itself and in principle. But these things are necessarily overridden in a large institution, in order to achieve a general result, which could not be attained were these points heeded with the attention due to them. Thus the individual is sometimes sacrificed for a general result. There may not be any high degree of blame attaching to anyone for this state of things-it is inherent in the nature of the institution. The degree and extent of this tendency vary in different institutions according to the management; but under any management it must largely prevail. Thus it is that the nurse, like the young physician, if she afterwards prac tise her profession in private life, has to unlearn many things learned in hospital, or her success will be little and her career short.

Let us take a case to illustrate a little in detail what I mean. We will suppose a patient to arrive at the hospital of Samaria, say. Over and above his present malady, he has for long past been preternaturally sensitive to cold, and has accordingly, by the charitable assistance of friends, been enabled to purchase body flannels, a set of which he wears at night. These he dons as he takes possession of his bed; they are perfectly clean and wholesome, but as the head nurse surveys him, she exclaims to the trembling novice, 'Why, nurse, you have allowed that man to go into his bed with flannels on! I never heard of such a thing. I cannot allow such doings in my ward. Those flannels are only fit to harbour fleas. Pray remove them.' 'Oh,' exclaims the patient, I have been accustomed to sleep in them for years; I shall take my death from cold if they are removed.' 'Nonsense,' retorts the 'head;' 'you can have an extra blanket if you choose, but you shall not sleep in those things here.' It does not occur to the mind of the head,'

darkened as it is by routine, that the extra blanket would have been adopted, by preference, long since, had it been found equally serviceable. So the poor man is deprived of his flannels, inflammation of the lungs supervenes, and before long his earthly troubles are over. As well might a shepherd shear his sheep in mid-winter and turn them adrift in the snow. This may seem an extreme case, but it is one that sometimes happens, nevertheless, after all the training and the medical Latin. Again, here is a patient just emerging from the low stage of typhoid. He is ordered wine by his physician. The 'head' brings him a dose of hospital' port. 'Oh, sister,' he exclaims, port wine never agrees with my stomach, it makes me retch violently. Is there nothing else I may have? May I not have a little claret? That suits me well, and is not more costly.' 'Claret, man! why that is not wine at all, no more than champagne. Come, drink your wine, and let me hear no more fuss.' So the poor wretch swallows his dose of plastered hospital port fortified possibly with thirty per. cent. of grain spirit loaded with fusel oil. In the course of half an hour the wine produces a violent attack of retching, the action of the abdominal muscles causes perforation of the bowel through those ulcers with which it has been struggling for weeks, and, lo! the end. Cause of death registered: typhoid-perforation. No mention of port wine plastered and fortified. Most important to a general sick-nurse is a thorough knowledge of the nature and composition of the various wines, ales, and spirits, and their adulterations. Yet the grossest ignorance prevails on these points amongst nurses educated in training institutions.

The mere whims and fancies of patients, even when harmless, could not be gratified in large institu

tions, where so much depends on a certain routine. Precisely as routine is such an aid in dealing with masses, so it has a deadening influence on ordinary minds not gifted with the wisdom to discern the cases where it must be modified. And it is this tendency of training institutions to make their pupils the mere slaves of routine, that turns out women of only average capacity such indifferent

nurses.

There is nothing more important to the sick man than the manner in which his food is prepared, and one would naturally suppose that the art and practice, as well as the principles, of cookery would form a leading feature in the instruction given to probationers in training schools. But so far is this from being the case that the most profound ignorance of this important subject prevails in such institutions. Nurses are turned out of them ignorant of the most elementary facts of this art. In illustration of this, the following example will suffice. After inspecting some of the cooked meat provided for patients in the ward of a large hospital, I turned to the sister or head nurse, who was standing near, and inquired: 'Sister, pardon me the question, but suppose, for instance, you were about to boil some meat solely for the purpose of being eaten, would you place it on the fire in hot or cold water?' 'Why, doctor,' she replied, I should place it in cold water.' 'And suppose, now, you wished to boil some meat solely for making broth, or beef-tea, what would you do?' 'Well,' she affirmed, I should place it in boiling water.' This is, as the reader knows, precisely reversing the proper order of things. The patient would thus have meat served him deprived of all nourishment, and into which he could scarcely get his teeth. The liquor containing the essence of the meat would most

probably-in accordance with the traditions of English cookery-be thrown away. And yet this woman had been highly trained in a model institution, and could spell out the medical Latin on the bedcards.

Certainly Mr. Buckmaster has not yet penetrated the kitchens of English hospitals. It would be difficult to say to what extent convalescence is retarded, and life jeopardised, or even lost, from the vile cookery prevailing in such places. The material is mostly good, but it is almost invariably maltreated and ruined in the process of cooking. I well remember inquiring of a hospital patient whether he had eaten boiled or roast mutton for dinner. 'Well, really, sir,' he replied, 'I can't tell you whether it were roast or boiled, it appeared to be a little of both; anyway there wasn't much taste in it.' With such cookery, is it surprising that the physician finds he is not able to sustain his patients without stimulants? And being familiarised with all this, is it surprising that a young nurse should come to look upon the preparation of an invalid's food as a matter of secondary importance, provided he have the material which is ordered? It is true that what is termed 'invalid cookery' is sometimes taught in training institutions. It consists only-so far as I have been able to ascertain-in learning indifferently well how to make egg flip and milk pudding. The first experience of a nurse should surely be in the kitchen, and thence she should not be allowed to depart until she has thoroughly mastered the elements practically; for though it may not be part of her duties to prepare the food of her patients, yet she should be able not merely to discern when food is well cooked, but be able to point out the nature of the fault when it is ill cooked.

An enormous amount of fuss has been made about this learning to nurse and this training of probationers. But, after all, what is there to learn that any active and sensible woman, trained in ordinary household work, cannot achieve under the guidance of a medical man? Let Let me recapitulate the qualifications needed in a good nurse. They are: personal cleanliness, a light step and touch, suppleness and strength of body, avoidance of tight stays, skill with the needle, a knowledge of bedmaking, aptness in changing the linen of an invalid, and knowledge of cookery. With the exception of the cookery and the pliant corset, are the above things so very rare in English households that they can only be encountered in training schools? As to observation of variations in the appearance and

demeanour of a patient, the taking of food, the ventilating and disinfecting of apartments, every medical man prefers that the nurse should act under his guidance in such matters rather than rely on her own ideas, and she must be very stupid indeed if she cannot carry out his instructions satisfactorily on these points. Strange too if, having the will and resolution to do it, she cannot watch for bed sores, and sponge, poultice, or disinfect them when instructed to do so by the medical attendant. If a woman is able to make a pillow-case, darn a stocking, or make a child's garment, would she find any insuperable difficulty in lining a splint, making a sand bag of given form and dimensions, or applying a poultice, without passing three years in a training school, and having her faculties benumbed by its routine?