. It is hard to understand, at least until you have lived in the midst of men's work and breathed the breath of men's activity, how necessary it is that woman's education should not be formed exclusively by women. Girls have naturally the woman's standpoint in themselves and around them in their classmates and friends; that is quite a good deal. Let them have the standpoint of men, and let the synthetical habit and judgment of man's mind control and counteract the feminine quality of their work. The memory of the American girl student, for instance, runs too much to words and to the habit of recitation from a certain text. She also studies chiefly because she is expected to recite an attitude of mind wholly too childish and mechanical for a serious student, and yet characteristic of woman's work. What the girl student needs is a training that leads her toward the wider and deeper appreciation of facts and items of knowledge; what she lacks is the more general idea, the broad substratum of culture and information, the enlivening spirit of scholarship. Her attention to the precision of details ought to be called upon only in the second instance. But then, again, how can the poor student grasp the synthesis, if the teacher herself does not know the way to it? How can she be expected to command extended and original views, when the teacher carefully prepares her lesson over some text-book before going to recitation, and plods her way only a few feet ahead of that of the student?

There is a too popular prejudice in education that the teacher who takes greater pains with her work is the one who does best work. Nothing of the kind—at least in the world of advanced scholarship. Such a rule is not always good even for the student-never for the teacher. In the teacher's case the pains was to be taken while she was a student, and must not appear in her work as a teacher. You remember the story of the German princeling for whom a great

artist completed a sketch in about twentyfour hours, asking, however, several thousands for it. The prince having expressed his astonishment," 'My lord," quoth the artist, "pray consider that it has taken me twenty-four years of training to produce such work in twenty-four hours." The princeling paid.

And there is something in the witty artist's answer which ought to be deeply meditated upon by all trustees of educational institutions in the country. The teacher who has to learn her lesson just before she teaches it ought to go for good and learn some more. For only when she is entirely satisfactory can we set to work upon the student. When a business plant does not prosper, we do not dismiss the office-boy; we see what's the trouble with the head man first.

On the other side, let us discriminate clearly between the kind of thing that we want to eliminate and the one that we want to emphasize. The kind of culture that woman is apt to get now is the worst thing that she possibly could be burdened with. If a woman knows very much, she will readily find poise, and revert by natural reactions to the primeval truths of the womanly soul. If, however, she knows only enough to be conscious of it, then she slips into the conviction that she knows it all, and there comes the trouble. And she never will acknowledge it, which makes the trouble worse. The superficially learned woman stops at the stage of artifice. The deeply learned woman returns to the natural essence of simplicity through the very essence of art. If the intellectual woman is a necessity of our times, let her be absolutely and perfectly such; she will only be the more womanly for it. But we certainly will not reach this ideal result by our present methods. So far as college education is concerned, I doubt whether it is well to inclose a girl student, through four years of her life, in the narrow circle of an academic village, which remains no less a village even if it is within or near a large citythe worse when farther removed-and which generally comes as short of scholarly seclusion as it does of real life. Anyhow, there ought to be more time given up to study in the ideal education