work well together; yet each member should be allowed her own individuality and personality in her work, that every friend she makes may know her as such, and not, as the small boys about us would say, "a teacher in a settlement."

BLACKWELL'S ISLAND HOSPITALS.

BY LOUISE DARCHE,

SUPERINTENDENT OF TRAINING SCHOOLS, BLACKWELL'S ISLAND, NEW YORK.

The almshouse hospitals on Blackwell's Island consist principally of a number of one-storied wooden pavilions, in which are several hundreds of chronic and incurable patients, many of them suffering from the infirmities of old age alone.

Into this unattractive field of nursing the Commissioners of Charities and Correction of New York City decided in 1891 to plunge the City Training School, and to make it responsible for the care and nursing of the patients in the almshouse hospitals.

The nursing at this time was in a deplorable condition, complaints were loud and frequent from the visiting physicians and members of the State Charities Aid Association, and it was imperative that some change be made. The management of the nursing was of the oldtime order; and, as a consequence, old-time results followed. The warden of the almshouse proper was also warden of the hospitals, and he was responsible for the nursing management. He engaged the nurses, and they were responsible to him in conduct and discipline. Knowing nothing practically about nursing, he placed them in the wards to work under the young internes; and, so long as no complaint was made by them, the nurses were considered satisfactory. When a difference of opinion arose between doctor and nurse, it often happened that the warden decided that the doctor was unjust and unreasonable; and the nurse stayed. The nurses received the small salary of $12 per month.

It was thought by the commissioners that the school, already responsible for the nursing of four hospitals, two in the city and two

on the island,— might be increased, and made to extend its field of labor to cover the nursing of these additional hospitals.

On visiting the wards of the almshouse hospitals after I had been placed in charge, I found: first, that the nursing there had no educative value, and was unsuitable for training purposes; and, second, that the old and infirm inmates required a more permanent system of nursing than the training-school system could give. Besides, the school had already as many hospitals and services as could be properly attended to without changing the nurses too frequently.

Finding it thus undesirable to introduce the nurses of the Training School into the hospitals, I suggested and put in force the following plan.

A supervising nurse, a graduate of the School, was appointed, and placed in immediate charge. She was expected to supervise the work of the nurses, and to look after their dietary, bedroom accommodation, and general welfare. She was also made responsible for the matron's duties in the matter of hospital supplies of bedding and clothing. The salaries of the nurses were raised, and placed on a graded basis. An entrance examination was established to exclude all applicants who might not possess a common-school education, and satisfactory testimonials of health and character were insisted upon. A probationary period of three months was fixed for the purpose of testing and training applicants before they could be permanently appointed, and receive the higher salary.

By this system of selection and training we gradually weeded out the undesirable element, and got good and reliable nurses. We found there were many women seeking employment as nurses who were either too old to enter upon a training-school course or who were not sufficiently bright and active for nursing in acute hospitals, but whose steady, faithful, quiet ways made them very valuable as nurses for the almshouse patients. Our plan was to alternate six months' day nursing with three months of night nursing; and, in order to give the regular fortnightly day "off duty" punctually, we had two nurses constantly employed for the purpose of relieving the nurses whose day was due. We improved the dietary, and looked. after the health and comfort of the nurses in every possible way.

At the end of a year, having got the system into fair working order, and where it could stand alone, the school severed its connection with this branch of its work; and the supervising nurse was left in supreme control.

With this one year's experiment in the management of almshouse hospital nursing, I am convinced that this branch of nursing need not be considered the bugbear it is, and that it may be reduced to a satisfactory and efficient system. The first point to observe is the fundamental principle of all training-school management, which is to make the nursing of the hospital a department in itself, with a duly qualified head over it. Let this head be a woman and a trained nurse, and make her responsible for the efficiency of the nursing staff. Give her due authority in the selection, management, and training of her nurses. Let there be a graded salary system, of a sufficiently high level to induce a respectable and efficient class of women to apply,—if possible, high enough at its highest grade to secure graduate trained nurses. Give the nurses a home detached from the hospital wards, where they may enjoy the ordinary comforts of home life when off duty.

I am sure that many women of ability and education would be found, under these conditions, willing to be trained in this branch of nursing; and it is possible that many graduate nurses, tired of the excitement and uncertainties of private duty, would gladly enter upon this quiet and uneventful mode of living and nursing. In either case the system, if properly managed, would be effective in providing for almshouse patients the thoroughly reliable and faithful woman as nurse whom they so peculiarly need and should have.

A FLOATING HOSPITAL.

SPECIAL RELIEF TO SICK CHILDREN IN CONNECTION WITH ST. JOHN'S GUILD.

BY MARIA S. ROBINSON, NEW YORK.

In the year 1866 the work began with the Floating Hospital. Many changes and improvements have been made during the twentyeight years since this unique charity was started. Next month we begin our twenty-ninth year, and every day the Floating Hospital will take its load of helpless little ones out from the heat and noise of the city into the restful pure air of the sea.

If you please, take a trip with us. You must be at the dock by eight o'clock if you are to see the people come on board. There the huge boat, fitted up with the comforts and conveniences of a hospital, stands, like a great cradle, ready to bear the sick children of the poor out into the pure, wholesome atmosphere of the bay or to convey them with loving care to the Seaside Hospital at the foot of Staten Island, about three hours' distance from the city.

Each has a

At eight o'clock the women begin to come on board. baby, and most of them have from one to six little children clinging to their skirts; for, in cases where the mother cannot leave any one in care of her flock, all are taken together, and God knows they all need it.

Before entering the boat, every child is examined by the attending physician, to see that no contagious disease is carried on board; and the Board of Health inspector confirms the doctor's examination before they are allowed to pass. It is very quickly done, but none

are missed.

Once on board, the very sickest ones are passed on by the head nurse to the wards on either side the deck, while those needing simply the good air are directed to the upper deck. The willing hands of the deck men help the tiny feet to mount, and mother carries the sick baby.

The upper deck is one huge veranda, open on all sides. The wind blows freely over the floor swarming with women and children, walking, standing, or sitting on the benches as they please.

All day long the doctors and nurses are busy caring for the babies or teaching the mothers, for our work is educational. The feeding begins about 10 A.M., that those going to the Seaside Hospital may be sent over comfortably. In the deck below neat tables are spread to accommodate three or four hundred. This is frequently filled four times during the trip. The utmost neatness and order are here insisted upon as an example, and many of the women are helped by it to better things at home. The girls have to work very hard, but they enter into the spirit of the work, and, I think, enjoy it very much; and, certainly, they form a strong factor in the educational work.

Meantime the bath-room has been the scene of much happy excitement. The girls are bathed first. All the older ones, unless the doctor prohibits it, are put under an individual spray bath.

The nurse goes from one to another with ready word of commendation or help; and, with quick eye to see all that is going on, she has many opportunities to impart lessons in cleanliness, purity, and right living. The bath in many cases works such a transformation in the children that one would hardly know them, were it not for the grotesque costuming into which they step; for here and there you recognize a child by the clothes you remember. Indeed, the change in all at the close of the day's trip is marvellous. Most of the fretful peevishness is gone. The pain and exhaustion have yielded without a drug to the fresh air and proper food.

At about noon we rest at anchor about a mile from the Seaside Hospital. Boats are lowered, and the little sick ones are handed down by the men as tenderly as if each owned the babies, and carried on shore. The mothers are weary, but much happier than they have been for many a day; for the fresh air, food, and kindly thoughtfulness have given them hope that baby may yet live.

The hospital is surrounded on two sides by the ocean, and has a background of pure country. Here the swish of the surf drowns the cries of the sick babies on one side, and on the other the singing boughs of the huge trees lull them to sleep. Here tired out mothers find rest and refreshment while infant life is saved. Here we have doctors and trained nurses, and everything needed for the sick children. Here without a cent the mother may keep her ailing child or children as long as they need the care; and, best of all, they are taught the laws of health, and sent home better able to care for themselves and their little ones.

Three years ago the trustees decided to open a hospital for the children of the poor entirely free, and thus to continue its help throughout the year. On 61st Street, at Nos. 155 and 157, we have now a comfortable hospital that will accommodate fifty children, and it is generally full, thus proving the need and its efficiency.

The last work started by St. John's Guild, in 1893 is, I think, the most far-reaching in its beneficent results, that of relief to sick children in their homes. Heretofore St. John's Guild stood foremost in the ranks of summer workers, but efforts were confined to the few summer months when the need is great. But the work did not reach the need of the poor children which is covered in the house to house visitation and hand to hand help which the trained nurse is able to give in the homes of sick children. Calls came in very rapidly from