THE PRESENT CRISIS AT GUY'S HOSPITAL.

THE affairs of one of our largest hospitals are at this present time occupying an unusual share of public attention among Londoners generally, and among medical men particularly. The struggle now going on at Guy's Hospital, and which may be shortly stated to be a difference of opinion between the Treasurer and the Medical Staff as to the way in which the nursing in the hospital shall for the future be conducted, and which has been referred to the Governors of the Institution for final settlement, is not by any means one of the merely local and passing storms by which from time to time all large institutions containing men with conflicting interests bound up more or less in those institutions are convulsed. The matter ought, I think, to be looked upon as having a wider significance than is generally supposed. It is not a mere quarrel over the patients in Guy's Hospital; in point of fact it is rather a typical struggle, showing symptoms of a combined and resolute attempt on the part of the medical profession generally to retain the old system of employing untrained women as nurses in our hospitals, instead of making use of the trained labour which is now at their disposal in this special branch of work.

In the largest institution of the kind, the London Hospital, the old system is still in full force, and until November last it was maintained in Guy's Hospital. Perhaps it may be well to state what constitutes the difference between the old and the new systems of nursing. Until comparatively lately our hospitals have been nursed by women drawn mainly from the class to which the domestic charwoman belongs, who, having received no kind of training whatever, were, perhaps, first taken into the hospital, after a superficial inquiry, or no inquiry at all, had been made into their character, in the position of scrubber or ward-maid, in order that they might see and learn, as well as they could, what went on there; or perhaps they were received at very small pay, or none, as a probationer or assistant nurse, to help in the work of nursing patients. At the end of three months, less or more, according to the convenience of the matron, and at the recommendation probably of the head nurse or sister of the ward, these women would be promoted to the position of head nurses themselves-having learnt, it is true, all that their superiors were able to teach them about the art of nursing, but being totally without experience of their own. Physically and morally untrained as they were, they were then immediately liable to be put in charge of patients who were more or less seriously ill, by day or by night as the case might be; the main duty which was inculcated on them from their first

acquaintance with hospital work being that they must study the character and special requirements and fancies of the particular medical man or surgeon under whom they were placed, with a view of gaining his approbation by every means in their power.

The day nurses were seldom if ever allowed to be absent from the ward when the medical officer came his rounds; therefore the only time at which they could obtain air and exercise was after nightfall, when the visits of the medical staff were over and their day's work was ended. Their meals, sometimes with the single exception of dinner, were taken in the kitchen or day-room of the ward. In the evening, by arrangement with the matron, who was a kind of upper servant or housekeeper, the lower order of nurse, or scrubber, was left in charge of the patients, while the old-fashioned head nurse went out to take her hardly earned holiday, too often, alas! in the nearest public-house. She came back at the regulation hour, more or less the worse for drink as the case might be, and went to bed to sleep off the effects of it; no inquiry was made into her condition, since it was nobody's business, as long as she satisfied the medical men by the work which came under their notice, to ask how her hours off duty were spent, or what her own moral condition might be.

I am far from saying that every nurse under the old system was drunken or dissolute, but I do say that, as a rule, their moral character was unsatisfactory, and that the long hours of work, with no regular interval allowed during the daytime for proper air and exercise, together with the practice of eating their food in the impure air of the wards, render the supporters of the old system largely responsible for the low moral as well as physical condition of the nurses who work under it. It is obvious that in an article like the present, details of nursing would be out of place. It ought, however, to be equally obvious, without going into details, that a woman untrained, undisciplined, and overworked, such as I have described, however intelligent she may naturally be, is not in any sense of the word fit to be called a nurse.

So much for day nurses under the old system. A few words about night nurses must be added. These were even more hardly dealt with in the matter of long hours and work than the day nurses, and they accordingly revenged themselves upon the authorities by sleeping whenever they were pretty safe from the chance of a visit from the house doctors to the ward, regardless of the wants and dangers of their patients, of whose pillows and blankets they often made free use for their own convenience and comfort. A medical man told me that when he was a student at St. Bartholomew's, a patient who had only had on six leeches was left, in consequence of this practice of the night nurses, to bleed to death. At certainly one large hospital, probably at others, no food whatever was allowed for the nurse's use during the night. She was fed during the day, and was supposed to be able to provide her own provisions for the night out of her small

wages. The consequences of this arrangement are not far to seek; the nurses helped themselves from the patients' private store of food, and, whenever it was practicable, from the patients' allowance of wine or spirits as well. Those nurses who were not too sleepy, sometimes occupied themselves in washing their own clothes in the wards, thus converting the hospital into a drying-ground for the benefit of the patients.

The main duty of the day nurse, which was noticed above, that of attendance upon the visiting medical staff, never of course devolved upon the night nurse. Therefore a still lower and less intelligent class of women might with propriety, it was thought, be employed on night than on day duty, and constantly very aged and feeble, to say nothing of hopelessly drunken, women were considered fit for nothing else but this branch of duty. They perhaps remained on night duty for years without intermission, except a short holiday. The day and night nurses were a distinct class. If the night nurse ́ became ill, or otherwise unfit for her work, she would apply and obtain leave from the matron or superintendent to hire,' as she called it, to do her work. By this means she was enabled to spend the night in resting herself, while a charwoman friend, who had probably been at work all day already, looked after the patients and gave (or did not give ?) medicines, wine, and brandy, under occasional direction from the nurse herself. The wages of both night and day nurses varied from 16l. to 22l. per annum, according to the rules of the institution to which they might be attached. :

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Both kinds of nurses were under the direct control of a woman, called the sister,' in each ward. Under the old system it was necessary for her to be little more than an experienced housekeeper. She had charge of the linen, and herself superintended a great deal of the cooking; she received the orders of the medical men with regard to the patients; she was responsible for the punctual administration of their medicines; she kept and gave out the wine and spirits ordered by the doctor, and either partook of them or not herself as she felt disposed. She was responsible for her patients during the night as well as during the day, and was liable to be roused from sleep at any moment, should an emergency arise. was unusual for a 'sister' to be moved from one ward to another, and therefore in course of time, if she were at all an intelligent woman, in spite of a want of general education and a total absence of any special training in the work of her calling, she would become expert in various ways, especially in attendance upon the medical staff, and in prompt and skilful obedience to their orders. She would learn to watch critical cases in the doctor's absence, and to act with ability under his orders. After some years at her work it would be strange indeed had she not accumulated a certain amount of experience in the treatment of various diseases of the particular kind she may have had to deal with in her own ward. But all this time she must have remained in absolute ignorance of the first principles of nursing the sick; forshe had never

seen nursing practised, much less had she been taught to nurse herself. She was therefore not only wholly incapable of training her nurses and probationers, but she was unaware of her own ignorance, and would, in all good faith, have called herself a thoroughly trained nurse.

So much for the old system, of which, however, I have been able to give little more than a sketch. Let those who desire to know more of it go into the wards of any of the great hospitals where it is still at work. Less need be said about the new system, because in these days, when nursing is rapidly becoming a fashionable mania, and books about the subject are widely read, the principles of modern nursing are pretty well known. Had the old system ever been as well understood by the public, our hospitals would all of them by this time have been placed on a better fouting. Under this new system of nursing, such, that is, as prevails in St. Thomas's, King's College, Charing Cross, and possibly other Hospitals, no woman is considered qualified to be put in charge of any patient, i.e. to be head nurse, until after one, two, or three years' probation. She must have had a good general education, and bear an excellent character, before she be admitted into the hospital, and she then receives during her probation regular and severe training in her work, and in all the details of nursing, from women who have been themselves thoroughly educated and trained. If she show herself to be in any way unfitted for the calling of a nurse, she is dismissed at the end of a month; if she remain and become a head nurse she receives wages like those of the nurses under the old system. But she has besides her dress given her, a uniform which she is required always to wear, in order that she may be recognised everywhere as belonging to the institution to which she is attached.

She has regular hours appointed to her during the daytime for air and exercise, and is rarely if ever allowed to leave the hospital after nightfall. Hence she is constantly absent during the visits of the doctors to the wards, and the nurse next in order takes her place, and thus learns her duty gradually. She takes her meals in a special room appointed for the purpose, and has sufficient time allowed her for them. In her case the temptation to drink spirits to which hard work and bad air combined are liable to lead, is, as far as possible under the circumstances, removed. Should she yield to it, however, she is considered as no longer fit for her calling, and is dismissed from it by the authorities.

The conduct and management of the ward, together with the absolute control of nurses and probationers, are in the hands of the 'sister.' She is a woman of good general education, besides that she must have passed satisfactorily through the regular course of probation and severe training in every department of hospital work, and be fully competent therefore herself to train her probationers, and to be responsible for the work of her head nurses. The cleanliness and due ventilation of the ward are her charge, the care of the linen, the more refined part of the cookery, the administration of

medicines, and the receiving and carrying out of the orders of the physician or the surgeon of the ward. But if in the proper sense of the word she be really a 'sister,' she regards the moral and physical welfare of her patients, nurses, and probationers, and the general tone of the ward, as her main duty and responsibility. To this end it is desirable that she be not only a gentlewoman by birth and education, but a thorough woman of the world as well; able to enter into and to deal with the wants and difficulties of men and women of diverse dispositions; to understand, and intelligently, loyally, and faithfully to carry out the orders of the physician or the surgeon, having regard to the spirit as well as to the letter of his injunctions. Above all she must be able to put some degree of her own spirit into those who work under her. She is, and ought to be, a paid officer of the hospital, like the sister under the old system, and whether she need a salary or not does not of course affect this question.

She is not responsible for her patients during the night, but she delivers a report of their condition to a night 'sister,' or superintendent, also a highly trained and educated woman, who is in charge probably of the whole number of patients contained in the hospital during the night, and is responsible for the conduct and discipline of the night nurses. Under the new system, these women are strictly obliged to spend a certain number of hours in bed during the day, and are forbidden, under pain of dismissal, like soldiers at their post, to sleep during the night. Proper food is provided for them by night as well as by day, and thus the temptation to steal the patients' food is removed from them. The night and day nurses are all one class, recognised only as regularly trained head nurses, and they take it in turns to perform night and day duty. In some cases the sisters' also take it in regular turns to act as night superintendents.

The sisters' are liable to be moved from ward to ward at the convenience of the matron, in order that they may understand the superintendence of both surgical and medical wards, that they may be accustomed to the ways and requirements of different medical men, and that they may thus be the better fitted for their work, and able, if need be, in their turn to fill the responsible post of matron in a large hospital.

I call this a responsible post, because the matron, superintendent, or whatever she may be called, ought invariably to be a gentlewoman, possessing what are perhaps the rarest of all qualities, true tact and discernment. It is scarcely necessary to say that she must be a highly trained nurse, and must have acted as a sister herself. As soon as she becomes matron, the very word suggests what is expected of her. She is the mother' of the members of the nursing staff. Just as the medical men are absolutely supreme with regard to the general treatment of the patients, their diet, medicines, &c., so is the matron the supreme authority with regard to the general rules of the nursing. The discipline of the whole nursing staff, and the care of the moral and physical well-being, as well as the thorough