ADDRESS TO THE GRADUATES OF THE LONG ISLAND COLLEGE HOSPITAL TRAINING SCHOOL FOR NURSES, DELIVERED JUNE 12, 1888.
BY GEORGE G. HOPKINS, A.M., M.D.
Ladies and Gentlemen and Class of 1888: We are apt to claim the trained female nurse as the outcome of the more rational treatment of disease, in modern times, but this is wide of the truth. So far as I can ascertain, in my researches among the ancient Vidas of Hindostan, and the literature of Egypt, Greece and Rome, I find no allusion to female nurses as a class, until the third century of the Christian era. Surgery and medicine had attained a high degree of perfection, many operations which to-day we claim as new to the nineteenth century were successfully performed 4,000 years ago; but the special nursing of them seems to have been done by the medical student, or by the practitioner himself. The earliest record I can find of women devoting themselves to the care of the sick, and attending to all the duties of a trained nurse, is that of Empress Helena, mother of Constantine the Great. This noble woman, who lived nearly fifteen hundred years ago, not only founded a hospital and endowed it, but herself, with the ladies of her court, there gave the most devoted and tender care to the sick poor. The Emperor Valens presented the most beautiful grounds and buildings in the neighborhood of Cæsarea to Archbishop Basil, “for the benefit of the poor whose bodies were afflicted with disease,” as being those who stood most in need of assistance. And as early as A. D. 373, the Archbishop had organized at Cæsarea an immense hospital, called the “Basilides,” which Gregory Nazienza thought worthy to be recorded among the wonders of the world; so numerous were the poor and sick who came thither, and so admirable was the care and order in which they were served. The charge of these sufferers was not at first assigned to humble hands; the most illustrious ladies of the empire participating in the offices of mercy.
At Constantinople the Empress Flacilla, wife of the elder Theodosius, in the year 380 was watching with solicitude over all those whose bodies were mutilated, or who had lost limbs. She visited them in their own dwellings, waited upon them herself, and supplied their wants. She repaired with the same zeal to the public hospitals of the church, where she attended the sick, made ready their culinary utensils, tasted their broth, carried the dish to them, broke the bread, divided the meal, washed the cups, and performed for them all the offices which usually devolve upon servants. One might justly be proud to be in such royal company, and regard, as she did, nothing degrading which is necessary to be done for a sick patient.
In modern times, the revival of nursing by trained women is due in great measure to that noble and accomplished woman, Florence Nightingale. As early as 1844, at the age of twenty-one years, she began to exhibit her interest in and the alleviation of suffering, and the improvement of the care of the sick poor in the hospitals of Great Britain. She visited and inspected the hospitals of Europe, and in 1851 entered into training as a nurse, in the institution of Protestant Deaconesses, at Kaiserworth on the Rhine. On her return to London she put into thorough order the Sanitarium for Governesses, in connection with the London Institute. She served ten years of apprenticeship before entering on her life work.
In the spring of 1854 war was declared with Russia, and an army of 25,000 men was despatched to the Crimea. The faulty arrangements of the British government for the care of the sick and wounded furnished the theatre in which Florence Nightingale was to win her first laurels. The hospitals were soon crowded, and the mortality in the wards so great that the casualties of the fiercest battles were as nothing in comparison.
The war office recognizing the condition of affairs, gladly accepted the offer of Miss Nightingale to go to the seat of war and organize a nursing department.
Her devotion to the sufferers can never be forgotten, she has stood twenty hours at a time, directing and assisting in the care of the sick and wounded. Her unfaltering devotion and incessant work undermined her health; but though sick and feeble, she never left the field of duty until Turkey was evacuated by the English troops. Major Delafield (who with Maj. Mordecai and Capt. Geo. B. McClellan, U. S. A., had been sent to Europe by our government, to study the art of war in the Crimea), in his report to the War Department, remarks, in speaking of the English hospital at Scutari, “It was in this well-arranged hospital that that most estimable lady, Miss Nightingale, exercised her powerful influence in alleviating the condition of the sick and wounded from the battle-field. Women as nurses were employed to attend upon the men in the wards, under the kind and beneficent guardianship of this good lady, with the many advantages that would naturally follow the most gentle, painstaking, and cleanly attendance of women as nurses. Miss Nightingale’s efforts have resulted in the establishing, in connection with the English army, an office known as the ‘Superintendant General of Army Nurses,’ the office to be always filled by a woman. She has under her a corps of female nurses, who take care of the sick in the military hospitals.” The Sanitary and Christian Commission of our late war was the outcome of the volunteer nursing in the English war of the Crimea and the fruit of these efforts in this country are the training schools for nurses which have sprung up all over this land.
Next to our entrance into this world and our departure from it, occasions such as the present, when we have completed our education and are about to enter upon our chosen vocation, are the most important events in our lives. The calling which you have chosen, while not a new one, is comparatively new in having special schools, and courses of study provided for it. Nursing has always been considered peculiarly woman’s work—more or less adaptation to such work is inborn in woman. What man can smoothe the pillow of the sick, or soothe an aching brow as gently and acceptably as one of the gentler sex! Who can move as quietly, and approach the bed of pain so gently as woman!
I have seen sick men, absent from home and friends, sigh for a mother, sister, or wife who is not at hand.
Thanks to this school, and others, everyone can now have skilled female care when sickness and disease are upon them.
You who are about to go out from us to-day, are entering upon a calling which will require all the skill, faithfulness, courage, patience, forbearance, endurance, watchfulness, self-possession, tenderness, cheerfulness and tact, that a human being can possess, and above all, “a conscience void of offence toward God and man.” “To thine own self be true, and it doth follow as the night the day, thou canst not then be false to any other.” You have each and all of you received, at the hands of your admirable Superintendent, and the lecturers of the College, such definite and varied information in all the departments in which you may be called to act, that you ought to be prepared for most emergencies, and have shown by your examinations that you have heard and understood them.
The fault will be yours, and yours alone, if you do not treasure them in your minds, so that you may be not only trained but skilled nurses. The responsibility for the proper management of a sick-room and the patient in it is a very high and grave position, and requires the utmost faithfulness on the part of the nurse. Unless you are willing to put aside everything that may interfere with your giving yourself entirely and conscientiously to the care of your patient, do not assume the charge. But when you once receive that charge remember that you are dealing with that which disease can destroy by your negligence, and no human power can restore—a precious human life. You therefore owe to each case all that a faithful mind can suggest and the body endure; and such faithfulness has not been wanting in the former graduates of this school.
I can never forget the scene when one of our graduates, after having charge of over thirty cases of typhoid fever among some orphan children, and we had to lose one, whom she had nursed as faithfully and tenderly as its own mother could have done, how, when she had done her all and death claimed him, there were tears shed for one who had no mother to shed them. And it was due largely to her unremitting faithfulness that we were able to record but two deaths in thirty-three cases. That woman has not had an idle day to my knowledge in several years.
When any unexpected emergency arises, which to your educated eye teaches you that your patient is in extreme danger, do not alarm the friends unnecessarily; try not to show in your voice or conduct that you are demoralized and have lost courage. While doing the best you can (until the arrival of the physician, whom it was your first duty to have summoned), encourage those around you, and keep them busy if you can, as, unless they are occupied, the coming of the physician will seem to them unreasonably delayed, even though he be at hand when called. Above all, do not let every physician within reach be sent for, unless the situation is one of great urgency, as I believe many patients have been frightened to death by the demoralization of solicitous friends.
If you can show yourself capable and maintain your own composure of mind, you will be able in nearly every instance to avert a panic, and in many cases prevent disastrous results to your patient. But if you fail at times for want of proper courage, do not give up with a feeling that you are unequal to emergencies, only be the more determined not to show the white feather again.
It is a well known fact to military men, that veteran troops who have stood the brunt of the fight in many a battle, become demoralized unexpectedly and retreat, to the utter surprise of their officers. But in their next battle their courage and deeds of prowess again surprise every one. So be it with you.
In the sick-room nothing so distresses the helpless sufferer as a want of frankness on the part of the attendant. You may refuse or neglect to answer, or turn the subject if possible, but never tell what are called “white lies.” One lie always requires another to cover it, and sooner or later you will be caught. If it is not best to tell, say outright it is better for me not to answer that question; or it may be the least of two evils to answer it faithfully as patients often imagine that things are far worse than they are. I believe that we of the medical profession often err in withholding from patients that which it is best in the end that they should know. This is one of our most difficult lines to draw.
If you have not learned or are not determined to learn to endure the caprices and demands of unreasonable men and women in the most unreasonable hour of their lives, you have mistaken your calling; as without Christian patience, I do not believe it possible for a nurse to succeed for any length of time. The trials and vexations of a nurse’s life are so numerous and so constant, that it is a wonder to me that there are so many who are ready to enter this calling in life. There is no need since the revival of professional nursing for women to torture themselves or do penance. Be as ready to minister to disagreeable people as a person who two years ago wrote that she would take a fresh air child, saying “send me one of the dirtiest, most unattractive and unruly of the children, one whom nobody else wants.” An unreasonable, selfish and wilful patient is a purgatorial discipline for both nurse and doctor.
Remember that the most gentle and considerate of people will say and do things when sick unwittingly, that in health they would sooner cut out their tongues or destroy a limb than say or do. The mind is sick as well as the body, and the patient not responsible. Cultivate forbearance and endeavor to sear all your tender points. Be ever ready to excuse and believe that no slight was intended, unless it is reiterated and you are forced to believe it.
The physical and mental strain which you are at times called to bear will be very great; that you may be able to endure it, you must give special care to your health. You have been taught the laws of health, and yours is so arduous a calling you must observe them strictly. Dame Nature is a stern mistress, and if you disobey her you will surely suffer for it. When you are out of employment you will need recreation and diversion to keep both body and mind in the best condition. When you are in charge of a patient, the time away from the bedside is not yours to do with as you please, but for rest and fresh air; as you owe it to your patient to give the best possible service, and thus only can you do it.
You must cultivate the habit of observing the least change in your patient’s condition, so as to be ready to meet any emergency; it will not do to sit down and watch your patient as a cat would a mouse. Yet in severe cases your eye should hardly ever be off your patient; this should be accomplished and can be done in such a way as to be almost imperceptible to the sufferer. Every little change should be noted, and if any importance may attach to it, it should be written down as soon as you can conveniently do so. You are the physician’s eyes, ears, and hands while he is absent; you cannot therefore be too watchful.
Each one of us has certain vulnerable points of character, but it is not always easy for us to see them. If we would be self-possessed we must seek to discover these weak points in our armor by seeing ourselves as others see us; then by learning how to cover them, and not be disconcerted when our weak point is attacked. No one virtue is of more value in your arduous calling than this one of self-possession.
In this world of care and trouble much can be done to ameliorate suffering and soften the sting of pain by tender, sympathetic care; your patients will expect less of you if all you do is done with ease and quietness and thoughtful tenderness. You will then be likely to gain a friend in every patient; the patient will feel that a friend has gone when you depart.
A cheerful character rides smoothly over many rough places in this world that otherwise would jolt terribly. A bright, cheery nurse is better than many a dose of medicine for the patient; therefore be always cheerful. By cheerful I do not mean frivolous, as levity is the last thing that should appear in a room where such mighty elements are at work as in the sick-chamber. Therefore be cheery, but not mirthful or giddy.
There are some words in the dead languages which it is almost impossible to put into English without, in a great measure, losing their meaning because they contain so much in themselves; they are so difficult to define. So there is one little word in the English language that contains so much in itself that it is impossible to define it in a few words, and after using many you feel that you have only sailed around it without getting at the central and most important part of it—that word is tact. But it is the want of that which has consigned some of the brightest and noblest minds that I have known to oblivion. I call to mind just now one of the best read and most highly cultured and gifted men that the medical profession of Brooklyn has ever known. He lived and died among us, unappreciated except by the few who knew him best, little sought after by those who needed balm for their diseases, which he was better able to apply than most of his companions, and with scanty maintenance, while medical sky-rockets about him were riding into lucrative practices. The suffering continued to suffer, when, if they had only known it, skilled and efficient help was at hand, in a man who did not know how to so bear himself as to win the confidence of the community. Had he possessed a little tact his name would have been known to the world.
I want to say to each one of you, consider well if you propose to follow this arduous calling, pause and consider whether you really feel that it is your vocation, and feel equal to its physical and mental demands.
An ideal to strive after is good for us all. I will lay before you to-night one that was realized in the history of a friend who is now in a better and happier clime than this, and whom I would be glad to have each one of you strive to emulate.
Some years ago, before, as far as I know, there were any trained nurses in this city, I was asked to go to see a lady in a neighboring village, who had been confined to her bed for more than a year, and was supposed to be incurable. A year from that time she was able to be about, and six months later she determined to devote her time to the care of the sick poor. She did so, and I never had any one who would, or could, take better care of every case that fell to her charge. I always felt that, as far as human skill and strength could do it, my directions would be carried out to the very letter. Her last case was that of a little girl who had been burned over about three-quarters of her body, a degree of burning usually considered fatal; but in this case it did not prove so; and for months this noble woman dressed this suffering child, and would let no one else do it. Little Tina dreaded to have any one else touch her. The child was almost well, and this good woman was just finishing her morning dressing of the burn, when she suddenly fell back and expired. The soldier died at her post of duty.
“Like a star which maketh not haste and taketh not rest, let each be fulfilling his heaven born hest.”