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CURRICULUM 



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NURSING 




UNIVERSITY OF CALIFORNIA 

AT LOS ANGELES 




... 



UNIVERSITY of CALIFOKM* 

AT 

LOS ANGELES 
LIBRARY 



STANDARD CURRICULUM 

FOR 

SCHOOLS OF NUBSIM 

PREPARED BY 

THE COMMITTEE ON EDUCATION 

OF THE 

NATIONAL LEAGUE OF NURSING EDUCATION 
1915 to 1918 



M. ADELAIDE NUTTING, Chairman 
Teachers College 
New York City 

ISABEL M. STEWART, Secretary 
Teachers College 
New York City 

ELLA PHILLIPS CRANDALL 
156 Fifth Avenue 
New York City 

MARY S. GARDNER 

Providence District Nursing 
Association, Providence, R. I. 

ANNIE W. GOODRICH 
Teachers College 
New York City 

MARY C. WHEELER 

Illinois Training School 
Chicago, 111. 

MARY M. RIDDLE 
Newton Hospital 
Newton, Mass. 



ELSIE M. LAWLER 

Johns Hopkins Hospital 
Baltimore, Md. 

MARY BEARD 

Boston Inst. Dist. Nursing Asso. 
Boston, Mass. 

LOUISE M. POWELL 



University Hospital 
Minneapolis, Minn. 



EDNA C. FOLEY 

830 Monroe Building 
Chicago, 111. 

ELIZABETH BURGESS 

State Educational Department 
Albany, N. Y. 

MARY W. MCKECHNIE 
420 West 118th Street 
New York City 

SUSAN E. TRACY 

818 Center Street 
Jamaica Plains, Mass. 



Copies may be secured from the secretary. Price $1.00 with postage in addition 
The preparation of this curriculum was made possible by a gift from Mrs. 
Helen Hartley Jenkins to meet the initial expenses. 



40154 



COPYRIGHT 1919 
BY THE COMMITTEE ON EDUCATION 

OP THE 
NATIONAL LEAGUE OF NURSING EDUCATION 



COMPOSED AND PRINTED AT THB 

WAVERLY PRKS8 

Br TUB WlLUAMB A WlI.KINS CouPAWT 

BALTIMORE, MD., U. 8. A. 



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TABLE OF CONTENTS 

f\ 

I. Introduction ...................................................... 5 

II. Relation of Hospital and Training School Organization and Admin- 

istration to the Curriculum .................................. 9 

A. The General Purpose, Character and Standing of the Hospital 10 

B. Form and Functions of Training School Control .............. 11 

C. Type and Capacity of Hospital .............................. 12 

D. Financial Resources .......................................... 15 

E. The Teaching Field (Range, Variety and Character of Services) 16 

F. Conditions of Life and Work for Students (Ratio of Nurses to 
<\ Patients, Hours of Duty, Housing and Living Conditions, 

etc.) ....................................................... 18 

G. The Administrative and Teaching Staff ..................... 22 

H. Standards of Entrance to Schools of Nursing ................. 24 

I. The Admission of Classes .................................... 27 

^-. J. Standards and Methods of Good Teaching .................... 27 

- K. Teaching Equipment. 4 . ....................................... 30 

C~) L. Records ..................................................... 31 

*""~ M. University Affiliations ....................................... 32 

N. References on Nursing Education and Teaching .............. 32 

III. Course of Study. 

A. Length of Course and General Division of Time ............. 35 

B. General Scheme of Practical Instruction ...................... 35 

C. General Scheme of Theoretical Instruction ................... 38 

IV. Outline of Subjects. 

A. Biological and Physical Sciences. 

Anatomy and Physiology. . .-. .............................. 40 

Elementary Bacteriology. . i- ................................ 45 

J Applied Chemisty. . . : .................... : ................. 48 

I B. Household Science. 

Nutrition and Cookery. . . .................................. 53 

Diet in Disease. . : . ......................................... 57 

Hospital Housekeeping. k .* .................................. 58 

Housekeeping Problems of Industrial Families.^ ............ 60 

C. Prevention of Disease. 

^ Personal Hygiene. . .< ...................................... 64 

Public Sanitation. . K ...................................... 67 

p D. Treatment of Disease. 

Drugs and Solutions. ..T. .................................. 70 

Materia Medica and Therapeutics. ^ ........................ 72 

Massage. .-. ................................................ 74 

Special Therapeutics (including Occupation Therapy).. ^. . . 76 
E. Nursing in Different Forms of Disease. 

Elementary Nursing Principles and Methods. . T ............ 79 

Elementary Bandaging. . * .................................. 84 

Elements of Pathology. . . v .................................. 86 

Nursing in Medical Diseases. . ..... . ....................... 88 

3 



4 TABLE OF CONTENTS 

Nursing in Surgical Diseases. . . 91 

Nursing in Communicable Diseases. . : 93 

Nursing in Diseases of Infants and Children. .\ 96 

Gynecological Nursing and Diseases of the Male Genito- 

Urinary Tract...; 101 

Orthopedic Nursing. 103 

Obstetrical Nursing 105 

Nursing in Diseases of the Eye, Ear, Nose and Throat 109 

Nursing in Mental and Nervous Diseases. . i Ill 

Nursing in Occupational, Skin and Venereal Diseases. . . K. . 115 

Operating-room Technic 117 

Emergency Nursing and First Aid. . .* 119 

Special Disease Problems 121 

F. Social and Professional Subjects 

History of Nursing (including Ethical and Social Principles) 123 

Elements of Psychology. 130 

_^. Principles of Ethics ^. 131 

Survey of the Nursing Field. 1 137 

Professional Problems . . . . 140 

Modern Social Conditions 143 

G. Special Branches of Nursing. 

Introduction to Institutional Work 147 

Introduction to Private Nursing 149 

Introduction to Public Health Nursing and Social Service. . 152 

Introduction to Laboratory Work 155 

Appendix I. Bibliography of Text and Reference Books Classified 

According to Authors, with Names of Publishers, prices, etc 157 

Appendix II. List of Inexpensive and Free Bulletins, Pamphlets, and 

Reports for Use in Training Schools 167 

Appendix III. List of Firms Supplying Equipment and Illustrative 

Material for Training Schools 169 

Appendix IV. Suggestions of Physical Exercises for Nurses in Training 171 
Appendix V. Schemes of Practical Training for College Students Receiv- 
ing Credit of Eight to Twelve Months for Satisfactory Previous 

Work in Science 173 

Appendix VI. Hour Schedules from Hospitals in which an Eight-hour 

Day is in Operation 175 

Appendix VII. Suggested Basin of Credit for Nursing Schools 177 



INTRODUCTION 

At the request of the Council of the National League of Nursing Education, 
the Committee on Education undertook some little time ago the task of pre- 
paring a curriculum which might serve as a guide to training schools struggling 
to establish good standards of nursing education, and which might also repre- 
sent to the public and to those who wish to study our work, a fair idea of what, 
under our present system, we conceive to be an acceptable training for the 
profession of nursing. 

In sending out this curriculum, the Committee desires to emphasize afresh 
its hope that there will be no failure to understand its purpose. It is not 
offered as a "model" curriculum. There are many improvements which we 
would gladly introduce if we could see any possibility of putting them into 
effect at the present time. Moreover, the Committee is not urging the un- 
qualified adoption of this curriculum in training schools generally. It realizes 
that under the widely varying conditions existing in hospitals at present, a 
relative uniformity only is attainable or advisable. Schools laboring under 
the handicap of long hours and insufficient teaching facilities would be unable 
to do justice to the curriculum here outlined until more favorable conditions 
could be established. A few schools with superior advantages and good leader- 
ship have already, in certain respects, gone beyond these standards and it is 
highly important that they should in no way relax their efforts, but should 
lead in working out something better than anything we have reached as yet. 

The purpose which the Committee has had in view, is to arrive at some 
general agreement as to a desirable and workable standard whose main features 
could be accepted by training schools of good standing throughout the country. 
In this way it is hoped that we may be able to gradually overcome the wide 
diversity of standards at present existing in schools of nursing, and supply a 
basis for appraising the value of widely different systems of nursing training. 

The work of the professional nurse is practically the same in all the states 
of the union, and it would seem to be perfectly evident that the training which 
is to guarantee a certain acceptable measure of competence, would need to 
follow somewhat similar lines, whether the nurse is trained in California or 
New York, and whether the training is given in a small or a large hospital. 

The main difficulty is the lack of a clear understanding of what the function 
of a modern nurse is, or what the purpose and scope of her training should be 
The war is making us realize, what the public generally and the training schools 
have been slow to recognize, that nursing is in a very special sense a national 
service, and that the training of the nurse is a matter of vital concern not only 
to her hospital and to herself, but to the country at large. It is not enough 
that she should serve the needs of a single institution or of a limited group 
of people. She must be ready to serve the whole community and to meet 
conditions as she finds them in many different kinds of communities. 

It is becoming clearly evident, that if she is to do this effectively, we must 
revise many of our old ideas about the nurses' training. The value of her 
service is being recognized in so many new fields of work, and the character of 
that service is changing so rapidly, that the preparation which was considered 
quite adequate a few years ago is no longer sufficient. 

5 



INTRODUCTION 

The steady expansion into new and exacting fields of effort, .s continually 
revealing to us both the strength and the weakness of our methods of training. 
The strength lies in the character of the actual practical work, which in most 
training schools is sincere and thorough and performed in a spirit of devo- 
tion, zeal and self-forgetfulness which is remarkable. Teachers and students 
alike are imbued with this spirit. It has become a part of the history and 
tradition of nursing and forms an almost invaluable contribution to the world's 
service. The weakness lies in the over-emphasis placed upon the practical 
aspects of the training and the consequent neglect of the theoretical founda- 
tion on which really good practical work must always be built. 

It is now recognized that if the sick patient is to have the most skilful and 
competent kind of nursing care, and if nurses are to keep pace with the ad- 
vances of modern medicine, they must have something more than a mere deft- 
ness in precise manipulations and the scattered fragments of scientific knowl- 
edge which are all that can usually be given in the scant time allowed by most 
hospital training schools. The development of more highly complicated pro- 
cedures in diagnosis and treatment, and the increased emphasis especially on 
dietetic, hygienic, occupational and mental factors in the treatment of dis- 
ease, make it necessary that the nurse should assume an increasing measure 
of responsibility in the care and treatment of the patient. To safeguard her 
in those responsible duties, she must have a large measure of scientific knowl- 
edge and she must be more highly trained both in observation and in judgment. 

A distinct limitation in the ordinary training is that it deals only or mainly 
with disease, neglecting almost entirely the preventive and educational factors 
which are such an essential element in the many new branches of public health 
work, such as school and visiting nursing, infant welfare, industrial welfare 
and hospital social service. Similarly the physical causes and evidences of 
disease have been recognized as important, but the social and economic con- 
ditions which He at the root of so many of our disease problems, have usually 
been over-looked in the course of training. This knowledge is fundamental, 
particularly in the newer branches of nursing, and the lack of it is a distinct 
handicap to the nurse in her work. 

In positions of leadership especially, we are suffering for the lack of well- 
trained women. Hospitals and training schools are looking everywhere for 
competent women to undertake the important duties of superintendents, 
supervisors, teachers and technical experts in many different departments. 
Unless the hospital itself selects good women and gives them a broad sub- 
stantial foundation to begin with, there is little hope that we will develop 
many of the kind of leaders who are needed for our very responsible educational 
and administrative work. 

Nurses themselves have been the first to realize the necessity for a better 
organized and more thorough course of instruction than is commonly given in 
the averge training school, and they are beginning to insist that they be 
given a kind of training more commensurate with the tasks which are laid 
upon them. It is certain that we cannot command the continued interest of 
intelligent and competent women in hospital and nursing work, unless we can 
provide a course of study which compares more favorably with the courses 
given in other technical and professional schools. 



INTRODUCTION 7 

The members of the Committee realize fully the difficulties of the hospital 
and the training school staff in meeting all these new conditions, with the 
many other perplexing and insistent problems which have to be faced. They 
do not for one moment forget the invaluable services to nursing education 
which have been given at great personal sacrifice or in spite of peculiar ob- 
stacles, by our large body of devoted and untiring superintendents and 
teachers, and by many physicians as well. Nor do they underestimate the 
unique value of many splendid features in our system of training. They are 
convinced, however, that the situation at present demands an unusual effort 
and they are confident that training schools generally will do their utmost to 
at least approximate these standards of nursing education which have been 
agreed upon as reasonable and desirable. They believe that the public and 
the pupil nurse are justified in expecting this effort from all hospital training 
schools, but particularly from those claiming to rank as nursing schools of the 
better class. 

The Committee wishes to make it quite clear that while it believes all the 
subjects suggested in the course of study are important, they are not all equally 
important. It will be noted that several of the subjects outlined are recom- 
mended only, and it is understood that they should not be introduced at the 
sacrifice of the more fundamental subjects. In suggesting some elective sub- 
jects, the Committee does not wish* to advocate specialization within the 
general training, but only an opportunity for students to get a fair introduc- 
tion to one of the fields of nursing in which they are specially interested. 

The general feeling of most of those who have gone over the outlines is that 
while the material is all necessary, and they would be unwilling to have any 
of it eliminated, the time usually allotted is too short to cover the ground in a 
really thorough way. The Committee has decided to leave the material as it 
is, with the suggestion that the hours should be increased wherever possible, 
and that instructors should use their own discretion in choosing what points 
should be particularly stressed and which should be omitted or treated less 
thoroughly. 

The work has proven much more difficult than at first anticipated, especially 
since the members of the Committee are all women already fully occupied 
with exacting professional duties which the pressing problems of the last year 
or two have greatly increased. After the general scheme was decided upon 
by the Committee and approved by the League of Nursing Education, the 
various subjects were assigned to members specially qualified in those 
branches, who proceeded with such help and advice as they were able to 
secure, to work out the outlines according to a general form. Each outline 
was then multigraphed and copies were submitted to a number of representa- 
tive training school superintendents, teachers, supervisors and public health 
nurses throughout the country for detailed criticisms and suggestions. Over 
one hundred members have assisted in this work. The outlines were then 
collected, the suggestions compiled and new outlines made out which were 
again, in several cases, referred back to various members 'before being finally 
approved. Opinions differed frequently and in such cases the majority 
opinion was accepted. A great many helpful suggestions were received, and 



8 INTRODUCTION 

the Committee takes this opportunity of again thanking all those friends who 
so generously assisted in the work. 

There is little doubt that the next few years will see many new developments 
along nursing lines. It is the intention of the Committee to keep the curricu- 
lum up-to-date by frequent revision, and to supplement the material in this 
first edition from time to time. The Committee begs the assistance of all 
those who are interested in the better training of nurses, in this work. We 
should be particularly grateful to have any suggestions for additions or cor- 
rections which should be made in the next edition. 



THE RELATION OF HOSPITAL AND TRAINING 
SCHOOL ORGANIZATION AND ADMINIS- 
TRATION TO THE CURRICULUM 

In working out a curriculum which aims to cover the ground required in the 
training of nurses in so satisfactory a way that it can be accepted as a standard 
and adopted generally in training schools, certain important facts must be 
kept steadily in mind. These are, first, that the education of nurses is notv 
carried on in the ordinary type of school, but in hospitals and under a well- 
established system which requires that the practical training shall be obtained 
through student service in the various departments. This practical training * 
'ndeed, is considered of such importance in the general scheme as to occupy 
almost the entire time and energy of the student; in all schools of which we 
have knowledge more than nine-tenths of the student's time throughout the 
three years being devoted to practical work. This means that the theory,,' 
essential and indispensable as it is, in reality occupies everywhere a relatively' 
small place in respect to time in the curriculum. It means also that the con- 
ditions in the hospital under which the teaching and training are conducted and 
under which the students live and work, are decisive factors in the situation. 

A curriculum does not operate itself. It is dependent upon persons and 
conditions to give it life. No matter how admirably planned, it can only be 
made truly effective in the education of the nurse if the hospital in which it is 
to be carried out is of proper character and standing, and provides in its clinical 
resources, teaching facilities and administrative policy, a suitable field for the 
training of nurses. It has seemed necessary, therefore, at the outset, to try 
to show what the general conditions and main requirements in hospitals should 
be in order to ensure the satisfactory working out of a good curriculum. 

This is a peculiarly difficult thing to do, because of the vastness and com- 
plexity of the hospital field. There are about as many types of hospitals as 
there are specialties in medicine. They exhibit extreme variation in purpose, 
scope of work, size, and also in form of administration, ranging from that 
exercised by municipal authorities or responsible bodies of trustees to that of 
commercial stock companies or of individual enterprise. How shall we judge 
of the ability of any one of these hospitals to provide a suitable field for the 
training of nurses, or of its fitness to undertake that important task? What 
standards and tests can we apply? For it is evident that many hospitals are 
unable to provide for the most fundamental requirements in any form of 
worthy educational work. 

The standards which the Committee has accepted as desirable and here 
presents in outline are those which have been gradually developed through 
the experience and experiment of nurses who have been long engaged in 
hospital and training school work, and in serious and continuous study of the 
administrative and educational problems involved. In the course of years 
certain conditions and requirements have been found to be essential to the 
conduct of a good and sound system of training school work. These condi- 
tions which have so important a bearing upon the situation, are found through- 

9 



10 HOSPITAL AND TRAINING SCHOOL STANDARDS 

out the entire structure of hospital life, from foundation and purpose to inti- 
mate daily conduct of affairs. They may in the main be summed up in a 
general way under the following headings: 

A. The General Purpose, Character and Standing of the Hospital. 

B. Form and Functions of Training School Control. 

C. Type and Capacity of Hospital. 

D. Financial Resources. 

E. The Teaching Field (Range, Variety and Character of Services). 

F. Conditions of Life and Work for Students. (Ratio of Nurses to Patients, 
Hours of Duty. Housing and Living Conditions.) " 

G. The Administrative and Teaching Staff. 

H. Standards of Entrance to Schools of Nursing. 

I. The Admission of Classes, 

J. Standards and Methods of Good Teaching. 

K. Teaching Equipment. 

L. Records. 

M. University Affiliations. 

A. THE GENERAL PURPOSE, CHARACTER AND STANDING OF THE 

HOSPITAL 

The first and one of the most fundamental requirements is that the hospital 
shall be of good standing in the community, that it shall be under the general 
direction of a responsible body of persons, trustees, directors, or managers of 
such weight and influence &* to establish beyond question, the purpose, dignity 
and stability of the institution, and to afford guarantees to the public, and to 
prospective students and their families in particular, that it is a suitable place 
to which to invite young women to enter for serious professional training. In 
other words it must show that it is both able and ready to meet its obligations. 

The character and standing of a hospital in any community must have a 
direct bearing upon the kind of teaching which it will offer. A hospital of 
established reputation will select with great care its officers and staff, physi- 
cians, nurses, and all others concerned in the care of the sick, and will exact 
from them a high quality of work, and single-minded devotion to the interests 
and welfare of the patients. If it does not its reputation cannot be maintained. 
The standards of its own work will be projected into its teaching throughout, 
and its teaching will be of two kinds, the conscious, deliberate and formal, and 
the unconscious and incidental. Not more surely by what the student is told 
ought to be done, than by what she sees done daily, will her ideals in work be 
shaped. That hospital, then, in which the teaching and training of nurses can 
best be carried on, is of a character which commands public confidence and 
respect not only through the sound scientific nature of its work, but through 
its ethical and altruistic purpose. Its whole life will be permeated by the best 
spirit and traditions of medicine and nursing. 

B. FORM AND FUNCTIONS OF TRAINING SCHOOL CONTROL 

If the training school for nurses were simply the nursing staff of the hospital 
and nothing more, then it could be placed upon the same basis as other hospital 



HOSPITAL AND TRAINING SCHOOL STANDARDS 11 

departments and dealt with accordingly. But in just such degree as the school 
is something more than the nursing staff, outside and beyond it, do new and 
different considerations enter into its management. Many elements which the 
training school brings into hospital affairs do not naturally fall into any part 
of the administrative scheme of an institution for the care of the sick. Quite 
alien to the general purpose and usual activities of the hospital, are the special 
and somewhat intricate problems of education to which the training school 
must give constant time and attention, or fail in its work. And because these 
problems are different, dealing with matters outside of hospitals which must 
be viewed from other angles besides those looking to efficient hospital adminis- 
tration, it is essential that there should be some body of persons who are very 
specially concerned with them. A good many hospitals are now providing for 
this need by the appointment of training school committees, and it is the 
opinion of almost all training school superintendents who have carried on their 
work with and without such committees, that they are an almost indispensable 
factor in a good organization. 

The composition of such a body varies in different institutions, but it is 
suggested that a good working committee appointed from the trustees of the 
hospital might be composed of five persons, which should include two Trustees, 
a member of the Medical Board, the Superintendent of the Hospital, and the 
Superintendent of the Training School. Such a committee would usually be 
greatly strengthened by the addition of some one engaged in educational work, 
such as the Superintendent of Public Schools, or the Dean, or Director of a 
good College, Normal, or Technical School. In connection with large city 
hospitals, into the government of which city politics sometimes enter, a 
separate board of women managers has been found to be a great support and 
protection to the training school. 

The functions of these committees would naturally vary under different 
conditions, but in the main they would consist in studying the needs of the 
school as an educational institution not purely concerned with the temporary 
service of the hospital, but with the permanent service of the public, and in 
establishing such equitable relationships between the hospital and training 
school, and such conditions of student life and work as will bring this result. 
They should see that suitable requirements for admission are established and 
maintained; that sound educational standards, for both practical and theo- 
retical work prevail; that there is a properly qualified administrative and 
teaching staff; that it is supplied with adequate school equipment and teach- 
ing material; and that proper regulations are made about such matters as 
tuition fees, loan funds, and scholarships. 

Since these are all fundamentals which are well recognized in every school, 
it is certain that ways and means must be found of providing them. It will 
therefore be the function of the Committee to prepare a budget, and to secure 
adequate appropriations from the hospital and from other sources, to place the 
school upon this dignified, secure and stable basis, and to ensure it that inde- 
pendence in its work and freedom for proper growth and development which 
are characteristics of any good educational system and which a satisfactory 
financial status alone can give. The securing and distribution of funds for the 
maintenance of the school may be one of the most important functions of a 



12 HOSPITAL AND TRAINING SCHOOL STANDARDS 

training school committee in fostering good standards and ideals in the work 
of the school. 

C. TYPE AND CAPACITY OF HOSPITAL 

The type of hospital in which a training school can best be established is that 
which provides the requisite number of patients and variety of services of a 
suitable character. It has long been accepted that the general hospital, in 
which all the more common forms of medical and surgical diseases are treated 
and which admits men and women patients, best answers to this description. 
General hospitals under municipal government or private endowment or main- 
tained by contributions are found in all large cities, in most moderate s zed 
and in many small cities. 

The actual number of beds and daily average of patients, within certain 
specified limits, is of less importance than the variety and character of the 
services. The very large municipal hospitals of from 600 beds up to 1000 or 
1500, usually offer the richest possible field for training, in so far as numbers 
and variety and character of services are concerned, and in the exceptional 
opportunities afforded by their clinics and dispensaries. The great difficulty 
here lies in securing enough expert supervisors, and qualified instructors, and 
enough in the way of resources and conveniences to maintain a good quality of 
work over such a vast area. The problem of training is difficult because of the 
almost unwieldy dimensions of the training field, and of the enormous bulk of 
work to be done. In such large city hospitals this problem may also some- 
times be complicated by the fact that there may be a division, sometimes a 
large one, of patients with chronic diseases providing little in the way of suit- 
able opportunity for training, yet requiring, under the system, a definite place 
in the general scheme of instruction. Granted, however, means to maintain 
a sufficiently large staff of graduate nurses in addition to the student nursing 
service, and a liberal and properly qualified staff of executive officers, super- 
visors and teachers, a great municipal hospital affords a wonderful teaching 
field. 

On the other hand, very small hospitals, even when general in character, 
have definite limitations not only in numbers of patients, and in range and 
variety of disease, but also in equipment and facilities. The opportunities 
they offer for observation and training and their resources are usually, in the 
very nature of the case, too meagre and restricted to provide more than a 
fraction of the required course of instruction in nursing. While these very 
small hospitals are obviously unable, in most instances, to provide a satis- 
factory field for the entire training of nurses, they are the class of institutions 
frequently most needing the assistance, which a training school provides. 
Their problem is a difficult one. Probably most of them could supply good 
practical training in the care of patients suffering from a few of the more com- 
mon forms of disease for a period, let us say, covering not more at the extreme 
than 12 months. How to secure the necessary instruction in theory is, how- 
ever, another question. There does not appear to be any other way to get the 
elementary scientific groundwork required in nursing than to turn to the 
visiting teacher, who might spend two days weekly in three not too widely 



HOSPITAL AND TRAINING SCHOOL STANDARDS 13 

separated hospitals, or to fall back upon the nearest high school for special 
classes, or upon a combination of both, with assistance from local physicians. 
The success of such plans would depend greatly upon the energy and initiative 
of the head of the training school, and upon her ability to make the utmost 
possible use of every available opportunity. It takes women of exceptionally 
good professional training, experience and resourcefulness to bring forth 
satisfactory results from a poor field. 

Given well-trained assistance in the hospital, and the certainty of a good 
quality of practical training, there appears to be no reason why at leas tone 
year of prescribed ground could not be covered and the students passed on to 
the larger schools to complete their training. Small schools should be as proud 
of sending up their students to certain large hospitals for the final two years, 
as preparatory schools are of sending theirs to colleges. The principle is the 
same. The necessity of a uniform arrangement of subjects is clear, for the 
larger school must know just what ground in theory and practice has already 
been covered, and must require that certain well-defined work has been done. 

Between these two extremes lie a large number of hospitals capable of pro- 
viding excellent teaching fields. In the order of their capacity in this direction 
they would stand about as follows : first, hospitals, general in character, and 
under municipal or private government, with from 400 to 500 beds, and having 
not only the four main services medical, surgical, children's and obstetric 
but certain of the special branches, such as nervous and mental disorders, 
contagious diseases, eye, ear, throat and nose, etc. These afford a practically 
complete field for the training of nurses. There can be no question of their 
ability under proper administration to conduct training schools of the very 
highest character. Next would come hospitals of the same general type and 
character, with from 150 to 200 beds, and a daily average of from 125 to 150 
patients. These also provide excellent teaching fields. 

While the smaller general hospitals can only meet the requirements and 
obligations which the establishment of schools of nursing imposes on them by 
acquiring suitable affiliations with other hospitals able to provide satisfactory 
instruction and training in the branches of nursing in which they are deficient, 
it is pretty generally agreed that unless such hospitals have a daily average of 
about 50 patients and a fairly acute service, it is hardly possible for them to 
maintain schools of nursing of the usually accepted standards. This appears 
to be about the minimum, in so far as the number of patients is concerned, and 
has been long accepted as such in England and various other countries, and by 
the American Red Cross in this country. In the training of medical students, 
the Council of Education of the American Medical Association urges that hos- 
pitals, to be satisfactory for teaching purposes, should have a daily average of 
not less than 200 patients who can be utilized for clinical teaching. (See 
Journal American Medical Association, August 19, 1916, pages 601-607.) 

There must be variations from these suggested standards in exceptional 
institutions, and particularly in certain states and sections where hospitals 
have developed slowly and are almost all quite small. They are all that is 
available for training purposes in such localities, and obviously the standards 
that are desirable in older communities where work is further advanced, cannot 
and should not be applied to them at present. 



14 HOSPITAL AND TRAINING SCHOOL STANDARDS 

Special hospitals present a peculiar problem. Many of them can contribute 
to the general scheme of training, and efforts should be made to utilize the 
special opportunities they provide. Few, if any of them, are competent to 
conduct schools in which the main portion of the work lies entirely outside 
their interests or activities. That they can cooperate largely, however, in 
educational work is clear, as more and more the special branches which they 
represent become incorporated into the regular accepted plan or scheme of 
training. Such subjects as obstetrics, and children's diseases are now com- 
monly required, and it seems probable that for public health work, training 
in contagious diseases, and possible in mental and nervous disorders may be 
called for. 

Special hospitals form numerically a very large group. They are often 
large, well equipped and carefully administered, and they are not infrequently 
well endowed and able to secure the best specialists in the branches they repre- 
sent to direct their work. The nursing in such hospitals is carried on in sev- 
eral ways by the employment of a trained graduate staff of nurses, by post- 
graduate courses, by affiliations with regular training schools, by maintaining 
regular schools of nursing or, in the cases of hospitals for the insane, of schools 
for the training both of nurses and attendants. The organization of this very 
large and valuable field of training still remains to be adequately worked out 
but in the main it seems fairly obvious that such hospitals can perform a better 
service by making their ownspecal contribution to the training of nurses, than 
by conducting regular schools of nursing. , Just because they are engaged in a 
special branch of work, it is practically certain that their whole energy will 
be thrown into efforts to make this branch still more highly and perfectly 
specialized. 

For this reason there is some genuine ground for question as to the ability 
of such institutions to conduct schools of nursing professing to offer complete 
general training. The main portion of the student's full period of training is 
spent working among patients rightly grouped in a special class. This may 
occupy two full years or even more, ou.t of the three, while in all accepted 
schemes for a satisfactory arrangement of work, this same specialty would 
seldom be given more than six months of time at the most. In addition to 
this, the full emphasis must of necessity be laid upon that particular branch. 
The impressions made upon the student's mind are in relation to a particular 
type and condition this is inescapable. The provision which is made for train- 
ing in general nursing (or for all other branches) will be comparatively small, 
and relatively all out of proportion in a sound scheme of training, and, further, 
the order of things is reversed, and the special is made to precede the general 
and fundamental. 

The more important special hospitals are those dealing with obstetrics, men- 
tal and nervous, contagious, and children's diseases. Children's depart- 
ments are now increasingly found in general hospitals, and there appears to 
be also an increase in the number of obstetrical wards. It is noticeable that 
maternity hospitals in most instances affiliate and offer three or four months 
of special training, to be included in the regular work of the student nurse. A 
few offer post-graduate work also. Contagious hospitals occasionally affiliate, 
but they appear more frequently to employ salaried graduate nurses varied 



HOSPITAL AND TRAINING SCHOOL STANDARDS 15 

with occasional post-graduate work. Hospitals for the insane and for children 
more commonly establish regular schools and require that the bulk of the 
student's training shall be received in the single special field represented. 

The question of affiliations is a matter of extreme importance in making up 
a proper curriculum for pupil nurses. It is important to ascertain just what 
any possible affiliation has to offer, and how long should be given to it in a well- 
balanced curriculum. The parent school should feel itself strictly responsible 
for the standards both of practical and theoretical work in the affiliating 
school, and should see to it that proper conditions of life and work and proper 
guardianship are assured. 

Efforts should be steadily made to bring about a better system of adjustment 
and to see that training in special branches follows upon a general groundwork. 
This could usually be easily done where the training school is under university 
direction, and a unifying and coordinating power can thus be provided. In 
every such special branch provision should be made for two types of students 
those who need some training in it as a part of a general course and those who 
are choosing it as a field of special work. A longer period of training is neces- 
sary for the specialist. 

Hospitals and sanitaria under private ownership cannot be recommended as 
suitable institutions to assume the direction of training schools for nurses. 
Their purposes are frankly commercial, and under such government the exploi- 
tation of pupil nurses is practically impossible to control. The maintenance 
of satisfactory standards of teaching, of work, or of student-life, may be 
assumed to be outside of their purposes and possibilities. 

No attempt has been made in this study to consider the very important ques- 
tion of post-graduate education for nurses. It may be said in passing, however, 
that the same general principles which have been laid down for the training 
of pupil nurses, apply to the courses for graduate nurses which are offered by 
hospitals. The graduate student should have a curriculum especially ar- 
ranged to meet her needs, and every facility should be given her so that she 
may profit to the full by both her class work and her ward experience. Most 
graduate students would be willing to pay for the kind of instruction they 
need, on the condition that they should be released from the long hours of 
exacting ward work, and should have the advantage of expert teaching and 
supervision. 

D. FINANCIAL RESOURCES 

Schools of nursing at present everywhere rest upon an unsound and pre- 
carious financial basis. None of them are endowed, none are maintained by 
public funds none, in fact, have any real resources whatever for the conduct 
of their work beyond the provision which the hospital (whose nursing services 
the school is supplying) is able and willing to make. Most hospitals find it 
hard to get enough funds to keep their work going on a satisfactory basis. 
They cannot contribute to the support of schools on the contrary, they must 
use the school to help support the hospital. A few hospitals may have some 
means available, but as a rule their conception of the function of their train- 
ing schools is so imperfect as to prevent serious consideration of their needs 
from a financial standpoint. There is a slight awakening of interest in this 



16 HOSPITAL AND TRAINING SCHOOL STANDARDS 

aspect of affairs, but until it has taken a real hold on the minds of those re- 
sponsible for the conduct of hospitals, and consequently of training schools for 
nurses, until there is a wider understanding of the vital importance to society 
of the work which nurses are doing, there can be little hope that schools of 
nursing can be maintained upon a truly satisfactory economic basis, or 
can render their full measure of usefulness to the public. 

The hospital, under certain conditions, can provide largely of the main essen- 
tials. Its wards form the indispensable laboratories for training in nursing; 
its life and disciplines are of incomparable value in such training, but equally 
necessary in any adequate system are bodies of trained teachers and suitable 
places in which to teach; lecture, and class rooms, laboratories, libraries, and 
other teaching equipment and material, scientific and technical. Equally 
important are suitable conditions of student life and work. These costs of 
education can never be neglected. 

The ordinary needs for the proper conduct of the training school should be 
considered carefully in the making up of the hospital budget. The head of the 
school should be required to present an estimate of the probable expenses of her 
department, which should include provision for necessary developments in any 
desirable direction. 

Where it is impossible for the hospital to supply the necessary funds, there 
should be no hesitation in making direct appeals to private individuals or 
associations, or, in certain cases, in asking for appropriations from public 
funds for the proper financial support of the school. No school of nursing can 
hope to carry on and develop its work satisfactorily without such support. 

E. THE TEACHING FIELD (RANGE, VARIETY AND CHARACTER OF 

SERVICES) 

It is commonly accepted that a good teaching field must provide satisfactory 
opportunities for training in the four main branches of nursing medical, 
surgical, obstetrical and children and that the services must be reasonably 
acute. Generally speaking, the value of any service from the standpoint of 
training, is directly proportionate to the number of acute cases being cared 
for. Chronic and convalescent cases are of limited value as teaching material, 
though they call for certain special kinds of care, certain personal qualities, 
and adaptations which should have a definite place in the scheme of instruc- 
tion. The degree of acuteness may be measured by the number of admissions 
per bed per year. A service in which the number of admissions per bed per 
year averages from 16 to 20 or over, is an acute service. Below 8 per bed per 
year, it would rank as an inactive service, and the diseases would probably be 
sub-acute or chronic in character. 

It must be recognized that the experience in medical wards particularly 
varies greatly at different seasons of the year, offering excellent material for 
study and nursing care during the pneumonia and typhoid seasons especially 
but at certain other times giving little opportunity for observation and spe- 
cial treatment. Efforts should be made by supervisors and instructors to see 
that if possible, students whose experience in a given department has been 
relatively uninstructive, should have an opportunity of supplementary train- 



HOSPITAL AND TRAINING SCHOOL STANDARDS 17 

ing later. In any case class teaching and ward clinics should help in making 
up any possible weakness in practical experience. In each service the com- 
moner varieties of cases should be found and when unusual forms of disease 
are admitted, the opportunity for observation and instruction which they 
present, should always be utilized as far as practicable for the benefit of all 
student nurses. 

From the standpoint of teaching, a large and active private service in a 
hospital presents difficulties. It makes excessive demands upon the time of 
administrative and supervisory staff, and occupies a relatively large place in 
the general scheme of training. Furthermore it is a distinct loss to the stu- 
dent, in that it substitutes the restricted experience of service with one or 
two individuals, for the varied and instructive opportunities provided by the 
many patients of the large open ward. It cannot be assumed that a student 
who is assigned to the care of from one to three patients during a given period 
can learn as much as during a similar period where from thirty to forty patients 
may be under her observation and care. 

The advantages to be derived from service in private wards are small in 
comparison and quite special in nature. Undue emphasis has been placed 
upon the value of this service, which, in the interests of good teaching, should 
be kept at a reasonable minimum. There is a difference in equipment and in 
some details of service for such patients, but there can be no difference in the 
nursing, and it is of the utmost importance that this point shall never be lost 
sight of. Standards and methods of nursing are the same, and special cases 
require special nursing, quite irrespective of their place in the hospital or their 
ability to pay. The large, open public ward is the ideal training ground for 
student nurses. It has been suggested that the ratio of private to free patients 
should not exceed one to four in teaching hospitals. 

A complete medical service should provide training in the care of all the 
usual medical diseases, and also in the nursing of communicable diseases. 
So important, indeed, is this in the preparation of nurses for modern public 
health work, that it is difficult to see how they can get along without it. 
Affiliations should be sought which would provide this training in the acute 
infectious diseases for those particularly needing it, even where it is not 
required or obtainable for the entire student body. Facilities for training 
in the care of nervous and mental patients should also be made available. 

The surgical service should provide training in the care of all the ordinary 
surgical diseases, and should include gynecology, orthopedics, operating-room 
work, and training in that department in which accidents, emergencies, and 
minor surgical matters are handled whether this be in a special ward or 
dispensary. 

It is desirable that the obstetrical service be sufficiently large and active to 
ensure a proper training within a reasonable period. Probably the measure 
of training here should be determined by the number of cases, rather than by 
the number of weeks. 

The children's service should .provide opportunity for the observation and 
handling of sick children not only in infancy, but up through the years of 
childhood.. It is one of the most important of all the services, and with the 
development of public health work, and the widespread introduction of nurses 



18 HOSPITAL AND TRAINING SCHOOL STANDARDS 

into public schools, it has become fundamental and indispensable in the scheme 
of training. 

The dispensary or outdoor service provides invaluable opportunities for 
instruction. Patients visiting dispensaries for advice or diagnosis present 
many conditions and states of disease rarely seen in the wards. The greater 
the number of cases in each division under close and continued observation 
and treatment, the more profitable the instruction to the student nurse. It 
may precede or follow her training in the wards. Probably a period of service 
in the early stage of training and again at a later stage, would prove of most 
genuine educational value though it might be difficult to work out. Fre- 
quenty a hospital will have a pretty well-developed dispensary or clinic for 
which it has no corresponding hospital service. This would perhaps be par- 
ticularly true of such special services as eye and ear, throat and nose, and skin 
diseases which are of special importance to those intending to enter public 
health work. The dispensary should play a much larger part in the training 
of the nurse than it has hitherto usually done, and its special resources should 
be as completely utilized as possible. As a partial preparation for almost any 
form of public health work, it is of unquestionable value, and if it has a social 
service bureau, with follow-up work in the homes, its powers in this direction 
are greatly enlarged. 

Where the hospital is used as a teaching ground for medical students or as a 
field for medical research, the value of the service to the student nurses is 
usually increased in certain ways. They work in an atmosphere of scientific 
inquiry and must frequently assist in experimental work; and they share in a 
measure in the instruction which goes on continually. In some departments 
of work, however, there may be a distinct loss to student nurses, as for instance 
when much of the required assistance in operating-rooms, dressing-rooms, etc., 
is taken over by the medical students. 

F. CONDITIONS OF LIFE AND WORK FOR STUDENTS 

Ratio of Nurses to Patients 

The ratio of student nurses to patients cannot be worked out on any basis 
which is capable of general application, because of the many and various 
factors entering into the situation. It is affected by the number and variety 
of services ; by the character of these services that is, whether they are acute, 
sub-acute or largely chronic in nature; by the proportion of private patients; 
by the plan and arrangement of the hospital (small wards always requiring 
a relatively larger service than large wards); and also in some degree by the 
number of orderlies and other helpers of various kinds provided. A teaching 
hospital where many clinics are held, and where medical students need to be 
looked after and helped, requires a larger staff of student nurses. There is a 
difference in the number of student nurses required in a medical and in a 
surgical ward of the same size, and a wide difference, usually, between these 
and the number called for in children's, maternity, infectious, or in mental 
wards. The operating-room offers a special problem contingent upon the 
number of operations daily. The dispensary and clinics must be governed by 
similar conditions. 



HOSPITAL AND TRAINING SCHOOL STANDARDS 19 

The general opinion appears to place the ratio, at present, of student nurses 
to patients in an active service about as follows : 
Free ward service 

Day duty 1 nurse to 5 patients 

Night duty 1 nurse to 10 patients 

Private ward service 

Day duty 1 nurse to 3 patients 

Night duty 1 nurse to 5 patients 

This is the minimum ratio, it is believed, which can be accepted as likely, 
under the usual conditions, to enable the school to maintain satisfactory 
standards of work and teaching. 

Hours of Duty 

In the last analysis, the pivot upon which the whole curriculum swings, is 
the system of hours of duty which the hospital requires of the nursing staff. 
The very purpose of the instruction for which the student pays by her service, 
is frustrated by long hours. Good teaching any teaching, in fact is wasted 
on students who have been engaged in prolonged, heavy, physical effort, or in 
exacting forms of nursing which involve considerable mental and nervous 
strain. The senses are dulled, the mind works more slowly, concentration is 
practically impossible, wrong impressions are frequently carried away, but 
worse than all of these is the fact that the student acquires a distaste for the 
work which is made too difficult for her to accomplish creditably. The fact 
is that long hours of work for student nurses have been for a quarter of a cen- 
tury the greatest stumbling block to progress in nursing. The whole experi- 
ence of that period goes to show unmistakably that an adequate body of 
instruction cannot be established by training schools, unless at the same time 
a system of hours is arranged which permits the students to accomplish the 
required study satisfactorily and without detriment to health and spirit. 

But even if we do not consider the educational work which as a rule has been 
carried on outside of the required number of hours of duty on the wards, the 
nine- to ten-hour working day, the twelve-hour night and the seven-day week, 
still required in most hospitals, would generally be considered excessive from 
the standpoint of health and efficiency alone, even for laboring men. It is 
strange that hospitals have been so slow in grasping and applying the findings 
of science on the subject of fatigue. The eight-hour day has been so generally 
accepted as the maximum for a normal, healthy life, especially under condi- 
tions demanding physical effort and mental strain, and it has been enforced by 
law in so many departments of the world's work, even under the unusual 
demands of war, that the hospital lays itself open to peculiarly unfavorable 
comparisons by its continued insistence on a policy which has been discredited 
not only by scientific and educational authorities, but by frankly commercial 
enterprises as well. 

The long hours of night duty are particularly grave in their effects upon the 
student's capacity to reap proper advantage from her instruction. Night 
duty in itself, under any conditions, is disturbing to the maintenance of a good 
system of instruction, in that each time the student is placed on night work 
there is a temporary new adjustment of habits of daily life. But any person 



20 HOSPITAL AND TRAINING SCHOOL STANDARDS 

who has performed twelve hours of work such as is required almost universally 
on night duty, should be looked upon as incapable of further effort mental 
or physical. Any kind of satisfactory educational work is made practically 
impossible for such hours. 

Training schools for nurses should be scrupulously sensitive in seeing that 
the instruction they offer is given under conditions which will in no way lessen 
or impair its value. It is necessary to be constantly watchful on this point, 
because the needs of the hospital are imperative and difficult to satisfy, and 
power and control are centered there. The head of the training school is fre- 
quently all that stands between the students and the urgent demands of the 
hospital for a larger service than can safely be required of them. Her vigi- 
lance, courage, and sense of justice may be their sole protection against con- 
ditions of life and work which would render of little value the best quality of 
actual instruction which could be offered. 

Although under the present system of education in nursing, tuition fees are 
not required from students, a very exacting form of student service is required. 
While, up to a certain point, we may look upon this service as indispensable in 
our method of training, we should not forget that it is always of distinct and 
substantial financial value to the hospital and that through it the student pays 
the equivalent of the most ample tuition fees, and also pays for everything 
else which the hospital provides her. 

In so far as hours of work for pupil nurses are concerned, there is general 
agreement that eight hours of practical work per day is the maximum which 
can be required in a satisfactory scheme of training. The findings of the Com- 
mittee, the opinion of heads of training schools, and the experience of those 
familiar with the system coincide in approving the eight-hour schedule, and in 
urging its adoption. They recommend that one afternoon of 6 hours per week 
be allowed, making a total of 54 hours a week for practical work. Those who 
have tried this system would not be willing to go back to the old, realizing that 
not only is the actual nursing care of the patients of better quality, but that 
good teaching becomes possible in the shorter day. Furthermore, it has been 
shown that shorter hours and better teaching inevitably attract more and 
better qualified candidates to the school. 

The change from a nine- or ten-hour day to an eight-hour day will necessarily 
call for an increase in the number of student nurses, and here one is met at 
once by the lack of adequate housing accommodations, which is an almost 
chronic condition in our rapidly growing hospital field. One solution of the 
problem may perhaps lie in the adoption of the plan now being tried out in a 
few hospitals of arranging for those students who have good homes in the com- 
munity to live at home. A somewhat different adjustment of hours makes this 
a practicable scheme, and it would provide a substantial increase in staff with- 
out additional expenditure for quarters and maintenance. The principle has 
for years been applied in arrangements for the service of special nurses in pri- 
vate wards of hospitals and here it works out satisfactorily. 

Housing and Living Conditions 

It is hardly possible to overestimate the importance of the conditions under 
which student nurses live. Next to hours of work these form the factors 



HOSPITAL AND TRAINING SCHOOL STANDARDS 21 

affecting most deeply their health, spirit, and general power to handle their 
work efficiently or to derive benefit from the instruction and training which is 
virtually offered in part payment for their services. 

Among the essentials which should be provided in students' residences are 
single rooms for all students. Double rooms should only be used when abso- 
lutely unavoidable and should be looked upon as a temporary and undesirable 
expedient. Student nurses receive their training under peculiarly difficult 
and exacting conditions, and are subject to certain strains and to responsi- 
bilities quite unlike those which students in any other profession whatever 
have to meet. They need, when off duty, the quiet and privacy of individual 
rooms they need it for rest and most particularly for study. These rooms 
should be comfortable, with good beds. They should be supplied with writ- 
ing tables and shelves for books and papers. Pupils should always have good 
lights to study by, since most of their study must be carried on in the evening. 
There should be such provision made for personal clothing and other necessi- 
ties a\s will enable the student to keep her belongings in good order. The 
standards of living for the student must be such as she will be expected to 
apply in the homes and institutions in which she works and teaches. These 
standards include the maintenance of orderly and hygienic surroundings, and 
immaculate personal cleanliness. The lavatories should provide ample facili- 
ties for this and not less than one bath room for six students is looked upon 
as meeting modern requirements. 

The dietary should be especially adapted to students engaged in arduous 
work involving physical as well as mental strain, and such disruption of normal 
life as night duty or special duty usually brings. No body of persons in the 
hospital needs more careful consideration on this point than the staff of student 
nurses. There should be a carefully worked out menu, the food should be well 
selected, well cooked and attractively served. 

Suitable quarters should be provided for students on night duty, to ensure 
protection from noise and other disturbances. The whole atmosphere of the 
nurses' home or dormitory should be one of quiet comfort and refinement. 
There should be suitable reception and sitting rooms and such service as is 
necessary in maintaining a dignified, orderly, attractive and homelike 
household. 

A number of schools are now employing social directors, or house mothers, 
to look after those aspects of the students' home life which the superintendent 
and staff cannot possibly give much attention to, owing to their other en- 
grossing duties. Definite provision is thus made for a wholesome and stimu- 
lating social life in the home, and for the introduction of outside interests 
which the pupil nurse particularly needs. 

Fees and Allowances. Scholarships 

It has long been the practice of hospitals to make a money allowance to 
pupils of from four up to fifteen dollars per month, to cover expenses of uni- 
form, text-books and other incidentals connected with their work. An in- 
creasing number of representative hospitals are giving up this practice, and 
are devoting the funds so released, to building up their educational system 



22 HOSPITAL AND TRAINING SCHOOL STANDARDS 

through better teaching and supervision, shorter hours of hospital work and 
better living conditions. 

Several schools have gone farther than this and are requiring a tuition fee 
of from $25 to $50 or more for the preparatory period of training, and at least 
one regular school of nursing requires tuition fees for the entire course of 
training. A tuition fee for the preparatory term is a just charge in those 
instances where practically the entire time of students is spent in class and 
practice work which requires the employment of several special teachers 
and supervisors. This fee is sometimes returned on the completion of the 
training. It should not be charged where any considerable proportion of the 
students' time in this preliminary period is spent in the hospital. It should 
be understood that the fee will not be returned to those students who do not 
remain after the preparatory term. 

There is no doubt that the tendency at present is toward the payment of 
tuition fees. Where this policy has been introduced and has been accompanied 
by a radical improvement in the course of study and the introduction of other 
features making for high standards of training, such as reasonable hours and 
good living conditions, the result has always been to increase rather than 
decrease the number of eligible applicants, and to definitely improve the class 
of women entering the school. It is useless to introduce tuition fees unless 
these conditions are assured. 

There is little use made of scholarships in schools of nursing. A few leading 
schools award them, but usually at the close of the full term of training, to a 
student desiring further study in some special branch. There might well be 
a wider use of scholarships, and they might be offered to exceptionally well- 
qualified candidates who desire to secure training in nursing but are unable 
to incur even the modest personal expenses which are usually a'l that student 
nurses are required to meet. Provision for such candidates is made in vir- 
tually all other educational institutions, and schools of nursing might through 
the adoption of this policy find a way of admitting some unusually desirable 
candidates. 

G. THE ADMINISTRATIVE AND TEACHING STAFF (FACULTY OF 

THE SCHOOL) 

The requirements here may be briefly indicated by calling attention to the 
double functions of practically all training school officers. They are respon- 
sible for the whole scheme of instruction and training, which is essentially an 
educational function; and they are also responsible for the efficient adminis- 
tration and supervision of the nursing service of the hospital and frequently of 
the housekeeping service as well, which are administrative functions. 

The administrative and teaching staff of the school (sometimes called the 
faculty) must generally include the following persons: 

a. A superintendent or director of nurses, who is also the principal of the 

school. 

b. Assistant (one or more, in accordance with the size of the hospital and 

school, and the character and dimensions of the work). 



HOSPITAL AND TRAINING SCHOOL STANDARDS 23 

c. Instructor (one or more, as needed). 

d. Graduate nurses as heads of all departments (medical, surgical, 

children's, maternity, dispensary, operating-room, etc.). 

e. Night superintendent (with such graduate assistants as may be needed). 

f. Dietitian (and assistants as needed). 

g. In addition there should be a carefully selected and paid staff of lec- 

turers in all the general medical and special subjects. 

It is hardly necessary to say that the woman who is to direct the education 
and training of nurses, and to direct also the nursing service of a hospital, even 
of moderate size and under the least exacting conditions, must be herself an 
educated woman. It is not enough that she should be a well-trained nurse 
with varied experience and also a reliable and trustworthy woman. These 
two considerations are indispensable. Nor is she to be considered qualified 
because she is a good business manager. Details of office management and 
ward supervision can be delegated to assistants, but the superintendent of 
nurses must herself be able to plan and direct the work of the school and must 
be able to coordinate it with the work of the hospital. She must under- 
stand people and be able to secure their cooperation, and she must have that 
kind of personality and judgment which will command the confidence and 
respect of her associates. It is imperative that the director of a school of 
nursing which undertakes to prepare young women for one of the most impor- 
tant of modern professions, should have a sound educational background and 
a broad point of view, so that she will be able not only to maintain satis- 
factorily already established standards, but to work out new methods and 
new educational policies in accordance with the needs of the times. 

As far as is practicable, a similar kind of education, of training, and of per- 
sonal qualities should be required of assistants and graduate heads of depart- 
ments. In addition to purely executive duties, they will all have to supervise 
and criticize the work of students and in many instances to assist actively in 
the regular teaching. It is desirable that as far as practicable, the heads of 
special departments should be prepared to teach the branches they represent. 

In most schools it will be necessary to employ at least one regular instructor 
who will be more directly responsible for the teaching of the younger nurses. 
She will usually be expected to teach the elementary sciences as well as the 
fundamental principles and technic of nursing. 

To hold the interest of pupils and to stimulate them to their best efforts, 
both in their theoretical and practical work, the instructor needs to have a 
strong and vigorous personality and a fund of real enthusiasm for her work. 
She should be approachable and helpful in dealing with pupils, but at the same 
time should show a reasonable degree of firmness and decision in keeping them 
up to a good standard of work. No one should attempt to teach who has not a 
fairly keen, well-balanced and well-ordered mind, a real love for study and a 
strong desire to help young nurses to enjoy their work and get the most out of 
their training. 

The instructor should know thoroughly the subjects she is to teach. It is 
not possible to make this knowledge exhaustive, but it should be authoritative 
and up-to-date, and always well in advance of her class. She must be con- 



24 HOSPITAL AND TRAINING SCHOOL STANDARDS 



stantly refreshing and supplementing her knowledge by study and observation, 
or her work will inevitably suffer. The teacher must also have a wide practical 
experience in the branches she teaches, and should be expert in demonstrating 
practical procedures. 

In addition to sound technical and professional training, some experience 
and training in teaching is almost essential. Fortunately many nurses have 
had Normal School preparation and have taught in elementary or high schools, 
but most of those who plan to teach in training schools will need to take special 
courses, both to increase their knowledge of their subjects and to help them to 
teach more effectively. 

As far as possible, all those who are concerned with the teaching work of the 
school should have these personal and professional qualifications. For all the 
special branches, such as dietetics, massage, pathology, etc., specialists will be 
needed, and though it is perhaps of first importance that they should be experts 
in those branches, this in itself would be of small value without the ability to 
"get the subject over" to the pupils. Physicians should be employed for all 
subjects dealing with the actual study and treatment of disease, such as sur- 
gery, obstetrics, etc., and they should be specialists in those branches, so far 
as possible. In each of these subjects, however, there are demonstrations and 
discussions of nursing treatment and technic which are better handled by 
nurses. As far as possible, the supervisors who have charge of the practical 
training in these special departments should be responsible for the nursing 
classes and quizzes which supplement the doctor's lectures on the various 
special branches. 

All good teaching requires time for preparation, and this should always be 
allowed for, as well as the correcting of note-books and the other routine work 
entailed in all branches of teaching. The instructor whose whole time is 
given to teaching should not be expected to give more than from four to five 
hours daily in actual class-room work, and she should be completely set free 
from all routine executive duties of the hospital which have little or no relation 
to teaching work. 

While it is important that the number of persons on the administrative staff 
should be sufficient for the demands of the work, its real strength must be 
determined not by numbers, but by the preparation and the personal qualities 
which each member contributes. It is practically impossible to conduct a 
good school without a well-qualified body of officers and teachers, all working 
together in the interests of students, and of the people whom these students 
are ultimately destined to serve. 

H. STANDARDS OF ENTRANCE TO SCHOOLS OF NURSING 

Education 

Schools of nursing in good standing should require all applicants to present 
evidence of graduation from a four-year high school, private school or other 
secondary institution of approved standards, or to provide satisfactory 
credentials from responsible school authorities showing that they have re- 
ceived the equivalent of high school training. In every case the fundamental 



HOSPITAL AND TRAINING SCHOOL STANDARDS 25 

subjects, such as high school English, history, mathematics, and science must 
have been thoroughly covered. In most good high schools the study of Latin 
or one modern language is also required for graduation. Training school 
officers should be provided with the lists of accredited high schools, and in any 
case of doubt should investigate the standing of the school. 

Where it is impossible at once to require full high school standing, two years 
is suggested as a temporary minimum, with approved and certified courses in 
English, mathematics, history, and elementary science. Any school wishing 
to attract the better class of applicants, will give preference to those with 
higher educational credentials, and will proceed as rapidly as possible to the 
full high school requirement, which is insisted upon for every other type of 
professional training. 

Nursing schools should secure the cooperation of high school principals and 
teachers, in urging girls who are interested in nursing to complete the full high 
school course, and in advising them regarding the best selection of pre-nursing 
subjects. Such students should all complete the regular college preparatory 
work if possible, because they may wish to enter a college for part of their pro- 
fessional work either before or after training, and because the regular cultural 
courses are all desirable as a basis for nursing work. Wherever there is free- 
dom for election, science courses, especially chemistry, physics and physiology, 
should be chosen, and household science should be included if at all possible. 
Mathematics is of relatively minor importance (apart from good sound arith- 
metic). It is a disputed question whether a modern language is not of more 
value than Latin, but one year at least of Latin is decidedly helpful in getting 
hold of technical terms. Music, drawing, physical training and voice culture 
are all helpful and should be included if possible. 

Deficiencies 

Applicants who are deficient in general education, but who qualify in other 
ways, should be advised to make good the deficiency by returning to high 
school, attending night school, taking extension or summer courses in con- 
nection with a university or normal school, or by securing a special tutor to 
prepare them for the state examinations. Slight deficiencies might be made 
up after entering the nursing school, but this is not generally advisable, owing 
to the pressure of other studies and the demands of practical work. It should 
be distinctly understood that credits for admission to nursing schools should 
be made up in approved high school subjects and not in stenography, book- 
keeping, and other technical courses which would be of much less value as a 
basis for nursing work. As a rule, such subjects as English, history or civics, 
chemistry, physics, biology and arithmetic (if not covered elsewhere) should 
receive first place, but languages, physical geography, and household science 
would also be of definite value to the prospective nursing student. 

Advanced Standing 

It is recommended that applicants who bring educational credentials in 
advance of high school graduation, should be allowed advanced standing in 
nursing schools under the following conditions : 



26 HOSPITAL AND TRAINING SCHOOL STANDARDS 

1. Graduates of approved colleges giving the regular four-years' course lead- 
ing to the A.B. or B.S. degree, should be allowed credit in time amounting to 
one academic year (eight or nine months), and should not be required to repeat 
class work which had been satisfactorily covered elsewhere.* 

It is suggested that this reduction in time should be allowed only to those 
who have graduated comparatively recently, and who have completed satis- 
factorily in college about one year's study in each of the fundamental sciences 
on which nursing is based biology, chemistry, sociology and psychology. The 
year of biology might include such subjects as physiology, bacteriology, bot- 
any, nutrition, hygiene, and sanitation; physics might be accepted for part of 
the year of chemistry; economics or social economy-for the sociology require- 
ment, and courses in ethics or education for part of the year in psychology. 
One year's work in a given subject usually means from two to six hours weekly 
throughout the year in that subject, depending on whether it is a lecture or 
laboratory course. 

2. Students from schools of household arts, normal schools, and others 
representing work in advance of high school, who have completed satisfactorily 
such subjects in the training school curriculum as anatomy and physiology, 
bacteriology, chemistry, nutrition and cookery, etc., should be exempt from 
compulsory attendance on those courses, but should be required to take 
examinations with other students. 

3. Credit for previous work in approved training schools should be granted, 
providing the student's character and records are satisfactory, the reasons for 
changing are good, and the experience in the first school is comparatively 
recent. A minimum of about two years should be spent in the hospital giving 
the diploma. Such a student should not be required to repeat work already 
satisfactorily covered in theory or practice. 

Age 

The minimum age at which students should be accepted in schools of nursing 
is twenty years, with occasional exceptions in favor of young women of nine- 
teen years of tested capability and unusual maturity, both physical and 
mental. The maximum age should be about thirty-five years, with rare ex- 
ceptions in favor of persons of unusual physical vigor and proven adaptability. 

Health 

The applicant should be of average height and weight and free from organic 
defects. She should present a recent certificate of good health from a physi- 
cian, showing not only that her constitution is sound and her general resistance 
good, but that her mental and nervous make-up is normal and stable, and her 
whole personality of a good wholesome type. This is a protection both to the 
school and the student. A certificate from a dentist should also be required. 

* A number of representative training schools have recently (1917) agreed 
to admit college graduates on this basis, and already there is a very gratifying 
increase in the numbers of college women coming into the profession. Sug- 
gestions for working out a scheme of training under these conditions will be 
found in Appendix V. 



HOSPITAL AND TRAINING SCHOOL STANDARDS 27 

Before acceptance into the school, the student should have a thorough physical 
examination by the training school physician, and it is very desirable that a 
similar examination should be made at the 'end of the training, to determine 
just what the general physical effects of the training have been. 

Character and Experience 

Certificates of character are usually of uncertain value, but should be re- 
quired in view of the nature and responsibilities of the nurse's work. A per- 
sonal interview with the applicant is always desirable. Direct correspondence 
between the school and the persons given as reference is advised. Wherever 
there seems to be any doubt as to character, a careful investigation should be 
made. Experience in home management, in business and in social, educational 
or club work, are distinct assets. The applicant who belongs to a cultured 
family with traditions of public service, who has travelled and seen something 
of life and people, is (other things being equal) generally found to be better 
fitted for success in nursing work. 

I. THE ADMISSION OF CLASSES 

Among the many points in the organization of training school work which 
need careful consideration, is the question of the number of classes admitted 
yearly. In some schools new classes are formed twice yearly; in others three 
or even four times yearly; in still others students are admitted irregularly, 
whenever vacancies must be filled. It is hardly necessary to point out that 
this method makes the conduct of a good curriculum exceedingly difficult. 
Certain subjects must be repeated three or four times during the year, and 
students must of necessity enter some of the classes in which repetition is 
impossible at late dates, and endeavor to pick up what they can. The burden 
laid upon the teaching staff of constant repetition is a heavy one, which the 
always insufficient force of instructors complicates. So long as the system of 
student nursing service exists, it will undoubtedly be necessary to admit 
students twice yearly, in order that the hospital service may not suffer from 
the removal at any one time of a considerable number of skilled workers, but 
in the interests of both students and teachers, the time of admitting classes 
should be kept as nearly as possible to twice yearly. The commonly accepted 
time in most training schools now conforms to those in other kinds of schools 
in September or October for the autumn and in January or February for the 
spring. In establishing relationships with colleges or other similar institu- 
tions, these periods will be found convenient as fitting in closely with their 
schemes of teaching. 

J. STANDARDS AND METHODS OF GOOD TEACHING 

In teaching nurses we have always to keep clearly in view the objects of the 
training. If the pupil is to be able to undertake the duties and responsibilities 
which meet her in the hospital and in the various fields of nursing outside, she 
must have not only a certain amount of sound knowledge, a high degree of 



28 HOSPITAL AND TRAINING SCHOOL STANDARDS 

technical skill and the spirit of service, but she must have a well-trained mind, 
good powers of observation, the ability to handle people and to manage affairs, 
and high ethical standards. 

The test of the teaching done in any school will be found not only in the 
examination records, but in the actual accomplishment of these results by the 
pupil. It should be judged not only by the present standing, but by the 
future growth and progress of the members of that school. The quality of 
teaching can be measured by a few fundamental tests : 

First. Where good teaching is being done the pupils are interested in their 
work they do not need to be driven to it by threats or bribes. The work is 
vital to them because it meets their needs, it helps them to solve their problems 
and it arouses in them worthy and serious hopes and ambitions which persist 
in their future life. 

Second. The pupils are doing real live thinking for themselves, and not 
simply memorizing facts. They are observing, comparing, judging, and learn- 
ing to seek out reasons and weigh conclusions. They show good sense and 
rational judgment in their handling of every-day situations, as well as in their 
class work. They relate their theory to their practice. 

Third. The pupils show the clearness and thoroughness of their knowledge 
by their ability to systematize and classify their ideas and to find them when 
needed. They do not simply accumulate masses of scrappy, unrelated facts. 
Their answers to questions, their class notes, and their method of setting about 
a practical task, will all show their ability to grasp the essential points, to sub- 
ordinate the unessential and to focus all their resources on the problem in 
hand. 

Fourth. Good teaching is shown by the degree of self-reliance, initiative and 
resourcefulness developed in the pupils, and their ability to adapt and apply 
their knowledge in new situations. The pupil who is absolutely dependent on 
the teacher, who cannot take any step without guidance and help, will not be 
of much use in the hospital or in the future work of her profession. The kind 
of teaching which substitutes tradition and authority for inquiry and investi- 
gation, which discourages mental activity and free self-expression and which 
destroys originality and initiative, is no longer accepted as good in any branch 
of education. 

The first thing for a teacher to decide is just what she wants to accomplish 
through any given subject, and she must then plan all her work with this in 
mind. She must also study her pupils to see what kind of material she has to 
work with, and what foundations she has to build on, so that the work may be 
neither above nor below their capacity. She must select her subject-matter 
with these two things in mind, and must then arrange an outline of work in 
each subject, divided into well-defined topics, which will receive attention in 
proportion to their relative importance. Different subjects in the curriculum 
should be correlated in every possible way. 

Every detail of teaching should be planned out ahead, and not left to the 
spur of the moment. Slavish dependence on a text-book usually means slip- 
shod, ineffective teaching, and rambling remarks, no matter how interesting, 
can never take the place of clear-cut, well-directed questioning and thoughtful 
discussion. 



HOSPITAL AND TRAINING SCHOOL STANDARDS 29 

A lesson-plan should be made out for each class, taking up in the form of a 
well-organized outline, all the main points to be discussed. The teacher 
should also have thought out beforehand her procedure in the teaching of the 
lesson the important questions she is to ask, the blackboard illustrations she 
is to use, the devices and material for demonstration and the plan for the pupils' 
practical work, reference readings, study, etc. 

The work of the class-room should be organized so as to secure the maximum 
of cooperation and efficiency, and the least loss of time and energy. This is 
especially important in the arrangement of classes in practical work, where, 
owing to lack of equipment and limited space, there is often serious waste of 
time for both pupils and teacher. It is scarcely necessary to state that classes 
should begin on time and finish on time, and that regular and prompt attend- 
ance on classes should be insisted upon. 

The type of class exercise or recitation should be adapted to the subject 
taught, to the time available, and to the resources of the school. Those which 
are best adapted to the work in training schools and which are suggested in 
this curriculum, are as follows: 

The Lecture Method 

This takes the form of a talk or address by the teacher, with no questions or 
responses by the pupil. It can be used profitably for introducing new material 
or arousing interest in a subject. It is economical of time, but it is limited in 
its teaching value unless supplemented by other methods. 

The Recitation Method 

This covers a variety of class exercises the drill, the quiz, the oral or writ- 
ten review, as well as the testing of assigned recitations. The problem method 
is a newer form of class exercise which is devoted to the discussion and solving 
of certain typical problems or situations which the pupil is likely to meet in 
actual life. Such methods help to maintain higher interest, help to clear up 
difficulties and test the actual knowledge of the pupil, as well as develop the 
power of oral and written expression and judgment. 

One or more of these methods would be used alone or in combination with 
other methods in practically every lesson. Their success depends on the skill 
of the teacher in putting live questions and directing discussion along profit- 
able lines. 

The Demonstration or Clinic 

This is a lesson conducted at the bed-side or in the demonstration room, for 
the purpose of showing certain conditions or performing certain experiments 
or practical procedures for the class. It is especially useful in the presentation 
of medical subjects and, in combination with the two previous methods, is 
used in nearly all the scientific and practical subjects. The excursion method 
is a modification of the demonstration, where pupils visit places illustrating 
certain conditions which they wish to study. 

The Laboratory Method 

Pupils here actually carry out experiments and practical procedures, in 
order to get a more complete understanding of the principles involved and to 



30 HOSPITAL AND TRAINING SCHOOL STANDARDS 

gain skill. This method is used in combination with those previously men- 
tioned in all the scientific subjects (anatomy and physiology, chemistry, bac- 
teriology, etc.) and in all the practical subjects (nursing, cookery, massage, 
etc.). It takes time, but is an extremely valuable and effective method of 
teaching, if properly handled. No up-to-date school or college attempts to 
teach any science or art, without providing laboratory facilities for each 
pupil. 

The Conference or Case-Study Method 

This is used with more advanced pupils, who are capable of gathering to- 
gether their own material and presenting reports on their observations or 
practical work, which are then discussed and criticized by the class and 
teacher. Such a method can be most profitably used in such subjects as 
Professional Problems, Introduction to Public Health Nursing, etc. 

The Study Period 

With more immature pupils it is often found helpful to arrange definite 
periods of supervised study, with instruction in the method of study and dem- 
onstrations in the use of reference materials, taking of notes, etc. This is 
particularly necessary in the preparatory period, where pupils have difficulty 
in acquiring the habit of study and where it is important to economize every 
available minute of study time. 

The teacher who has had no special training in teaching will find it very help- 
ful to study some of the books on teaching which are included in the bibliog- 
raphy at the end of this article. It is suggested that groups of head nurses 
and supervisors might be organized for the study of some of these commoner 
teaching problems, and if regular lecturers cannot be secured from a university 
or normal school, they might form into a club for the discussion of teaching 
and administrative problems. 

K. TEACHING EQUIPMENT 

To accomplish satisfactory results, a school should provide for its teaching 
work comfortable, well-lighted, well-ventilated class-rooms and laboratories, 
such as are found in all modern educational institutions. The number and 
size of the class-rooms will depend on the size of the school, but most schools 
will need at least a general class and lecture room, a demonstration room, and 
a diet kitchen equipped for teaching. A science laboratory for the teaching 
of chemistry, anatomy and physiology, bacteriology, solutions, etc., is also 
desirable, but in a small school the regular class-room, or demonstration room, 
or the pathological laboratory may be equipped to serve for this purpose. 
Where the hospital does not afford a well-equipped dietetic laboratory, it is 
often possible to secure the use of a high school or technical school laboratory. 
Medical schools may also furnish excellent facilities especially for the teaching 
of the sciences. All class-rooms should be supplied with ample blackbard 
spaces and cither chairs and tables, or chairs with the desk arm. 

Under each course will be found a suggestive list of equipment and illus- 
trative material to be used in teaching the various subjects. While ample 
equipment is not enough in itself to guarantee good teaching, it is practically 



HOSPITAL AND TRAINING SCHOOL STANDARDS 31 

impossible to teach nursing subjects without a fairly complete and up-to-date 
equipment and abundance of illustrative material. Much of this is easily 
secured in a hospital (beds, linen, utensils, chemicals, laboratory supplies, 
etc.), and a great deal can be readily improvised by an ingenious teacher. 
The bulk of the material for class-room use should be kept for this purpose 
only and should be properly arranged and cared for, so that it will not be 
scattered and destroyed. 

A good reference library is absolutely essential to satisfactory teaching 
work. The size of the library is not the main thing, though it is important 
that it should represent a fairly wide range of subjects. The books must be 
up-to-date and reliable, and in good condition. If possible, a special room 
should be set apart for the reference library where students can read and study 
without interruption, and a responsible person should be put in charge. It is 
very important that students should have easy access to the reference books 
and that they should be encouraged to make the fullest possible use of them. 
The text and reference books and magazines recommended under the different 
subjects of the curriculum would make a fairly complete working library for 
the average training school. If it is impossible to secure all of these books, 
the public library is usually willing to put upon its shelves books of a more 
general nature which will be used by pupil nurses, and in many cases will 
install a "travelling" unit, or a branch library in the school. 

L. RECORDS 

It is essential that a good system of records should be established which will 
provide full and exact statements. of the work which every student has done, 
and which will also give certain details regarding the health, general education, 
personality and character of each student who has been in the school. The 
importance of this matter can hardly be overestimated. Records are needed 
constantly for reference by the superintendent and staff of the training school, 
and serve as a useful check of the actual training which each pupil is getting. 
A new superintendent entering a training school has no other means of deter- 
mining the standing of the pupils and the experience they have had. The 
graduate nurse who wishes to enter the Red Cross, or take any of the post- 
graduate courses which are now offered in colleges, will have to furnish com- 
plete records of her work in the training school. The only way in which these 
records can be supplied is through her school, and if they are not available, the 
standing of both the nurse and the hospital is likely to be seriously questioned. 

The records of theoretical instruction should cover the subjects, the number 
of periods of class, lecture or laboratory in each, the years in which each sub- 
ject was studied and the grades which the student has made. Class books, 
with a record of attendance for each class, should be kept by each teacher, and 
the results filed on the student's card when the class has been completed. 

The record of practical training in each department should include the dates 
of such periods and the number of days or weeks in each. As before stated, 
the time spent in a given department may not accurately indicate the actual 
training and experience of the student, but at present this seems about the 
only method of measurement available, except in maternity work, where the 
number of cases often determines the period of training. It is suggested that 



32 HOSPITAL AND TRAINING SCHOOL STANDARDS 

every effort be made to keep track of the number and variety of cases which 
the student has observed and cared for, in all services, and that a blank be 
supplied to each student for this purpose. A number of suggestive blanks 
will be found in the Modern Hospital of July, 1917, covering not only the 
records of pupils in the school, but also admission blanks, health certificates, 
etc. 

It cannot be too strongly emphasized that a few simple blanks, kept with 
absolute accuracy, are of greater value than a very elaborate system which is 
poorly kept. It is obvious that properly trained secretarial help is required 
for the handling of such records, and correspondence relating to the school, 
and that the valuable services of expert nurses should not be employed in this 
way under ordinary circumstances. 

M. UNIVERSITY AFFILIATIONS 

The advantages of university or college relationship for schools of nursing 
are likely to be very great. Precisely those essentials in all educational work 
which the hospital finds it most difficult to supply, are freely available in every 
college or university of good standing properly equipped class-rooms and 
laboratories, libraries and other teaching material; adequately trained teach- 
ers ; associations with teachers and students interested in other lines of thought 
and activity; the atmosphere of study all of these, and other things less 
tangible are to be expected from any good university connection. The results 
in improving the standards of theoretical work in schools of nursing in helping 
to maintain the right balance between theory and practice and particularly 
in attracting better qualified candidates, can hardly be overestimated. 

The value of this relationship appears to be in proportion to the degree in 
which the university participates in the direction of the entire scheme of train- 
ing school work. Several such schools now established as regular departments 
of universities, give evidence not only of excellent standards and ideals of 
work, but of ability to grow and develop, to try out new ideas and methods. 

Where, however, the university opens up its class-rooms and laboratories 
to classes of students from schools of nursing and fails to look into the nature 
of the practical training in the hospital and the conditions under which it is 
carried on, the result may be far from satisfactory. 

The university must exact thorough work from its students, and it must 
require a good many hours of study. If this is combined with the usual hours 
of duty, there is imposed upon the student a program of study and work which 
it is entirely impossible for her to carry out. All university relationships pre- 
suppose a rational system of hours of duty, and there can be no escape from the 
ruling that every increase in the amount of theory means a corresponding 
decrease in the amount of practical work. 

N. REFERENCES ON NURSING EDUCATION AND TEACHING 

ROBB, ISABEL HAMPTON. Educational Standards for Nurses. 

BEARD, RICHARD OLDING. The University Education of the Nurse. Fif- 
teenth Annual Report of Society of Superintendents of Training 
Schools (1909), also Teachers College Record, May, 1910. 



HOSPITAL AND TRAINING SCHOOL STANDARDS 33 

The Trained Nurse of the Future. Journal of the American Medical 

Association, December 13, 1913. 
WASHBURN, F. A. (M.D.) Supply of Pupil Nurses and Nursing Standards. 

Fourteenth Annual Report, American Hospital Association, 1912. 
ROWLAND, J. B. Obligations of the Hospital and the Public to Training 

Schools for Nurses. Journal of the American Medical Association, 
. December 13, 1913. 
SMITH, WINFORD N. (M.D.) The Educational Function of the Hospital. 

Twenty-first Annual Report of the National League of Nursing 

Education (1915). 
HALL, HENRY C. The Trusteeship of Training Schools. American Journal 

of Nursing, May, 1915. 
HURD, HENRY M. (M.D.) Shall Training Schools be Endowed? American 

Journal of Nursing, September, 1906. 
FAVILL, HENRY B. (M.D.) What the Medical Profession Can Contribute to 

Nursing Education. American Journal of Nursing, January, 1916, 

and Twenty-first Annual Report of National League of Nursing 

Education (1915). 
MURPHY, FRED T. (M.D.) Demand and Supply as Related to Nurses and 

Nursing. Modern Hospital, October, 1914, and Twentieth Annual 

Report of National League of Nursing Education (1914). 
DOCK, GEORGE (M.D.) Essentials of Professional Education. Twentieth 

Annual Report of National League of Nursing Education (1914). 
WINSLOW, C.-E. A. The Public Health Nurse and Her Preparation for Her 

Calling. Pamphlet, published by National Organization for Public 

Health Nursing. 
NUTTING, ADELAIDE. Educational Status of Nursing (Pamphlet, Publication 

Bureau, Washington). 
A Sounder Economic Basis for Training Schools for Nurses. Teachers 

College Record, January, 1916. 
Hospital Trustees and the Training School. Twentieth Report of 

National League of Nursing Education (1914). 

Some Problems of the Training School for Nurses. Transaction Ameri- 
can Hospital Association, 1908, and Canadian Nurse, December, 1908. 
Some Ideals in Training School Work. Twenty-second Annual Report 

of National League of Nursing Education (1916). 
GOODRICH, ANNIE W. How Shall the Superintendents of Small Hospitals Be 

Trained? The Modern Hospital, November, 1916. 
STEWART, ISABEL M. Problems of Nursing Education. Teachers College 

Record, May, 1910. 
Apprenticeship as a Method of Vocational Education (with Special 

Application to Nursing). Seventeenth Annual Report of Society of 

Superintendents of Training Schools (1911). 

BELL, ALICE. Training School Records. Modern Hospital, July, 1917. 
TUCKER, KATHARINE. The Training School's Responsibility in Public Health 

Nursing Education. Twenty-second Annual Report of National 

League of Nursing Education (1916). 



34 HOSPITAL AND TRAINING SCHOOL STANDARDS 

FOLEY, EDNA L. Fundamental Requirements in the Training of the Public 

Health Nurse. Twentieth Annual Report of National League of 

Nursing Education (1914). 
LEE, FREDERICK, S. (M.D.) Fatigue. 
GOLDMARK, JOSEPHINE. Fatigue and Efficiency. 
BULLETIN 221. United States Bureau of Labor-Statistics. Hours, Fatigue 

and Health in British Munitions Factories. 
JAMME, ANNA. Effect of Legislation upon Schools of Nursing in California. 

Modern Hospital, August, 1915. 

SNEDDEN, DAVID. Problems of Vocational Education. 
DEWET, JOHN. How We Think. 
McMtiRRY, FRANK M. How to Study. 

STRAYER, GEORGE D. AND NORSWORTHY, NAOMI. How to Teach. 
PARKER, SAMUEL C. Methods of Teaching in High Schools. 
BETTS, GEORGE H. The Recitation. 
WHIPPLE, GUY M. How to Study Effectually. 
JAMES, WILLIAM. Talks to Teachers. 

Psychology (Briefer Course). 
THORNDIKE, EDWARD. Elements of Psychology and Principles of Teaching. 

Individuality. 

COLVIN, STEPHEN S. AND BAGLEY, WILLIAM C. Human Behavior. 
PALMER, GEORGE H. AND FREEMAN, ALICE. The Teacher. Houghton- 

Mifflin. 
See also articles in American Journal of Nursing and other Nursing Periodicals. 



THE COURSE OF STUDY 

A. LENGTH OF COURSE AND GENERAL DIVISION OF TIME 

The length of the course is three calendar years, divided into the preparatory 
or first year, the junior or second year, and the senior or third year. 

One month should be allowed each year for vacations. These should all be 

arranged for the summer term, when no lectures and classes are being given. 

The academic or class year would be the same as in most other educational 

institutions, extending from the first week of October till the end of May, 

(about thirty- two weeks). 

This period is generally divided into two terms of about sixteen weeks each 
the first, or winter term, extending from October to January (allowing at 
least one week for Christmas vacation) ; the second, or spring term, extending 
from February till May. New classes would be admitted in the beginning of 
the winter and spring terms only. 

It would usually be assumed that the last week of each term would be de- 
voted to examinations, leaving about fifteen weeks each term for class and 
lecture work. 

The general schedule of hours suggested for the first four months or prelimi- 
nary term is as follows : 

4 hours daily in practical work. 
3 hours daily in lecture and class. 
3 hours daily in study and practice. 
2 hours daily in recreation. 

For the subsequent terms the schedule would be as follows : 
8 hours daily in practical work, 
f to 1 hour (average) daily in lecture and class work. 

1 hour daily for study. 

2 hours daily for recreation. 

This means 10 hours of actual required work daily throughout the academic 
year with the exception of Sundays, when class work and study would be 
omitted, and the one day a week when an afternoon off is allowed. So far as 
possible evening hours should be left free from all class and lecture work. 

The hours for night duty should be the same as for day duty in any case 
never to exceed ten hours a night. The total length of night duty should not 
exceed four months and not more than two months' night duty should be given 
at any one time. The first term of night duty should be as an assistant, not in 
charge of a floor. 

B. GENERAL SCHEME OF PRACTICAL INSTRUCTION 

Division of Time for Practical Work 

Preliminary or Probationary Period 4 months. 

If possible, the pupil is not to be counted upon for any regular ward 
duties during this time, and her practical work should not exceed 4 
hours daily. Her practice in the various departments is for the pur- 

35 



36 THE COURSE OF STUDY 

pose of giving her a background for her class work, and helping 
her to apply the methods which she has learned in the class-room. 
It is also an opportunity for testing out her ability for nursing work. 
The practice should be closely tied up with her studies, and should 
be under the careful supervision of the instructor. Each pupil 
should, if possible, have a short period of time in each of the fol- 
lowing departments: diet kitchen, hospital supply-room, linen- 
room, dispensary, and wards. Time should also be provided for a 
few visits to homes with social service workers or visiting nurses, in 
order that the pupil may see for herself the conditions under which 
many of her patients live. 

Medical Nursing 8 months. 

This time is to be divided among medical wards (men's and 
women's). The medical service should provide experience in the 
care of all the commoner medical diseases, the greater proportion of 
which should be acute. In addition to typhoid fever, pneumonia 
and such communicable diseases as may be cared for in general medi- 
cal wards, it is important that experience should be given in the care 
of tuberculosis and also, if at all possible, the acute infectious dis- 
eases, such as scarlet fever, diphtheria, measles, etc. If the hospital 
docs not care for mental and nervous cases, it is urged that affilia- 
tions with mental hospitals should be secured to give this training. 

Surgical Nursing 8 months. 

This should be divided among surgical wards (men's and women's) 
and should include gynecological, orthopedic and operating-room 
services. The surgical experience should represent a fairly wide 
range of operative cases, including emergency work. Opportunity 
for assisting at operations and doing surgical dressings should also 
be provided. 

Nursing in Diseases of Infants and Children 4 months. 

This time should be given in special wards or in an affiliated hospital 
devoted to the care of infants and children. It should include both 
boys and girls and should cover both medical and surgical conditions 
of childhood. If possible, some experience should also be given in 
the handling of fairly normal run-about children, such as may be 
be found in the children's clinic. Visiting or follow-up work in 
connection with the children's services is also important. Work 
in the milk-room, in preparation of infant's feedings should be 
included in this period. 

Obstetrical Nursing 3 months. 

This should be given in special maternity wards or in an affiliated 
hospital devoted to obstetrical work. It should include the care of 
both normal and operative cases, and of normal and premature 
babies. Out-patients' service, if provided, should be supplemen- 
tary to the above, and given only under expert supervision. 

Nursing in Special Diseases 2 months. 

It is desirable, though not always possible, to give practical experi- 
ence in eye, ear, nose and throat work, occupational, venereal and 



THE COURSE OF STUDY 37 

skin diseases, etc. This may be secured either in the dispensary 
or wards preferably in both. It is particularly important for 
those who are planning for public health work. 

Electives 4 months. 

This period should be arranged, so far as possible, with reference 
to the special aptitudes and future plans of the pupil. Those in- 
tending to do private nursing might spend part of the time in the 
private wards or in special duty. Those intending to enter some 
form of public health nursing should be detailed to the hospital 
social service department, or to an affiliated visiting nurse associa- 
tion (only, however, when the practical work there can be as thor- 
oughly supervised as the work in the hospital). Those who expect 
to go into some form of institutional work may assist a head-nurse 
or supervisor in charge of some hospital department. For the 
remainder of this period, the pupil may be assigned to one of the 
regular services in which she wishes to secure further experience 
and training, or to some special branch of work, such as contagious, 
mental hospital, or laboratory work, which may not be included in 
the regular training. 

Vacations (one month each year) 3 months. 

Total 36 months. 

Arrangement of Practical Training 

No fixed order of services can be recommended, as this must depend on a 
great many factors which vary widely in different hospitals. In general, how- 
ever, it is believed to be important that experience in medical and surgical 
nursing, should precede training in special branches and that services demand- 
ing the more fundamental and uncomplicated measures, should precede those 
which demand considerable differentiation and a higher degree of skill and 
adaptability, such as mental nursing or children's nursing. Operating-room 
work should precede obstetrics and all the regular branches of hospital service 
(such as children, obstetrics, contagious, etc.) should be covered before the 
pupil takes up public health nursing or social service. The following arrange- 
ment is suggested : 

Preparatory or First Year: 

Elementary nursing, diet kitchen (elementary) and hospital 
housekeeping (in preliminary course). General medical and general 
surgical services. 

Junior or Second Year: 

Infectious, tuberculosis and admitting services (if given); chil- 
dren's service and milk-room; gynecological, orthopedic, operating- 
room and obstetrical services (the latter will frequently be extended 
into the third year). 

Senior or Third Year: 

Psychopathic service (including practical work in hydrotherapy 
and occupation therapy, where possible), dispensary, special dis- 
eases. Advanced or special work in any one of the regular depart- 



38 THE COURSE OF STUDY 

ments. One of the following electives (1) special duty or private 
ward service, (2) hospital social service or visiting nursing service, 
(3) executive work as assistant to head-nurse or supervisor. 

C. GENERAL SCHEME OF THEORETICAL INSTRUCTION 

* Preparatory or First Year 

First or Winter Term hours 

Anatomy and Physiology 60 

Bacteriology 20 

Personal Hygiene 10 

Applied Chemistry 20 

Nutrition and Cookery. r 40 

Hospital Housekeeping 10 

Drugs and Solutions 20 

Elementary Nursing Principles and Methods 60 

Bandaging 10 

History of Nursing (including Social and Ethical Principles). . . 15 

Total , 265 

Second or Spring Term 

Elements of Pathology 10 

Nursing in Medical Diseases 20 

Nursing in Surgical Diseases 20 

Materia Medica and Therapeutics 20 

Diet in Disease 10 

Elements of Psychology (recommended) 10 

Total 80 to 90 

Junior or Second Year 

First or Winter Term 

Nursing in Communicable Diseases 20 

Nursing in Diseases of Infants and Children (including Infant 

Feeding) 20 

^Massage 10 

Principles of Ethics 10 

Total... . 60 



* When two or more groups are brought in during the first year, it will be 
necessary to repeat most of the subjects in the first year with each group, so 
that all may be ready to enter for the second year's work together. 



THE COURSE OP STUDY 39 

Second or Spring Term 

Gynecological Nursing 10 

Orthopedic Nursing 10 

Operating- Room Technic 10 

Obstetrical Nursing 20 

Nursing in Diseases of the Eye, Ear, Nose and Throat 10 

Total 60 

Senior or Third Year 

First or Winter Term 

Nursing in Mental and Nervous Diseases 20 

Nursing in Occupational, Venereal and Skin Diseases 10 

Special Therapeutics (including Occupation Therapy) 10 

Public Sanitation 10 

Survey of the Nursing Field 10 

Total 60 

Second or Spring Term 

Modern Social Conditions 10 

Professional Problems 10 

Emergency Nursing and First Aid 10 

"Introduction to Public Health Nursing and Social 

Service 10 hours 

"Introduction to Private Nursing 10 hours 

"Introduction to Institutional Work 10 hours 

"Introduction to Laboratory Work 10 hours 

"Housekeeping Problems of Industrial Families 10 hours 

"Special Disease Problems (Advanced work in any of 

special forms of disease studied above) 10 hours 

Total 60 

Total number of hours for the three years 585 to 595. 

The outline of each of these subjects is given in the following pages. The 
subjects are classified according to their relationship to one another rather 
than in the order in which they would follow one another in the curriculum. 
They are divided into the main fields of Biological and Physical Science, House- 
hold Science, Prevention of Disease, Treatment of Disease, Nursing in Dif- 
ferent Forms of Disease, Social and Professional Subjects and Special Branches 
of Nursing. 

* The subjects starred are all elective, to be selected according to the stu- 
dent's future line of work. Each student would be expected to cover at least 
three of these subjects, to make up a total of 60 hours of work for the last term. 



30 



OUTLINES OF SUBJECTS 

A. BIOLOGICAL AND PHYSICAL SCIENCES 

Anatomy and Physiology 

TIME: 60 hours, divided as follows: 

Lectures and demonstrations by qualified teacher of anat- 
omy, preferably a physician or trained nurse instructor, 30 
hours. 

Classes, quizzes and individual laboratory work conducted 
by nurse instructor, 30 hours. 

Course to be given (and completed) in the early part of the 
first year. 

OBJECTS OF THE COURSE 

1. To give the pupil a practical working knowledge of the 
structure and function of the normal human body as the essen- 
tial basis for the study of hygiene, dietetics, materia medica, 
and all pathological conditions, as well as for the safe and in- 
telligent practice of nursing measures in the wards. 

2. To discourage popular, haphazard and pseudo-scientific 
ways of thinking about the body and its functions, to give 
practice in the correct use of ordinary scientific terms, to train 
in habits of exact observation and reasoning and to arouse an 
intelligent interest in scientific work generally. 

OUTLINE OF CLASSES AND LABORATORY PERIODS 

I and III. (Lectures and Demonstrations) Introduction. 

Biological functions common to all forms of life Eight biologi- 
cal systems skeletal, muscular, alimentary, vascular, respi- 
ratory, excretory, nervous, reproductive. Body as a whole 
cavities, surface anatomy, location of organs. The cell theory 
cell structure and activities. Evolutionary theory (very 
briefly). 

II and IV. (Laboratory and Quiz) 

Dissect frog of larger animal to show body as a whole. Study 
simpler animal types amoeba and paramecium under micro- 
scope. Show slides illustrating cell-division in diderent stages. 

V and VII. (Lectures and Demonstrations) Study of Tissues 

Embryonic origin of tissues. Four elementary tissues epi- 
thelial, connective, nervous, muscular. Glandular tissue flat 
and columnar cells, tubular glands, branched tubular glands. 
Special membranes serous, synovial, mucous, cutaneous. 

VI and VIII. (Laboratory and Quiz) 

Charts or pictures showing folding off of tissues in embryo. 
Students make slides of epithelial tissue from the lips. Stain 
and examine under the microscope. Draw. Illustrate dif- 

40 



ANATOMY AND PHYSIOLOGY 41 

ferent tissues by meat obtained from the butcher or by dis- 
secting small animal ; also show slides under microscope. 

IX and XI. (Lectures and Demonstrations) Skeletal System 

Osseous tissue gross and microscopic. Structure of bone. 
Regeneration of bone. Study of skeleton head, trunk, ex- 
tremities, articulations. 

X and XII. (Laboratory and Quiz) 

Examine and sketch slides showing longitudinal and trans- 
verse sections of bone. Fresh bone, showing articulations. 
Bone treated with acid. Quiz on skeleton and separate bones 
to be studied and identified. (X-rays plates very helpful.) 

XIII and XV. (Lectures and Demonstrations) Muscular System 

Muscular tissue. Mechanics of locomotion. Muscular fa- 
tigue. Study of more important muscles, particularly those 
involved in common surgical procedures. 

XIV and XVI. (Laboratory and Quiz) 

Slides showing different types of muscular tissue. Charts 
showing different types of levers. Examination of fresh meat. 
Rabbit or cat dissection for muscles and tendons. 

XVII, XIX, XXI, XXIII, and XXV. (Lectures and Demonstrations) 
Alimentary System 

Anatomy of alimentary canal. Anatomy of accessory organs 
of the digestive system teeth, tongue, salivary glands, pan- 
creas, liver and gall-bladder. Foods, food constituents, body 
constituents, food values. Digestion mechanical, chemical 
and psychical factors. Absorption. 

XVIII, XX, XXII, -XXIV and XXVI. (Laboratory and Quiz) 

Charts, models, slides and fresh specimens of animal organs 
used freely. Government charts showing food values. Dem- 
onstrate chemical tests in digestion and absorption of foods, 
salivary digestion, gastric digestion and saponification of fats 
and oils. X-ray plates showing bismuth meals. (For full 
directions as to tests see Bigelow Applied Biology and Labora- 
tory Manual.) 

XXVII, XXIX, XXXI, and XXXIII. (Lectures and Demonstrations) 
Vascular System 

Blood-vascular system blood, heart, arteries, veins and 
capillaries. General circulation pulmonary, systemic and 
pSrtal. Control of local circulation, blood pressure, pulse. 
Lymph-vascular system lymph, lymph-vessels. 

XXVIII, XXX, XXXII and XXXIV. (Laboratory and Quiz) 

Show charts, models, slides and diagrams. Dissect beef 
heart with vessels. Students make slides of drop of their own 
blood; examine, make drawings. Show method of counting 
r. b. c. and leucocytes. Effect of different solutions, tempera- 
tures, etc. on clotting. Demonstrate taking blood-pressure. 
Pulse-tracings in normal and abnormal cases. Examine foot of 
live frog under microscope for study of circulation and heart 
action in dead frog. Color index for haemoglobin. 



42 OUTLINES OF SUBJECTS 

XXXV and XXVII. (Lectures and Demonstrations) Respiratory System 

Anatomy of respiratory organs. Function of respiration. 
Mechanical factors. Effect on blood. 

XXXVI and X CXVIII. (Laboratory and Quiz) 

Examination, inflation and dissection of beef lungs, includ- 
ing trachea and larynx. Microscopic study of lung tissue. 
Demonstrate mechanics of respiration. Demonstrate lung- 
motor. Test students' lung capacity. 

XXXIX, XLI and XLIII. (Lectures and Demonstrations) Excretory 
System 

Anatomy of kidneys, ureters, bladder, etc. Physiology of 
urinary system. Anatomy and physiology of the skin. (Pri- 
mary function heat regulation, secondary function excretion.) 
Appendages of the skin hair and nails. Body temperature 
normal, abnormal. Mechanism of heat regulation. 
XL, XLII and XLIV. (Laboratory and Quiz) 

Dissect sheep's kidney. Show charts, models, slides, etc., of 
kidney and skin. Constituents of normal urine and simple tests. 
XLV. (Lecture and Demonstration) Ductless Glands and Metabolism 
Structure and functions of suprarenal, thyroid and pituitary 
glands. Influence of internal secretions on functions of the 
body. Metabolism. Anabolic and katabolic changes. 
XLVI. (Laboratory and Quiz) 

Examination of specimens and slides. Review of digestion, 
excretion and metabolism. 

XLVII, XLIX, LI, LIII, LV. (Lectures and Demonstrations) Nervous 
System and Special Senses 

Nervous tissue. Degeneration and regeneration of nervous 
tissue. The neurone, the spinal cord, spinal nerves. Reflex 
and automatic action. The brain structure and function. 
Sensation. Anatomy and physiology of special sense organs 
ear, eye, organs of taste and smell. 
XLVIII, XL, LII, LIV and LVI. (Laboratory and Quiz) 

Charts, models, and slides of brain, cord and special sense 
organs. Dissection of fresh pig's head. Dissection of pig's 
eye. Drawings. 
LVIII, LIX. (Lectures and Demonstrations) Reproductive System 

Anatomy of female generative organs. Review of pelvic 
bones. Birth canal. Anatomy of male generative organs and 
male pelvis. Physiology of the reproductive system. 
LVIII and LX. (Laboratory and Quiz) 

Show lantern slides or charts of different stages in develop- 
ment of embryo. Dissect cat or rabbit to show embryo and re- 
productive system as a whole. 
METHODS OF TEACHING 

1. In the lecture periods, groups of 30 pupils or more can be 
handled, but for laboratory work, smaller groups not exceeding 
15 to 20 are advisable. 



ANATOMY AND PHYSIOLOGY 43 

2. It is important to have pupils themselves handle material 
and carry out observations and experiments as far as at all 
possible. Laboratory work arouses interest, stamps facts in 
the memory, trains in careful observation and clears up difficul- 
ties. Clear written directions should be given for all laboratory 
exercises. Pupils can often work in groups of two or three, 
where the material and equipment is limited. Note books of 
laboratory work should be kept with diagrams and drawings, 
descriptions of experiments, etc. These should be handed in 
for inspection at regular intervals. 

3. Where the time is limited, demonstrations by the teacher 
may take the place of some of the laboratory exercises. Some 
teachers advocate the observation of one or two post-mortems 
for pupils in anatomy classes, but this would probably come 
more profitably in the later part of the training. 

4. Short papers on special topics can be assigned to pupils 
in turn, and read in class. Oral and written quizzes and reviews 
should be frequent. 

5. Special emphasis should be laid on the phases of the sub- 
ject which apply to nurses' work. The close connection be- 
tween the theoretical and the practical work should be empha- 
sized, and illustrations should be used constantly by the in- 
structor to form a close association between the two. The 
work here should also be correlated with parallel courses in 
chemistry, bacteriology, hygiene, dietetics, etc. 

6. Good blackboard work is essential here. A good-sized 
blackboard and colored chalks should be provided. Students 
should be encouraged to use diagrams extensively in note-books 
and should also learn to draw on the blackboard. 

7. A good text book should be used, and assignments required 
regularly. Other readings can be assigned where the text- 
book needs to be supplemented. 

8. Take students to a good Natural History Museum if pos- 
sible, to show comparison between human anatomy and that 
of other animals; also to show cellular structure and embryonic 
development. 

9. It is not expected that this arrangement of topics will 
suit all teachers. Many prefer to take the skeletal and muscu- 
lar systems before tissues, some introduce the nervous system 
much earlier in the course, and some take the circulatory sys- 
tem before the digestive. Such readjustments in the order 
of topics would not alter the general character of the course. 

EQUIPMENT AND ILLUSTRATIVE MATERIAL 

Skeleton with separate skull, separate bones; compound and 
dissecting microscopes (one for every two students if possible), 
colored chalks, charts, slides and X-rays plates; papier-mache 
manikin and models of kidney, sweat glands, eye, ear, etc. 



44 OUTLINES OF SUBJECTS 

Specimens in formalin brain, kidney, spinal cord, larynx, etc. 
Modelling clay. Excellent home-made charts can be made with 
manilla paper and wax crayons, or with Bristol board and paints 
or water colors. 

MATERIALS TO BE KEPT IN CLASS-ROOM (for a group of 12) : 

Two trays, 6 dissecting pans with paraffin (squares of soft 
wood may be used instead of paraffin pans); flat glass dishes; 
6 finger bowls; 6 small glass jars; 12 dissecting needles; paper 
pins (small); bank pins; 8-in. square gauze; 6 glass stoppered 
bottles; 6 Bunsen burners; 6 tripods; 6 wire-screens; 3 small 
alcohol lamps; slides; cover slips; glass covered jars for speci- 
mens; labels; 3 red wax pencils; 3 doz. text-tubes, 6 glass fun- 
nels (2 sizes); filter paper (2 sizes); 6 sets of beakers (4 in set) 
6 funnel racks; 6 test-tube racks; 6 test-tube holders; stickers; 
cotton thread; No. 36; dishes for specimens; 3 casseroles; 2 
mortars and pestles; litmus paper; HC1 0.2 per cent, HC1 10 
per cent; Fehling-Benedict solution; Filter paper; Iodine; 
NaOH; Alcohol; 6 glass stirring rods; 6 pipettes; 6 scalpels; 
6 pr. scissors (those discarded from operating room may be 
used, or scissors may be bought at the ten cent store); 10 per 
cent formalin. 

TEXT AND REFERENCE BOOKS 

Kimber: Anatomy and Physiology for Nurses. 

Pope: Anatomy and Physiology for Nurses. 

Dawson: Anatomy and Physiology for Nurses 

Bundy: 'Anatomy and Physiology. 

Howell: Text-book of Physiology. 

Starling: Principles of Human Physiology. 

Tigerstedt: Text-book of Physiology. 

Hough and Sedgwick: Human Mechanism. 

Martin: Human Body. 

Bigelow: Applied Biology. 

Halliburton: Hand-book of Physiology. 

Brubaker: Anatomy and Physiology. 

Hertar: Biological Aspects of Human Problems. 

Cannon: Mechanical Factors in Digestion. 

Cannon: Bodily Changes in Pain, Hunger, Fear and Rage. 

Parker and Parker: Practical Zoology. 

Parker and Haswell: Text-book of Zoology. 

Gray: Anatomy. 

Gcrrish: Anatomy. 

Sabotta-McMurrich: Atlas and Text-book of Human Anatomy. 

Marshall: Vertebrate Embryology. 

Wiedersheim : Comparative Anatomy. 

Piersol: Normal Histology. 



BACTERIOLOGY 45 

Hill: Histology. 

Stiles: Nutritional Physiology. 

Sherman: Chemistry of Food and Nutrition. 

Elementary Bacteriology 

TIME: 20 hours arranged as follows: 

Lecture, demonstration, and recitation 10 hours. 

Laboratory work 10 hours. (Laboratory period to follow 

class period.) 

Taught by a physician with nurse assistant, or by trained 
nurse instructor. The course to be given early in the pre- 
paratory year. 

OBJECTS OF COURSE 

1. To help pupils to understand the characteristics and hab- 
its of microorganisms, so that they may be better able to 
protect themselves, their patients, and the public from 
infection. 

2. To teach them something of laboratory technic so that 
they will appreciate better the necessity for surgical asepsis, 
and learn to apply the same careful methods in their nursing 
procedures, cleaning, cookery, etc. 

3. To arouse interest in this new and very important branch 
of science, so that the pupils will continue to read and study 
along these lines, and keep up-to-date in the latest discoveries 
and methods. 

OUTLINE OF CLASSES AND LABORATORY WORK 

I. (Class) Introduction 

Uses of bacteriology to the nurse. Historical theories of dis- 
ease. Leaders in science of bacteriology Pasteur, Koch, Er- 
lich, etc. (very briefly). Consideration of plants green and 
colorless. Eight biological systems of higher animals and 
parallel functions of one-celled organisms. Structure of typi- 
cal plant and animal cells. Independent plants. Economic 
and biological functions of green plants. Photo-synthesis, 
respiration and transpiration. Reproduction by mitosis. 
Conditions favoring growth. 

II. (Laboratory) The microscope how to use it and care for it. 
Demonstration showing osmosis. Study of onion epidermis to 
show cell structure and plasmolysis. Microscopic study show- 
ing cell structure of leaves. Experiments showing photo- 
synthesis, respiration and transpiration. 
III. (Class) Molds 

Dependent plants molds, parasitic and saprophytic organ- 
isms. Economic relationships. Mold diseases. Distribution 
of molds. Structure. Reproduction' sexual and asexual, 



46 OUTLINES OF SUBJECTS 

spore formation. Conditions favoring growth and methods of 
destruction. 

IV. (Laboratory) Study of two or three common molds under 
microscope with drawings. Making of pure cultures of mold 
by inoculating sterile bread or crackers with a selected mold. 
V. (Class) Yeasts 

Economic relationships. Structure. Reproduction by bud- 
ding, fission and spores. Enzyme action. Fermentation. 
Work of Pasteur. Conditions favoring growth. Methods of 
destruction. 

VI. (Laboratory) Observation and drawing of yeast cells and 
starch grains. Technic of the hanging drop. Experiment to 
show effect of different temperatures on growth and viability 
of yeast or experiment to show ability of yeast to ferment 
various carbohydrates. 
VII. (Class) Bacteria 

Distribution of bacteria. Structure of bacterial cell. Clas- 
sification according to morphology and grouping. Methods of 
reproduction by fission and by spore formation. Conditions 
affecting growth temperature, moisture, food supply, light, 
oxygen. Effect of electricity, chemicals, agitation, etc. Vital 
phenomena odor, motility, light, heat, pigment, etc. Special 
media for laboratory study of bacteria. 

VIII. (Laboratory) Exhibit of various laboratory media. Descrip- 
tion of culture growth. Making of agar pour plate and exposing 
to various conditions as air, hair, fly, washed and unwashed 
fingers, etc. Use of oil immersion lens. Preparation and ex- 
amination of stained smear of bacteria from teeth. Examina- 
tion of prepared slides of staphylococci, streptococci, and 
bacilli for morphology. 

IX. (Class) Effects of Physical and Chemical Agents on Micro- 
organisms 

Methods of destroying bacteria. Physical by dry and moist 
heat, sunlight, etc. Chemical by germicides and antiseptics. 
Length of exposure for bacteria and spores. Effects of strength 
and temperature of chemical agents on bacteria. 
X. (Laboratory) Examination of cultures from Lesson VIII. 
Making pure culture by fishing and transferring to broth cul- 
ture. Testing results of common physical and chemical agents 
on bacteria. 

XI. (Class) Bacteria and Disease 

Disease production by toxins, endotoxins, and ptomaines. 
Avenues of entrance into body of bacteria. Growth in tissues. 
Avenues of discharge. Special study of the colon and typhoid 
groups of bacteria. 

XII. (Laboratory) Examine broth culture from laboratory X for 
characteristic growth of organisms in broth. Make streak cul- 



BACTERIOLOGY 47 

ture on agar slant. Demonstration of plating method in 
examination of water. 

XIII. (Class) Dissemination of Disease-Producing Organisms 

Transmission of disease by direct and indirect contact. The 
r61e of insect carriers, human carriers, fomites, water, shell- 
fish, milk and other foods, air and "filth." Special study of 
staphylococcus, streptococcus, pneumococcus and filterable 
viruses. 

XIV. (Laboratory) Examination of streak cultures from laboratory 
XII to identify organisms, purity of colonies, etc. Prepara- 
tion and examination of slides of streptococcus, staphylococcus 
and pneumococcus. Making cultures of water and milk. 

XV. (Class) Bacteriology of Milk and Water 

Relation of bacteria to milk supply. Sources of bacterial 
infection in milk. Methods of safe-guarding milk supply. 
Water as a medium of infection. Sources of contamination. 
Tests for water and milk supplies. 

XVI. (Laboratory) Examination of cultures of water and milk and 
estimation of number to cubic centimeters of water or milk 
tested. (Visit to Board of Health Laboratory if possible.) 
XVII. (Class) Defences of the Body Against Pathogenic Bacteria 

External defences of the body. Vital resistance and factors 
modifying it. Theories of immunity, antibodies, phagocytes, 
etc. Vaccination. Use of antitoxines and sera. Special study 
of tubercle, Klebs-Loffler, tetanus and anthrax bacilli. Prepa- 
ration of sera and vaccines. (Seen in laboratory if possible.) 
XVIII. (Laboratory) Hanging drop showing motility and agglutina- 
tion. Examination of prepared slides of bacilli given special 
study in class, also slides showing phagocytosis. 
IX. (Class) Applications of Bacteriology 

Applications of above principles to methods of disinfection, 
to sterilization of water, instruments, dressings, to care of dis- 
charges and excretions. Applications of bacteriology and se- 
rum-therapy in prevention, diagnosis and treatment of small- 
pox, typhoid, fever, diphtheria, syphilis, rabies, etc. Special 
study of organisms causing malaria, syphilis and gonorrhoea. 
XX. (Laboratory) Demonstration of the taking of throat cultures. 
Preparation and examination of smears from throat. Examina- 
tion of prepared slides showing organisms discussed in class. 

METHOD OF TEACHING 

1. Follow class method for presentation of subject matter as 
far as possible. Have outside readings and reports from as- 
signed books or current journals. 

2. Laboratory work to be given in sections, not exceeding 
15 to 20 students with facilities for each pupil or pair of pupils 
carrying out all the experiments. Note-books for drawings and 
laboratory notes. 



48 OUTLINES OF SUBJECTS 

3. Correlate as closely as possible with other subjects, espe- 
cially with hygiene and practical nursing work. A short paper 
on "The Practical Applications of Bacteriology to Nursing" 
will help to focus attention on the uses of the subject. 

4. No one text book for nurses covers the ground adequately. 
Choose the best and supplement liberally from larger reference 
books. Recent editions of text and reference books should be 
used, as changes are constantly taking place in this subject. 

5. Have at least one visit to a well-equipped laboratory such 
as might be found in the Board of Health or the hospital itself. 

EQUIPMENT AND ILLUSTRATIVE MATERIAL 

Microscopes (one for every two students if at all possible), 
petri dishes, test tubes, fermentation tubes, slides (plain and 
prepared), racks for drying slides, cover slips, stains, oil, balsam, 
lens paper, platinum needles, bunsen burners, tripods, pipettes, 
etc. Small utensil sterilizer, culture media and cultures from 
pathological laboratory. Charts, photographs and slides. 

Room should be fitted up with tables or shelves where mi- 
croscopes can be placed in good light. Should also have gas 
and running water attachments. 

TEXT AND REFERENCE BOOKS 

Conn: Bacteria, Yeasts and Molds in the Home. 

Bolduan and Grund: Applied Bacteriology for Nurses. 

Roberts: Bacteriology and Pathology for Nurses. 

Fox: Bacteriology and Protozoology. 

Buchanan: Household Bacteriology. 

Curtis: Nature and Development of Plants. 

Bigelow: Applied Biology. 

Conn: Agricultural Bacteriology. 

Hiss and Zinnser: A Text Book on Bacteriology. 

Park and Williams: Pathogenic Micro-Organisms. 

Jordan: General Bacteriology. 

Zinnser: Infection and Resistance. 

Chapin: The Sources and Modes of Infection. 

Marshall: Microbiology. 

Rosenau: Preventive Medicine and Hygiene. 

Gibson: Clinical Laboratory Technic. 

Carey: A Text-book for Nurses in BacteriologE. 

Applied Chemistry. 

TIME: 20 hours divided as follows: 

Lecture and class-work 10 hours. 
Laboratory work and demonstrations 10 hours. 
Taught by the instructor of nurses or a teacher of chemistry 
(secured from a high school or college) Course to be given 
early in the preparatory year. 



CHEMISTRY 49 



OBJECTS OF COURSE 



1. To serve as a basis for the more intelligent study of physi- 
ology, dietetics, household economy, materia medica, and other 
nursing subjects. 

2. To make the pupil nurse more observant of the chemical 
phenomena of every-day life, especially those chemical reac- 
tions which are of practical and economic importance in nurs- 
ing and hospital work. 

3. To train her to be skillful and accurate in handling labora- 
tory material and to be exact in her reasoning. 

4. Where pupils have already had a good course in chemistry, 
the special applications of chemistry to nursing can be enlarged 
upon and the general principles of organic and inorganic chem- 
istry reviewed. 

NOTE : It is highly desirable that all pupils should be required 
to have covered a good elementary course in chemistry before 
admission to nursing schools. It is quite impossible to teach 
a subject of this kind in 20 hours. All one can hope to do is to 
give a few foundation principles, and a few practical applica- 
tions in this time. 

OUTLINE OF CLASSES AND LABORATORY WORK 

I. (Lecture and Class) Introduction 

Relation of chemistry to animal life. Changes involved in 
life processes. Relation to plant life. Classes of changes 
physical and chemical. Definitions of physics, chemistry, etc. 
Factors in all energy changes matter changes mechanical 
mixtures chemical compounds elements. 
II. (Laboratory) 

Construction of simple laboratory apparatus and experiments 
showing physical and chemical changes. 

III. (Lecture and Class) Elements and Chemical Formulae and Equa- 
tions 

Definition of elements occurrence, physical states, names 
and symbols of those in most general use. Dalton's Atomic 
Theory. Valence. Molecules. Uses of formulae and equa- 
tions. Study of formulae of compounds in most general use. 

IV. (Laboratory) Mechanical and chemical compounds. Physical 
processes. Dissolving true solution and saturated solution. 
Distillation (to be given as a demonstration). 

V. (Lecture and Class) Oxygen 

Occurrence, properties, importance to life. Oxidation. 
Measuring of food value in terms of calories. Oxidizing and 
reducing agents. Compounds of oxygen. Carbon dioxode. 
Carbon monoxide. Water. Impurities of water hard and 
soft. Fire extinguishers. 



50 OUTLINES OF SUBJECTS 

VI. (Laboratory) Experiments in preparation of oxygen, showing 
combustion. Determination of carbon dioxide. Tempera- 
ture. Scales for measuring. Freezing and boiling points. 
VII. (Lecture and Class) Acids 

Composition. Brief talk on properties of hydrogen. Non- 
metals their classification. The acid radical. Formulae of 
acids in most common use. Characteristics of acids. Classi- 
fication of acids into binary acids, oxy-acids and halogen acids. 
Action of acids on tissues. 

VIII. (Laboratory) Test for characteristics of acids taste, litmus 
reaction, reaction with zinc, reaction with carbonates. Tests 
for the presence of hydrogen. 
IX. (Lecture and Class) Bases 

Composition. Mention of some of the most important met- 
als. Hydroxyl group. Definition of alkali. Characteristics 
of bases. Classification of bases. Neutralization. 
X. (Laboratory) Composition and preparation of lime water. 
Test for characteristics of bases, litmus reaction, taste, feeling, 
neutralization. 
XI. (Lecture and Class) Salts 

Classification of salts. Normal or neutral salts. Salts of 
binary acids, oxy-acids, hypo-ous acids. Importance of salts 
to the body. Uses of normal saline. Brief discussion of salts 
used medicinally. Classification. Chlorides. Sulphates. 
Phosphates. Halogen salts. Functions of special salts cal- 
cium, etc. 

XII. (Laboratory) Experiments to show effect of distilled water on 
blood. Test for reaction of salts sodium chlorides, sodium 
bicarbonates, acid sodium phosphates, etc. Tests for presence 
of chlorides, sulphates, phosphates, etc. 

XIII. (Lecture and Class) Introduction to Organic Chemistry 

Definition. Constituents of organic compounds. Distribu- 
tion of carbon. A few of the compounds of carbon. Organic 
acids their classification. Properties similar to inorganic 
acids. Organic bases. Alcohols and alkaloids. Organic salts. 

XIV. (Laboratory) Experiments to show constituents of organic 
matter. Tests for presence of carbon, hydrogen, nitrogen, sul- 
phur, phosphorus, etc. Tests for presence of alkaloids. 

XV. (Lecture and Class) Carbohydrates 

Molecular construction. Classification into monosaccharids, 
di-saccharids and poly-saccharids. Their solubility, digestibil- 
ity, properties and occurrence. Digestion of carbohydrates. 
XVI. (Laboratory) Test for presence of glucose. Determination of 
the composition of di-saccharids and poly-saccharids. Deter- 
mination of elemental composition of carbohydrates. Salivary 
digestion. Hydrolysis. Fermentation. Osmosis. 



CHEMISTRY 51 

XVII (Lecture and Class) Proteins 

Nitrogen and some of its compounds (very briefly discussed). 
Molecular construction of proteins. Classes of proteins 
where found. Digestion of proteins. End waste products of 
protein metabolism. 

XVIII. (Laboratory) Tests for presence of protein. Nitric acid test. 
Biuret, precipitation test. Coagulation test for albumen. 
Determination of nitrogen as ammonia. Preparation of pro- 
teose and peptone. Test for urea. 
XIX. (Lecture and Class) Fats 

Use of fats to the body. Caloric value of fats. Molecular 
construction. Fatty acids. Emulsions. Soaps. Alcohols. 
XX. (Laboratory) Experiments showing solubility of fats in water, 
alcohol, ether. Determination of glycerine. Extraction of pure 
fat from beef suet. Saponification with an alkali. Emulsifica- 
tion (Cod liver oil and NaC0 3 ). Separation of fatty acids. 

METHODS OF TEACHING 

1. It is impossible to teach chemistry by the lecture method 
alone. Discussions and frequent quizzes are necessary to clear 
up the difficult points and the demonstration of experiments is 
essential to any clear understanding of the simplest principles 
of chemistry. As far as at all possible each individual should 
be able to work out her own experiments in the laboratory. 
Where this is not possible a good deal can be accomplished 
through demonstrations by the teacher. 

2. In the laboratory stress is placed on the care with which 
experiments are set up, and on the keenness of observation, the 
accuracy of records and conclusions to be drawn. Before pass- 
ing on to another experiment, each student is quizzed by the 
instructor to be sure that she understands thoroughly what she 
has done, and connects it with her notes. 

3. Not more than 16 to 20 can be taken together in a labora- 
tory section, unless one has unusual facilities. Students may 
often work in groups of two. 



EQUIPMENT 



1. The room for the laboratory work should be well venti- 
lated and fitted with a hood for carrying away odors of disagree- 
able gases. This last is not indispensable. A large stationary 
table with drawers and cupboards for each student, fitted with 
running water and gas burners, is desirable, though one can 
manage with one sink and alcohol lamps. 

2. Apparatus, provided for laboratory groups of 12 pupils 
working in pairs (cost is approximate only) : 6 500 cc. flasks, 
$3.15 per dozen, 6 two-hole rubber stoppers No. 5 at 15 cents 
each, 6 thistle tubes at 25 cents each, 1 pound glass tubing, 



52 OUTLINES OF SUBJECTS 

3/16 (25 2-foot length) at $1.10 pound, 6 ignition tubes at 10 
cents each, 6 rubber stoppers, No. 1, at 92 cents dozen, 12 wide 
mouth bottles at 11 cents each, 6 cake tins at 10 cents each, 6 
deflagrating spoons at 45 cents each, 12 watch glasses at $2.00 
per 100, scales and weights $10.50, 6 porcelain crucibles with 
cover, at 40 cents each, 6 evaporating dishes (2 oz.) at $3.00 per 
dozen, 6 asbestos mats at 25 cents each, 6 retort stands (three 
rings) at $1.35 each, 3 dozen test tubes at $3.15 per gross, 6 test 
tube holders at 32 cents each, 6 test tube racks at 90 cents each, 
6 glass stirring rods at 40 cents dozen, 1 file (triangular) at 50 
cents, 6 horn spoons (4^ in.) at $1.50 dozen, 6 pipettes at 5 cents 
each, 1 nest beakers at $2.25 nest, 3 graduates (10 cc.) at 46 
cents each, 3 graduates (50 cc.) at 96 cents each, filter paper 
(4 in.) at 11 cents package, 3 mortars and pestles at 60 cents 
each, 6 funnels (3 in.) at 35 cents each, 12 test tube brushes at 
65 cents dozen, 1 Centigrade thermometer at $1.67. 

TEXT AND REFERENCE BOOKS 

McPherson and Henderson: Elementary Study of Chemistry. 

Vulte: Household Chemistry. 

Asher : Chemistry and Toxicology for Nurses. 

Bliss and Olive: Chemistry for Nurses. 

Amoss: Chemistry for Nurses. 

Pope : Physics and Chemistry for Nurses. 

Lynde: Household Physics. 



B. HOUSEHOLD SCIENCE 

Nutrition and Cookery 

TIME: 40 hours, given in 20 two-hour periods, each period to include class, 
demonstration and laboratory work. Class to be conducted by 
a trained dietitian. Course to be given in the first term of the 
Preparatory Year. 

OBJECTS OP COUBSE 

1. To give pupils a good fundamental understanding of the 
principles and methods of simple cookery for well and sick 
people. 

2. To make them familiar with the nutritive values of foods, 
and help them to arrange a balanced dietary for well people 
or convalescents according to the demands of age, physical ac- 
tivity, climate, etc. 

3. To help them to understand and administer the ordinary 
hospital diets. (Dietary treatment of particular diseases to 
come later.) 

OUTLINE OF CLASSES 

I. (Class) Introduction 

Definition of food. Chemical composition of the body and 
of food. Classification of foods, according to sources (animal, 
vegetable, and mineral) and according to chemical composi- 
tion (proteins, carbohydrates, fats, mineral salts and water). 
Function of each of these in the body. 

(Laboratory) The diet kitchen and its equipment. Care of 
utensils and apparatus, sinks, refrigerators, etc. Study of 
stoves and fuels. Uses of each kind. 
II. (Class) Digestion 

Review of the digestive system, and processes of digestion, 
absorption, assimilation, excretion and metabolism. Effect of 
methods of cooking and preservation of food on digestion. 

(Laboratory) Temperatures and methods of cooking and 
their effect on food stuffs (baking, boiling, broiling, frying, 
etc.). Handling of utensils measuring and weighing. 
III. (Class) Fuel Values in Foods 

Basis of measurement of fuel values. The body requirement 
in health according to variations of sex, age, weight, activity, 
climate, etc. General variation in illness. How to compute 
the caloric value of different kinds of foods. 

(Laboratory) Practice in measuring out 100-calorie portions 
of common carbohydrates, sugars, fats and proteins. (Metric 
system.) 

53 



64 OUTLINES OF SUBJECTS 

IV. (Class) Building Materials in Foods 

Basis of measurement of protein in foods. The body require- 
ment of protein according to sex, age, weight, activity, etc. 
Variations in illness. How to compute the protein content of 
common foods. Comparison of digestibility and costs. Body 
requirement in mineral salts and water. 

(Laboratory) Practice in weighing and computing protein 
content of foods, also mineral salts and water. 
V. (Class) Preparation and Serving oj Foods 

General principles in the feeding of sick people. Selection 
of food, preservation and handling, considerations of taste, 
variety, digestibility, appearance, nutritive value and economy. 
Table and tray equipment for serving food dishes, linen, sil- 
ver, decorations, etc. Principles of tray service. The con- 
valescent table. 

(Laboratory) Practice in setting table and tray for break- 
fast, dinner, luncheon, and light diet. 
VI. (Class) Beverages 

Place of water and beverages in the dietary. Sources, varie- 
ties, composition and preparation of stimulating and acid bev- 
erages. Mineral waters uses, kinds and methods of serving. 

(Laboratory) P ac ice in preparing and serving tea, coffee, 
cocoa, fruit drinks, wines and mineral waters. 
VII. (Class) Cereals, Gruels and Starchy Drinks 

Composition and food value of common cereal foods. Cook- 
ery of starches, especially breakfast cereals and gruels, with 
special reference to digestibility. 

(Laboratory) Various preparations of oatmeal, wheat, hom- 
iny, rice, barley, etc. Starchy beverages. 
VIII. (Class) Vegetables 

Composition and fold value of common legumes, roots and 
green vegetables. Selection, preparation and cooking. 

(Laboratory) Practice in preparation of potatoes, spinach, 
beans, cauliflower, celery, etc. 
IX. (Class) Fruits and Sugars 

Composition, sources, kinds and food value of common fruits 
and sugars. Selection, preparation and cooking. 

(Laboratory) Preparation of common fresh, dried and 
canned fruits. 
X. (Class) Fats and Oils Salads 

Place of fats in the dietary. Comparison of animal and 
vegetable fats. Use of fats in cooking. Food value of nuts. 
Varieties of salads and salad dressings. 

(Laboratory) Practice in making fruit and vegetable sal- 
ads and salad dressings. 
XI. (Class) Protein Foods Milk 

Milk as a food. Its production and handling. Principles 
observed in the cooking of milk. Combinations of milk with 



NUTRITION AND COOKERY 55 

cereals and vegetables. Forms of serving raw milk. Principles 
of pasteurization. 

(Laboratory) Preparation of milk soups, milk gruels, milk 
shakes, milk punches. Pasteurized milk. 
XII. (Class) Special Milk Products 

Source and food value of cream, butter, cheese, curds and 
whey. Composition and preparation of milk powder, con- 
densed milk, malted and peptonized milk. Lactic acid prepa- 
rations. 

(Laboratory) Preparation of junket, cottage cheese, whey, 
peptonized milk, koumiss and buttermilk. 
XIII. (Class) Eggs 

Composition, food value and digestibility of eggs. Tests for 
freshness. Effects of temperature. Combinations of eggs with 
milk, cereals, fruit juices, etc. 

(Laboratory) Preparation of baked, boiled, scrambled and 
poached eggs, omelet, custards, egg-nogs, and albumen water. 
XIV and XV. (Class) Meats and Poultry. 

Composition, structure, food value and digestibility of 
meats. Different cuts and organs used as food. Tests for 
freshness. Effects of temperature. Methods for extraction 
and retention of juices. General principles of carving meat 
joints and fowl. 

(Laboratory) Preparation of roast, broiled and stewed 
meats, poultry broth, beef juice and scraped beef. Carving. 
XVI. (Class) Fish, Mollusks and Crustaceans 

Classes of fish goods, composition, food value and digesti- 
bility. Tests for freshness. Special dangers of shell fish. 

(Laboratory) Preparation of baked, boiled and fried fish, 
oysters and clam stews and broths, lobster. 
XVII. (Class) Gelatines and Frozen Desserts 

Composition, sources and food value of gelatine. Effect of 
freezing on foods. Principles of freezing mixtures. 

(Laboratory) Preparation of gelatine alone and in combina- 
tion with other foods. Preparation of ice creams and sherbets. 
XVIII. (Class) Breads (Leavening Agents) 

Composition, food value and digestibility of various kinds of 
breads. Leavening agents such as yeasts, baking powders, etc. 
and their action. 

(Laboratory) Making bread and rolls, biscuits, sponge cake, 
gluten bread, etc. Toast and sandwiches. 
XIX and 

XX. (Class) Hospital Diets 

Classes of patients in hospital requiring specialized diet. 
Modification of regular diet for children, adolescents and the 
aged, also for chronics, convalescents, etc. Types of hospital 
diets fluid, light, nitrogenous, farinaceous, milk, etc. 



66 OUTLINES OF SUBJECTS 

(Laboratory) Making of menus for typical patients not 
acutely ill. Preparation and serving of complete meals, repre- 
senting balanced normal diet and various types of special hos- 
pital diets. 

METHOD OP TEACHING 

1. The most satisfactory method is the combination of class, 
demonstration and laboratory in lessons of from two to three 
hours each. The pupils then have a chance to tie up their prin- 
ciples directly with their practice, and to carry out their cook- 
ing procedures when the demonstration and discussion are 
fresh in mind and when they are under direct supervision. The 
number in the class should not exceed 20 pupils. Regular diet 
kitchen experience would follow such a course of class and lab- 
oratory work, and the pupil would then be able to proceed with 
little additional instruction. 

2. If such a method is impossible, classes and demonstrations 
could be held by the dietitian, and the applications made later 
when the pupil has her diet kitchen experience. This method 
requires a great deal of individual instruction and supervision 
in the diet kitchen, and there is danger of the practical and 
theoretical side of the work not being so closely connected up. 

ILLUSTRATIVE MATERIAL AND EQUIPMENT 

1. There is a great variety of illustrative material available 
in the form of food charts, sample food products, models of 
meat cuts, etc. (See list of firms, Appendix III). 

2. A full equipped cooking laboratory is essential for the 
satisfactory teaching of dietetics. For discussion of the plan 
and equipment of such a laboratory, see Teachers College 
Record, May, 1909. 

TEXT AND REFERENCE BOOKS 

Friedenwald and Rurah: Dietetics for Nurses. 

Pope and Carpenter: Essentials of Dietetics. 

Pattee: Practical Dietetics. 

Hall : Nutrition and Dietetics. 

McCollum: The Newer Knowledge of Nutrition. 

Farmer: Foods and Cookery for the Sick and Convalescent. 

Farmer: Boston Cook Book. 

Rose: Handbook of Laboratory Dietetics. 

Rose: Feeding the Family. 

Barrows and Lincoln: Home Science Cook Book. 

Pamphlets and Bulletins: Department of Agriculture. 

Cornell and Teachers College Bulletins. 



DIET IN DISEASE 57 



Diet in Disease 



TIME 10 hours divided as follows: Lectures or classes given by a physi- 
cian, nurse or dietitian 5 hours. Demonstrations and labora- 
tory work conducted by trained dietitian 5 hours. 
Course to be given in second term of the Preparatory Year. 

OBJECTS OP COURSE 

To apply the fundamental principles of cookery and nutri- 
tion to the dietary treatment of the commoner diseases. In 
each of the conditions mentioned below, general principles of 
feeding are discussed, diet lists examined, menus made out, 
food values computed, and typical diets prepared and served. 
The charting of diets is also emphasized and the importance 
of proper records, especially in metabolism studies. Infant 
feeding is included under Diseases of Infants and Children 
P. 100. 

OUTLINE or CLASSES 

I. Diet in diseases of the digestive system gastritis, constipation, 
diarrhoea, dyspepsia, gastric ulcer, dysentery, acute colitis, 
appendicitis, gall-stones, gastric disorders. Test diets and 
nutrient enemata. 

II. Diet in fevers slight infections, tonsilitis, pneumonia and 
tuberculosis. Special typhoid diets, including the high caloric 
feeding. Diet in convalescence. 

III. Diet in anaemia, cardiac disorders, nervous and mental condi- 
tions, obesity. 

IV. Diet in nephritis, cystitis, calculus, rheumatism, gout, scurvy, 
rickets and diabetes. 

V. Diet in surgical cases for control of nausea in peritonitis, in 
laparotomies, head and mouth cases. Formulae used for feed- 
ing through gastric and intestinal fistulas and by rectum. 

(Each of these classes should be followed by a laboratory 
period in the diet kitchen where all special diets would be 
prepared.) 

METHODS OF TEACHING AND ILLUSTRATIVE MATERIAL 

As in preceding, course. 
TEXT AND REFERENCE BOOKS 

Carter and Howe: Nutrition and Clinical Diet. 
Thompson: Practical Dietetics. 
Sherman: Chemistry of Food and Nutrition. 
Friedenwald and Rurah: Diet in Health and Disease. 
(See also under Nutrition and Cookery) 



58 OUTLINES OF SUBJECTS 

Hospital Housekeeping 

TIME: 10 hours. Classes, discussions, demonstrations and written re- 
ports. Conducted by the instructor of nurses. Given in the 
preparatory course. (Correlated practice work outside of this 
time to be given in nurses' home and hospital departments.) 

OBJECTS OP COURSE 

1. To give the student a better understanding of the prin- 
ciples and methods of good housekeeping and to make her ap- 
preciate their fundamental importance in nursing work. 

2. To enable her to exercise intelligence and economy in the 
proper selection, use and care of the materials and equipment 
relating to her work, and to develop a high degree of efficiency 
in the technic and organization of housekeeping measures. 

OUTLINE OF CLASSES 

I. Introduction 

Meaning of "Household Economy." The nurses' home as a 
type of larger household. General plan. Relation of one de- 
partment to another. Principles of efficiency and economy in 
the household. Visit to various departments of the nurses' 
home and talk on general regulations of the household. Care 
of nurses' bed-room. 

II. Cleaning and Polishing. 

Materials to be cleaned woods, paints, fabrics, metals, 
glass, rubber, china, etc. Appliances and their care brooms, 
brushes, mops, etc. Materials soaps, polishes, bleaches, etc. 
Methods of sweeping, dusting, cleaning, scrubbing. 

Practice. Daily cleaning of bed-room by each pupil. Clean- 
ing of silver, brass, marble, etc. 

III. Interior Furnishings and Finishings. 

Materials of construction of floors wood, tile, terrazzo, 
cement, etc. Dressings and coverings paints, oils, polishes, 
linoleum, rugs, carpets, etc. Walls and ceilings finish, paints, 
paper, tile, etc. materials and colors. 

Practice. Thorough house-cleaning of bed-room. 

IV. Equipment and Arrangement 

The kitchen, pantry, living room, dining room, etc. Equip- 
ment of each use, cost, durability, artistic design, sanitary 
aspect, etc. Arrangement from practical and artistic stand- 
point. 

Practice. Cleaning and arrangement of living room or 
library. 
V. Healing and Ventilating Systems 

Types of heating radiation, convection (steam, hot water, 
hot air). Equipment furnaces, boilers, ranges, stoves, grates, 



HOSPITAL HOUSEKEEPING 59 

electrical heaters. Fuels wood, coal, oil, etc. Use of meters. 
Ventilating systems natural and artificial ventilation. Tele- 
phone and electric bell systems. Fire escapes and use of fire 
extinguishers. Fire drills. 

Practice. Taking room temperature, ventilating rooms, 
practicing fire drill, etc. 
VI. Lighting and Plumbing Systems 

Types of lighting natural, artificial, direct, indirect. Equip- 
ment fixtures, lamps, etc. Cleaning and care. Systems of 
plumbing. Water supply and sewage disposal pipes, traps, 
sink, lavatory equipment. Their cleaning and care. 

Practice. Caring for lighting and plumbing fixtures. Clean- 
ing sinks, bathrooms and lavatories in nurses' home. 
VII. Disposal of Garbage and Household Pests 

Methods of garbage disposal and hospital wastes. Special 
precautions in the hospital . Insects found in food and clothing. 
Insects injurious or disagreeable to people. Means of extermi- 
nation. Protection of food supplies in the household. 

Practice. Looking over garbage cans to discover sources of 
waste. Cleaning of kitchen refrigerator, care of food supplies, 
etc. 
VIII. The Laundry 

Purpose and plan of the laundry. Care of soiled linen. 
Gathering linen sorting, washing, bleaching, rinsing, man- 
gling. Soap making. Equipment washers, manglers, extrac- 
tors, starch kettle, dryers, etc. Disinfection of linen. Removal 
of stains. Washing things out by hand. 

Practice. Pupil should spend a short period in the laundry, 
should help in sorting linen and see all the processes at first 
hand. 
IX. The Central Linen Room, Sewing Room and Clothes Room 

Purpose and plan of linen room arrangement, inventory, 
mending, marking, folding. Systems of replacement and 
exchange. Care of linen closet in the wards. Care of patients' 
clothing cleansing and repair disinfection, etc. 

Practice. Looking over linen for mending, folding and stack- 
ing linen, caring for linen closet, etc. 
X. Hospital Supplies 

Economy in the hospital. Necessity of conserving hospital 
finances for necessary care of patients. Cost of hospital sup- 
plies. Sources of waste. Methods of economy in standardiz- 
ing hospital supplies and study of types and costs. Visit to 
store room. 

Practice. Making out lists of stores with costs Making up 
dressings and hospital supplies in supply room. 

METHODS OF TEACHING 

1. To make the course comprehensive the objects should as 
far as possible, be placed before the students and attention 



60 OUTLINES OF SUBJECTS 

directed to points under discussion. Where this is not possible 
cuts from catalogs may be used. Catalogs may be also used 
to get prices of hospital supplies. Pupils should themselves 
look these up and bring to class. 

2. When possible the instructor should illustrate by demon- 
strating or by taking pupils to the various departments and 
showing them processes in operation. All students should have 
an opportunity to carry out the practical procedures as soon as 
possible after the lesson. 

3. This instruction should be closely correlated with that of 
chemistry, physics, bacteriology, hygiene, and sanitation. It 
should, if possible, precede the course in practical nursing, and 
might be given in daily classes during the first ten days as a 
preparation for later work in the hospital. 

4. Pupils may be assigned full care of their own rooms during 
the preparatory course. Practice should also be provided in the 
nurses' home, laundry, diet kitchen, supply room and other 
departments of the hospital where the above principles can be 
applied. The time spent in such work should be limited as it 
is important only that pupils should get a good command of 
fundamental processes and not that they should be employed 
in routine household work. 

EQUIPMENT AND ILLUSTRATIVE MATERIAL 

Individual utensils and tools for work as far as possible. 
Samples of flooring materials, cleaning agents, etc. Catalogs. 
Illustrations from current magazines. 

TEXT AND REFERENCE BOOKS 

Parloa: Home Economics. 

Richards: Home Sanitation. 

Broadhurst: Home and Community Hygiene. 

Campbell: Household Economics. 

Terrill: Household Management. 

Balderston: Laundry Manual. 

Balderston: Housewifery. 

Kinne and Cooley: Shelter and Clothing. 

Putnam: Plumbing and Household Sanitation. 

Butler: Household Physics. 

Lynde: Physics of the Household. 

Priestman: Art and Economy in Home Decoration. 

Kittredgc: Practical Home Making. 

U. S. Government Bulletins 1914 No. 37, 38, and 39. 

Housekeeping Problems of Industrial Families ((Elective) 

TIME: 10 hours. Classes, demonstrations, and excursions. Given by 
a visiting nurse or a visiting housekeeper, with the possible 



HOUSEKEEPING PROBLEMS OF INDUSTRIAL FAMILIES 61 

assistance of the hospital dietitian. To be given in the latter 
part of the third year. 

OBJECTS OF THE COURSE 

This course is intended for pupils who expect to go into 
families either as private or public health nurses. It is de- 
signed to help them to understand the economic problems of the 
family of limited income, and to enable them to give assistance 
and advice in matters pertaining to the proper feeding and 
care of the household. 

OUTLINE OF CLASSES 

I. The Household Budget 

The varying costs of living as indicated by budget studies. 
The value of a budget in helping towards a wiser planning of 
expenditures, and a more thrifty use of the income. Methods 
and standards to be followed in estimating a budget for a 
family. 

Assigned work. Planning a weekly budget for a family of a 
certain size and income. 
II. Housing Standards and Costs 

The importance of good housing. Characteristics of a satis- 
factory house from the health standpoint. Proportion of 
income ideally to be used for rent. Rents which are charged 
in the vicinity in relation to wages being paid. 

III. Food Costs 

Variations in the cost of food per person, as indicated by 
"cost of living" studies. Minimum standards for food expendi- 
tures. Characteristics and limitations of a low cost dietary. 
Assigned work : Planning very inexpensive meals for a family 
for a day, reckoning food value and cost. 

IV. Food Selection and Care. 

Importance of buying clean food in a clean store, and caring 
properly for it in the home. Points to be considered in select- 
ing inexpensive meat, fish, fruits, vegetables, cereal products, 
etc. (Trip to market or food store if at all possible.) 
V. Reducing\Food Costs 

Value of planning meals ahead; buying in person for cash, in 
as large quantities as practicable ; cooking food when possible 
rather than using prepared products; choosing food which will 
give largest nutritive return for the money; keeping household 
accounts. Using fireless cooker, iceless refrigerator, and other 
appliances which make possible low cost cooking and low cost 
caring for food. 

VI. Racial habits and customs, climate, and other factors which influ- 
ence dietary selection (with special reference to the feeding 
of children.) 



62 OUTLINES OF SUBJECTS 

Characteristics of Italian, Russian, Jewish, Polish, Irish, 
German and Negro dietaries. Changes to be advised if found 
inadequate under local conditions. The dietary in the rural 
and urban community; winter and summer dietaries as illustra- 
tive of the dietary of cooler and warmer climates. Food 
requirements at different ages. 
VII. Special Diets in (he Home 

Planning the home diet of tubercular and diabetic patients, 
expectant mothers and others requiring marked variation of 
the ordinary family dietary. 
VIII. Clothing Standards and Costs 

Hygienic essentials in clothing for men, women and children. 
Minimum costs for clothing. Economics in the purchasing of 
clothing which might be practised. 
IX. Laundering and Housekeeping Methods 

The importance of cleanliness in the home. Relative values 
in laundering and cleaning supplies. Labor saving devices 
and methods. 
X. Household Management and Thrift. 

The importance of system in household management, especi- 
ally as it affects the care of children or a sick person. Methods 
of planning and organizing household tasks. The importance 
of thrift which will make possible the saving towards sickness 
or other household emergency. 

METHOD OF TEACHING 

1. The most satisfactory way is to have the pupil study 
individual families with the object of assisting them in working 
out a satisfactory budget on an economic basis. Such work 
might be done through the social service department, a visiting 
nurse association, or a charity organization society. 

2. Individual or class visits to tenements stores and markets 
in various parts of the city are also exceedingly helpful in get- 
ting a clear picture of sanitary conditions and the housing and 
shopping problems of the family. 

3. Plenty of outside practice in making out menus and 
dietaries for typical cases should be provided. 

ILLUSTRATIVE MATERIAL AND EQUIPMENT (see Cooking and Dietetics) 

Local dealers' catalogs and market guides can also be used 
to good advantage. 

TEXT AND REFERENCE BOOKS 

Streightoff : Standard of Living. 
Chapin: Standard of Living in New York City. 
Nearing: Financing the Wage Earner's Family. 
Gibba: Lessons in Feeding the Family. 



HOUSEKEEPING PROBLEMS OF INDUSTRIAL FAMILIES 63 

Nesbitt: Low Cost Cooking. 

Jaffa: A Standard Dietary for an Orphanage. 

Rose: Food for School Boys and Girls. 

Rose: Feeding the Family. 

Langworthy: Food Customs and Diet in American Homes. 

U. S. Dept. Ag., Bulletin 110. 
Hills and others: Dietary Studies in Rural Regions. U. S. 

Dept. of Agriculture, Bulletin 221. 

Rose: Cost of Food. Cornell Bulletin, Food Series No. 7. 
American Home Economics Association : Thrift by Household 

Accounting. 



C. PREVENTION OF DISEASE 

Personal Hygiene 

TIME: 10 hours. Classes conducted by the instructor of nurses. Given in 
the early part of the preparatory course. (Supplemented by a 
course of physical exercises in a gymnasium if at all possible 
otherwise the simple exercises given in Appendix IV might 
be taught by the instructor in connection with the hygiene 
classes. 

OBJECTS OF COURSE 

1. To impress upon the pupil nurse the paramount importance 
of good health, and to help her to protect herself and keep her- 
self well through understanding and practising the fundamental 
laws of health. 

2. To show the close relationship of hygiene to all nursing 
work, to emphasize the teaching function of the nurse, especially 
in matters relating to hygiene, and to develop a rational and 
scientific attitude toward the whole question of health pres- 
ervation and disease prevention. 

3. To teach a few general exercises which will help to 
strengthen special muscles and keep the whole body in good 
condition. To establish habits of regular outdoor exercise. 

OUTLINE OP CLASSES 

I. Introduction 

Health and disease defined. Ancient and modern theories 
about disease. Causes classified. Definitions of hygiene, 
sanitation, public health, etc. Various ideals and conceptions 
of health. Conditions governing individual health. Ethical 
and economic aspects of hygiene. Importance of hygiene to 
the nurse. Her educational function as an example and teacher 
of hygiene. 
II. Hygiene of Exercise 

Muscular activity in relation to health. Kinds of exercise 
and adaptation to age, sex, occupation, climate, etc. Meaning 
of recreation. Value of sports and games. Fatigue, its symp- 
toms and effects. Methods of rest and relaxation, mental and 
physical. Importance of posture and right methods of stand- 
ing, bending and walking. 
III. Hygiene of the Skin 

Structure and functions of the skin. Bathing. Kinds of 
baths and effects of different temperatures. Care of the teeth, 
hair, nails and hands. Soaps and toilet accessories their 
use and abuse. Prevention and treatment of common skin 
infections and minor injuries. 
64 



PERSONAL HYGIENE 65 

IV. Hygiene of Clothing 

Function of clothing. Materials cotton, silk, wool, linen, 
etc., and their various uses. Adaptation of clothing to cli- 
mate, age, occupation, etc. Hygienic clothing for the nurse 
on and off duty. How to choose a good shoe. Special care of 
the feet. Prevention and treatment of corns, bunions, ingrow- 
ing toe-nails, and other foot troubles. Care of arch of foot. 
Preventive exercises. 
V. Hygiene of Respiration 

Composition of normal air. Sources of impurities in the air. 
Effect of temperature and moisture, still and moving air. 
Principles of ventilation. Types of breathing. The use of the 
voice tone, pitch, quality, etc. Some principles of correct 
speech and breathing. 
VI. Hygiene of Nutrition, 

Relation of food and food habits to efficiency. Energy re- 
quirement of average nurse on active duty. Food fads, over- 
eating, and under-eating. Conditions which interfere with 
digestion and nutrition. Use of condiments, stimulants and 
drugs. Water-drinking. Hygiene of elimination. Constipa- 
tion common causes and measures for relief. 
VII. Hygiene of Special Senses 

The causes and effects of common eye troubles. Conditions 
for normal vision. Care and protection of the eyes especially 
in hospital work. Need of expert examination and treatment 
in eye defects. Common disorders of hearing their causes 
and effects. Protection and care of the ear. Causes and symp- 
toms of common nose and throat troubles. Prevention and 
care of colds and sore throats. 
VIII. Hygiene of the Nervous System 

Importance of nervous system to health of the whole body. 
Ways in which mental influences affect the body. Conditions 
in modern life which produce high nervous tension and fatigue. 
Increase of nervous diseases and insanity. Importance of re- 
laxation and sleep for conservation of nervous energy. Some 
principles of mental hygiene for both nurse and patient. 
IX. Hygiene of the Reproductive System 

Function of menstruation and common disorders. Precau- 
tions and ordinary measures to be observed. Problems of 
social hygiene which confront the nurse. Necessity for a sane 
and wholesome attitude of mind . . Effects of ignorance and 
wrong teaching in the community at large. Ways in which 
the nurse can help to promote racial and personal health and 
happiness. Essentials of sex-hygiene. 
X. Relation of Personal Hygiene to Community Health 

Outstanding causes of ill-health in the community due largely 
to individual ignorance and neglect. Standards of community 
health as shown in death-rates. What constitutes a high and 



66 OUTLINES OF SUBJECTS 

low mortality rate for the general population for infants. 
Main causes of premature death and illness. Some movements 
for the conservation of individual and public health by volun- 
tary organization for prevention and care of tuberculosis, can- 
cer, social diseases, diseases of infancy, diseases of middle age, 
insanity, etc. How the nurse in the hospital and home may 
help to educate the public. 

METHODS OF TEACHING 

1. Base hygienic rules on scientific principles, using courses 
in anatomy and physiology and bacteriology as ground-work. 

2. Stress the phases of the subject most needed by nurses, 
and emphasize applications to nursing work. 

3. Knowledge of hygiene is not of much use unless it is con- 
sistently applied. Effort must be made to arouse stong in- 
centives as a means of forming good hygienic habits. Some 
teachers have pupils keep daily records for a time of baths, 
exercise, sleep, etc., and report progress in habit-formation. 
Often illness and slight indispositions, such as colds, etc., can 
be traced back to personal lapses, and sentiment formed in 
the school will aid greatly in maintaining good standards of 
health. 

4. Text books if used at all should be liberally supplemented 
by outside readings from a variety of reference books, pam- 
phlets, etc. Pupils in this way get a wider range of information 
and a better knowledge of sources. They should be encouraged 
to collect interesting cuttings from magazines, pamphlets, etc., 
and report on these in class. 

EQUIPMENT AND ILLUSTRATIVE MATERIAL 

Anatomical charts, skeleton, models, etc. Popular litera- 
ture, posters, exhibit material. Lantern and slides. Gymna- 
sium or room fitted up with simple apparatus, a distinct asset. 
Also swimming pool. 

TEXT AND REFERENCE BOOKS 

Price: Hygiene and Sanitation for Nurses. 

Hough and Scdgwick: Human Mechanism (Part II). 

Pyle: Personal Hygiene. 

Galbraith: Hygiene and Physical Culture for Women. 

Latimer: Girl and Woman. 

CFouston: Hygiene of the Mind. 

Rosenau: Preventive Medicine. 

Chapin: Sources and Modes of Infection. 

Fisher and Fi.ske: How to Live. 

Lee: Health and Disease. 

Bancroft: Posture of School Children. 



PUBLIC SANITATION 67 

Lovett: Lateral Curvature of the Spine and Round Shoulders. 

McKenzie: Exercise in Education and Medicine. 

Pamphlets published by organizations dealing with prevention 

of disease (see Appendix II.) 
For Household Hygiene see under Hospital Housekeeping. 

Public Sanitation 

TIME: 10 hours. Lectures and quizzes conducted by physician with 
Board of Health experience, or sanitarian, if possible. Given 
in senior year. 

OBJECTS OP COURSE 

1. To give the nurse a general, practical knowledge of the 
methods which are being used to protect the health of individ- 
uals and communities so she may cooperate actively with Boards 
of Health and other preventive agencies, and be able to take 
a definite share in educating the public in matters relating to 
public health. 

OUTLINE OP LECTURES 

I. Introduction 

History of sanitation, and older theories regarding the causes 
of disease. Modern ideas as to sources and modes of infection. 
Parasites and hosts. R6le of carriers, air, dust, discharges, 
fomites, contact, food and drink, insects. Portals of entry and 
exit in all commoner infections. Communicable diseases clas- 
sified according to source of infection. 
II. Sewage and Garbage Disposal 

Danger from excreta. Composition of sewage. Methods of 
disposal in large, small and rural communities. Dangers from 
garbage. Composition and methods of disposal. 

III. Water Supply and Ice 

Sources of water supply. Dangers of polluted water pro- 
tection of water supply. Purification processes. Special prob- 
lems of rural communities. Use of household filters. Sources 
of ice supply. Dangers and methods of protection. 

IV. Food Supply 

Dangers of unclean or infected food supplies, especially meat, 
shellfish, uncooked fruits and vegetables. Protection of food 
supplies from dust and flies, from adulteration and misbrand- 
ing. Pure food legislation. Special dangers from milk ani- 
mal diseases and human infection. Production of clean milk. 
Dairy inspection. Bacteriological tests. Inspection of res- 
taurants and lunch-counters. Medical examination of cooks, 
waiters and others who handle food. 
V. Air Supply and Ventilation 

Normal air and its pollutions. Main dangers excessive 
heat with excessive humidity. Methods of air analysis. Effects 



68 OUTLINES OF SUBJECTS 

of dry air. Ventilation standards. Natural and artificial 
methods of ^'entilation. Dangers in dust, largely mechanical. 
Relation to tuberculosis. Methods of reducing dust in indus- 
trial establishments. 
VI. Housing and Extermination of Vermin 

Effects of over-crowding. The tenement house problem. 
Relation to tuberculosis, social diseases, and infant mortality. 
Fundamental needs fire protection, light, air, and cleanliness. 
Remedial and preventive measures. Essentials of sanitary 
inspection. Insects as carriers of disease. Household and 
community measures for controlling vermin pests, flies, mos- 
quitoes, etc. 
VII. Industrial Hygiene 

Brief history. Dangers of industry. Preventable accidents 
on railroads, in mines and factories. Prevention of industrial 
poisoning. Dangerous trades. Over-work and fatigue. Re- 
medial agencies. Education, legislation, and inspection. 
Work of Consumers League and other agencies. Welfare work 
in factories from sanitary point of view. 
VIII. Hygiene of Schools, Public Buildings and Conveyances 

Importance of school hygiene in relation to community 
health. Essentials of school hygiene as to construction, venti- 
lation, light, seats, cleanliness, water-supply, toilet facilities, 
fire protection, etc. Medical'inspection and school nursing in 
relation to control of contagious diseases and identification 
of physical defects. Hygiene of other public buildings such as 
churches and theatres, of street cars and railways coaches (es- 
pecially sleeping cars). Public toilets in relation to health. 
IX. Vital Statistics. 

Place of vital statistics in public health work. Neglect of 
vital statistics in United States. Laws for registration of births 
and deaths. Important points in the compilation and analysis 
of statistics. Interpretation of statistical data. High and 
low death rates for adults and infants. Mortality from im- 
portant classes of disease compared. 
X. Health Departments and Health Legislation 

National, state, and local Boards of Health province, powers 
and organization of each. Function of bureaus of sanitation, 
contagious diseases, laboratory service, vital statistics; pub- 
licity, etc. General progress of health legislation. Rural 
health organization. Publications of health departments. 

METHODS OF TEACHING 

1. The classes will usually be conducted by the lecture 
method, supplemented by quizzes if possible. 

2. Base the present course on previous knowledge of chem- 
istry, bacteriology, and hygiene, and correlate closely with the 
course in comrnunioablo diseases. 



PUBLIC SANITATION 69 

3. If possible, visits should be made to a sewage disposal 
plant, a model dairy, an industrial plant, and other local places 
of interest, to get a clear and vivid conception of conditions 
and methods. Otherwise photographs, diagrams, and models 
could be shown. Several good moving-picture screens on sani- 
tary subjects are in circulation and should be seen. Excellent 
exhibits are on view in the Natural History Museum in New 
York City and in similar institutions in other cities. The 
National Public Health Service and several state and local 
Health Boards have loan collections of lantern sides which 
can be borrowed for a time for educational work. 

EQUIPMENT AND ILLUSTRATIVE MATERIAL 

Lantern slides, models, charts, maps, etc. A collection of 
pamphlets and reports from Boards of Health and voluntary 
orgznizations are very helpful and can be secured free of cost. 
(See lists Appendix II and III.) 

TEXT AND REFERENCE BOOKS 

Price: Hygiene for Nurses. 

Rosenau: Preventive Medicine and Hygiene. 

Baskerville: Municipal Chemistry. 

Chapin: Sources and Modes of Infection. 

Kinnicutt and Winslow: Sewage Disposal. 

Kober: Industrial and Personal Hygiene. 

Oliver: Diseases of Occupation. 

Sedgwick: Principles of Sanitary Science and Public Health. 

Doane: Insects and Disease. 

Hill: The New Public Health. 

Broadhurst: Home and Community Hygiene. 

Veiller: Housing Reforms. 

American Journal of Public Health. 

Local and State Board of Health Bulletins. 

Public Health Service Bulletins. 

See also under Bacteriology, Hygiene, and Communicable 
Diseases. 



D. TREATMENT OF DISEASE 

Drugs and Solutions 

TIME: 20 hours or ten two-hour periods divided about equally between 
class and laboratory work. Teacher the instructor of nurses 
(preferably) or the pharmacist. 
To be given in the Preliminary Course. 

OBJECTS OF THE COURSE 

1. To make the nurse familiar with the appearance and use 
of the commoner drugs which she will be handling in the earlier 
part of her course. 

2. To teach her to weigh and measure drugs accurately, to 
make up all the standard solutions, and the commoner phar- 
maceutical preparations used in the wards. . 

3. To teach her the terms and symbols used in materia medica 
and prepare her for the further study of the therapeutic action 
of drugs. 

OUTLINE OF CLASSES AXD LABORATORY WORK 

I. (Class) Introduction Weights, Measures, Symbols, etc. 

Review of simple arithmetical problems. Roman and arabic 
numerals. English system of weights and measures. Symbols, 
abbreviations. Drops and minims. 

(Laboratory) Practice in use of apothecaries' weights and 
measures. Drill in the tables. Problems, oral and written. 
II. (Class) Weights and Measures (continued) 

Metric system. Approximates in apothecaries and house- 
hold measures. 

(Laboratory) Practice in use of metric system. Drill and 
problems in approximates. 
III. (Class) Solutions. 

Definition of solute, solvent, and examples. Saturated and 
supersaturated solutions. Solutions of solids, liquids and 
gases (examples). Fahrenheit and Centigrade scales. Method 
of expressing strength, ratio and percentage. Method of 
calculating solutions from pure drug. 

(Laboratory) Make physiological salt solution. Problems 
and drill in converting ratio to per cent and vice versa. Prob- 
lems in calculating the amount of drug for solutions of different 
strength. 
IV and V. (Class) Disinfectants, Antiseptic, Deodorants 

Physical properties, therapeutic uses, method of bactericidal 
action, care in handling, and toxicology of common solutions, 
such as phenol, bichloride, boric, iodine, crcolin, lysol, formalin. 

(Laboratory) Practice in making these solutions. Problems 
and drill in calculations. 

70 



DRUGS AND SOLUTIONS 71 

VI. (Class) Symbols and Abbreviations 

Orders and abbreviations used in order book. Prescriptions, 
form, abbreviations. Method of making weak from strong 
solutions. 

(Laboratory) Practice in making solutions from stock. 
Problems in calculations . Practice in reading prescriptions. 
VII. (Class) Dosage 

Method of calculating doses for children. Method of cal- 
culating fractional doses. Method of measuring minims and 
half drop. 

(Laboratory) Review of solutions. Practice in measuring 
fractional doses and in calculating children's doses. 
VIII. (Class) Common Pharmaceutical Preparations 

Sources of drugs. Crude drugs, Methods of preparing 
tinctures, extracts, emulsions, etc. Method of application of 
local remedies such as ointments, salves, liniments, supposi- 
tories. 

(Laboratory) Visit to pharmacy. Some of preparations 
made by students or demonstrated. 
IX. (2-hour class and quiz) Action of Drugs on the Body 

Meaning of terms such as local, systemic, cumulative, ra- 
tional, empiric, physiological and therapeutic, with examples. 
Methods of administration, absorption and excretion of drugs. 
Forms suitable for each method of administration. Names and 
meanings of common classes of drugs such as analgesics, ano- 
dynes, diuretics, and common examples. 

X. (2-hour class and quiz) Introduction to a Few Specially Im- 
portant Drugs 

Common potent drugs' strychnine, caffeine, atropine, and 
morphine. Use, forms commonly used, early symptoms of 
over-dosage, treatment of poisoning. Common cathartics, 
emetics and carminatives. Action and method of administra- 
tion. Dangers in the use of habit-forming drugs. The patent 
medicine evil, and the menace of self-drugging. Use and abuse 
of drugs. 

METHODS OF TEACHING 

1. Class periods should be conducted by the question and 
answer method, with full discussion of all the new drugs which 
have come under the pupil's observation. 

2. Laboratory periods should be held in a specially fitted 
up class-room or in the hospital pharmacy. Pupils should 
make up solutions and should have extra experience in the 
pharmacy, if possible, in the making up of stock preparations 
of various kinds. 

3. A great deal of drill will be needed in the making-up of 
solutions and solving of solution problems. Many of these 
arithmetical problems may be worked out outside of class and 



72 OUTLINES OF SUBJECTS 

handed in. Many teachers find it necessary to give a pre- 
liminary drill of two or three lessons in fractions, decimals, 
proportion and percentage. 

EQUIPMENT AND ILLUSTRATIVE MATERIAL 

Drugs in different forms. Samples of crude drugs and grow- 
ing plants when possible. Charts for metric and English system 
and all the different kinds of measures' pitchers, measures, 
funnels, etc. (a set for each pupil in the laboratory section) and 
stock bottles of all the common drugs for making up solutions. 

TEXT AND REFERENCE BOOKS 

Dock: Materia Medica for Nurses. 

Parker: Materia Medica. 

Stimson: Nurses' Handbook of Drugs and Solutions. 

Bastedo: Materia Medica and Therapeutics. 

Sollmann: Text Book of Pharmacology. 

New and Non-Official Drugs (published yearly by the Ameri- 
can Medical Association). 

Stevens: Modern Materia Medica and Therapeutics. 

Blumgarten: Materia Medica for Nurses. 

Foote: Essentials of Materia Medica and Therapeutics for 
Nurses 

Materia Medica and Therapeutics 

TIME: 20 one-hour periods. To be given in the second half of the first 
year, preferably by a physician. 

OBJECTS OF COURSE 

1. To continue the study of drugs from the standpoint of 
their therapeutic action, emphasizing the accurate and intelli- 
gent administration of medicines, and the observation and 
reporting of results. 

2. To teach pupil nurses enough about the nature and thera- 
peutic action of drugs, so that they may understand the general 
purposes for which different drugs are ordered, may cooperate 
intelligently with the physician in his effort to get the best 
results from the drug, and may appreciate the importance of 
observing the after-effects, particularly watching for any 
dangerous or untoward effects from drugs. 

3. They should also be familiar with the toxic doses of all the 
more dangerous drugs, so that they may better safeguard the 
patients from possible errors. Every nurse should know the 
antidotes for all common forms of poisoning and should be 
ready to render first aid in such cases. 

OUTLINE OF CLASSES 

I. Applications of Chemistry to Materia Medica. Active princi- 
ples of plants alkaloids, glucosides, oils, etc. Chemical and 



MATEKIA MEDICA AND THERAPEUTICS 73 

physical properties, therapeutic action and use, source and 
examples. Action and common uses of acids, alkalies and 
medicinal salts. 
II. Poisons and Antidotes 

Studied in groups acids, metallic salts, alkaloids, etc., with 
general principles for the treatment of poisoning by each type. 
Demonstration or practice in preparation of general antidotes. 
Ill, IV, V, VI. Drugs which Act on the Nervous System 

Central stimulants. Central depressants. Hypnotics. Gen- 
eral anesthetics. Local anesthetics. Analgesics. Anodynes. 
Mydriatics. Myotics. 
VII, VIII, IX. Drugs which Act on the Circulatory System 

Tonics. Stimulants. Depressants. Vasodilators. Vaso- 
constrictors. Hematinics. 
X, XI. Drugs which Act on the Respiratory System 

Stimulants. Sedatives. Antiseptics. Expectorants. 
XII. Drugs which Act on the Digestive System 

Emetics. Antiemetics. Digestants. Stomachics. Intestinal 
Antiseptics. Carminatives. Cathartics. Antidiarrheics. 
Anthelmintics. 
XIV, XV. Drugs which Act on the Excretory System. 

Diaphoretics. Anhidrotics. Urinary antiseptics. Diuretics. 
XVI, XVII. Drugs which Act on Skin and Mucous Membranes 

Counter-irritants. Disinfectants. Astringents. Styptics. 
XVIII, XIX. XX. Specifics and Miscellaneous Drugs 

Phosphorus. Iodides. Antipyretics. Specifics. Quinine. 
Mercury. Salvarsan. Salicylates. 



1. Same general principles as outlined under Drugs and 
Solutions. 

2. Every opportunity should be taken to tie up the class work 
with the ward work. Pupils should be asked to report on the 
action of drugs being used on their wards. The teacher should 
visit the wards and quiz the pupils on the medicines which are 
being given to different patients and the effects they have 
observed. Any unusual action of drugs, such as a drug rash, 
or any case where a rare or new drug is being used, should be 
brought to the attention of the whole class in the form of a 
clinic. 

3. Frequent short tests, both oral and written, should be 
given. The analysis of prescriptions to determine the amount 
of any given drug being given in one dose or in 24 hours, is 
often helpful. 

EQUIPMENT AND ILLUSTRATIVE MATERIAL 

Same as under Drugs and Solutions also bedside charts. 



74 OUTLINES OF SUBJECTS 

TEXT AND REFERENCE BOOKS 

See under Drugs and Solutions. Also 

Hare: Practical Therapeutics. 

Brunton: Lectures on the Action of Medicines. 

Stainsbury: Drugs and the Drug Habit. 

Nostrums and Quackery (Published by the American Medical 

Association). 
See also under subjects like Medical Nursing, Surgical Nursing, 

Obstetrical Nursing, etc. 

Massage 

TIME: 10 hours divided as follows: 

Classes and Demonstrations 5 hours. 

Practice periods each group 5 hours. 

Teacher an expert masseuse preferably a trained nurse. 
Given as early as possible in the training not later than the 
early part of the second year. 

OBJECTS OF THE COURSE 

1. To teach the nurse to do ably, intelligently and with ease 
(without awkwardness and wasted energy) such rubbing as is 
necessarily a part of her duties as a nurse; and to enlarge this 
field somewhat. (The nurse is not trained however, to be a 
specialist in massage.) 

2. To develop a good touch, and a fair degree of manual 
. dexterity in both hands. 

3. To give the nurse an intelligent conception of the full 
scope of massage as a therapeutic measure, and to fit her to 
justly appraise the work of a masseuse employed for a patient 
in her charge. 

OUTLINE OF CLASSES AXD PRACTICE PERIODS 

I. (Class) Introduction 

Object of instruction in massage and growing importance of 
this form of treatment. History of massage. Definitions and 
nomenclature. Fundamental manipulations common to all 
systems of massage analyzed and demonstrated. Review of 
anatomical land-marks and essential points in anatomy of 
muscles, blood vessels and nerves. 

II. (Practice) Class practice of simplest examples of the funda- 
mental manipulations with special reference to the stroking 
movements. 
III. (Class) General Massage 

The physiological effects of massage therapeutic uses and 
centra-indications to use. General massage defined and pro- 
cedure outlined. Preparation of patient and care during and 
after treatment. 
IV. (Practice) General Massage 



MASSAGE 75 

V and VII. (Class) Local Massage 

Conditions in which local massage is used. Effects to be 
produced. Procedure in various conditions. Precautions to 
be observed in abdominal massage, massage of spine, joints, 
breast, etc. 

VI and VIII. (Practice) Application of local massage in above conditions. 
IX. (Class) Medical Gymnastics 

Various systems of medical gymnastics. Active and passive 
movements. Conditions in which used and resulting effects. 
X. (Practice) Assistive and resistive movements circumduction, 
rotation, flexion, etc. 

METHODS OF TEACHING 

1. Classes and demonstrations may be given to fairly large 
groups, but for practice work, class must be divided into sec- 
tions of not more than 8 to 10 pupils. For small groups the 
class and practice may be combined in one period. 

2. It is absolutely essential that pupils should have plenty 
of practice to gain facility in the use of the hand. Convales- 
cent patients may serve as subjects or pupils may practice on 
each other. The latter method is preferred. 

3. Questions and criticisms by the teacher serve to bring out 
important points, Written questions may be assigned for 
students to look up and answer. Both written and practical 
tests should be required at the end of the course. 

4. Selected text and reference books should be used, and if 
necessary the teacher may supply abridged notes of the essen- 
tial points and procedures covered, to economize the pupil's 
time and secure accuracy. 

5. Every opportunity should be given for the practice of 
these procedures on the wards. 

EQUIPMENT AND ILLUSTRATIVE MATERIAL. 

Beds and ordinary bedding with extra light-weight treatment 
blankets, chest-blankets, towels, sheets, (small) pillows, (small) 
knee pillows, hot-water bag, lubricant and talcum powder. 
Four beds should be provided for a class of eight. 

TEXT AND REFERENCE BOOKS 

Mitchell and Gulick: Mechano Therapy and Physical Educa- 
tion. 

Palmer: Lessons on Massage. 
Despard: Text-Book of Massage. 
Cyriax: Kellgren's Manual Treatment. 
McKenzie : Exercise in Education and Medicine. 
Graham: Massage. 



76 OUTLINES OF SUBJECTS 

Special Therapeutics (Including Occupation Therapy) 

TIME: 10 hours in lectures, class and demonstration, by instructors who 
are specialists in the various branches discussed. 
Given in the Senior Year. 

OBJECTS OF COURSE 

1. To give the nurse a good general idea of the principles 
underlying the newer methods of treatment which are to a con- 
siderable extent replacing the treatment by drugs. 

2. No attempt is made here to specialize in any of these 
forms of treatment, but only to enable the nurse to cooperate 
intelligently with those who prescribe and administer them 
and to show the possibilites of specialization which are open 
to nurses. 

OUTLINE OF CLASSES 

I. Hydrotherapy 

History and modern development of treatment by water. 
Effects of temperature and pressure on skin and nervous sys- 
tem. Indications and contra-indications for treatment. Com- 
bination of hydrotherapy with special climatic conditions. 
Influence of altitude, temperature and moisture in air. Com- 
parative value of mountain, sea-side and mineral springs for 
various heart, kidney, lung and nervous conditions. 
II. Practical Procedures in Hydrotherapy 

(Demonstration) Salt-rubs mineral baths needle baths 
sprays and douches packs, tubs and ablutions local and 
general. 

III. Mechanotherapy 

Newer forms of manual and mechanical treatments. Indica- 
tions and contraindications for treatment. Physical exercises. 
Active games. Exercising apparatus. Equipment, varieties 
and value. Substitutes where a gymnasium is not available. 

IV. Treatment by Light-Rays and Electricity 

X-Ray Radium Finsen Light Heliotherapy Electrother- 
apy. The therapeutic action of these agents. Special indi- 
cations and contraindications for treatment, precautions and 
after care of patients. 
V. Serum-Therapy 

Theories underlying the use of serums reviewed. Prepara- 
tion of various sera. Methods of administration. Observation 
of patient. Prophylaxis and anaphylaxis. (Visit to a research 
laboratory, if possible.) 
VI. Occupation Therapy 

History of the development of work cures. Conditions in 
which occupation is particularly indicated as a therapeutic 
agent. Mental and physical effects of occupation. Psycho- 



SPECIAL THERAPEUTICS 77 

logical and physiological processes involved. Economic and 
moral aspects of occupation therapy. 
VII and VIII. Choice of Occupations 

Factors to be considered in choice of occupations for patients 
physical condition, nature of the disease or handicap, dura- 
tion of the disease, mental and manual equipment, age, previ- 
ous life, personal tastes and capacities, disposition, etc. Main 
types of patients to be considered. Types of occupations 
suitable for sick and handicapped therapeutic value of each 
suitability and practicability for various types of cases 
mental and nervous, tubercular, heart cases, etc. Sedentary 
work embroidery, basketry, chair-caning, modeling, paper- 
work, string work, etc. Active indoor occupations shop- 
work, cement, loom-weaving, etc. Outdoor work gardening, 
farming, photography, etc. Recreations entertainments, dra- 
matic games, dancing, music, reading, etc. 
IX. Equipment and Materials 

Requirements in tools, materials, etc., needed for commoner 
types of occupations. Practical possiblities for the general 
hospital patient, for sanatoria, private cases and district work, 
etc. Prices and purchasing of reed, wood, paper, etc. The 
use of waste materials rags, paper, string, etc. Disposal of 
products. 
X. Methods of Teaching Occupations 

The problems of bedside teaching and class-teaching. How 
to secure interest and cooperation. Need of careful planning 
and preparation. Importance of variety. Dangers of over- 
doing. Cultivation of originality and initiative. Develop- 
ment of the artistic sense. Value of appreciation and com- 
mendation as incentives. Encouragement of social motives 
as opposed to commercial or individualistic. Concrete prob- 
lems provided. Helping real people. Perfection in workman- 
ship comparatively unimportant. Educational and therapeu- 
tic results primary objectives. 

(NOTE). If additional time can be given and a teacher of 
occupations can be secured, these classes should be supple- 
mented by at least 10 to 20 hours in hand-work. A selection 
might be made from the following: 

Sewing and fancy work Knitting, crocheting, tatting, 
embroidery, rug-making, rake-knitting, etc. 

Basketry and weaving, using raffia, reed, and other mate- 
rials. 

String-work knotting and hammock-making. 

Wood-work carving and simple construction in wood. 

Paper-work simple book-binding, papier mache work. 

Leather work. 



78 OUTLINES OF SUBJECTS 

METHODS OF TEACHING 

1. Lecture and class work should be supplemented by demon- 
stration as far as possible. If more time is available, students 
should also carry out the main procedures in class to be sure 
that they have a grasp of the principles of technic, otherwise 
practice should be provided in connection with the nurse's 
general work. Class visits to X-ray rooms, hydrotherapeutic 
departments, etc., should be made to show the equipment in 
operation. 

2. In the occupational classes samples of the patient's work, 
poor as well as good, should be exhibited with brief histories 
of the cases, showing how handicaps are overcome and therapeu- 
tic results accomplished. Nurses should be encouraged to make 
themselves skillful in as many forms of occupational work as 
they can. Patients should be observed at work, and case 
records and charts studied to trace the relation between oc- 
cupation prescribed and the patient's condition. 

ILLUSTRATIVE MATERIAL AND EQUIPMENT 

Samples of work, pictures of work-rooms, of handicapped 
individuals at work, and finished products. X-ray plates, 
charts, apparatus, etc., to illustrate subjects under discussion. 

TEXT AND REFERENCE BOOKS 

Dunton: Reconstruction Therapy. 

Hare: Practical Therapeutics. 

Kellogg: Rational Hydrotherapy. 

Baruch: Principles and Practice of Hydrotherapy. 

Hinsdale: Hydrotherapy. 

Potts: Electricity in Medicine and Surgery. 

Tracy: Invalid Occupations 

Tracy: Rake-Knitting. 

Dunton: Occupation Therapy. 

Hall and Buck: The Work of Our Hands. 

See also under Nursing in Mental and Nervous Diseases, 
Materia Medica and Therapeutics^ etc. 

For Dietary Treatment see under Diet in Disease p. 22. 



E. NURSING IN DIFFERENT FORMS OF DISEASE 

Elementary Nursing Principles and Methods 

TIME : 60 hours, 30 lessons of 2 hours each divided about equally between 
theory and practice. To be given in the preparatory course. 
Teacher the nurse instructor. 

OBJECTS OF COURSE 

1. To give a clear understanding of the fundamental princi- 
ples which underlie all good nursing, to develop habits of ob- 
servation, system, economy, and manual dexterity and to 
establish a uniform an.d finished technic. 

2. To prepare pupils to meet the problems that will confront 
them in their daily work, limiting their duties as far as possible 
to those which they can understand and safely practice in the 
earlier stage of their training. 

3. To test out the aptitude of pupils, with a view to selecting 
those who are fitted to continue the work. 

OUTLINE OF CLASSES 

I. Introduction. How to Provide the Best Kind of Accommodation 

for Sick People. 

Purpose of the hospital and kinds. Importance of the nurs- 
ing service. What such service includes. Survey of general 
plan of the hospital. Different departments and their relation 
to one another. Plan of work to secure efficient service. 
(Class to be taken on a trip round the hospital.) 
II. The Patients' Surroundings. How to Make Them Clean, Com- 
fortable and Attractive. 

Effect of environment on sick people. The plan of the ward 
and private rooms, furnishings, arrangement, temperature, 
ventilation, light, cleaning and care. (If the course in hospital 
housekeeping can not be given, a longer time will have to be 
given to this lesson and the following.) 
III. Lavatories and Service Rooms. How to Keep Them in Good 

Condition. 

Relation of these to welfare of patient and work of the 
staff. Equipment and arrangement of lavatories, linen-rooms, 
utility rooms, etc. Care and cleaning of rooms, utensils and 
appliances. 
IV and V. Getting a Bed Ready for a Sick Patient 

Possible conditions to be met in person to occupy bed. Kind 
of bed and bedding needed in hospitals for comfort, safety, 
economy, sanitation, etc. Cleaning, disinfection and care of 
beds and bedding. How to make closed and open bed and 
children's cot. 

79 



80 OUTLINES OP SUBJECTS 

VI. How the Hospital Admits its Patients and Cares for Their 

Property 

Types of patients and how they come to the hospital. What 
can be done to make them feel at home and save them from fear 
and worry. Routine in admitting-room, office and ward. 
Clothing to be provided. Helping with tub bath and getting 
patient to bed. Listing and caring for clothing and valuables. 
Precautions regarding vermin. What the social service de- 
partment does for special cases. 
VII and VIII. How to Care for the Patient's Immediate Physical Needs and 

Make Him Comfortable in Bed 

Sources of discomfort and how to alleviate them. Positions 
of patients in bed. Devices for comfort pillows, pads, rings, 
etc. Giving bed-pan. Lifting and turning. Dressing and 
undressing. Changing bed with patient in it. Changing 
mattress with patient in bed. 
IX . Moving and Carrying Sick and Helpless Patients 

Condition of patients to be specially considered. Impor- 
tant points in handling and carrying patients. Assisting in 
walking. Carrying with and without a stretcher. Putting 
the patient up on a back-rest. Getting patient out of doors 
in a chair. Making bed for balcony patient. Restraint for 
irresponsible patients. How and when to restrain. 
X and XI. Bathing the Patient 

Purpose of the bath and method of giving bed-bath and night 
toilet. Care of mouth and teeth. Care of nails and hands. 
Brushing and combing hair. Precautions and treatment for 
pediculi. Washing the hair in bed. Care of nurse's basket 
or tray. 

XII. Prevention and Treatment of Bed Sores. Relief of Common Dis- 
comforts 

Causes of skin irritations. Prevention and care of bed-sores. 
Other causes of restlessness and sleeplessness. How to secure 
relaxation. Regulation and treatment of visitors. General 
handling of nervous patients. Hot-water-bags and cold com- 
presses, etc. as aids to comfort. Alcohol rub and simple rub- 
bing movements. 
XIII. How to Nourish the Patient 

Importance of food in restoring health. Physiological and 

psychological factors in relation to appetite. The serving of 

food to different types of sick and helpless persons. Care of 

food in kitchen and ward. Care of convalescent table. 

XIV, XV and XVI. What to Observe and Record About a Sick Patient's 

Condition 

Importance of accurate and careful observation. How to 
observe. Cardinal nymptoins temperature, pulse, respiration, 
and other important indications of patient's condition. Col- 



ELEMENTARY NURSING 81 

lection and care of specimens. Purpose of charts. Methods 
of charting. (Extra practice in printing to be given.) 
XVII. Assistance in Examination of the Patient 

Purpose of examination and common procedure followed. 
What the doctor needs for various types of examinations. 
Positions and assistance. How to protect the patient. Prep- 
aration for blood counts, Widals, etc. How to take the doc- 
tor's orders. 
XVIII. Administration of Common Medications 

Special precautions in handling of medicines. Care of medi- 
cine tray and hypo tray. Care of medicine cupboard and ap- 
paratus. Administration of medicines by mouth. The ticket 
and other systems for ensuring accuracy. 

XIX. Nursing Measures in Common Digestive or Intestinal Disturb- 
ances 

Causes and treatments usually given for nausea, vomiting, 
flatulence, colic, etc. How to give a simple enema. How to 
irrigate the bowel in a child. 
XX. Nursing Measures in Simple Infectious Conditions 

Infectious nature of colds, coughs, sore throats, etc. Pre- 
cautions in care of excreta, linen, dishes, etc. How to give 
sprays, irrigations, gargles and inhalations. How to prepare 
a croup-tent. How to give oxygen. Care of room and belong- 
ings after an infectious case. 

XXI, XXII, XXIII. Local Applications for Inflammation and Congestion 
Condition of circulation in inflammation. Action of heat 
and cold. Application of hot-water-bags, electric pad, poul- 
tices, fomentations, compresses, ice-bags, ice-coils, etc., to 
different parts. Action of counter-irritants and application 
of mustard paste. The foot bath, sitz bath, and mustard bath. 
XXIV. The General Care of Chronic and Convalescent Patients 

Position and care in chronic heart-troubles, asthma, ascites, 
paralysis, etc. Care of rheumatics. Baking for stiff joints. 
Wrapping joints. Application of liniments. Simpler move- 
ments of massage. Filling and care of air and water beds. 
Care of convalescents. 
XXV. The General Care of Sick Children in the Hospital 

Special problems to be met with children. Methods of 
lifting, carrying, bathing, dressing and feeding. Common 
conditions and treatments in children's ward. The daily rou- 
tine. Entertaining and managing sick children. 

XXVI and XXVII. Elementary Nursing Measures in Surgical and Ortho- 
pedic Conditions 

General principles in surgical work. Cleaning and steriliza- 
tion of instruments. Clearing trays, care of splints, sand-bags, 
extensions, etc. Making of surgical bed and ether bed. Care 
of patient in Bradford frame. Arm and foot baths for surgical 
conditions. 



82 OUTLINES OF SUBJECTS 

XXVIII. Elementary Nrirsing Measures in Gynecological Conditions 

Nature of conditions to be dealt with. Positions and mate- 
rials for examinations and treatments. Douches. Prepara- 
tion and clearing away of catheterization trays. Venereal 
precautions. 
XXIX. Elementary Measures in Eye, Ear and Skin Cases 

Nature of conditions to be cared for. Eye-bathing, com- 
presses and drops. Removal of foreign bodies in eye. Prep- 
aration of trays for eye and ear treatments. Application of 
ointments and lotions for common skin troubles. Eczema 
masks. Care of infectious skin conditions. 
XXX. Special Problems 

How the hospital discharges its patients. Getting the pa- 
tient ready to go home. Routine of discharge. Assistance by 
social service department in special cases. What to do in case 
of approaching death. The care of the body. Disposal of 
clothing, valuables, etc. Care of delirious patients. Night 
care of sick patients. 

NOTE. It is very desirable that some additional time should 
be given in connection with this course for a brief discussion 
of occupations and diversions for ward patients. Pupils can 
teach each other many of these processes, and if their interest 
is once aroused they will begin at once to devise and learn 
new ways of employing their patients' idle hands and minds. 
Some practical application of the simpler games and common 
forms of hand-work could be made in the daily work in the 
wards and dispensary. The special therapeutic effects of occu- 
pation would not be discussed here. The main points to be 
covered are as follows: 

1. How to occupy the patient's mind. The mental and 
physical effects of idleness both on well and sick people the 
special need for diversion and occupation in certain types of 
disease, as an antidote to worry and a source of interest and 
mental stimulation. Use of books and pictures in the hospital. 
Choice of stories and anecdotes for different ages and types of 
patients, bed games, cards, puzzle-pictures, floor and table 
games, checkers, chess, dominoes, block-building, etc. The 
storing and care of materials in the wards. The use of waste 
materials. 

2. Suggested occupations for special types of patients in the 
hospital. Hand-work, entertainment and diversions, suited to 
children, women, men, and patients with special handicaps. 

(For equipment, reference-books, etc., see under Special 
Therapeutics.) 

METHOD OF TEACHING 

1 . In order to insure complete understanding of the principles 
involved, about half the time will usually be required to ques- 



ELEMENTARY NURSING 83 

tion the students and explain the purpose of the various treat- 
ments, the conditions in which each is used, the effects to be 
looked for and the precautions required. The demonstration 
should follow or accompany this part of the lesson, and might 
be given to the whole class unless it is very large. 

2. For practice work, the class should be divided into sections 
of from eight to twelve pupils, depending on the amount of 
equipment available. For all the commoner procedures each 
pupil should have an individual set of appliances as in the diet 
kitchen, but if this is not possible pupils can work in groups of 
two or three. The teacher supervises the practice work, quiz- 
zing the pupils and explaining where necessary. Pupils may 
be asked to criticize each other's work, and sometimes to dem- 
onstrate for the group. Frequent reviews are desirable, and 
a final demonstration before the superintendent and head nurses 
is often found to stimulate careful and finished work. 

3. If the pupils are regularly assigned to ward duty, much of 
the practice or drill can be carried on in the wards under the 
general supervision of the instructor. If the student is not on 
ward duty, extra hours will have to be allowed for practice work 
in the demonstration room till skill and confidence are de- 
veloped. Pupils should not be allowed to perform any duties 
in the wards till the method has been thoroughly taught in the 
demonstration room. This method should be the one in use 
throughout the hospital. 

4. To secure uniformity in method, it is well to have a type- 
written or printed book of standardized procedures for reference 
in each ward. These methods should be carefully worked out 
to secure the greatest safety, comfort, and best therapeutic 
results for the patient, and the greatest economy in time, 
effort and materials for the staff and the hospital. Neatness 
and simplicity of procedure are also of primary importance. 

5. It is desirable that the nursing procedures taught in the 
probationary period should include only the simpler and less 
technical treatments, those which do not demand fine skill or 
much experience and understanding of disease, and those which 
would not likely be misused if the pupil is not retained in the 
hospital. If it is absolutely necessary for pupils to be given 
more responsible work such as night duty immediately follow- 
ing the preparatory course, certain other procedures may have 
to be taken up in this elementary course, such as catherization, 
hot and cold packs, intestinal irrigation, nutrient enema, etc. 
It is advisable however to defer these till the pupil has had 
more experience and knowledge and till she has properly mas- 
tered the fundamentals as outlined above. Courses in medical 
and surgical nursing should follow this elementary course. 



84 OUTLINES OF SUBJECTS 

EQUIPMENT AND ILLUSTRATIVE MATERIAL 

1. A special demonstration room or laboratory should be 
fitted up for the teaching of practical nursing. This should be 
large enough to allow eight to twelve students to work freely 
at one time. It should have ample cupboard and drawer space 
for supplies, and several good-sized tables, as well as black- 
boards, chairs, etc. 

2. The demonstration room should contain a complete equip- 
ment of the materials needed for class work beds, linen, 
enamel and glass-ware, drugs and supplies. For all the com- 
moner procedures each pupil or pair of pupils should have an 
individual set if possible. Expensive or cumbersome articles 
can be borrowed from the wards, when needed. Sometimes it 
is possible to use an empty ward or a good-sized private room 
as a practice room and then ward supplies and equipment may 
be used. 

3. Demonstration dolls or manikins can be used for many 
demonstrations, though the living subject is better if one can 
be secured. Pupils can be used as subjects in many procedures. 
A home-made life-size doll can be made quite inexpensively, 
covered with single-faced rubber so that it can be bathed and 
tubbed if desirable. 

4. Anatomical charts and models, the skeleton, and other 
illustrative material will be needed. 

(For plan and equipment of demonstration room see articles 
in 1914 and 1915 Reports of National League of Nursing 
Education, also The Modern Hospital, June, 1918.) 

TEXT AND REFERENCE BOOKS 

Nightingale: Notes on Nursing. 
Maxwell and Pope: Practical Nursing. 
Sanders: Modern Methods in Nursing. 
Robb: Nursing Principles and Practice. 
Mclsaac: Primary Nursing Technique. 
Brown: The Junior Nurse. 
Bridge: Nursing Manual. 
Wheeler: Nursing Technic. 

See also books on Anatomy and Physiology, Bacteriology, 
Chemistry, Physics, Hygiene, and Medical and Surgical Nurs- 
ing. 

Elementary Bandaging 

TIME: 10 hours. Class, demonstration and practice in two-hour periods. 
Taught by the instructor of nurses or a competent head-nurse. 
Given in the preparatory course. (May be combined with 
course in practical nursing). 



ELEMENTARY BANDAGING 85 



OBJECTS OF THE COURSE 

1. To teach the fundamental principles of good bandaging 
as a basis for all future practice in connection with surgical 
and orthopedic work, first aid, etc. 

2. To develop a fair degree of manual dexterity and skill 
in the application of the commoner and simpler bandages. 

OUTLINE OF CLASSES 

I. Introduction 

Purposes for which bandages are used. Variations in mate- 
rials, width, length, etc., of roller bandages. How to make 
and roll bandages. Triangular, cravat, four-tailed, and sculte- 
tus bandages. Their uses and common applications. Slings 
of different types and their application. Knots. 
II. The Circular and Spiral Bandage, and the Spica (Hand and Arm) 

Methods of holding, starting and ending the roller bandage. 
Circular bandage of the wrist, spiral of the arm and finger, 
spica of the thumb, complete gauntlet of the hand and demi- 
gauntlet. 

III. The Spiral Reverse and Figure-of-Eight of the Arm 

Purpose and technic of the reverse. Spiral reverse of the arm, 
figure-of-eight of the arm and elbow (including the hand), 
spica of the shoulder. 

IV. Spiral Reverse and Figure-of-Eight of Leg and Foot 

Spiral reverse of leg. Spica of the foot (covering the heel). 
Figure-of-eight of the ankle. Figure-of-eight of the leg. Spica 
of the groin. 
V. Special Bandages of the Head and Chest 

Figure-of-eight of the shoulders and chest. Suspensory of 
the breast (single and double). Recurrent head-bandage. 
Oblique of the jaw. Barton's bandage and eye-bandage. 

METHODS OF TEACHING 

1. The class period should be devoted largely to demonstra- 
tion and practice, with criticism by the teacher. When the 
pupil has caught the right idea, the necessary extra practice 
to acquire speed and dexterity can be done outside the class- 
room. 

2. Pupils may practice on each other where this does not 
necessitate a great waste of time for the model. It is better to 
have the human model to practice on, but fairly satisfactory 
work can be done on wooden or plaster-of-paris models (see 
below) or on the doll until the method is acquired. 

3. Books or charts with good illustrations of bandaging 
technic should be used freely by the pupils to supplement 
demonstrations by the teacher. 



86 OUTLINES OF SUBJECTS 

EQUIPMENT AND ILLUSTRATIVE MATERIAL 

1. Bandages of all varieties should be available for demon- 
stration and for use by pupils. 

2. Models of head, arm, leg, hand, etc., may be secured and 
mounted in convenient positions for practice. 

3. Improvised models may be made by pouring plaster-of- 
paris into a firm glove or stocking and moulding quickly to 
the shape desired. Plaster-of-paris models of heads may also 
be made at small cost. 

TEXT AND REFERENCE BOOKS 

Eliason: Practical Bandaging. 
Davis: Principles and Practice of Bandaging. 
Hopkins: The Roller Bandage. 
Wharton: Minor Surgery and Bandaging. 
Morrow: Immediate Care of the Injured. 
See also under Surgical and Orthopedic Nursing. 

Elements of Pathology 

TIME : 10 hours. Lecture, class and laboratory work, conducted by pathol- 
ogist with assistance of instructor if necessary. Second term 
of first year. 

OBJECTS OF COURSE 

It is not the intention here to make the nurse technically 
skillful in performing laboratory tests, but rather to help her 
to understand the principal causes that lead to disease, the na- 
ture of some of the commoner disease processes, the meaning of 
terms used in describing pathological conditions, and the 
importance of the various diagnostic measures especially as they 
touch her work. If she understands these things she will boa 
better observer of symptoms, more intelligent in applying treat- 
ments, and will be able to cooperate intelligently with the phy- 
sician and the pathologist in such tests and experiments as they 
wish to carry out on the wards. 

OUTLINE OF CLASSES AND DEMONSTRATIONS 

I. General Features of Diseases 

Brief review of history of pathology. Classification of dis- 
eases according to effect on the body (functional and organic), 
origin (constitutional and environmental) and nature of disease. 
Causes classified into predisposing (heredity, environment, 
climate, age, sex, occupation, etc.) and direct or exciting (me- 
chanical, physical, chemical, and parasitic) . Examples of each. 
Meaning of immunity, susceptibility, predisposition, and idio- 
syncrasy. Role of bacteria and animal parasites reviewed. 
Effects of bacteria on the tissues. 



ELEMENTS OF PATHOLOGY 87 

II and III. Disease Processes or Conditions 

Congenital (malformations, weaknesses, defects, etc.). Dis- 
orders of digestion and metabolism (faulty digestion, elimina- 
tion or secretion). Disturbances of circulation (heart lesions, 
congestion, haemorrhage, thrombosis, oedema, etc.). Retro- 
grade processes (atrophy, degeneration, necrosis, gangrene, 
death). Progressive processes (hypertrophy). Inflammation 
symptoms, causes, processes (hyperemia, exudation, diape- 
desis, resolution, suppuration, ulcer, abscess, sinus, etc.). Proc- 
esses of tissue rapair. Results of reparative processes. 
IV. New Growths 

Tumors cause, structure, nature (benign and malignant), 
dangers, varieties (lipoma, fibroma, dermoid cyst, sarcoma, 
carcinoma). Tumor-like growths (gummata in syphilis, tuber- 
cles in tuberculosis, and nodules in leprosy), cavities (tubercu- 
losis and dental caries). False membranes, strictures and 
adhesions. 
V and VI. Observation of Symptoms (Aids to Clinical Diagnosis) 

Importance of correct observation and accurate description 
of symptoms' objective and subjective. Important symptoms 
relating to central nervous system, special senses, respiratory 
tract, alimentary tract, vascular system, organs of elimination, 
muscular system, bony system, reproductive system, and duct- 
less glands. Purpose and care of the stethoscope, sphygmo- 
manometer, and other apparatus used in clinical diagnosis. 
VII. Methods of Laboratory Diagnosis 

Methods of obtaining and preserving specimens for examina- 
tion. General purpose and significance of tests made in patho- 
logical laboratory (blood, dropsical fluid, spinal fluid, pus, 
sputum, vomitus, feces, urine, vaginal smears, throat cul- 
tures, and specimens from operating room). Interpretation of 
results. Charting. 
VIII. Examination of Feces and Gastric Contents 

Normal stools' number, form, consistency, color. Gross ap- 
pearance of pathological stools, with mucus, pus, blood, para-, 
sites, calculi, foreign bodies. Clinical significance. Purpose 
of commoner tests. Appearance of normal stomach contents,. 
Nature of tests. Charting. 
IX. Examination of Urine. 

Appearance of normal urine quantity, color, turbidity, odor, 
reaction, specific gravity, and constituents. Abnormal urine 
conditions producing changes in composition, quantity, spe- 
cific gravity, etc. Nature of chemical tests for sugar, albu- 
min, indican, and bile. Nature of microscopic tests for crys 
tals, pus, casts, bacteria, etc. Charting. 
X. Laboratory Period 

Students divided into groups make simple tests of normal and 
abnormal urine. 



88 OUTLINES OF SUBJECTS 

METHOD OF TEACHING 

1. Classes should be held in the pathological laboratory or 
museum where students can be shown specimens illustrating 
the conditions and processes described. Lantern slides can 
also be used to great advantage. 

2. This course is a continuation of the courses in Anatomy, 
Bacteriology, and Chemistry which were given in the prepara- 
tory term, and is intended to serve as a basis for the courses in 
Medical and Surgical Nursing. It should therefore be corre- 
lated closely with these subjects. 

3. It is important that pupils should get a good command of 
all the ordinary terms used in describing disease conditions 
their spelling, pronunciation, and their exact meaning. Hence 
it is advisable to have brief written and oral reviews and quizzes 
when possible. 

ILLUSTRATIVE MATERIAL 

Pathological specimens, slides, charts, X-ray photographs, 
and illustrations from books. Microscopes. 

TEXT AND REFERENCE BOOKS 

Roberts: Bacteriology ahd Pathology for Nurses. 

Sedgwick: Principles of Sanitary Science. 

Roger: Principles of Medical Pathology. 

Adami and McCrea: Textbook on Pathology. 

Wells: Chemical Pathology. 

Henry: A Nurse's Handbook of Medicine. 

Emerson: Essentials of Medicine. 

Councilman: Disease and Its Causes. (Home University 

Library) 

Mackenzie: Health and Disease. (Home University Library). 
Mackenzie: Symptoms and their Interpretation. 
Medical Dictionaries. 
See also books on Bacteriology, Medicine, Surgery, and 

Hygiene. 

Nursing In Medical Diseases 

TIME: 20 hours, divided as follows: 

Lectures a.nd clinics by physicians 10 one-hour periods. 
Classes and demonstrations by nurse instructor 10 one- 
hour periods. Given in the second half of the first year. 

OBJECTS OF COURSE 

1. To give the nurse a practical understanding of the causes, 
symptoms, prevention and treatment of the commoner medical 
diseases, so that she may intelligently care for her patients, and 
give skilled assistance to the physician. 



NURSING IN MEDICAL DISEASES 89 

2. To give her skill and precision in the administration of the 
more advanced nursing treatments and to make her a keen 
observer and reporter of the symptoms of disease and the effects 
of treatments. 

OUTLINE OF LECTURES AND CLASSES 

I and III. (Lectures) Diseases of the Blood, Heart and Circulatory System 
Anaemia, leukaemia, chlorosis, pericarditis, endocarditis, 
myocarditis, valvular diseases, arteriosclerosis, aneurism, 
phlebitis. 

II and IV. (Classes) Quiz on lectures. General nursing measures used 
in above conditions diet, drugs, appliances, etc. Symptoms 
to be observed. Special treatments. Administration of drugs 
by hypodermic. Hypodermoclysis, transfusion, and intra- 
venous. Saline infusion. 
V and VII. (Lectures) Diseases of the Respiratory System 

Pneumonia, broncho-pneumonia, pleurisy, empyema, pneu- 
mo-thorax, oedema, bronchitis, bronchial asthma, etc. 

VI and VIII. (Classes) Quiz on lectures. General nursing measures re- 
quired in above conditions. Review treatments such as in- 
halations, croup-tent, irrigations, oxygen, etc., adding, cupping, 
actual cautery, cantharides, leeches, and special counter- 
irritants. Administration of pneumonia serum. 

IX, XI, XIII. (Lectures) Diseases of the Gastro-Intestinal Tract and Acces- 
sory Organs 

Gastritis, dilatation of stomach, duodenal ulcer, carcinoma 
of stomach, haematemesis, gastric neurosis, constipation, diar- 
rhoea, mucous colitis, chronic appendicitis, ascites, jaundice, 
cirrhosis and carcinoma of the liver, etc. (Typhoid should be 
included here if pupils are likely to care for such cases early. 
See communicable diseases.) 

X, XII, and XIV. (Classes) Quiz on lectures. General nursing measures 
required in above conditions. Special treatments test meals, 
lavage, gavage, nasal feeding, intestinal irrigations, procto- 
clysis, rectal feeding. Antipyretic measures cold sponge, 
slush bath, cold pack. 

XV, XVII, and XIX. (Lectures) Diseases of the Urinary Tract and 

Constitutional Diseases 

Nephritis, uraemia, cystitis, rheumatism, gout, diabetes, 
and diseases of the special glands. 

XVI, XVIII, and XX. General nursing measures required in above con- 

ditions. Catherization, bladder irrigation, instillation, cysto- 
scopic examination. Diaphoretic treatments hot pack, vapor 
and hot air baths, medicated baths. 

NOTE. If it is impossible to combine the medical lecture 
and nursing classes in this way for each group as it finishes the 
preliminary course, it is suggested that the nursing classes be 



90 OUTLINES OF SUBJECTS 

given separately to each group, and that all groups be combined 
for the medical lectures. Where the medical lectures have to be 
postponed till the second year, the nursing classes should in- 
clude a summary of the principal medical diseases such as is 
found in most nursing text books. The course in pathology 
should precede or accompany the course in medical nursing. 
Practical experience in the general medical wards should be 
given early to all pupils, as it is fundamental to all the special 
branches of nursing. 

METHODS OF TEACHING 

1. The clinical method of teaching medical diseases is to be 
preferred wherever it is possible. Lectures and classes should 
be illustrated constantly by reference to patients in the wards 
and nurses quizzed on the cases from their own wards. Short 
written reports on interesting cases may be read in class by 
pupils. 

2. The anatomy and physiology of each system should be 
assigned for review before taking up the diseases of each system. 
Quizzes should include previous related work in bacteriology, 
hygiene, materia medica, dietetics, etc. 

3. In the short time allowed it will not be possible for nurses 
to practice the nursing procedures in the class-room. However 
each nurse should be given an opportunity as soon as possible, 
to carry out each procedure on the ward. No treatment should 
be given the first time without observation by the head nurse 
or instructor. The pupil's card should be marked up when the 
treatment has been given satisfactorily and care should be 
taken to see that no important procedure is omitted. 

4. Charting should be emphasized in connection with every 
lesson and typical charts studied in connection with the differ- 
ent diseases. 

EQUIPMENT AND ILLUSTRATIVE MATERIAL 

Laboratory specimens showing diseased organs, charts, 
diagrams, X-ray plates, lantern slides, skeleton, bones, etc. 
Demonstration room equipment. 

TEXT AND REFERENCE BOOKS 

Emerson: Essentials of Medicine. 
Robb: Nursing Principles and Practice. 
Maxwell-Pope: Practical Nursing. 
Sanders: Modern Methods in Nursing. 
Wheeler: Nursing Technique. 
Osier: Practice of Medicine. 
Hughes: Practice of Medicine. 
Stevens: Practice of Medicine. 



NURSING IN SURGICAL DISEASES 91 

Rosenau: Preventive Medicine and Hygiene. 

Hare: Practical Therapeutics. 

H^nsdale: Hydrotherapy. 

Baruch: Principles and Practice of Hydrotherapy. 

Brunton: Lectures on the Action of Medicines. 

Farr: Internal Medicine. 

Lee: Scientific Features of Modern Medicine. 

See also reference books on Pathology, Materia Medica, 
Dietetics, etc. 

Nursing in Surgical Diseases 

TIME : 20 hours divided as follows : 

Lectures or clinics, conducted by a surgeon 10 hours. 
Nursing classes, quizzes and demonstrations, conducted by 
an expert surgical nurse 10 hours. 

OBJECTS OP COURSE 

1. To give the pupil nurse a good general idea of the nature 
of the principal surgical diseases, their symptoms and treat- 
ment, so that she may care for surgical patients intelligently, 
be of the greatest possible assistance to the surgeon in dressings 
and surgical treatments, and be able to act promptly and wisely 
in emergencies. 

2. To give her skill in elementary surgical procedures and 
bandaging, and to establish good habits of surgical technic. 

OUTLINE OP LECTURES AND CLASSES 

I. (Lecture) Introduction 

History of antiseptic and aseptic surgery. Microorganisms 
specially concerned in wound infections. Sources and modes of 
infection. Surgical nomenclature. Outline of the surgical 
field. General principles of modern surgery. 
II. (Class) Essential qualifications for success in surgical nursing. 
Surgical materials and their preparation. Sterilization of 
surgical instruments and dressings. Skin disinfection and 
surgical toilet. Care of the dressing carriage and dressing room. 

III. (Lecture) Wounds and Wound Infections 

Kinds of wounds accidental and operative clean and 
infected. The healing process. Pathological conditions in- 
flammation, suppuration, necrosis, gangrene, septicaemia, 
pyaemia, erysipelas, tetanus. Burns and scalds. 

IV. (Class) Surgical dressings in clean and infected wounds. 
Wet dressings. Packing, drainage, and special applications. 
Removal of sutures. Treatment of contusions. Nursing care 
of burn cases. Setting up of surgical trays for various kinds of 
dressings. 



92 OUTLINES OF SUBJECTS 

V. (Lecture) Surgical Emergencies 

Hemorrhage causes, symptoms, and treatment. External 
and internal hemorrhage. Shock causes, symptoms and 
treatment. Theory and technic of anoci association. 
VI. (Class) Methods of controlling hemorrhage by digital pres- 
sure, position, toruniquet, etc. After treatment of hemorrhage. 
Prevention and treatment of shock. 
VII. (Lecture) Minor Surgical Procedures 

Local incisions for abcesses, empyema, tracheotomy. Tech- 
nic of exploration, lumbar puncture, phlebotomy, aspiration, 
paracentesis, etc. Local anaesthetics. 
VIII. (Class) Preparation for local incisions and operations and 

after care. Provision for drainage. Biers cups. 
IX. (Lecture) Major Surgical Operations and Surgical Complica- 
tions 

Preparation of patient for operation. General care during 
and after operation. Post-operative complications nausea, 
vomiting, tympanites, auto-intoxication, pulmonary and 
kidney complications, hemophilia, thrombosis, embolism, phle- 
bitis, etc. 

X. (Class) Review ether-bed, Fowler's position and general points 

as to routine nursing care and treatment in major operations. 

Observation of symptoms. How to keep surgical charts and 

records. Treatment of surgical complications. 

XI. (Lectures) Surgical Conditions Involving Bony and Muscular 

Systems 

Fractures, dislocations and sprains. Amputations of ex- 
tremities. Necrosis and osteomyelitis. (Orthopedic conditions 
discussed in special course.) 

XII. (Class) Review of fracture bed, splints, extensions, etc. 
Preparation and after care rh each type of operation or injury, 
especially fractures of skull, spine, pelvis, and compound 
fractures. Special bandages Velpeau, stump, ankle, etc. 
Strapping for sprained ankle, knee, etc. 

XIII. (Lecture) Surgical Conditions of the Alimentary Tract and 

Accessory Organs 

Common operative procedures involving stomach, spleen, 
liver, and intestines. Operations for ulcer and cancer of stom- 
ach and intestines, intestinal obstruction, tubercular peri- 
tonitis, appendicitis, hernia, gallstones, etc. 

XIV. (Class) Preparation for above, procedures and after care in 
each type of operation. Bandages and dressings. Special 
nursing care of fecal fistula, gall-bladder and hernia cases. 
Charting. 

XV. (Lecture) Surgical Conditions of Thorax and Back 

Operations on chest, breast and kidney, including sarcoma, 
carcinoma, cysts, tumors, stone, etc. (Brief survey of surgery 
of genito-urinary tract given here. To be treated more fully 
later in a special course.) 



NURSING IN COMMUNICABLE DISEASES 93 

XVI. (Class) Preparations and after care in each type of operation. 

Special bandages and dressings. Charting. 
XVII. (Lectures) Surgery of the Head and Spinal Cord 

Surgical conditions of brain and spinal cord, mouth, tongue, 
and thyroid gland. 
XVIII. (Class) Preparation and after care in each type of operation. 

Special dressings and bandages. Charting. 
XIX. (Lecture) Plastic Surgery 

Grafts bone and skin. Surgical treatment of hare-lip, 
cleft palate, etc. 

XX. (Class) Preparation and after care in each type of operation. 
Special dressings and bandages. 

METHOD OF TEACHING 

Follow same general method as that outlined under medical 
nursing. 

EQUIPMENT AND ILLUSTRATIVE MATERIAL 

Dressing carriage and full equipment of surgical materials. 
Trays for various types of surgical dressings, hypodermoclysis, 
preparation, etc. Samples of special instruments and appara- 
tus. Lantern slides, X-ray plates, skeleton, etc. Anatomical 
and first aid charts. 

TEXT AND REFERENCE BOOKS 

Parker and Breckenridge : Surgical and Gynecological Nursing. 
Fowler: Operating Room and Patient. 
Howell: Surgical Nursing and Hospital Technique. 
Rose and Carless: Manual of Surgery. 
DaCosta: Modern Surgery General and Operative. 
Morrow: Immediate Care of the Injured. 
Saleeby: Surgery and Society. 
Crile: Anoci-Association. 
See also under Elementary Bandaging and First Aid. 

Nursing in Communicable Diseases 

TIME : 20 hours divided as follows : 

Medical lectures or clinics by a physician 9 hours. 

Medical classes and demonstrations, by a nurse who is a 
specialist in the field 9 hours. 

Lectures on social aspects by social service worker or special- 
ist in this phase of the subject 2 hours. Course to be given 
in the earlier half of the second year. 

OBJECTS OF COURSE 

1. In most infectious diseases, the nursing care is the most 
important part of the treatment, hence the nurse needs to be 
thoroughly informed on the nature of these diseases, and on 
every point that would help her to give intelligent nursing 
care and to prevent the spread of disease to others. 



94 OUTLINES OF SUBJECTS 

2. Especially in public health nursing, the nurse is expected 
to detect the early signs of the infectious diseases, so she ought 
to be very familiar with the symptoms of all the commoner 
infections, and should know the local regulations for the han- 
dling of such cases. 

3. It is very important that she should also recognize the 
social and economic aspects of this whole question of prevent- 
able diseases, and should appreciate her responsibilities and 
opportunities in the campaign to eradicate them. 

OUTLINE OF LECTURES AND CLASSES 

I. (Lecture) Typhoid Fever 

Introduction to the study of fevers. General clinical fea- 
tures, causes, stages and general lines of prophylaxis and treat- 
ment. The causes, modes of transmission, incubation period, 
symptoms, varieties, complications, aftereffects, and treatment 
of typhoid. 

II. (Class) Quiz on lecture. Sanitation of sick-room and hygiene 
of patient, family and nurse, Patient's toilet, antipyretic 
measures, diet, and general nursing care in fevers. Prepara- 
tion for Widal and anti-typhoid serum. Precautions and treat- 
ment in hemorrhage, perforation, tympanites, etc. Quaran- 
tine and personal precautions 

III. (Lecture) Scarlet Fever, Measles, German Measles 

General features of the exanthemata. Latest conclusion.-, 
regarding causes and methods of infection. Periods of incuba- 
tion, immunity, symptoms, types and characteristics of eacli 
disease. Complications, after effects, and treatment. Gener.il 
precautions and Board of Health regulations. 

IV. Quiz on lecture. General technic of aseptic nursing, disinfec- 
tion, isolation, etc. Prevention of cross infections. Nursing 
care in above diseases. Special care of mouth, nose, throat, 
eyes, and ears. Precautions as to rest, warmth, diet, and bath- 
ing. Nursing treatment of nephritic complications, otitis 
media, endocarditis, etc. Charting. 

V. (Lecture) Small-pox, Co>v-pox, Chicken-pox, and Erysipelas 
History of small-pox. Cause, mode of transmission, incuba- 
tion period, symptoms, types, stage of eruption, toxemia, 
complications, after effects, and treatment of each disease. 
Degree of quarantine and infectivity. 

VI. (Class) Quiz on lecture Nursing care in above diseases as to 
rest, bathing, diet, etc Preparation for vaccination and dress- 
ing. Local applications of cold, antiseptics, etc. Irrigation of 
eyes and prevention of pitting in small-pox. Methods of dis- 
infection and precautions. Care of body after death. 
VII. (Lecture) Diphtheria, Tonsillitis and Septic Sore. Throat 

History of diphtheria. Causes, sympton.s, complications, 
after effects, and treatment of each disease. Board of Health 
regulations. 



NURSING IN COMMUNICABLE DISEASES 95 

VIII. (Class) Quiz on lecture. Nursing care and management of 
above diseases. Local throat treatments. Preparation for 
giving antitoxine, intubation, tracheotomy, Schick test. 
After-care of intubated cases. Heart precautions. Vincent's 
angina. Use of mouth gag and feeding. Care of tubes thread- 
ing, cleaning, etc. 
IX. (Lecture) Influenza, Whooping Cough, Mumps and Colds 

History, causes, modes of transmission, symptoms, complica- 
tions, after effects, treatment, etc. Board of Health regula- 
tions. 

X. (Class) Quiz on lecture. Nursing care and management of 
above. Review of hot and cold applications, counter irritants, 
croup-tent, etc. Precautions. Technic of isolation and dis- 
infection in a private home for more severe and milder infec- 
tions. 
XI. (Lecture) Cerebro-Spinal Meningitis, Infantile Paralysis 

Causes, modes of transmission, infectivity, symptoms, com- 
plications, after effects, and treatment. Board of Health 
regulations. 

XII. (Class) Quiz on lecture. Nursing care in the above diseases. 
Importance of surroundings, position and support. Care in 
convulsions. Preparations for lumbar puncture. Precautions 
and disinfection. 

XIII. (Lecture) Malaria, Yellow Fever, Typhus, Amoebic Dysentery, 

Bubonic Plague and Hook-worm 

History, causes, mode of transmission, symptoms, complica- 
tions, after effects, and treatment. Recent campaigns for 
eradication of malaria, plague, hook-worm, etc. Maritime 
quarantine. 

XIV. (Class) Quiz on lecture. Nursing care in above. Baths, diet, 
intestinal irrigations, and specifics. Measures for destruction 
of insects. Camp sanitation. 

XV and XVI. (Lecture) Tuberculosis 

History of tuberculosis, and modern campaign for prevention 
and control. Exciting and predisposing causes, sources and 
modes of infection, pathology, types and infection, early 
symptoms and course of disease, complications and accidents, 
treatment, Board of Health regulations. 

XVII and VIII. (Classes) Quiz on lectures. Nursing care in tuberculosis. 
Hygiene, rest, diet, and fresh air. Provision for out-of-door 
sleeping. Klondike bed. Methods of disinfection. Care of 
advanced cases. Technic of special treatments strapping, 
blistering, cupping, aspiration, pneumothorax. Care in hem- 
orrhage. Temperature taking and charting. Nurse's 'care of 
herself. 

XIX and XX. (Lectures) Social, Economic, and Educational Factors in Pre- 
vention and Treatment of Communicable Diseases 
Problems of industry, housing, and poverty in relation to 
infectious diseases, particularly tuberculosis. Institution?- for 



96 OUTLINES OF SUBJECTS 

the care of such patients. Education and care of patients in 
their hbmes. Occupation and employment. Problems of re- 
lief. The out-door clinic. Reports and records. Methods of 
instruction. Relation of immigration to communicable dis- 
eases. Publicity methods. 

NOTE If the course in venereal diseases cannot be given 
separately, at least two lectures in this subject should be in- 
cluded here. 

METHODS OF TEACHING 

1. The method advocated is much the same as that followed 
in medical nursing. 

2. A visit to the Board of Health laboratories would be 
extremely profitable during this series of classes; also exhibits 
in preventive methods. 

3. Experience in an infectious hospital and in tuberculosis 
nursing is of the very greatest importance, especially for all 
those who may engage in any form of Public Health work. 
Experience in the out-patients' department is also invaluable. 

EQUIPMENT AND ILLUSTRATIVE MATERIAL 

Bacteriological slides and cultures, charts, models, etc. 
Equipment for demonstration of all practical procedures. 

TEXT AND REFERENCE BOOKS 

Lee: Scientific Features of Modern Medicine. 

Paul: Nursing in the Acute Infectious Fevers. 

Register: Practical Fever Nursing. 

Wilson: Fever Nursing. 

Wilcox: A Manual of Fever Nursing. 

Emerson: Essentials of Medicine. 

Roseneau: Preventive Medicine and Hygiene. 

McNutt: Manual for Health Officers. 

Knopf: Tuberculosis a Curable and Preventable Disease. 

Newsholme: The Prevention of Tuberculosis. 

Otis: The Great White Plague. 

Crowcll: Tuberculosis Dispensary Method and Procedure. 

Publications of Boards of Health. 

See also under Medical Nursing, Bacteriology and Public 
Sanitation. 

Nursing in Diseases of Infants and Children 

TIME: 20 hours divided as follows: 

Lectures or clinics by pediatrician 7 hours. 
Classes and demonstrations by nurse (head of children's 
ward) 7 hours. 



NURSING IN DISEASES OF INFANTS AND CHILDREN 97 

Lectures on social and psychological topics (special lectures) 
2 hours. 

Classes and demonstrations in infant feeding by nurse or 
dietitian 4 hours. 

The course to be given early in the second year. 

OBJECTS OP THE COURSE 

1. To help nurses to understand something of the physical 
and mental development of normal children and the essential 
principles of child hygiene and management, so they may 
intelligently care for normal children and teach others to care 
for them properly. 

2. To teach them the principal diseases which affect children, 
what their special manifestations are, and how to adapt nurs- 
ing measures to meet the needs of sick children. 

3. To make the pupil nurse intelligent, skillful and exact in 
the preparation of infant feedings, and to emphasize the im- 
portance of proper feeding as a therapeutic measure in the 
diseases of infancy. 

4. To give a good sound basis for later work in connection 
with milk depots, baby welfare, school-nursing and other fields 
of work where knowledge and skill in children's nursing are 
of essential importance. 

5. To give pupils some appreciation of the causes and social 
aspects of infant mortality, and secure their interest and 
cooperation in the conservation of child life. 

OUTLINE OF LECTURES AND CLASSES 

I. (Lecture) The Physical Development of the Normal Child from 
Birth to Adolescence 

How the child differs from the adult. Appearance, weight, 
height, muscular development of organs and special senses at 
various ages. Normal dentition and possible complications. 
Normal excretions. Relation between physical and mental 
growth. Hygiene of infancy and childhood. Hygiene of 
adolescent boy and girl. 
II. (Class) Physical Care of the Normal Infant 

Bathing, exercise, fresh air, sleep and clothing. The han- 
dling of the baby and run-about child. The nursery its fur- 
nishings and care. The daily regime at different stages. Quali- 
fications of a good children's nurse. 
III. (Lecture) The Feeding of Normal Children 

Feeding during the first year. The very great importance of 
breast feeding and methods of encouraging and promoting it. 
Artificial feeding. Conditions to be met. Modified milk. 
Formulae adapted to the infant at various stages. Feeding 
of the premature infant. Diet through later stages of child- 
hood. Food habits. 



98 OUTLINES OF SUBJECTS 

IV. (Class) Quiz on above. Position and care of infant in breast 
feeding. Care of feedings on the ward, and administration. 
Feeding delicate infants and run-about children. Making diet 
attractive to older children. 

(Classes XVII to XX to run parallel if possible.) 
V. (Lecture) Disorders of the Digestive Tract in Infancy and Child- 
hood 

The sick baby variations in symptomatology from adults. 
Diseases of nutrition, digestion and metabolism marasmus, 
rachitis, etc. Their causes, symptoms, treatment and con- 
valescent care. Relation of diet to gastro-intestinal disorders. 
(Distinguish clearly between the infant up to 2 years and over.) 
VI. (Class) Quiz on lecture. Observation and description of symp- 
toms in babies and older children. Difference in handling and 
nursing care of sick children. Gavage, nasal feeding, lavage, 
and enemata, as applied to small babies and older children. 
Care of buttocks. Administration of medicines to children. 
Collection and care of specimens. 
VII. Lecture) Disorders of the Respiratory System in Infancy and 

Childhood 

Bronchitis, pneumonia (broncho and lobar), pleurisy, empy- 
ema, croup, tuberculosis. Relative gravity of symptoms in 
child as compared with adult. Treatment and convalescent 
care. 

VIII. (Class) Quiz on lecture. Observation and nursing care. 
Fresh-air treatment. Out-door bed and clothing. Helio- 
therapy. Croup-tent. Preparation for aspiration of chest. 
Restraint of child during treatments. 
IX. (Lecture) Infectious Diseases in Infancy and Childhood 

Susceptibility of children to infectious diseases and differ- 
ences in reaction from adults. Sources and modes of infection 
in hospital wards. Prevention of spread of diphtheria, scarlet 
fever, influenza, common colds, etc. Control of vaginitis and 
isolation of specific diseases in children's wards. Typhoid 
in children. After-effects of various infections. 
X. (Class) Quiz on above. Aseptic precautions in nursing care 
of children, with special reference to utensils, thermometers, 
etc. Care of special precaution and isolation cases. Treatment 
of infected eyes in infant. Modifications of other treatments 
with infants and children baths, packs, hot and cold applica- 
tions, etc. 
XI. (Lecture) Constitutional and Nervous Disorders in Infancy arid 

Childhood 

Principal causes of nervous disorders, hysteria, chorea, epi- 
lepsy, convulsions, "tantrums," etc. Mental defects idiocy, 
imbecility, cretinism and mutism. Rheumatism, nephritis, 
and chronic heart diseases in children. The significance of 
"growing pains." 



NURSING IN DISEASES OF INFANTS AND CHILDREN 99 

XII. (Class) Quizonabove. Observation and management of nerv- 
ous children. Mental hygiene. Care of defective children. 
Daily re*gime for heart cases. Modifications of common treat- 
ments hot pack, mustard bath, cupping and counter irritants, 
etc., for children. 

XIII. (Lecture) Surgical Conditions in Infancy and Childhood 

Congenital and acquired deformities and malformations 
cleft palate, hare-lip, spina bifida, obstruction, imperforate 
anus, etc. Phimosis, circumcision, umbilical hernia, intus- 
suception. Effects of anaesthetics on children. Early symp- 
toms of spinal and other deformities. Burns. 

XIV. (Class) Quiz on above. Care of such cases before and after 
operation, including special dressings and treatments. Feed- 
ing and restraint. Nursing care of burn cases. (For care of 
orthopedic conditions see later course.) 

XV. (Lecture) Social Aspects of Children's Diseases. (By head of 
Social Service Department or special lecturer.) 

The problem of infant mortality what it means to the com- 
munity. Causes of high death rate in infants. Home versus 
institutional care of infants. Effects of child labor, mal- 
nutrition, bad housing, etc. on vitality and health of children. 
Movements for conservation of child life. (An excursion to a 
milk station or orphanage, day nursery or foundling home 
might supplement this lecture.) 

XVI. (Lectures) The Psychology of Childhood (Given by a teacher 
or other expert in child psychology should be introduced 
before Lecture XI if possible.) 

Mental development of the normal child from birth to adoles- 
cence. Instincts and capacities as they appear in normal 
development. Characteristic phases of development in boys 
and girls. How to interest and manage children at various 
stages. Abnormal types. How to deal with pernicious habits. 
The psychological and therapeutic value of play. Some prin- 
ciples of education. (This lecture might be supplemented by 
one or more classes by a kindergartner dealing with appro- 
priate plays, games and amusements for children, good pictures 
and stories for children at different ages, and the way of telling 
an interesting story.) 

The following classes in infant feeding should run parallel 
to topics III to VI if possible. 
XVII. (Class) Utensils 

Sterilizer, pasteurizer, pitcher (aluminum), bottle rack, 
feeding bottles, Chapin dipper, glass funnel, graduate, ounce 
measuring glass, thermometer, bottle brush, nipples, skewer, 
etc. Kinds and reasons why some are better than others. 
Substitutes for home use ex. quart dipper for graduate and 
tablespoon for ounce measuring glass, etc. 



100 OUTLINES OF SUBJECTS 

XVIII. (Class) Materials 

Lime water its composition and action. Sugars lactose, 
maltose, dextri-maltose, cane sugar their composition and 
action. Milk cows' milk as compared with human milk. 
Composition of each and reasons for modifying. Sources of 
supply and methods of handling certified milk. Reasons for 
using and Board of Health regulations governing certified 
milk. Pasteurized milk, method of pasteurization, reasons 
for pasteurizing and objections. Percentage milks table show- 
ing composition of bottled milk at different depths. Starches 
barley flour, oatmeal flour their composition and action. 
XIX. (Class) Formulae 

Simple dilution with boiled water, whole milk, percentage 
milk, milk sugar and lime water. Simple dilution with cereal 
waters rice, oatmeal or barley action of each. Splitting of 
protein by (1) coagulation of casein and using of whey. Con- 
stituents of whey. (2) Coagulation of casein and using of 
casein' Eiweiss. Fat free milk. Predigested foods. Pepsin 
or pancreatin extract. Patent foods their objections and 
uses. Malt soup mixtures. Use of strained cereals, broths and 
vegetable soups in infant feeding. 
XX. (Class) Technic 

Care of hands. Care of milk after delivery. Care of milk 
after modifying. Care of utensils to be used only for formu- 
lae to be thoroughly washed and sterilized. Care of nipples 
and bottles. Accuracy in measurements. Preparation of 
feedings bottles filled with exact amount required for feed- 
ings. Sealing with sterile cotton handled with forceps or patent 
caps. Method of labelling for hospital use. Method of apply- 
ing nipples. 

METHODS OF TEACHING 

1. Follow the general method outlined under medical nursing. 
The clinical method is infinitely superior to the simple lecture, 
and should be adopted in this subject if at all possible. Every 
opportunity should be taken to have pupils observe and handle 
actual cases. 

2. Practical experience in the care of children is of paramount 
and increasing importance for every nurse. Such experience 
should include the care of very young children as well as those 
of later years, and in medical and feeding cases as well as surgi- 
cal and orthopedic cases. Dispensary experience in the chil- 
dren's clinic is also invaluable, especially for those who expect 
to go into school or milk station work or any form of Public 
Health work. 

3. The nursing procedures as applied in the children's ward 
are so different in many respects from the methods employed 
in adult wards, that it will be necessary to discuss those modi- 



GYNECOLOGICAL NURSING 101 

fications and adaptations in detail and to demonstrate them for 
pupils. These demonstrations can be given in the ward or in 
the demonstration-room. 

4. Work in this course should be correlated closely with 
courses in general medical and surgical nursing, dietetics, or- 
thopedics, etc. 

5. The classes in infant feeding should be held in the diet 
kitchen or milk laboratory where all the materials and utensils 
can be seen and demonstrated. In the limited time assigned, 
no individual laboratory work could probably be covered, but 
each student should have a period of practical experience in the 
milk-room in connection with her training in the children's 
wards. 

ILLUSTRATIVE MATERIAL AND EQUIPMENT 

Charts, models, pictures, utensils and materials for infant 
feeding, food-charts, etc. 

TEXT AND REFERENCE BOOKS 

McCombs: Diseases of Children for Nurses. 

Ramsay: Care and Feeding of Infants and Children. 

Holt: Diseases of Infancy and Childhood. 

Holt: The Care and Feeding of Children. 

Chapin and Pisek: Diseases of Infants and Children. 

Brown : The Baby. 

Grulee: Infant Feeding. 

Morse: Care and Feeding of Children. 

Morse and Talbot: Diseases of Nutrition and Infant Feeding. 

Kerley: Practice of Pediatrics. 

Kerley: Short Talks to Young Mothers. 

Starr: Hygiene of the Nursery. 

West: Care of Children and Prenatal Care Pamphlets from 

Children's Bureau, Washington, D. C. 
Rose: Feeding the Family. 
Smith: Baby's First Two Years. 
Kirkpatrick: Child Study. 
Kirkpatrick: Individual in the Making. 
Amusements for Convalescent Children from New York 

State Board of Health. 
American Journal Diseases of Children. 
American Journal for Care of Cripples. 

See also under Special Therapeutics, Orthopedic Nursing 
Obstetrical Nursing, etc. 

Gynecological Nursing and Diseases of the Male Genito-Urinary Tract 
TIME : 10 hours divided as follows 

Lectures or clinics by physician specialist in gynecology and 
genito-urinary diseases 5 hours. Quizzes, classes and demon- 



102 OUTLINES OF SUBJECTS 

strations conducted by the head nurse of the gynecological 
ward 5 hours. Course to be given in the Second Year. 

OBJECTS OF COURSE 

1. It is intended, through the lectures, to give the student an 
intelligent understanding of the diseases of the genito-urinary 
tract, and the various forms of operative treatment for surgical 
conditions of the tract. 

2. The classes and demonstrations are for the purpose of 
enabling the student to become more familiar with the partic- 
ular nursing procedures in this branch of work. 

OUTLINE OF LECTURES AND CLASSES 
I. (Lecture) Introduction 

Brief history of gynecology as a specialty. Anatomy and 
physiology of the reproductive organs in review. Menstrual 
and reproductive functions of organs. Puberty and the meno- 
pause. Sterility and its causes. Abnormal menstruation- 
causes and treatment. Menstrual hygiene. 

II. (Class) Quiz on anatomy and physiology of pelvic organs. 
Review on surgical materials especially those used in gyne- 
cological and G. U. dressings and treatments. Equipment and 
care of the dressing-rooms for gynecological and genito-urinary 
cases. Nurses' relation to educational and ethical problems 
arising from this special type of work. 

III. (Lecture) Diseases of the Reproductive Tract 

Sources of infection, symptoms, treatment. Relation of 
venereal disease to infection. Displacement of organs. Mal- 
formations. Tumors of the pelvic organs, benign and malig- 
nant. Early symptoms and cancer. Importance of early diag- 
nosis and treatment. Tumor complications. 

IV. (Class) Quiz on causes, treatment and nursing care in above 
conditions. Reception of patient. Observation of symptoms. 
Importance of mental attitude of patient. Review of gyne- 
cological treatments douches, catherization, etc. Nurse's 
responsibility in the early diagnosis of malignant tumors. 
Opportunities for educational work in the prevention of cancer. 

V. (Lecture) Diseases of the Urinary Tract 

Malformations, foreign bodies, infections, fistulae, tumors, 
stricture, calculi and diseases of the external genitalia. Ex- 
aminations, treatments and operative measures used in above 
conditions. 

VI. (Class) Preparation for examinations abdominal, pelvic, 
cystoscopic. Discussion of nursing care and technique in 
relation to important treatments. Nursing care of drainage 
cases. 
VII. (Lecture) Gynecological Operations 

The various postures, and instruments used. Protection of 
patient. Assistance to physician. Preparation for operation 



ORTHOPEDIC NURSING 103 

the skin the digestive tract. The main types of minor 
operations and the nursing measures required to insure success- 
ful results. 

VIII. (Class) Quiz r on major and minor operations and vocabulary 
in connection. Preparation of patient for operation, local 
and general. Importance of comfortable positions during 
operation and in post-operative care. Care of skin and binder. 
Importance of air and nourishment. Drugs used in treatment. 
Dressings in each type of operation. 
IX. (Lecture) Gynecological Operations 

Vocabulary. Major operations, including those for mal- 
formations and displacements. Injuries. Inflammatory con- 
ditions and new growths. Post-operative treatment and com- 
plications. Post-operative care of patient. 

X. (Class) Observation of first symptoms after operation. 
Methods of preventing and meeting complications and emer- 
gencies shock, hemorrhage, infected stitches, retention of 
urine, burns by heat, iodine, anesthetic or acid, phlebitis, etc. 

METHODS OF TEACHING 

The general plan to be followed is outlined under Surgical 
Nursing. 



EQUIPMENT AND iLi/csTRATiyE MATERIAL 

Bony pelvis of skeleton, muscular pelvis of mannikin with 
organs in position ; pathological specimens of tract from labora- 
tory. 

TEXT AND REFERENCE BOOKS 

Parker and Breckinridge : Surgical and Gynecological Nursing. 

Cragin: Essentials of Gynecology. 

Kelly: Medical Gynecology. 

Kelly: Operative Gynecology. 

Davis: Obstetric and Gynecologic Nursing. 

MacFarlane: Gynecology for Nurses. 

See also books under Anatomy and Physiology, Obstetrics, 
Hygiene and Venereal Diseases, etc. 

Orthopedic Nursing 

TIKE : 10 hours divided as follows : 

Lectures or clinics by orthopedic specialist' 4 hours. 

Classes and demonstrations by a nurse with special training 
in orthopedic work 5 hours. 

Lecture on social aspects of orthopedic work by head of social 
service department' 1 hour. Given in the later part of the sec- 
ond year. 



104 OUTLINES OF SUBJECTS 

OBJECTS OF THE COURSE 

1. To give the nurse a definite idea of orthopedic nursing as 
distinct from general surgical nursing, with a knowledge and 
practice in the use of various splints and apparatus peculiar to 
orthopedic work. 

2. To teach her the cause and prevention as well as the care 
of orthopedic conditions, and the subsequent needs of the indi- 
vidual resulting from what at best is generally a long contin- 
ued illness, whether it be chronic or acute. 

3. To give her a better understanding of certain educational 
and social problems concerning the physically deficient children 
in our schools, and a keener interest in public health and tuber- 
culosis work. 

OUTLINE OF LECTURES AND CLASSES 

I. (Lecture) Orthopedic Conditions Due to Tuberculosis 

Anatomy and histology of bone. Deformities due to tubenju- 
losis and the care and treatment of the same. General hygiene. 
Congenital malformations and deformities. Dislocations, 
club feet, etc. 

II. (Class) Orthopedic apparatus- frames, traction splints, 
Thomas splint, caliper splints, braces, strappings (adhesive), 
etc. Practice in the application of apparatus, frames and ex- 
tensions. Bed making, bathing and general nursing care for 
such patients. 

III. (Lecture) Diseases Due to Faulty Nutrition 

Causes, symptoms and treatment of rickets, bow legs, breech 
knees, etc. Prevention. Dietetic and hygienic care. 

IV. (Class) Quiz on lecture. Practice in application of appara- 
tus splints, adhesive strappings, for flat foot and other strains. 

V. (Lecture) Deformities of the Spine 

Causes, symptoms, and treatment of Pott's disease, curva- 
tures, etc. Orthopedic exercises and corrective work. 
VI. (Class) Quiz on lecture. Practice in general exercises and 
special gymnastic work. Special scoliosis clinics. Possibility 
of home treatment. 
VII. (Lecture) Infantile Paralysis. Spastic and other paralyses. 

After-care. Muscle-training. Splints and other appliances. 
VIII. (Class) Quiz on lecture. Use of the plaster-of-paris bandage. 

Practice in making and applying. 
IX. (Lecture) Social Problems Connected urith Orthopedic Work. 

Special problems of education and training of physically 
handicapped. Employment for cripples. Special schools and 
institutions for crippled children. Work of the school nurse 
and visiting nurse in discovering and dealing with orthopedic 
cases. Cooperation with social and educational agencifes. 
X. (Class) Practice in the making and application of the plaster- 
of-paris bandage. 



OBSTETKICAL NURSING 105 

METHOD OF TEACHING 

1. The method of teaching is by lecture, demonstration, reci- 
tation and practice, all lectures and demonsrations being illus- 
trated by clinical material from the wards. An effort should be 
made throughout to emphasize the nursing side of the various 
problems presented. 

2. It is particularly rlecesssary that the nurse have ample 
practice in the handling of apparatus, and the actual applica- 
tion of splints, frames, plaster and the like, under careful super- 
vision, before she be allowed to do the work for the patient. 
It is presupposed that she shall already have been well in- 
structed in bandaging, massage and general surgical technique. 
To be complete her ward experience should be supplemented 
by outside visiting or dispensary work, where she_may learn the 
end results which in such long cases do not come to her atten- 
tion in the hospital wards. 

3. This course should be correlated closely with courses in 
surgical nursing, in diseases of children and massage. 

EQUIPMENT AND ILLUSTRATIVE MATERIAL 

Plaster bandages and materials for making Bradford frames, 
traction, Thomas and caliper splints, braces for breech knees, 
bow legs, curvature of the spine, etc. Adhesive plaster, plas- 
ter models, charts and photographs illustrating deformities. 

TEXT AND REFERENCE BOOKS 

Berry: Orthopedic Surgery for Nurses. 

Thorndike: Orthopedic Surgery. 

Bradford and Lovett : Treatise on Orthopedic Surgery. 

Tubby: Deformities including diseases of the Bones and 

Joints. 

See also Surgical Nursing, Nursing in Diseases of Infants and 
Children, etc. 

Obstetrical Nursing 

TIME : 20 hours divided as follows : 

Lectures and clinics by obstetrician' 10 hours. 
Classes and demonstrations by nurse (head of obstetrical 
ward preferably) 9 hours. 

Lecture on social aspects of obstetrics by social service nurse 
1 hour. 

OBJECTS OF COURSE 

1. To make nurses intelligent and competent in the nursing 
care of obstetrical cases, both normal and abnormal, and in the 
care of small babies. 

2. To enable the nurse to advise and instruct mothers in the 
care of their own health both before and after child-birth, and 
in the. conditions necessary for the rearing of healthy children. 



106 OUTLINES OF SUBJECTS 

3. To arouse an interest in obstetrical nursing and a keener 
appreciation of its importance, not only to individual mothers 
and babies, but to the welfare of the race. 

4. To arouse an interest in the social aspects of obstetrical 
work and to develop a wholesome and helpful attitude toward 
such sex problems as the nurse meets in connection with her 
work. 

5. To establish a definite connection between previous work 
in surgical technic and obstetrics. 

OUTLINE OF CLASSES AND LECTURES 

I. (Lecture) Introduction 

Brief history of obstetrics. The place of obstetrics in medi- 
cine. Responsibilities and opportunities of obstetricians and 
nurses. Anatomy of female pelvis. Landmarks. Varieties of 
pelvis and their relation to position and presentation. Abnor- 
malities and their relation to child-birth. Review of female 
organs of generation. 

II. (Class) Brief quiz on anatomy of reproductive system. Out- 
line of reproduction in lower animals, beginning with one-celled 
animals and using the chick, the frog, and the rabbit or cat as 
types. (See Marshall's Embryology, or Bigelow's Applied 
Biology.) 

III. (Lecture) Physiological Pregnancy 

Ovulation, menstruation and impregnation. The phenomena 
of pregnancy and segmentation. Nourishment of fetus 1 size 
and weight at different stages. Circulation. Conditions neces- 
sary for normal development. The facts about "maternal im- 
pressions." Influence and determining factors in heredity. 
The purpose and scope of eugenics. 

IV. (Class) Quiz on lecture. The mother's preparation for her- 
self as to clothing, dressings, utensils, etc. The "layette." 
Newer ideals as to babies' clothing. Simplicity and economy 
emphasized. The baby's cot or basket. 

V. (Lecture) Changes in the Maternal Organism During Pregnancy 
Signs and symptoms of pregnancy presumptive, probable, 
And positive. Duration. Methods of reckoning date of termi- 
nation. Hygiene and management of pregnancy. 
VI. (Class) Quiz on lecture. Pre-natal care. How to advise and 
help the mother as to employment, reading, diversions, cloth- 
ing, diet, etc. Importance of mental attitude. Problems in 
calculation of dates. Make out suggestive diets. Routine ex- 
amination of urine in pregnancy. The nurse's obstetrical outfit. 
VII. (Lecture) Disorders and Diseases nf Pregnancy 

Nausea, pernicious vomiting, varicose veins, oedema, anemia, 
neuralgia, eclampsia, ectopic gestation, placenta praevia, abor- 
tion, and miscarriage. Causes, symptoms, and treatment. 



OBSTETRICAL NURSING 107 

VIII. (Class) Quiz on lecture. Nursing care in above conditions. 
Drill on obstetrical terms. Instruments and equipment of de- 
livery-room. Making of bed for obstetrical case. Rules for 
admission of obstetrical patients in the hospital. 
IX. (Lecture) Mechanism and Conduct of Normal Labor 

Theories concerning cause of labor. Obstetrical ether. Ni- 
trous oxide or American ' ' Twilight Sleep . ' ' Signs of labor the 
three stages. Presentations. Management of each stage. 
Immediate care of mother and infant. 

X. (Class) Quiz on lecture. Preparation of delivery-room. Prep- 
aration of patient. Technic of nursing care and assistance to 
physician at each stage of labor. Duties of nurse in absence of 
physician. 
XI. (Lecture) Operative Delivery 

Forceps delivery, breech delivery, Caesarian section and de- 
structive operations. Methods of inducing premature labor. 
Requirements for repair of lacerations. 

XII. (Class) Quiz on lecture. Preparation for various operative 
measures, and nursing care of patient before, during and after 
each. Care of perineal stitches. 

XIII. (Lecture) Accidents and Complications 

Symptoms and treatment of post-partum and intra-partum 
haemorrhage, eclampsia, heart-failure, retained placenta, etc. 
Accidents and injuries to the new-born asphyxia, haemor- 
rhage, traumatisms, infections, etc. 

XIV. (Class) Quiz on lecture. Nursing care of patient in above 
conditions. Preparation for uterine packing, saline infusions, 
hot packs, etc. The care of the baby dressing of cord, care of 
the eyes, etc. First care of the premature baby jacket and 
cot, feeding, resuscitation and use of lung motor. 

XV. (Lecture) The Puerperium 

Anatomical changes in uterus, cervix, vagina, and abdominal 
walls. Symptoms to be observed and reported. Special at- 
tention to lochia. Care of breasts and encouragement of breast 
feeding. Contra-indications for breast-feeding. 
XVI. (Class) Quiz on lecture. The routine nursing care of normal 
cases position, bathing, diet, application of breast and ab- 
dominal binders and perineal dressings. Use of breast pump. 
Massage of breast. Local applications for nipples and breasts. 
The obstetrical chart. Catheterization of puerperal patient. 
XVII. (Lecture) Pathological Puerperium 

Puerperal septicaemia, phlegmasia dolens, mastitis, puerperal 
insanity, urinary and intestinal disturbances, etc. Causes, 
symptoms, treatment, and general care. 

XVIII. (Class) Quiz on lecture. Nursing care of above cases and 
special treatments reviewed. Preparations for intra-uterine 
douche. Dressing for incision of breast. Precautions and 
treatment in puerperal insanity. 



108 OUTLINES OF SUBJECTS 

XIX. (Lecture) Social Aspects of Obstetrical Nursing 

The older and newer attitude toward child-birth. Social 
problems arising in obstetrical work. The unmarried mother. 
The child mother. Relation of industry to child-birth. Res- 
cue homes and foundling institutions. Infanticide and abor- 
tion. Blindness of the new-born. The problem of birth con- 
trol. Reasons for and against the teaching of birth-control. 
Legislation governing in this and other countries. The midwife 
problem. The nurse's influence and responsibility in such 
problems. 

XX. Observation lesson or clinic to be introduced wherever it will 
be most helpful preferably in small groups. Attendance 
throughout one case of labor with full report of the case. 

METHODS OF TEACHING 

1. The clinical method should be used as far as possible. 
All specially interesting cases should be seen by nurses. As 
many procedures as possible should be demonstrated in the de- 
livery room. 

2. The nurse should have her operating room training before 
she has her practical work in obstetrics. If these lectures and 
classes can not run parallel with the practical training it is 
better for them to come first. The practical experience is of 
very great importance and it should be as full and complete as 
possible. Out-patient work is not very profitable unless care- 
fully supervised by a teaching graduate nurse. 

3. Correlate course in obstetrics closely with courses in bac- 
teriology, gynecological nursing, surgical nursing, and nursing, 
of infants and children. 

ILLUSTRATIVE MATERIAL AND EQUIPMENT 

Skeleton, separate pelvis, model of baby and placenta. 
Laboratory specimens of embryo and fetus at various stages. 
Lantern slides illustrating reproduction. 

TEXT AND REFERENCE BOOKS 

De Lee: Obstetrics for Nurses. 

Cooke: A Nurse's Handbook of Obstetrics. 

Williams: Obstetrics. 

Polak: Obstetrics. 

Marshall: Vertebrate Embryology. 

Bigelow: Applied Biology. 

Siemens: Prospecive Mother. 

Latimer: Girl and Woman. 

Prenatal pamphlet published by Federal Children's Bureau. 

Pamphlet on Midwives published by Committee on Blindness 

of State Charities Aid, N. Y. 

See also under Diseases of Infants and Children, Venereal 
Diseases, etc. 



NURSING IN DISEASES OF THE EYE, EAR, NOSE AND THROAT 109 

Nursing in Diseases of the Eye, Ear, Nose and Throat 

TIME: 10 hours, divided as follows: 

Medical lectures and clinics given by specialists 5 hours. 

Nursing classes and demonstrations given by nurse specially 
qualified in E. E. N. and T. work' 4 hours. 

Lecture on social aspects given by head of social service de- 
partment or other qualified person 1 hour. This course to be 
given in the latter half of the second year preferably. 

OBJECTS OF COURSE 

1. To give nurses an understanding of the care and treatment 
of the eye, ear, nose and throat in normal and abnormal condi- 
tions. 

2. To enable them to safely and efficiently care for patients 
with diseases of these organs. 

3. To arouse an interest in this branch of nursing which will 
lead nurses into this field equipped with a basis for further 
specialization, and for preventive and educational work. 

OUTLINE OP CLASSES AND LECTURES 

I. (Lecture) Diseases of the Eye 

Review of the anatomy and physiology of the eye. Eye 
strain prevention and effects. Injuries of the eye. Diseases 
of the lids, lacrymal apparatus and conjunctiva. Corneal ul- 
cer, keratitis, iritis, glaucoma, cataract, gonorrheal ophthal- 
mia, opthalmia neonatorum, and trachoma. Causes, symp- 
toms and treatment of these. Usual operative procedures. 
II. (Class) Quiz on lecture. Assisting with examinations of the 
eye. Solutions used in treatment,' effects, preparation, care. 
Demonstrations of hot and cold eye applications, the eye irri- 
gation, the preparation for dressings. Preparation of patient 
for operation and after care. Nurse's duties in cases of injuries 
or foreign bodies. Precautions in care of patient suffering 
from communicable eye disease. 

III. (Lecture) Diseases of Mouth, Pharynx and Larynx 

Review of anatomy and physiology. Diseases of the teeth 
and gums pyorrhea, abscesses, etc. Effect on health. Hy- 
giene of mouth and teeth. Operative procedure for correctioto 
of deformities of teeth and jaws. Diseases of the tonsils and 
adenoids causes, effects, symptoms, treatment and operative 
procedures. Diseases of larynx. Tumors, benign and malig- 
nant. Causes, effects, symptoms, treatment and operative 
procedures. 

IV. (Class) Quiz on lecture. Nurse's duties in connection with 
oral hygiene. Assisting with examinations of mouth, pharynx, 
and larynx. Applying medication. Gargles, irrigations, in- 



110 OUTLINES OF SUBJECTS 

halations, etc., reviewed. Preparation of patient for operation 
and after care in case of tonsillectomy, laryngectomy, trache- 
otomy, etc. Control of hemorrhage. 
V. (Lecture) Diseases of the Ear 

Review of anatomy and physiology of the ear. Examination 
of ear. Deafness its causes and prevention. Common tests 
of hearing. Diseases of the auricle and external ear (foreign 
bodies, eczema, furunculosis, impacted cerumen, etc.). Dis- 
eases of the middle ear chronic and acute otitis media, mas- 
toiditis, etc. Complications cerebral abscess, meningitis, 
sinus, thrombosis, etc. causes, symptoms and treatment, 
operative and non-operative. 

VI. (Class) Quiz on lecture. Advice nurses may give concerning 
foreign bodies, chronic discharging ears, etc. Demonstration 
of hot and cold applications. The ear irrigation. Preparation 
for myringotomy and incision of furuncle. Preparation of pa- 
tient for mastoid operation and post-operative care. Dress- 
ings, instruments and supplies used. Symptoms and signs of 
complications. Xursing care of patients with cerebral abscess, 
meningitis, thrombosis. 
VII. (Lecture) Diseases of the Nose and Accessory Sinuses 

Review of anatomy and physiology. Diseases of the nasal 
tract, including acute and chronic rhinitis and deflections of 
the septum' their causes, symptoms and effect on general 
health. Methods of examination and treatment, operative 
and non-operative. Infections of the sinuses. Mechanism of 
infections their causes, symptoms and effect on health 
Methods of examination and treatment. 

VIII. (Class) Quiz on lecture, assisting with examination of the 
nose and sinuses. Demonstration of nasal irrigation and nasal 
spray. Control of nasal hemorrhages. Care of patient after 
nasal operations. The preparation of patient and apparatus 
for opening and irrigating the sinuses. 

IX. (Lecture or clinic) The Observation of Early Symptoms and 
Marked Abnormalitise 

How to recognize early signs of eye, ear, nose and throat 
trouble. Simple routine tests of vision and hearing for school 
nurses. Examination of the mouth for adenoids, enlarged ton- 
sils, and defective teeth. Assistance in dispensary treatment. 
(This lesson should be held in the dispensary or children's clinic 
and pupils should have an opportunity to observe cases them- 
selves and try to identify the commoner abnormal conditions.) 
X. (Lecture) Social Aspects of Diseases of the Eye, Ear, Nose and 
Throat 

Social importance of defects and diseases of the special 
senses. Relation todefectiveness, dependency, unemployment, 
etc. Social causes of blindness industrial accidents, venereal 
diseases, the midwife problem. etc. OrganizM troverr.cnt" for 



NURSING IN MENTAL AND NERVOUS DISEASES 111 

the prevention of blindness. Legislation, research and pub- 
licity. Institutional care of the blind and deaf. Relation of 
adenoids, tonsils and teeth defects to education and delin- 
quency. Special applications to the work of the school nurse 
and general public health work. 

METHODS OP TEACHING 

The clinical method should be used as much as possible. A 
term of service in the out-patient department will usually pro- 
vide good experience in this line of work. The general operat- 
ing room training should precede the course. 

EQUIPMENT AND ILLUSTRATIVE MATERIAL 

Skeleton and separate head. Models of eye and ear. Charts. 
All materials needed for practical demonstrations. 

TEXT AND REFERENCE BOOKS 

Emerson: Essentials of Medicine. 

Bacon: Manual of Otology. 

May: Diseases of the Eye. 

Manhattan E. E. and T. Hosp. : Nursing in Diseases of the Eye, 

Ear, Nose and Throat. 
Pamphlets published by the New York State Committee for 

the Prevention of Blindness. 

See also under Anatomy and Physiology, Bacteriology and 
Modern Social Problems. 

Nursing in Mental and Nervous Diseases 

TIME : 20 hours divided as follows : 

Lectures and clinics by physician (neurologist or psychia- 
trist), 10 hours. 

Classes and demonstrations by nurse instructor with special 
training, 9 hours. 

Lecture on social aspects by head of social service department 
or a specialist in mental hygiene, 1 hour. 

Course to be given in early part of third year. 

OBJECTS OF THE COURSE 

1. To teach the student nurse the relationship between men- 
tal and physical illness and the application of general nursing 
principles to mental nursing. 

2. To teach the underlying causes of mental disease with 
modern methods of treatment available both in the hospital 
and in the community, and to endeavor to overcome the stigma 
attached to mental illness or mental hospital care. 

3. To train the nurse in observation of symptoms as expressed 
in early childhood and in later life through the behavior of 
patients, so that the early signs of mental illness may be under- 



112 OUTLINES OF SUBJECTS 

stood and appreciated, and so that nurses may give active and 
intelligent cooperation in movements for the prevention of 
mental illness. 

4. To teach the importance of directed habits of thought, de- 
sirable associations and proper environmental conditions in 
early childhood and to show the relationship of make-up to 
mental disorders. 

5. To assist in developing resourcefulness, versatility, adapt- 
ability and individuality in the nurse. To emphasize quali- 
ties essential to success in mental work and the importance of 
special training in this branch of nursing. 

OUTLINE OF LECTURES AND CLASSES 

I. (Lecture) Introduction 

Anatomy and physiology of the central nervous system. 
Biological introduction. Sympathetic system and function. 
II. (Class) Quiz' Anatomy and physiology of the nervous system. 

III. (Lecture) Neurology 

Disorders of the cord: tumors, myelitis, poliomyelitis, tabes, 
syringomyelia, sclerosis, atrophies, paralysis agitans, chorea, 
tics, tetany. 

IV. (Class) Summary of care of mental patients in hospitals with 
present-day developments. The mental hygiene movement. 
The admission of patients. Commitment procedures and pa- 
role. Indications and contra-indications for restraint meth- 
ods of treatment. Personal qualifications and educational re- 
sources desirable for the nurse in mental work. 

V. (Lecture) Neurological Conditions Associated with Abnormal 

Mental States 

Epilepsy, traumatic psychosis, brain tumor and brain ab- 
scess, arterio-sclerosis of brain, aphasia, paralysis. 
VI. (Class) General principles governing care of mental and nerv- 
ous patients. The application of nursing procedures in neu- 
rological conditions with special emphasis on care of skin and 
the care of patients in convulsions. The effect of environment, 
diet, exercise, massage, electric treatment, etc. The observa- 
tion of symptoms as indicated in behavior. The necessity for 
accurate record keeping of what actually occurs, not simply 
impressions received. The importance of noting all physical 
symptoms as well as mental. 
VII. (Lecture) Organic Reaction Types 

Senile dementia, dementia paralytica (general paralysis, 
syphilis of nervous system). Cause, treatment, prognosis. 
Laboratory aids to diagnosis. 

VIII. (Class) Quiz on previous lecture. Nursing procedures in re- 
tarded conditions, deteriorations, unconscious states, paralysis. 
Importance of attention to bodily functions, diet, cleanliness, 
prevention of bed sores, etc. Nursing measures in treatment 



NURSING IN MENTAL AND NERVOUS DISEASES 113 

by salvarsan or mercury. Methods of administering. Obser- 
vation of symptoms. 

IX. (Lecture) Delirium and Infectious Exhaustive States 

States of intoxication. Alcoholic and drug psychosis. Hal- 
lucinosis. Value of treatment by elimination drugs, hydro- 
therapy, etc. 

X. (Class) Quiz on lecture. Nursing procedures in delirium and 
exhaustion. Continuous tubs, packs, sponges. Various pre- 
scribed treatments by eliminative, sedative or stimulating 
drugs. Precautionary protective measures in administering 
drugs and in giving treatments. 

XI. (Lecture) States of Defect: Idiocy and Imbecility 

Types of personalities. Constitutional inferiority and psy- 
chopathic personalities. Psychopathology. Mental conflict 
and perversions of adjustment and behavior. 

XII. (Class) Quiz on lecture. Description of terms used in expres- 
sion of mental states and conditions. Methods of dealing with 
patient's questions. Observations necessary to gain the confi- 
dence of patients. Disciplinary methods. The necessity for 
a sympathetic understanding of human nature. Observation 
of habits and tendencies to perversions. Preventive measures. 

XIII. (Lecture) Dementia Praecox 

Etiology, types, treatment. 

XIV. (Class) Quiz on lecture. Observation of early symptoms 
habit deteriorations, etc. Re-educative measures. Thera- 
peutic value of occupations and diversions. Tube feeding. 

XV. (Lecture) Manic-Depressive Psychoses 

XVI. (Class) Quiz. Management of resistive, combative, violent 
and destructive patients. Precautionary measures against 
homicide and suicide or injury. The furnishing of rooms of 
wards for excited patients. The serving of meals. Observa- 
tions to prevent accidents care of keys, doors, locks, sharp 
instruments, clothing, dishes, etc. Routine necessary for pro- 
tection of patients. The value of hydriatic treatment and di- 
version. The management and care of untidy patients. 
XVII. (Lecture) Psychasthenia and Hysteria 

Psychoneuroses. Minor psychoses. 

XVIII. (Class) Quiz on lecture. General nursing procedures in func- 
tional psychoses. Value of rest, isolation, diet, occupations, 
hydrotherapy, diversions, re-education, environment, good 
hygiene mental and physical. Management of hysterical 
convulsions. Value of packs and continuous tubs. Methods of 
dealing with delusions and hallucinations. 
XIX. (Lecture) Psychoanalysis in Diagnosis and Treatment 

Means of obtaining data. Mental examinations. The value 
of early hospital care. The nurse's influence in the community 
as a means of furthering education and for the prevention of 
mental disease. 



114 OUTLINES OF SUBJECTS 

XX. (Lecture) Social Aspects of Mental Disease 

Economic and social conditions conducive to mental and nerv- 
ous diseases, poverty, over-work, social vices, drugs and al- 
cohol, isolation, etc. Relation of mental disorders and defects 
to the family, to occupation, education, prostitution, crime and 
lawlessness, etc. The burden on the community for the care 
of mentally ill and defective. Measures for the prevention and 
control of mental disease. 

METHODS OF TEACHING 

1. Few hospitals offer a special department in psychiatry, but 
there is usually some clinical material in any general hospital, 
which might well be used to illustrate the principles outlined 
above. Some of these are the mental or nervous conditions 
following or accompanying infectious diseases, toxemias, al- 
coholism, advanced heart and kidney cases, carcinoma patients, 
drug cases, and the various forms of hysteria and neurasthenia. 
Where possible an affiliation should be arranged with a mental 
hospital or psychiatric department, giving the pupils the op- 
portunity for more continued observation and experience in this 
very important branch of nursing. 

2. As in other medical subjects the clinical method should be 
used wherever possible, and every effort made to connect the 
nursing, medical and social aspects of this class of diseases. 

EQUIPMENT AND ILLUSTRATIVE MATERIAL 

Charts and models, case notes, lantern slides and laboratory 
specimens. 

TEXT AXD REFERENCE BOOKS 

Meyer and Kirby: Notes of Clinics in Psychopathology. 
White: Outlines of Psychiatry. 
White: Principles of Mental Hygiene. 
Kraeplin: Clinical Psychiatry, Vol. III. 
Barrus: Nursing the Insane. 
Davenport: Heredity in Relation to Eugenics. 
Richards: Euthenics "The Science of Controllable Environ- 
ment." 

Thorndike: Elements of Psychology. 
Thorndike: Individuality. 
James: Psychology. 
Tiffany: Life of Dorothea Lynde Dix. 
Dubois: The Education of Self. 
Dubois: The Influence of the Mind on the Body. 
Munsterberg: Psychotherapy 
Hollander: Nervous Women. 
Chapin: Compendium of Insanity. 
Beers: The Mind that Found Itself. 

See also references on Occupation Therapy, and Modern 
Social Conditions. 



NURSING IN OCCUPATIONAL, SKIN AND VENEREAL DISEASES 115 

Nursing in Occupational, Skin, and Venereal Diseases 

TIME: 10 hours, divided as follows: 

Lectures and clinics by physicians (specialists) 7 hours. 
Classes and demonstrations by nurses (specially equipped in 
these branches) 2 hours. 
Lecture by social service nurse 1 hour. 

OBJECTS OP COURSE 

1. To make the pupil nurse familiar with the outstanding 
features of the diseases in question, so that she may be able to 
care for such cases, intelligently and skillfully and assist in 
preventive work. 

j. To help her to understand the social significance of these 
diseases and to secure her interest and cooperation in remov- 
ing the social and economic causes which contribute so largely 
to their development. 

OUTLINE OF LECTURES AND CLASSES 

I and II. (Lectures) Occupational Diseases 

Occupational factors in disease in general. Classification of 
health hazards. Occupational diseases due to (a) gases, vapors 
and high temperature, (b) conditions of atmospheric pressure, 
(c) metallic poisons, dust and fumes, (d) organic and inorganic 
dust and heated atmospheres, (e) fatigue. Special forms of 
poisoning' lead, phosphorus, arsenic, mercury, etc. Parasitic 
diseases. Fatigue its causes and effects. Occupation neu- 
roses. Industrial accidents. Nursing care of occupational 
diseases. 

(For principles of Industrial Hygiene, see Public Sanitation.) 
III. (Lecture) Venereal Diseases- Syphiliis 

History of syphilis. Earliest recorded appearance in Europe. 
Discovery of germ and its characteristics. Clinical and lab- 
oratory methods of diagnosis. Pathology of syphilis and gen- 
eral characteristics of acquired syphilis. Primary stage from 
venereal and non-venereal infection. Value of early diagnosis. 
Secondary stage clinical symptoms' infectious and non-in- 
fectious lesions. Tertiary stage general symptoms and physi- 
cal complications (mental, nerve, heart, etc.) Hereditary 
syphilis' evidences in infants, children and adults. 
IV. (Lecture) Gonorrhea 

History of gonorrhea. Characteristics of gonococcus. Clin- 
ical and laboratory methods of diagnosis. Acute gonorrhea, 
ophthalmia neonatorum and vaginitis in children. Symptoms, 
treatment and complications. Manifestations in adults' symp- 
toms, treatment and complications. Mode of infection. Pre- 
ventive measures. Chronic or recurring gonorrhea. 



116 OUTLINES OF SUBJECTS 

V. (Class and Demonstration) Quiz on preceding lecture. Nurs- 
ing care of patients suffering from above diseases. Precautions 
regarding infection. Preparation for Wassermann and Leuten 
tests, administration of salvarsan (by intravenous, intraspinal, 
and intramuscular methods), mercury injectibns and inunctions, 
injection of silver salts and topical applications. 
VI. (Lecture) Diseases of the Skin Introduction 

Review structure and function of the skin and accessory or- 
gans. Relation to nerve supply and temperature control. The 
hygienifc care of the skin. Pathology of skin diseases. Inflam- 
matory changes of pigment and the causes of growths. Classi- 
fication of skin lesions. Assign cases for observation and re- 
port. 
VII. (Lecture) Lesions of the Skin 

Review bacteriology of skin diseases. Types of lesions in 
akin proper and in mucous membranes. Symptomfe general 
and local. Characteristic rashes. Complications, treatment 
and general precautions. Board of Health Regulations. 
VIII. (Lecture) Common Skin Diseases 

Occurrence, causes, symptoms, treatment, and prophylaxis of 
anaemia of the skin, hyperemia, erythema, eczema, herpes, 
urticaria, dermatitis, impetigo, psoriasis, erysipelas and para- 
sitic diseases of the skin. 

IX. (Class) Quiz on three preceding lectures. Nursing measures 
in skin diseases with special reference to hygiene, diet, bathing, 
local applications and dressings, etc. Starch and alkaline 
baths. Preparation for X-ray treatments. 
X. (Lecture) Social Aspects of Skin and Venereal Diseases 

Relation of housing, living conditions, social habits, immi- 
gration, etc., to skin diseases. Relation to occupation and to 
social intercourse (as in schools, clubs, etc.) Relation of ve- 
nereal disease to prostitution, blindness, illegitimacy, infant 
mortality, insanity, crime and other social problems. Public 
Health aspects of the problem. Legislation and publicity 
methods. Reporting of cases of venereal diseases. The men- 
ace of charlatans and secret remedies. The function of the free 
and pay clinic. 

(For social and economic aspects of occupational disease and 
for educational problems connected with sex-hygiene see under 
Modern Social Conditions.) 

METHODS OF TEACHING 

1. Use the clinical method wherever possible. Have pupil 
study case records and observe typical cases in wards and out- 
patients department between classes. Dispensary experience 
is especially valuable in connection with this course. 

ILLUSTRATIVE MATERIAL AND EQUIPMENT 

Bacteriological slides and cultures, charts and models, pub- 
licity literature and exhibits. 



OPERATING ROOM TECHNIC 117 

TEXT AND REFERENCE BOOKS 

Oliver: Diseases of Occupation. 

Thompson: Occupational Diseases. 

Goldmark: Fatigue and Efficiency. 

Dock: Hygiene and Morality. 

Morrow: Social Diseases and Marriage. 

Stelwagon: Diseases of the Skin. 

Jackson: Diseases of the Skin. 

Meachen: Diseases of the Skin for Nurses. 

Publications of Society of Moral and Sanitary Prophylaxis 
(N. Y.). American Social Hygiene Association and State 
Departments of Health (See Oregon and other state and 
local publications). 

Operating Room Technic 

TIME: 10 hours. Classes and demonstrations I to VIII conducted by the 
operating-room nurse. Lectures IX and X by a physician or 
trained anesthetist. Course given in the second year. 

OBJECTS OF THE COURSE 

1. To give the pupil nurse a good scientific basis for the 
surgical technic of the operating room, to introduce her to the 
various methods and procedures in use in all forms of operative 
work, whether in the hospital or outside, and to help in develop- 
ing the "aseptic conscience." 

2. To make the pupil familiar with the equipment of the op- 
erating-room, its cost, use, and care, and to help her in the 
preparation of standard supplies. 

3. To give her a general idea of the use and action of anes- 
thetics, so that she may be able to care for the patient and assist 
the anesthetist more intelligently, and if necessary administer 
an anesthetic in an emergency, under a surgeon's direction. 

NOTE. It is not the intention here to have the pupil special- 
ize in either operating-room work or anesthetics. This would 
require a 1'dnger preparation and should be deferred till after 
graduation. 

OUTLINE OF CLASSES 

I. The Operating Room and its Equipment 

The relation of this department to others in the hospital. 
Structure, finishings, and furnishings of the operating-room 
and suite. Temperature and moisture of air. Light. Care 
and cleaning of the room and equipment. Manipulation of 
tables, etc. The operating-room staff, its duties and responsi- 
bilities. Special need for intelligence, concentration, and 
trustworthiness on part of operating-room nurses. Organiza- 
tion of the daily service. Surgical nomenclature. 



118 OUTLINES OF SUBJECTS 

II. The Sterilizing Room 

Review of surgical bacteriology and principles of sterilization. 
Construction, operation, and care of autoclave and sterilizers. 
Fractional and single sterilization. Disinfectant solutions in 
the operating-room. Their preparation and use. Sterilization 
of utensils, pitchers, basins, etc. 

III. Instrument and Supply Room 

Names of instruments. Care, cleaning, and sterilization. 

Drugs and solutions, kinds, preparations, and sterilization. 
Storage and care of splints, sandbags, and mechanical appli- 
ances. Care of actual cautery and special apparatus. 

IV. Preparation of Dressings and Supplies 

Preparation and sterilization of gauze dressings, pads, pack- 
ings, drains, bandages, needles, sutures, ligatures, and linen 
supplies (gowns, masks, sheets, swathes, etc.) Storing and as- 
sembling supplies. 
V and VI. The Operation 

Essentials of aseptic technic. Results of broken technic. 
Necessity for good team work in securing speed and efficiency. 
Fitting up the operating-room. Preparation of surgeon and 
nurse. Preparation of the patient. Positions on the table, 
support and draping. Preparation of the site of operation. 
Operative steps. The sponge count. Emergency measures, in- 
fusions, transfusions, etc. Duties of each member of the oper- 
ating and assisting staffs. Removing patient from the table. 
After care and clearing away. Care of pathological specimens. 
VII. Modifications of Technic for Special Types of Operation 

Selection of instruments, dressings, sutures, etc., for opera- 
tion on head, neck, liver and gall bladder, kidney, vagina, etc. 
Also for fractures, orthopedic cases, minor operations and 
septic cases. 
VIII. The Emergency Operating-Room 

Equipment of the emergency operating-room. Emergency 
technic. Minimum requirements. Typical emergencies as a 
result of mine disasters, train wrecks, etc., and their handling, 
with and without standard equipment. Night operations. Ar- 
rangements of light and other special adjustments. 
IX and X. Anesthetics 

History of anesthesia. Types of anesthetics, local, spinal, 
and general, and their uses. Types of inhalers. The equip- 
ment of the anesthetic room. The anesthetic table and stimu- 
lating tray. Oxygen apparatus. Nurse's care of the patient 
before, during, and after the anesthetic. Principles to be ob- 
served in the administration of the commoner anesthetics. 
The preliminary steps. Unfavorable symptoms. Accidents. 
After-effects. Mental influences in relation to anesthesia. 
Technic of anoci-association. 



EMERGENCY NURSING AND FIRST AID 119 

METHOD OP TEACHING 

1. The classes should be held in the operating-room where 
pupils can see and hatodle the equipment and where demonstra- 
tions can be set up by the instructor and the pupils. Observa- 
tion of one or two operations would help to illustrate the main 
principles and methods. 

2. If it is possible it would be better to give this course to 
smaller groups, taking those who have just begun their operat- 
ing-room training or who are soon to begin i4;. The class and 
practical work would then supplement and reinforce each other. 
If it is impossible to give ftine for regular organized class 
work, the subject should be covered through individual instruc- 
tion and demonstration with supplementary readings in good 
reference books. 

3. Quizzes should be given frequently, and drills on essen- 
tial points. Students should not be required to memorize 
lists of instruments and supplies but should if possible have 
typewritten sheets giving typical layouts, which can be re- 
ferred to when needed. 

EQUIPMENT AND ILLUSTRATIVE MATERIAL 

The equipment of the operating-room. Catalogues of sup- 
ply houses giving names and prices of instruments, furniture, 
utensils, etc. Skeleton, charts, etc., as required. 

TEXT AND REFERENCE BOOKS 

Parker and Breckinridge : Surgical and Gynecological Nursing. 

Howell: Surgical Nursing and Hospital Technic. 

Robb: Aseptic Surgical Technic. 

Senn: Opera ting-Room Technic. 

Fowler: The Operating-Room and the Patient. 

Smith: The Operating Room. 

Emergency Nursing and First Aid 

TIME: 10 hours. Classes and demonstrations conducted by the nurse 
instructor, or by a physician and nurse who are especially com- 
petent to handle this subject. To be given in the latter part 
of the senior year. 

OBJECTS OP THE COURSE 

1. This short course is intended to help the nurse to adapt 
her hospital methods a little more readily to the situations 
which she will meet on graduation, especially to emergency 
conditions such as may be met in army work, in accidents of 
various kinds, and in pioneer service where equipment and 
facilities are limited. 

2. Such a course will also serve as a review of practical nurs- 
ing principles and procedures for students who intend to take 



120 OUTLINES OF SUBJECTS 

the state examinations. Quick thinking, adaptability, re- 
sourcefulness, economy and speed, would be emphasized as well 
as careful technic. 

3. The demand for classes in elementary nursing and first 
aid to be given to clubs and groups of various types is increas- 
ing so rapidly that nurses should be prepared to assist in such 
teaching and should thus be in touch with the latest and most 
approved methods in emergency work. 

OUTLIVE OF CLASSES AND DEMONSTRATIONS 

I. Introduction 

General principles and scope of first-aid work. Qualities 
demanded and dangers to be avoided. Materials required. 
First-aid outfits of various types. Improvised outfits. Or- 
ganization of nursing service in case of fires, railway accidents 
and other public disasters. Organization for service in time 
of war. 
II and III. Transportation of the Injured 

General principles to be observed in transportation. Ve- 
hicles available. Ambulances. Improvised vehicles. Stretch- 
ers' manufactured and improvised. Loading and carrying 
stretchers, carrying over obstructions, up and down stairs, etc. 
Carrying patients in a chair, hammock or blanket-sling. Car- 
rying pick-a-back and in arms. The fireman's lift. The two, 
three and four-handed seat. Special methods of transportation 
in fires, in case of flood, etc. Stretcher drill. 
IV and V. Surgical Emergencies 

Essentials of surgical first-aid. Emergency dressings and 
methods of sterilization and disinfection. Improvised splints, 
padding and bandages for use in fractures, dislocations, sprains, 
etc. Improvised tourniquets. First-aid treatment of frac- 
tures, wounds, burns, bruises, frost-bites, etc., of various 
types. Treatment of hemorrhage. 
VI and VII. Medical Emergencies 

States of unconsciousness. Various causes and how to dis- 
tinguish commoner conditions. First-aid treatment of fainting, 
shock, apoplexy, intoxication, convulsions (of commoner types), 
sun-stroke, heat exhaustion, electrical shock, drowning, chok- 
ing, gas and drug poisoning. 
VIII. Adaptation of Nursing Measures 

Surroundings, conditions and facilities usually found in city 
tenements, in country districts, in military camps, mining dis- 
tricts, etc. Essentials of sick-room sanitation and personal 
care under any of these conditions. Modification of treatments 
to be worked out on basis of resources available. 
IX and X. (Two-hour period) Demonstration of Nursing Measures 

The following problems are suggested: Putting up a croup- 
tent in a city tenement; making a camp bed; giving a slush 



SPECIAL DISEASE PROBLEMS 121 

bath in a camp bed; giving a hot pack in a camp or country 
house; preparing for an obstetrical case in a private house; 
preparing for an operation in a private house or camp; care of 
shock under emergency conditions, etc. 

METHODS OF TEACHING 

1. Since most of the principles covered in this course should 
be familiar to senior nurses, the main effort will be to have 
them work out the applications as a test of their understanding 
and resourcefulness. Problems should be assigned ahead of 
time and each individual should be responsible for some part of 
the discussion and demonstration. 

2. It is suggested that the demonstrations be made before 
the school and the pupils rated on the points most essential in 
first-aid work. 

3. An excellent way of developing interest in such a course 
is to have the pupils assist in giving classes to a small group 
of factory girls, boy or girl scouts or camp-fire girls. Great 
care should be taken, however, that the work should be very 
elementary in character and thoroughly taught. 

EQUIPMENT AND ILLUSTRATIVE MATERIAL 

1. Beds, bedding, utensils, furnishings and surgical materials 
as for other nursing classes, with a variety of common house- 
hold and out-door materials to be used for improvising equip- 
ment. 

2. First-aid outfits for use in factories, mine accidents, 
schools and households, army kit, Red Cross kit, outfit for 
automobile trips, etc. 

3. First-aid charts (Red Cross and other kinds). 

TEXT AND REFERENCE BOOKS 

Morrow: Immediate Care of the Injured. 
Lynch: Red Cross Text-book on First-aid and Relief Columns. 
Wharton : Minor Surgery and Bandaging. 
Doty: Prompt Aid to the Injured. 
Eliason: First Aid in Emergencies. 
See also text-books in Nursing, Medicine and Surgery. 

Special Disease Problems (Elective) 

TIME: 10 hours. Conferences, case studies and written reports. Con- 
ducted by experts in different subjects studied. 

OBJECTS OF COURSE 

1. The idea is to give each senior student an opportunity of 
making a more extended study of some method of treatment 
or some one disease or class of diseases, taking the case as the 



122 OUTLINES OF SUBJECTS 

unit of study, and coordinating all the various aspects (pathol- 
ogy, therapeutics, nursing, etc.) previously studied as separate 
subjects. 

2. To test out their ability to work out an independent 
problem as they will have to do when they leave the hospital, 
to consult sources and gather material for themselves and to 
organize the results of their observation and inquiry in the 
form of a report or case history, such as might be published 
in a nursing journal. 

3. To study any new or special forms of disease or treatment 
which may have been slighted or overlooked in the previous 
courses. 

SUGGESTED PROBLEMS 

These would vary widely, according to the special interest of 
the student, and the material at hand. Problems along the 
following lines might be suggested: 

I. Newer methods of treatment in pneumonia, infantile 
paralysis, typhoid or any otjier disease. 

II. Devices for improving nursing technic and increasing 
efficiency in nursing procedures. 

III. Special dietary studies. 

IV. Special forms of therapeutics. 

V. Nursing treatment of rare or unusual cases. 

VI. Study of a hospital epidemic. 

VIII. Special features in any branch of nursing obstetrical, 
children's, mental and nervous, etc. 

IX. Study of certain symptoms or phases of disease such as 
shock, post-operative vomiting, chill, crises, symptoms of ap- 
proaching death, sleeplessness, delirium, etc. 

METHODS OF TEACHING 

1. A great deal of this work would have to be individual. 
General direction and advice could be given by the best quali- 
fied person available, but the student must do the greatest 
part of the work herself. 

2. A few conferences of the class would be held to present 
reports of the work being done, so that each student would 
profit by the results of the others' work. 

3. These should be supplemented by lectures by specialists 
on any new or interesting subjects connected with the study and 
treatment of disease. 

TEXT AND REFERENCE BOOKS 

See under preceding subjects. 



F. SOCIAL AND PROFESSIONAL SUBJECTS 

History of Nursing (including Ethical and Social Principles) 

TIME: 15 hours, divided as follows: 

Classes I to X conducted by the superintendent of nurses or 
instructor 10 hours. 

Classes XI to XV given by the social service worker or visit- 
ing nurse 5 hours. This course to be given in the early part 
of the preparatory year. 

OBJECTS OF COURSE 

1. To arouse interest and enthusiasm in nursing as an occu- 
pation, by introducing the pupil nurse early to the long and 
splendid history of nursing, and the great leaders who have 
established its traditions and ideals. 

2. To make them appreciate some of the obstacles that have 
been overcome in making the profession what it is, sind some 
of the opportunities which are open to them in the future. 

3. To explain the origin and meaning of hospital regulations 
and hospital etiquette, and to secure the cooperation of the 
pupil nurse in carrying out the purposes of the hospital har- 
moniously and effectively. 

4. To interest the pupil from the beginning in the social as 
well as the medical aspects of her work and give her some 
realization of the social and economic conditions which bring 
patients to the hospital and complicate recovery. 

5. To encourage in the pupil a sympathetic attitude toward 
her patients as people, a better understanding of their prob- 
lems and the conditions under which they live, and to make 
her more ready and able to cooperate with the social service 
department and other agencies in helping them., 

OUTLINE OF CLASSES 

I to X. History of Nursing- including ethical principles 
I. Introduction: 

Brief discussion on the meaning of nursing, the present de- 
mands in hospital work, and the ideals which pupils bring to 
their new task. Reasons for the study of nursing history to 
understand and appreciate nursing traditions and ideals, to 
study the stages of development through which nursing has 
passed, to note the people and influences which hare helped 
to make the profession what it is and to find out the origin of 
common observances and customs. Explanation of the pur- 
pose of training and those features of hospital life which are of 
immediate importance to new pupils. A very brief outline of 
the main periods in general history reviewed as a basis for 
nursing history. 

123 



124 OUTLINES OF SUBJECTS 

II. The Origin and Early Development of Nursing 

Original meaning of nursing "to nourish." Maternal or 
parental instinct, the root of the nursing impulse shown in 
protection, nourishment, care and fondling of young. Nurs- 
ing and first-aid among animals. Rudiments of nursing care 
among primitive peoples. Influence of religious beliefs and 
ceremonials on the care of the sick. Early rites of hospitality 
their relation to ancient institutions for the care of sick 
strangers. Gradual development in standards of humanity 
and justice. Beginning of public relief for sick and unfortu- 
nate. General standards of hygiene, sanitation, therapeutics, 
nursing and medical science in ancient civilizations. Hippoc- 
rates' the "Father" of medicine influence on medicine and 
nursing. Ethical ideals as shown in the Hippocratic Oath. 
Countries where nursing is still in the primitive stage of de- 
velopment. 

III. Influence of Christianity on Nursing. The Ascetic or Saintly 
Ideal 

Influence of Christian ideas of brotherhood, pity, charity 
and self-sacrificing service seen in the work of the deacons 
and deaconnesses of the early church first organized nursing 
service. Relief of sick and unfortunate gradually taken over 
by the church. Hospitals established as religious and char- 
itable institutions. Nursing advocated as a form of religious 
discipline and service. Paula, Marcella and Fabiola types 
of nursing leaders of this period. Growth of monastic institu- 
tions and tendency toward seclusion from the world and the 
contemplative life rather than the active ife of service. 
Emphasis on ascetic practices' penance, self-mortification and 
self-abnegation. Monasteries as centres of relief and hospi- 
tality. Nursing and medical work of monks and nuns. Influ- 
ence of prevalent superstititions, and belief in magic and 
miracle on the care of the sick. Radegunde and Hildegard, 
types of monastic women. 
IV. Aristocratic and Military Influences. The Romantic or Knightly 

Ideal 

Rise of the institution of chivalry with new ideal of the 
Christian knight, defender of the weak and helpless and re- 
dressor of human wrongs. Life of struggle, adventure and 
romance opposed to the repressed, sheltered, contemplative 
life of the cloister. Virtues of the warrior-knight, robust, 
active and positive courage, hardihood, honor, courtesy, 
loyalty, leadership, etc. Combination of chivalric and monas- 
tic ideals in military nursing orders developed during the cru- 
sades. Hospital expansion under the knightly orders. Intro- 
duction of aristocratic and military features in hospital organi- 
zation and management. Knights of St. John as types of 
Hospitallers. Influence of knightly and military ideals on 
later hospital nursing. Red Cross and army work. 



HISTORY OF NURSING 125 

V. Democratic and Secular Tendencies in Mediaeval Nursing 

Rise of the mendicant order under Saint Francis of Assisi 
as a reaction against extreme forms of monasticism and aris- 
tocratic tendencies of military orders. Friars a democratic 
organization bringing spirit of brotherhood and ideals of prac- 
tical religion into every day life. Nursing one of many forms 
of active social service undertaken by mendicants, illustrated 
by St. Francis' work among the lepers. Founding of secular 
and semi-secular orders for nursing and relief opened avenues 
of service to people in common walks of life and led to higher 
ideals of citizenship. Extreme restrictions and ascetic dis- 
cipline of monastic orders no longer considered essential to 
nursing and charitable work. The Tertiaries of St. Francis, 
and the Beguines, types of voluntary secular orders organized 
on a religious basis. St. Catherine of Siena and St. Elizabeth 
of Hungary types of non-monastic nursing saints and popular 
heroines of mediaeval times. Cities and communities begin- 
ning to undertake some responsibility for 'relief and care of sick 
and unfortunate and prevention of poverty and distress. Re- 
vival of interest in medicine after a long period of indifference 
and neglect, and study of medicine in the early universities. 

VI. The Dark Period in Nursing 

Decline in many of the religious orders and general dete- 
rioration in hospital and nursing work. Suppression of many 
orders. Hospitals gradually taken over by civil authorities. 
Servant nurses generally employed for the care of the sick both 
in religious and civil hospitals. "Sairey Gamp"- type of the 
ignorant, secular, servant nurse or "monthly nurse." Low 
ideals of honesty, personal morality, dignity and humanity. 
Standards of hospital service very low. Amateur "Lady 
Bountiful" type of nursing and charitable work in parish and 
country districts. Work of missionary nurses in Canada com- 
pared with servant nurses and religious orders at home. 
Countries where nursing is at present largely in the hands of 
servant nurses and amateurs. 

VII. Humanitarian Movements of the Early Modern Period 

Beginnings of organized charity in France (17th C) under 
leadership of Vincent de Paul. Sisters of Charity new type 
of nursing and relief organization. Reforms in care of pris- 
oners, insane and sick in hospitals, stimulated by work of 
John Howard, Elizabeth Fry, William Tuke, Dr. Pinel and 
other humanitarian leaders. Revival of deaconess work by 
the Fliedners of Kaiserworth. Humanitarian and religious 
ideals combined in these newer nursing organizations, with 
beginnings of definite standards of nursing work and training. 
Gradual advance in medicine as a result of discoveries of Har- 
vey and other scientists. Revival of surgery through barber 
surgeons, Pare" and others. 



126 OUTLINES OF SUBJECTS 

VIII. Modern Nursing Established by Florence Nightingale 

Story of Florence Nightingale's life and work. Her new 
conception of nursing as an economically independent secular 
vocation or art demanding intelligence, knowledge and skill, 
as well as devotion and moral purpose. The necessity of long 
and careful training emphasized and the first schools of nurs- 
ing established. Ideals of nursing as shown by Florence 
Nightingale's example and teachings. Influence of the growing 
freedom and independence of women on nursing work. 

IX. Recent Developments in Nursing 

Scientific advances of the 19th C in medicine, surgery, sani- 
tation, anesthetics, etc., due to the work of Pasteur, Lister, 
Morton and others. Social and philanthropic movements a< 
seen in the work of Dorothea Dix, Octavia Hill, etc. Founding 
of the Red Cross. Work of Dunant, Clara Barton and others. 
Educational advancements, especially in the education of 
women. The influence of all these movements on nursing. 
Founding of first nursing schools in America. Pioneer leaders 
in nursing education. Founding of nursing organizations. 
Modern expansion of the field of nursing. 
X. Modern Professional Ideals and Standards 

Evidences of religious, ascetic, military, democratic and 
humanitarian ideals in nursing of the present day. Status of 
nursing in principal countries of the world. What it means to 
be a member of a profession. Application of nursing ideals and 
spirit to practical problems of hospital life. Origin and mean- 
ing of hospital etiquette, hospital discipline, the uniform, etc. 
Responsibility of nurses in maintaining the great traditions of 
nursing. 
Periods XI to XV. Social Aspects of Nursing and Hospital Work 

XI. Relation of Nursing and Hospital Work to Community and 

Family Welfare 

Brief survey of nursing history to show the identification of 
nursing with all forms of social and philanthropic work in the 
past. Nursing still essentially a form of social work. The 
hospital also essentially a social institution bound up inti- 
mately with family and community welfare. Meaning of com- 
munity or social welfare. Recent changes in the conception of 
all charitable and philanthropic work. New emphasis on pre- 
ventive and constructive measures. Definition of "society" 
"social." Elements for which adequate provision must be 
made in a normal or healthy community health, education, 
employment, recreation, moral and spiritual life. Importance 
of the family in community life. Biological and social func- 
tions of the family. Training for citizenship and life in larger 
social groups. Deficiencies in institutional typo of upbringing. 
General effects of family disorganization and disintegration. 
Efforts to conserve the family and promote its influence and 
wolf are. 



HISTORY OF NURSING 127 

XII. Some Social Problems as Seen in the Hospital 

Types of patients seen in the wards and dispensary who rep- 
resent social problems of various kinds drug habitues, pros- 
titutes, unmarried mothers, tramps and rounders, dependents, 
alcoholics, patients with venereal diseases, patients with other 
communicable diseases, foreigners, victims of industrial dis- 
eases and accidents, etc. Social causes operating to bring 
these people to the hospital ignorance, poverty, lack of sani- 
tation and sanitary control on part of community, bad in- 
dustrial conditions, etc. In case of foreigners all of above 
combined with exploitation and lack of adaptation to American 
conditions. What the social service department tries to do for 
these people. 

XIII. How Adverse Social and Economic Conditions Operate in Child- 

hood 

In infancy bad heredity due to alcoholism, mental defect, 
degeneracy of parents, etc., insufficient care of mother before 
and after childbirth and of child at birth and during early 
period, inability of mother to nurse child, impure milk, bad 
sanitary surroundings, mother's ignorance, etc. In childhood 
lack of care, due to ignorance, poverty, resulting in malnu- 
trition and bad environment, bad housing, etc. Effects of 
communicable diseases of childhood, physical defects, child 
labor, bad sanitary conditions at school and lack of medical 
inspection and nursing. (Specific examples of these condi- 
. tions.) 

XIV. How Adverse Social and Economic Conditions Operate in Adult 

Life 

Effects of poverty and insufficient wages, communicable dis- 
eases (especially tuberculosis), bad housing, overcrowding, 
unemployment, bad working conditions resulting in industrial 
diseases and accidents, insufficient opportunity for recreation, 
etc. Special difficulties in the case of immigrant families. 
Problems of mental defectives. 
XV. Local Social and Economic Conditions 

Make a broad general survey of the community or section 
of the city in which the hospital is located, noting its history, 
population (number, characteristics, nationalities, etc.), 
health activities (state and local milk supply, institutions 
for the sick, preventive work, housing); industries (kinds, 
legal regulations, dangerous occupations, etc.), opportunities 
for recreation; social institutions (churches, schools, settle- 
ments, clubs, etc.). Show how the character of the community 
and its problems affect the work done in the hospital and how 
the hospital affects the community. Show how pupil nurses 
can assist in making the hospital work most effective socially 
as well as medically. 



128 OUTLINES OF SUBJECTS 

METHOD OF TEACHING 

1. In such a short course it is impossible and unnecessary to- 
take up many detailed historical facts. If the pupils get a 
good general picture of the progress of nursing and the inter- 
esting personalities and events which have helped to mould 
it, if they catch the spirit of the great leaders, and their inter- 
est is aroused in the literature of nursing, the greatest result 
will have been achieved. The class and discussion method is 
to be preferred to the lecture for most of this course. 

2. It is essential that some view of the general historical 
background should be given before taking up the nursing his- 
tory. A rough tabulated chart of the chief historical epochs 
and events of European history according to centuries will 
help to place the general scheme before the pupil's mind and 
will enable her to correlate her nursing and general history 
better. 

3. Every means should be taken to make the events and the 
personalities vivid and concrete. Pictures are invaluable 
and fortunately there are many excellent ones available. A 
collection of historical books adds greatly to the interest. 

4. In the social topics the first effort should be to arouse in- 
terest in people rather than in abstract principles and prob- 
lems. Specific cases should be studied as types' preferably 
patients the pupils have met in the wards or out-patients de- 
partment. Only the essential elements in each case should be 
pointed out and anything like a mere curious or sentimental 
interest should be discouraged. Hopelessly tragic cases 
should not be selected, and the opportunities and methods of 
helpful constructive work along very simple lines should be 
suggested. There should be no attempt to teach methods of 
social work at this stage but pupils can be assigned to help in 
running messages, amusing children, dressing and undressing 
them, etc., so getting an insight into the problems of the dis- 
pensary. 

5. In addition to selected readings and class reports, the 
pupils should visit some of the social institutions and agen- 
cies in the community, and each individual should accompany 
the social service worker or visiting nurse in her home visits 
for a few afternoons to get a good picture of home conditions. 

ILLUSTRATIVE MATERIAL 

Photographs of pictures illustrating care of the sick in an- 
cient and modern times, nursing saints, medical and nursing 
leaders, historic institutions, etc. Pictures, exhibits and 
charts illustrating social conditions and the work of social 
agencies. Bulletins and pamphlets published by various social 
organizations. 



HISTORY OP NURSING 129 

TEXT AND REFERENCE BOOKS 

I. History of Nursing 

History of Nursing: Nutting and Dock, 4 vols. 

Cooke : Life of Florence Nightingale, 2 vols. 

Tooley: History of Nursing in the British Empire. 

Robinson and Breasted: Outlines of European History. 

Berdoe: Origin and Growth of the Healing Art. 

Withington: Medical History from the Earliest Times. 

Tuker and Malleson: Handbook to Christian and Ecclesiasti- 
cal Rome. 

Putnam: The Lady. 

Mozans: Women in Science. 

Loch: Charity and Social Life. 

Saleeby: Surgery and Society. 

Richards: Reminiscences of Linda Richards. 

Tiffany : Life of Dorothea Dix. 

Dickens: Martin Chuzzlewitt. 

Epler: Life of Clara Barton. 

Boardman: Under the Red Cross Flag. 

Articles in Encyclopedia Britannica under Medicine, Monas- 
ticism, Chivalry, Church History, Mendicant Orders, St. 
Francis, etc. 

Paget: Confessio Medici. 

Richer: L'Art et la Medicene. 

Lacroix: Military and Religious Life of the Middle Ages. 

Mullerheim : Die wochenstube in der Kunst. 

(The last three especially interesting for their illustrations.) 
(See also under Nursing Ethics, Professional Problems, etc.) 

II. Social Aspects of Nursing 

Wald: The House on Henry Street. 

Hunter: Poverty (especially chapters I and IV). 

Devine: Misery and Its Causes (especially chapters I and II). 

Devine: The Normal Life. 

Reports of the Federal Children's Bureau (especially Infant 

Mortality Series, no. 3, Johnstown Report). 
Kelley: Modern Industry (especially chapters I and II). 
Elwood: Sociology and Modern Social Problems Chap. IV- 

VIII inclusive. 

Addams: Twenty Years in Hull House. 
Addams: The Spirit of Youth and the City Streets. 
Addams: Democracy and Social Ethics. 
Commons : Races and Immigrant in America. 
Steiner: On the Trail of the Immigrant. 
Osier: An Alabama Student and Other Essays. 
Ross: Social Psychology. 
Lee: Social work with Families and Individuals, published by 

the New York School of Philanthropy and other pamphlets. 
Byington: What Social Workers should know about their own 



130 OUTLINES OF SUBJECTS 

Communities (Pamphlet published by Russell Sage Foun- 
dation, New York). 
The Survey: (Journal of Social Work). 

Elements of Psychology 

TIME: 10 hours. Lectures and class discussions. Taught by a psy- 
chologist or a qualified nurse or social worker. Given in the 
latter part of the first year. 

OBJECTS OF COURSE 

1. To attempt to state the fundamental principles underly- 
ing human conduct. 

2. To give the student practice in considering people's ac- 
tions with impersonal understanding and sympathy. 

3. To develop certain principles for dealing wisely with pa- 
tients and others in professional relations. 

4. To help the student toward self-mastery and good sense 
in the relationships of private life. 

5. To provide a basis for subsequent courses in psychiatry 
or ethics. 

OUTLINE OF CLASSES 

I. Psychology the Science of Behavior 

Behavior considered as responses to "stimuli." People con- 
sidered as organisms adjusting to changing environment, nat- 
ural and social, by acting upon the environment. Behavior 
such adjustment. 
II. Adjustment made by the Nervous System 

Its structure brain, cord, fibres, sympathetic system; 
neurones. Functions. Nervous pathways Readiness. 

III. Pathways Due to Original Nature 

Reflexes. Instincts, their nature. Typical instincts. Read- 
iness and the original satisfiers. Modifying instincts. 

IV. Individual Differences in Behavior 

Central tendencies the "curve of distribution." Causes of 
differences. Heredity race and family, variations. Age, sex, 
and past experience. 
V. Effect of Past Experience on Behavior 

Learning. Habits. The "laws of learning." Practice. 
Specific nature of habits. 
VI. Variety of Responses to Same Stimulus 

Influence of accompanying circumstances. "Mind set," 
mood, temperament. Influence of weather, health, fatigue, 
drugs, emotional state, purpose, etc., on responses. 
VII. Thinking 

Physiological basis. Attention and interest. Memorizing. 
Association and analysis. Studying, "appcrceptive mass." 
Reasoning. 



PRINCIPLES OF ETHICS 131 

VIII. Feeling 

Pleasantness. "Satisfiers and annoyers." Associative 
shifts of satisfaction. Emotions, their dependence on organic 
action. Control and use of feeling. 
IX. Doing 

Will and habit. Selection and attention in willing. Individ- 
ual differences in will. Morality, social basis, psychological 
elements. "Character." 
X. Suggestion 

. Presenting the stimulus that calls forth the desired act. Tact. 
Use of principles already discussed. Understanding people. 
Self-mastery. 

METHODS OF TEACHING 

Class discussion based on simple text-book if possible. Lec- 
ture on points for which text-book is not available. Reference 
reading. Written and oral reports of actual experiences, and 
questions from pupils relating to individual problems. 

EQUIPMENT AND ILLUSTRATIVE MATERIAL 

Anatomical charts and models of brain and nervous system. 

REFERENCE BOOKS 

Thorndike: Elements of Psychology. 

Thorndike: Educational Psychology. (Briefer course, 1914.) 

Thorndike : Individuality. 

Colvin and Bagley: Human Behavior. 

James: Psychology. (Briefer course.) 

James: Talks to Teachers on Psychology. 

Pillsbury: Essentials of Psychology. 

Miller: Psychology of Thinking. 

Ribot: Diseases of the Personality. 

Ribot: Diseases of the Will. 

Kirkpatrick: Fundamentals of Child Study. 

Tyler: Growth and Education. 

Principles of Ethics 

TIME: 10 hours. Classes and conferences conducted by the superinten- 
dent of nurses or a special lecturer. Given in the second 
year. 

OBJECTS OF THE COURSE 

1. To follow up the work of the first year in the historical 
and social aspects of nursing by a fuller discussion of the prin- 
ciples of behavior, their origin, meaning and practical bear- 
ings on the common experiences and problems of life. 

2. To try to lead the pupil to formulate more clearly and defi- 
nitely her philosophy of life, to stimulate her in the formation 
of the right kind of personal habits, to help her in building up 



132 OUTLINES OF SUBJECTS 

a strong and an attractive personality, and to give her a vision 
of what a full, happy, useful, and well-ordered life may be. 

3. The effort is made here to build up broad general principles 
which apply equally well to all phases of life and all types of 
people, rather than to emphasize a special code which is re- 
stricted to one group and one type of occupation. 

OUTLINE OF CLASSES 

I. Introduction Customary Morality 

Meaning and derivation of ethics, morals, customs. Dis- 
tinguish from etiquette, manners, religion. Kind of pjoblems 
considered in a study of ethics (give concrete examples) <YT3asis 
of all behavior found in the original nature of man with its 
equipment of instincts ( and tendencies,' These neither good 
nor bad in themselves, but become good or bad according to 
their effect on other human beings. Repetition and resulting 
satisfaction the conditions of development. Four levels of 
stages of conduct: (1) Instincts, controlled and influenced 
only by physical pains and pleasures; (2) modified by rewards 
and punishments; (3) controlled by the thought of praise or 
blame; (4) Conduct regulated by a personal ideal which enables 
one to do right even when it entails personal suffering and the 
condemnation of society. First stage non-moral, represented 
by infants and mental defectives. Most people in second and 
third st&ges' where custom and tradition are principal guides 
to conduct (group or customary morality). Customs and laws 
gradually built up by the social group for its own welfare and 
protection, and habits enforced through ritual and ceremony, 
force of public opinion or physical force. Weakness and lim- 
itations in this kind of morality. 

II. Personal or Reflective Morality 

Personal as opposed to group or customary morality involves 
free choice and independent moral judgment, instead of un- 
reasoning acceptance of custom and slavish imitation of others. 
Social habits and customs still determine conduct to a large 
extent but the individual is responsible and accountable for his 
own actions. His conduct becomes purposeful, voluntary, and 
spontaneous, as opposed to impulsive or forced conduct. Laws 
which he first obeyed mechanically, he learns to obey ration- 
ally. In this stage of conduct, morals are differentiated from 
manners, conscience substituted for custom, and principles 
for rules of conduct. ' Personal or reflective morality has three 
aspects: (1) right feeling or a delicate sensitiveness to ethical 
ideals and an ardent desire to realize them; (2) right thinking 
or sound moral judgment; (3) right doing or the vigorous carry- 
ing out of one's purposes and ideals. This is conscientiousness 
or obedience to the inward law "where the person himself 
sets up the ideal standard, judges his conduct by it, holds him- 



PRINCIPLES OF ETHICS 133 

self responsible to himself and seeks to do justice." Con- 
science is not infallible needs constant enlightenment and 
training, must be kept sensitive and responsive, and must be 
obeyed as the highest moral law which the individual knows. 

III. Ethical Ideals and Standards 

Ethical ideals are the product of all the preceding ages and 
of all one's experiences in life. The body of accepted moral 
and ethical principles have very slowly accumulated and are 
constantly undergoing changes and modifications. Each age 
works out a different conception of moral worth or goodness. 
Great moral leaders are those who break through traditions and 
customs, and establish new ideals of conduct. They are the 
prophets, saints, martyrs, and reformers. Moral ideals are 
embodied in art, literature, religion, law, etc. Earliest ethical 
principles of high value found in Hebrew and Greek literatures. 
The Roman law and the Christian Church, the main sources 
of later ethical standards and the great conservative forces in 
preserving old standards. Examples of early ethical teachings 
seen in the ten commandments, the golden rule, proverbs, 
fables, etc. Ethical influence of great characters in history, 
biography, fiction, and contemporary life. 

IV. Moral Judgment 

The second essential to reflective morality, is sound moral 
judgment or wisdom, "the parent or nurse of all the virtues." 
Element of choice and moral valuation implies capacity for 
reflection, discrimination and sound thinking as well as an 
adequate body of knowledge to guide one's decision. Imagi- 
nation needed to forecast possible results of any given choice 
and to see the wider and more remote as well as the immedi- 
ate results. Sympathetic insight into others' lives and a wide 
acquaintance with human nature necessary to insure just judg- 
ments. Wisdom needed in deciding means to be used as well 
as ends to be realized. Wisdom means insight, sagacity, san- 
ity, and common sense; not to be confused with mere knowl- 
edge. Moral judgment not essentially different from judgments 
required in business or professional matters. Ability to judge 
wisely in some degree inherited, but may be developed by exer- 
cise and self-criticism. Impulsive, capricious, or "snap" judg- 
ments likely to be superficial and unreliable. Prejudice and 
strong emotion warp judgment. Dogmatism and intolerance 
usually based on narrow range of facts, and shallow thinking. 
Until facts can be obtained, judgment should be suspended. 
V. Conduct and Character 

The third essential will power or moral energy to control 
vagrant or selfish impulses and carry out one's purpose and 
ideals. High ideals and thoughtful decisions are ineffective 
unless put into practice. Those who profess fine ideas and emo- 
tions without doing anything to carry them out are called sen- 



134 OUTLINES OF SUBJECTS 

timentalists or hypocrites. Motive power comes from the 
emotions and sentiments which are the springs of action as well 
as the key to character. What a person is, is shown by what 
he desires most, what annoys, pains, or grieves him, in what he 
finds satisfaction. Disposition and temperament are largely 
inherited, but character is made. It is the result of all one's 
choices and actions, of all one's physical, mental or moral 
habits. Important to make allies instead of enemies of one's 
habits. Rules for habit-formation (see James). Action must 
be vigorous and forceful as well as rightly directed must be 
applied consistently in all the affairs of every-day life. 
VI. The Place of "the Self" in the Moral Life 

Virtues are habits of will or modes of conduct which tend to 
promote the welfare of both individual and collective life. 
Vices are abnormal developments of the will that tend to en- 
slave and destroy life. The normal impulse of individuals is to 
satisfy the desires and claims of self. The higher welfare of 
self includes the welfare of the larger group. Involves struggle 
between egoism and altruism, between narrow selfishness and 
benevolence. Self-control the mainspring of character mas- 
tery of the lower by the higher impulses. Suppression and 
eradication of natural impulses and emotions and extreme 
self-renunciation as advocated by ascetics tend to cripple and 
narrow life. Self-expression and self-development to be em- 
phasized, as well as self-denial and self-sacrifice. Courage or 
persistent natural vigor needed to resist lower desires and 
give moral power to meet pain, danger, and public disapproval, 
when necessary. Strong character implies virility, vigor, and 
strong moral fibre, not negative, spineless "goodyness." Mod- 
esty (freedom from false pride and excessive desires), chastity, 
self-possession, perseverance, fortitude, patience, constancy 
all aspects of self-control and courage. A high conception of 
individual honor, self-respect, and wholesome ambition, essen- 
tial to complete development of the self. Vanity, servility, ag- 
gressiveness, etc. are perversions of the impulse to further 
self's welfare and development. 
VII. The Social Virtues 

The parental or "motherly" instinct the main root of the 
social virtues. Tenderness, compassion, sympathy, pity, be- 
nevolence, and helpfulness, generally expressed in various 
forms of charity and philanthropy, such as caring for children, 
the sick, helpless, and dependent. Unless safeguarded by 
knowledge and good judgment, benevolence may be injurious 
to oneself and others. Good will, or love of one's neighbor, is 
incompatible with envy, malice, and all the subtle as well as 
active forms of cruelty and selfishness. Patriotism or love of 
one's country another form of benevolence. Justice a funda- 
mental social virtue, representing the idea of equity, rectitude, 



PRINCIPLES OF ETHICS 135 

fairness, impartiality, honesty as opposed to exploitation, op- 
pression or injustice of all kinds. Veracity implies frankness, 
fidelity, and sincerity in all human relationships as opposedto 
lying, flattery, slander, and misrepresentation. Social virtues 
of cooperation, good-will, fair play, give and take, enter into 
every phase of human life and work. 
VIII. Ethical Principles as Applied to Community Life 

The growth of democracy in modern life. Result of growing 
belief in the worth and possibilities of the individual and his 
right to self-expression and development. Danger of over- 
emphasis on individual rights and neglect of obligations. New 
emphasis on social ends or group welfare, not incompatible 
with individual development. Social efficiency the modern 
ideal highest self-realization and self-expression through 
service for the common good Wide variation in types of serv- 
ice and ability needed for community service. Public-spirited- 
ness and patriotism expressed in the faithful doing of incon- 
spicuous and common tasks as well as heroic deeds. Impor- 
tance of training and efficiency as well as good-will. Recent 
changes in the status of women and new possibilities of public 
service opened up. Local questions of family and community 
welfare discussed from the ethical point of view with practical 
suggestions for useful service. 
IX. Principles of Ethics as Applied to One's Work or Profession 

The relation of various forms of occupation to community 
welfare. Ideals and traditions of service developed by such 
professions as the church, the army, medicine, etc. The 
spirit of the craftsman or artist in relation to his art. Putting 
one's soul into one's work. The value of work as .a means of 
happiness, personal satisfaction, and development. "/Growth in 
independence, integrity, industry, and self-respect through 
work. The "business-like" qualities and virtues system, 
thoroughness, promptness, alertness, economy, reliability, and 
persistence. Qualities demanded in working with others 
loyalty and intelligent cooperation with those in charge, trust- 
worthiness, ability to do good team-work, spirit of courtesy 
and helpfulness, a sense of humor, discretion. Qualities neces- 
sary in leading and guiding others' good judgment, justice, 
dignity, generosity, initiative, enthusiasm, self-reliance, and 
the ability to take responsibility. Dangers of narrowness and 
stagnation in relation to one's occupation; of materialism, cyni- 
cism, and mechanical routine. Effects of over-fatigue, and 
over-work as well as idleness in breaking down moral resistance, 
decreasing moral sensitiveness, and sapping energy and spirit. 
X. Principles of Ethics as Applied to One's Personal Life 

The importance of having definite purposes to work towards, 
laws to obey, ideals to follow. Self-direction and self-mastery 
achieved thrpugh concentration and practice. The place of 



136 OUTLINES OF SUBJECTS 

religion in the building of character, and the development of 
one's spiritual life. Essentials of an attractive, wholesome, 
and strong personality. Its influence on others. Possibili- 
ties of strengthening weak moral fibre and cultivating hidden 
resources of personality and ability in others. The ability to 
meet moral crises in one's own life and the lives of others. 
Provision for growth. What we mean by self-government. 
Application of foregoing principles to special problems, es- 
pecially those involved in recreation, amusements, and social 
life, dress and the expenditure of money, relations between 
men and women, friendships, etc. 

METHODS OF TEACHING 

l.'The practice of ethics is a matter of attitude, spirit, and 
1-Will more than knowledge. Teaching will never be effective in 
changing behavior unless it is backed up by the example and 
personality of the teacher and by the atmosphere and influ- 
ences which surround the pupil every day. Every subject 
taught in the training school should be a medium for teaching 
ethics, and every problem which the pupil meets in her daily 
work should be an opportunity for practice in ethics. The 
social life of the pupil nurse is a particularly strong influence 
in shaping her ideals and developing her powers. Emphasis 
should be laid on the formation of habits of positive service 
and helpfulness rather than merely the correction of faults 
and the observation of rules and regulations; on the strength- 
ening of character through complete development rather than 
the repression and elimination of the more undesirabletraits. 
If the principles of student government are in force in the 
Nurses' Home, it will give a much better opportunity for exer- 
cising the qualities of self-direction and self-control in regard 
to the pupils' personal life. 

2. In teaching ethics, concrete examples should be given to 
illustrate every point, or to lead up to the discussion. These ex- 
amples will be found in history and standard literature, poetry, 
current fiction, newspaper items or personal experiences. 
It is better not to draw too many examples from hospital life 
but to give as broad a point of view as possible. Pupils should 
be asked to bring in examples and to contribute to the discus- 
sions in every possible way. The course should be tied up 
with the earlier course in the historical and social aspects of 
nursing and to psychology if this is given. It might follow the 
course in psychology or be combined with it if there is not time 
for both. 

3. If possible personal conferences might supplement such a 
course. The teacher could thus get into closer touch with the 
pupils and could help them better in working out their indi- 
vidual problems. 



SURVEY OF THE NURSING FIELD 137 

TEXT AND REFERENCE BOOKS 

Robb: Ethics of Nursing. 

Parsons: Nursing Problems and Obligations. 

Nightingale : Notes on Nursing. 

Nightingale: Talks to Pupil Nurses. 

Osier: Aequanimitas. 

Dewey and Tufts: Ethics. 

Mackenzie: Manual of Ethics. 

McDougall: Social Psychology. 

James: Talks to Teachers. 

McCunn: Making of Character. 

Emerson: Essays. 

Cabot, (E. L.) Every-Day Ethics. 

Cabot, (Richard) What Men Live By. 

See also under Historical, Ethical and Social Aspects of 
Nursing, Psychology and Problems of Professional Life. 

Survey of the Nursing Field 

TIME: 10 hours,' lectures, classes and conferences conducted by the 
superintendent of nurses and special lecturers representing 
different fields. Given in the early part of the third year. 

OBJECTS OP COURSE 

1. To introduce the pupil nurse to all the varied branches of 
nursing work, so that she may be more able to choose the 
field in which she is likely to find the greatest interest and 
success. 

2. To show pupils what is being done in all these important 
fields, what the main problems are and what their responsi- 
bilities are in connection with them. 

OUTLINE OF CLASSES 
I. Introduction 

Brief survey of the historical development of nursing work 
showing the division into three main branches of hospital, 
visiting and private nursing. Later subdivision of each of 
these main branches into many distinct fields. Reasons why 
nurses should choose future work with care. Points to be 
considered in choice of vocation. Need of further training for 
special branches or positions of leadership. Kinds of train- 
ing available. Points to be considered in regard to post-gradu- 
ate training. 
II. Hospital or Institutional Nursing 

History of the origin and development of hospital nursing 
reviewed. Nature and general conditions of work, salaries, 
qualifications and preparation for executive positions, such as 
hospital superintendent, assistant superintendent, dietitian, 



138 OUTLINES OF SUBJECTS 

housekeeper, matron of nurses home, etc. Technical special- 
ties such as operating-room work, administration of anes- 
thetics, massage, hydrotherapy, electro-therapy, laboratory 
work, etc. Duties, opportunities, qualifications and training 
demanded. 

III. Educational Work in Hospitals 

The origin and development of training schools and the 
work of the training-school as distinguished from that of the 
hospital. The position and duties of the superintendent of 
nurses, assistant superintendents, instructors and head nurses. 
Qualities and training demanded. The scope of educational 
work in nursing schools. Number of training schools in U. S. 
(approximately 1570). Growing importance of this field. 

IV. Visiting Nursing (General) 

The origin of visiting nursing under deaconesses and older 
religious orders reviewed. Later secular orders, and rise of 
modern visiting nursing. Outline of modern expansion at 
home and abroad. Leaders in this field. Outstanding features 
of visiting nursing in urban and rural districts. Work of town 
and country nursing service. Visiting nursing in connection 
with insurance companies, etc. Duties of visiting nurse 
qualifications and training demanded. 
V. Infant Welfare Work and School Nursing 

Origin of modern movements for conservation of children. 
Nurse's part in this movement at home and abroad. Baby- 
welfare work in hospitals, dispensaries, milk stations and 
homes. Pre-natal work. Origin of school nursing and rapid 
expansion of this field. The position and duties of such nurses 
including resident nurse in school or college dormitory. The 
qualifications and training demanded. 
VI. Tuberculosis and Industrial Nursing 

Place of the nurse in the tuberculosis movement. Kinds of 
positions open to nurses both in institutional and visiting 
work. The special needs of this field. The new industrial 
welfare work for nurses its nature and possibilities. Duties, 
salaries, requirements and training of nurses for these branches. 
VII. Mental Hygiene and Medical Social Service 

History of the care of the insane reviewed. The place of the 
nurse in mental hygiene and mental nursing. Kinds of posi- 
tions open in both institutional and visiting work. The un- 
usual demands and opportunities in this field. The origin and 
development of medical social service. The nature of the work 
and the demands, requirements and special preparation of 
nurses for these fields. 
VIII. Red Cross, Army and Navy Nursing 

History of the Red Cross and army nursing. Organization 
of nursing service for war and other disasters in America and 
in other representative countries. Service in army and navy 



SURVEY OP THE NURSING FIELD 139 

hospitals. Nature and possibilities of such work. Require- 
ments and special preparation of nurses for these fields. 
IX. Private, Hourly and Office Nursing 

Origin and development of these branches. The scope of 
the field. Duties and economic status of private nurse. Pros- 
pects for advancement. Newer specialties in private nursing. 
Qualifications required and preparation for each of these 
fields. 
X. Miscellaneous Branches 

Nursing in home and foreign mission fields, inspection of 
Training Schools, work of hospital consultant, work of secre- 
tary or organizer of philanthropic or public health organiza- 
tions, almshouse and prison nursing, sanitary inspection, 
teaching of invalid occupations, etc. Nature and general 
conditions of work in all these fields. Salaries, qualifications 
and preparation demanded. 

METHODS OF TEACHING 

1. Class or lecture method, especially interesting if special- 
ists in the representative branches could come in and tell of 
their work. 

2. If at all possible, students should have an opportunity of 
observing something of the principal branches of work out- 
side of the hospital and should have enough experience in each 
of the three main branches to enable them to test out their 
aptitudes and determine which field they want to enter. 

EQUIPMENT AND ILLUSTRATIVE MATERIAL 

Books, pamphlets, journals and pictures, lantern slides. 
TEXT AND REFERENCE BOOKS 

Nutting and Dock: History of Nursing, vols. I-IV. 

Robb: Nursing Ethics. 

Robb: Educational Standards 

Wald: The House on Henry Street. 

Opportunities in the Field of Nursing: (Pamphlet.) 

Perkins: Vocations for the Trained Woman. 

Kingsbury: Vocations for Trained Women. 

Morley: Women Workers in Seven Professions. 

Gulick and Ayres: Medical Inspection in Schools. 

Boardman: Under the Red Cross Flag. 

La Motte: Tuberculosis Nursing. 

Crowell: Tuberculosis Dispensary Method and Procedure. 

Waters: Visiting Nursing in the United States. 

Cannon: Social Work in Hospitals. 

De Witt: Private Duty Nursing. 

Gardner: Public Health Nursing. 

Struthers: School Nursing. 

Parsons: Nursing Problems and Obligations. 



140 OUTLINES OF SUBJECTS 

Reports of League of Nursing Education. 
American Journal of Nursing: (Complete Files). 
Public Health Nurse Quarterly. 

See also under Private Nursing, Public Health Nursing, 
Institutional Work and Professional Problems. 

Professional Problems 

TIME: 10 hours. Classes and conferences conducted by the superinten- 
dent of nurses, and special lectures. Given in the later part 
of the senior year. 

OBJECTS OF COURSE 

1. To anticipate some of the problems which will confront 
the pupils when they graduate, and to help them to meet 
their difficulties in a rational high-minded and effective way. 

2. To awaken their interest in professional organizations, 
and to secure their enthusiastic cooperation in advancing the 
mutual interests of the public and their own profession. 

(Special problems of the private nurse, the public health 
nurse, and the institutional nurse are considered in courses 
on these subjects.) 

OUTLINE OF CLASSES 

I. The Social and Civic Status of Nurses 

Claims of nurses to professional status based largely on serv- 
ice rendered to the public and on controlling ethical, and edu- 
cational principles. Responsibility of individual nurse in 
maintaining professional and social status. Qualities and con- 
duct which make one acceptable in good society. The nurse 
as a citizen and public servant. What the community has a 
right to expect of her. Duties in times of crisis- war, epidem- 
ics, etc. Responsibility for community health and welfare 1 . 
Relationship to civic, philanthropic, religious, educational and 
public health agencies and activities. Relations to women's 
clubs and organizations which aim to advance the welfare of 
women. 
II. Professional Ethics and Etiquette 

Origin of the ethical code of medicine. Accepted forms of 
professional courtesy. Relation of the nurse to the physician 
in all the various branches of nursing work. Relations of indi- 
vidual nurses to one another, and to the profession as a whole. 
The necessity of loyalty, harmony and cooperation. Primary 
rights of the patient and patient's family in case of doubt. Pos- 
sible conflicts between the general good and professional soli- 
darity. Nurses' attitude to incompetents, irregulars, and 
quacks in both nursing and medical professions. Professional 
courtesies toward representatives of related professions and 
occupations. 



PROFESSIONAL PROBLEMS 141 

III and IV. Nursing Economics 

The economic status of the nurse as compared with other 
professional women. The professional as opposed to the com- 
mercial spirit. The economic independence of the modern pro- 
fessional nurse compared with the comparative dependence of 
the religious orders. Provision for sickness and retirement. 
Business principles, as applied to bills, banking, investments, 
insurance, etc. The nurse's budget. Proportion of yearly in- 
come spent in rent, board, clothing, etc. Principles of econ- 
omy. Loan and relief funds for nurses. The sliding scale of 
charges. Provision for maintenance of health and working ca- 
pacity. Regulation of conditions of work in all branches of 
nursing hours, vacations, living conditions, rest, sleep, food, 
etc. The social life of nurses. Provision for recreation and 
self-improvement. Nurses' clubs and hostels. Nurses' regis- 
tries. Professional vs. commercial bureaus. The central reg- 
istry how it should be maintained and managed. 
V. Legal Problems (given by a lawyer) 

Laws which affect the nurse in her relations with patients, 
physicians, hospitals and the general public. Legal situations, 
in which a nurse may be involved' accidents, sudden death, 
poisoning, suicide, homicide, insanity, etc. Court procedures 
especially those involving testimony by nurses. General 
advice to nurses in all cases where legal difficulties arise. 
VI. Nursing Education 

Educational status of nursing as compared with other pro- 
fessions. Economic difficulties in establishing a sound basis 
for nurses' education. Need of independent endowments for 
Training Schools, better applicants, higher standards of edu- 
cation, suppression of commercial and inferior schools. What 
constitutes a good school of nursing. Development of univer- 
sity affiliations. Work of Nursing and Health Department at 
Teachers College, Columbia University and other university 
courses, Nurse's responsibility for adding to her own efficiency 
and increasing the general fund of professional knowledge. 
VII. Nursing Legislation 

Registration of nurses through legislative enactments as a 
valuable means for controlling the practice of nursing and the 
education of nurses. History of the registration movement in 
America. Essentials of a good bill, and measures for its 
enactment. Present status of nursing legislation in different 
states. 
VIII. Nursing Organizations (general and alumnae) 

What organization has done for nurses. Essential elements 
in any organization. Types of nursing organizations. Aims 
and activities of the alumnae. Duties of nurses toward pro- 
fessional organizations. Elements of organization and parlia- 
mentary procedure for use in nursing organizations. 



142 OUTLINES OF SUBJECTS 

IX. National Nursing Organizations and Publications 

Development, main activities and general plan of the Ameri- 
can Nurses Association, League of Nursing Education and Na- 
tional Organization of Public Health Nursing. State and 
local branches. Publications and reports. The nursing press 
American Journal of Nursing, Public Health Nursing Quar- 
terly, and other publications. Dangers in commercialization 
of nursing publications. 
X. International Relationships 

Origin, aims, and activities of the International Council of 
Nurses. Brief survey of countries represented, noting general 
hospital and nursing situation, social, educational and eco- 
nomic status of nurses, leading women and publications. Atti- 
tude toward nurses of other countries. Means for the promo- 
tion of friendly and helpful relationships with other countries. 
Opportunities for assisting in the development of nursing in 
backward countries. 

METHODS OF TEACHING 

1. Use the discussion method as far as possible. Have 
pupils read short papers, prepare bibliographies, and bring 
problems to class for discussion. The case method can be 
used to advantage in many of these topics, basing the discussion 
on actual situations that have occurrred. 

2. Personal conferences with pupils are found to be very help- 
ful in this course. It is evident that more time is needed to 
deal with the subject in any adequate way. Many additional 
topics could be suggested for supplementary work such as a 
short course on public speaking and parliamentary law. It 
would be very helpful also to have the nurses organize a jour- 
nal club to run parallel with this and other -courses in the 
senior year. A few important journals might be selected and 
one assigned to each member of a class for review. Probably a 
better plan is to assign a topic to each pupil and have her 
search for important articles on that topic. Brief reports on 
these articles are given, and filing cards with name, author, 
reference and annotations are filed for the use of the club mem- 
bers. Students should be encouraged to use discrimination 
in the selection of articles and to give the gist of the contents 
only in the report. Time should be left for discussion. 

ILLUSTRATIVE MATERIAL 

Journals, books, photographs, charts, etc. 
REFERENCE BOOKS 

Nutting and Dock: History of Nursing, vols. I -IV. 

Nutting: Educational Status of Nursing (published by Bureau 
of Education, Washington). 

Robb: Nursing Ethics. 



MODERN SOCIAL CONDITIONS 143 

Robb: Educational Standards. 

Nightingale: Notes on Nursing. 

Osier: An Alabama Student and other Essays. 

Osier: Aequanimitas. 

Paget: Confessio Medici. 

Parsons: Nursing Problems and Obligations. 

Reports of National League of Nursing Education. 

Reports of International Council of Nurses. 

American Journal of Nursing. 

Public Health Nurse Quarterly. 

Nurse's Journal of the Pacific Coast. 

Canadian Nurse. 

British Journal of Nursing. 

Modern Hospital, etc. 

See also books on History of Nursing, Nursing Ethics, Mod- 
ern Social Problems, etc. 

Modern Social Conditions 

TIME : 10 hours, to be given by authorities on the various topics outlined, 
or by an expert in Social Economy or Social Science. Given 
in the latter part of the third year. 

OBJECTS OP THE COUESE 

1. To give the pupil a general understanding of the broad 
fundamental problems inherent in society today, showing the 
methods of approach and the agencies at work in attempting 
to solve these problems. 

2. To make the nurses sufficiently familiar with the present 
emphasis in methods of social work so that they will have some 
basis for further reading and study, also to serve as a back- 
ground for public health nursing and other forms of social work. 

3. To further emphasize the close relationship between 
health and social problems. 



I. Poverty and Philanthropy 

Brief historical sketch of the development of society, show- 
ing how as the organization of society became more complicated 
the emphasis shifted from the individual to the group. In 
philanthropy this meant organized scientific treatment of social 
problems, rather than the spasmodic efforts of benevolent in- 
dividuals. Present tendency toward governmental action 
federal children's bureau, state, country and local public health 
agencies, state employment agencies, social legislation, etc. 
Change in conception of poverty no longer considered dis- 
tinct from other problems, but rather the result of them and 
must be attacked through them. Treatment of poverty insep- 
arable from treatment of all the various social ills unnecessary 



144 OUTLINES OF SUBJECTS 

sickness, dependency, feeble-mindedness, insanity, physical 
or mental degeneracy, physical handicaps, insufficient wages, 
unemployment, etc. 
II. Delinquency and Crime 

Causes of delinquency 1 hereditary and environmental. De- 
fectives 1 diagnosis and treatment; psychological and mental 
clinics, tests; ungraded classes, segregation in institutions 
with special occupation training. Close relation between men- 
tal diseases and delinquency. Special problem of juvenile 
delinquency. Treatment- proper recreation, schools adapted 
to the needs of the individual, socializing court action, proba- 
tion officers, prison reform, making correctional institutions 
stand'for the highest development of the individual rather than 
the punishment of offense, the indeterminate sentence. 

III. Education and Recreation 

Modern conception of education and recreation. Schools to 
be the center and guide in all activities, mental, physical and 
social, assisting each child to develop his highest potentialities 
along these various lines. Vocational guidance through schools 
The industrial school. Recognition of the importance of play 
for normal development. Natural desire for play when mis- 
directed may lead to delinquency and immorality gangs, gam- 
bling, dance halls, etc. Boys and girls clubs 1 Boy Scouts, 
Girl Scouts, Junior Police, etc. 

IV. Social Hygiene 

The far reaching effects of the sex instinct. Individual and 
social ills that come through lack of understanding and mis- 
use. Mental and physical diseases, immorality, prostitution 
and illegitimacy. Desirability of frank intelligent conception 
of the significance and proper place of the sex instinct. Sex 
education how and by whom to be given. The problem of 
prostitution and agencies for its control and prevention. 
V. Alcohol and Drugs 

The problem of alcohol and drugs in relation to poverty, 
unemployment, crime, prostitution, insanity and other social 
and health problems. History of the movement for the con- 
trol of alcoholism. Scientific investigations into effects of 
alcohol and their results. Causes and effects of the drug habit. 
Methods of handling cases and preventing sale of drugs. 
VI. Modern Industry 

Brief survey of some modern industrial problems. Unem- 
ployment. Women and children in industry. Labor organi- 
zations both for employer and employee. Use of the strike. 
The protocol and boards of arbitration. Tendency toward 
governmental control of industry in the interest of common 
welfare. Labor legislation regulating hours, minimum wage, 
child labor, working men's compensation. 



MODERN SOCIAL CONDITIONS 145 

VII. Immigration and Race Problems 

Causes of emigration from other countries. Dominant race 
traits and social backgrounds. Problems of assimilation. 
Influences which stimulate and retard adjustment and develop- 
ment. Direct efforts toward safe-guarding the immigrant. 
Relation of the immigrant to industrial problems. 
VIII, IX and X. Agencies and Methods for Relief and Prevention 

General principles of case work family the unit. Social 
diagnosis and treatment with special factors to be considered. 
Relief agencies' use of relief as social treatment. Society 
for Organizing Charity, etc. Children's agencies Children's 
Aid Society, Society for the Prevention of Cruelty to Children, 
etc. Specialized agencies' for wayward girls, for mental cases, 
for court cases, etc. Value of social records and social sta- 
tistics their interpretation. Methods of education and 
publicity. Mass methods' settlements, social centers, play- 
grounds, etc. Value of schools, churches, theaters, the press, 
etc., as social agencies. Social legislation. Work of the Con-* 
sumer's League; Child Labor Committee, etc. Labor Legis- 
lation. Social Insurance. Old Age and Widow's Pensions. 

METHODS OF TEACHING 

1. Lectures and reference reading, followed by class discus- 
sion or conference, if possible, with the lecturer, or by the 
Head of the Social Service Department or someone actively 
engaged in social work. 

2. The lectures must necessarily be sketchy in character, 
giving but a bird's eye view of the subject and should be given 
in simple non-technical terms. 

3. Excursions should be made, if at all possible, to the in- 
stitutions and agencies dealing with these particular problems 
in the community. 

4. The assignment of reading is most important, as this should 
supplement the necessarily limited ground covered by the 
lectures. As the time usually available is very limited assign- 
ments should be brief and very carefully selected. 

TEXT AND REFERENCE BOOKS 

Ellis: Task of Social Hygiene. 

Devine: The Normal Life. 

Addams: Democracy and Social Ethics. 

Streightoff : Standards of Living. 

Hunter: Poverty. 

Devine: Misery and its Causes. 

Devine: Principles of Relief. 

Henderson: Dependents, Defectives and Delinquents. 

Healy: The Individual Delinquent. 

Loch: Charity and Social Life. 



146 OUTLINES OF SUBJECTS 

Publications of the New York State Committee on Mental 
Hygiene. 

Addams: The Spirit of Youth and the City Streets. 

Lee: Play in Education. 

Abbott: Women in Industry. 

Richmond, Mary: Social Diagnosis. Russell Sage Founda- 
tion. 

Schreiner: Woman and Labor. 

Publications of the American Association for Labor Legislation. 

Antin: The Promised Land. 

Steiner: Ebb and Flow of the Immigrant Tide. 

Zangwill: The Melting Pot. 

Devine: The Spirit of Social Work. 

Cabot: Social Service and the Art of Healing. 

Addams: Twenty Years at Hull House. 

Addams: A New Conscience and an Ancient Evil. 

Wald: The House on Henry Street. 

Seager: Social Insurance. 

Proceedings of the National Conferences of Charities and 
Corrections. 

The Survey. 

See also under History of Nursing, Survey of the Nursing Field, 

etc. 

NOTE' Lectures devoted to the social aspects of special classes of dis- 
ease, will be found under such subjects as Obstetrical Nurs- 
ing, Children's Diseases, Communicable Diseases, etc. If not 

covered in this way, such topics might be included under 

Modern Social Conditions. 



G. SPECIAL BRANCHES OF NURSING 

Introduction to Institutional Work (Elective) 

TIME: 10 hours. Classes and conferences conducted by the principal 
of the training school. Course to be given in latter part of 
third year. 

OBJECTS OF COURSE 

To give the student a better understanding of some of the 
problems and responsibilities of the supervisors and head 
nurses in charge of various hospital departments. The course 
is intended for students who have shown special ability along 
executive lines, and who intend to continue in hospital work. 

No attempt should be made to deal with the larger and more 
responsible duties which belong to hospital and training school 
administration. 

OUTLINE OF CLASSES 

I. Hospital Organization 

Different types municipal, state, private, semi-private. 
Study of general plan of organization in hospital. The ward 
as a hospital in miniature needs of ward as sample of needs 
of hospital as a whole. Relation of ward to other departments 
of hospital kitchen, laundry, linen and supply rooms, phar- 
macy, social service department, training school, admitting 
department, general office, etc. 
II. Ward Planning and Equipment 

The planning of wards and accessory rooms; size and arrange- 
ment for convenience in work ; finish and structural equipment. 
Standard hospital furnishings. Average allowance of linen, 
utensils, etc., per patient. Standardization of equipment 
for different types of work. Consideration of use, cost, special 
advantages, durability, sanitary features, etc. Economy in 
use of equipment and supplies. Care and renewal of supplies. 
Methods of exchange. Responsibility for medical and surgical 
supplies on wards. Methods of purchase contract, open 
market. 
III. Ward Personnel and its Organization 

Responsibility of head nurse for ethical atmosphere. Influ- 
ence of her personality in developing esprit de corps of the ward. 
The head nurse as a judge of character. Especial responsi- 
bility toward the new probationers. Relation of head nurse 
to visiting staff, house staff and nurses, students and employees. 
Arrangement of ward services, hours of work for nurses, off- 
duty time, etc. Reasons for the eight-hour day and various 
systems of carrying on ward work on this basis. The night 
nurse and her special problems. Special nurses hours of 

147 



148 OUTLINES OF SUBJECTS 

work, relief, etc. Relation of head nurse to maids and order- 
lies interest in their hours of work, living conditions, recrea- 
tion, etc. 

IV. The Head Nurse and the Patients 

Purpose of hospital care and comfort of patients. The 
rights and obligations of patients in a hospital. Reception of 
patients first impressions. Hospital noises' how to mini- 
mize. Respect for religious and racial differences and peculiar- 
ities. Opportunities for social service. Some principles of 
psychology used in the handling of patients. Occupations for 
ward patients. Relation of head nurse to patients' friends. 
Attitude and support of community influenced largely by per- 
sonal care and consideration of patients and attitude toward 
their friends and relatives. Care of patients' clothing and 
property. 
V. The Head Nurse as an Executive 

Some principles of good management collectiveness and 
cooperation. Capacity for leadership how developed. Dan- 
gers of arbitrary leadership. Staff and line functions. Rela- 
tion of head nurse to other hospital departments. Assignment 
of work. Value of schedules. Delegation of responsibility. 
Discipline its meaning and purpose. Test of ability for 
executive work. Opportunity for individual development. 

VI. The Head Nurse as a Teacher 

Teaching functions of the head nurse what they involve. 
Value of bedside teaching. Supervision and constructive crit- 
icism of work, done by nurses. Perfection of technique, 
standardization of work, motion study. Need of keeping in 
touch with theoretical teaching given to nurses. Cooperation 
with instructor of nurses. Head nurse as teacher of applied 
hygiene and sanitation to patients and public. Head nurse as 
teacher of ward maids and orderlies in methods of house work, 
care of cleaning utensils, cleaning process and agents, etc. 
VII. Ward Housekeeping 

Review of general principles of household economics. Estab- 
lishment of standards. Inventories. Stock-taking. Repairs 
and renewals. Disposal of garbage and waste. Prevention of 
pests. Supervision of maids and orderlies. Schedules of work 
daily and weekly cleaning. Care of diet kitchen, refrigera- 
tors, etc. Care of lavatories. Private rooms and their care. 
Surgical dressing rooms, service rooms, balconies, etc. 
VIII. The Patient's Food 

Food its preservation, preparation and service. Dietaries 
for ward and private patients need of personal supervision 
of head nurse. Special diets caloric feeding, etc. Feeding 
helpless patients. Prevention of waste. Diet sheets and 
their importance. Care of food trucks. Question of allowing 
food to be brought to patients by their friends. Problems in 



INTRODUCTION TO PRIVATE NURSING 149 

relation to racial and personal preferences in diet, religious 
observances, etc. 
IX. Records and Record Keeping 

Value of records and their functions to hospital adminis- 
tration to medical staff for protection of nurse. Card in- 
dex system. Hospital cost accounting. Ward inventory. 
Daily reports, charts, orders, etc. Necessity for scientific 
accuracy, judgment, neatness. Honesty in record-keeping as 
test of character. 
X. Special Problems in Ward Management 

Application of foregoing principles to work in various de- 
partments medical, surgical, obstetrical, children's operat- 
ing room, dispensary^ etc. Opportunities for continued edu- 
cation and training of the nurse in the hospital. Dangers of 
too narrow specialization, and the institutional point-of-view. 
Importance of outside interests and diversions, and a whole- 
some and normal social life. Opportunities for advancement 
open to head nurses and supervisors. Importance of constant 
study and self-improvement through reading, journal clubs, 
visiting other institutions, etc. 

NOTE: If not given as part of the regular nurses' training it 
is suggested that the above outline might serve as a suggestive 
basis for head nurses' conferences. 

METHODS OF TEACHING 

A course of this kind will usually take the form of a more or 
less informal class discussion. The idea is to have the stu- 
dents assisting head nurses in some of the departments of the 
hospital where they will be in close touch with many of the 
problems under discussion. Individual problems may be 
assigned for investigation and reported on in class. 

TEXT AND REFERENCE BOOKS 

Palmer: The Teacher. 

James: Talks to Teachers. 

Taylor: Shop Management. 

Pillsbury: Essentials of Psychology. 

Nutting: Educational Status of Nursing. 

Robb: Nursing Ethics. 

Robb: Educational Problems. 

Parsons: Nursing Problems and Obligations. 

Cannon: Hospital Social Service. 

Standard Curriculum for Nursing Schools. 

Articles in The American Journal of Nursing, Journal of 
Home Economics, The Modern Hospital, etc. 

Introduction to Private Nursing (Elective) 

TIME: 10 hours. Class work, discussions and demonstrations conducted 
by a member of the staff who has had experience in private 



150 OUTLINES OF SUBJECTS 

nursing, or by a specially qualified private nurse. To be given 
in the latter half of the third year. 

OBJECTS OF THE COURSE 

To discuss in detail the more important problems which 
confront the nurse in private duty, and to establish the underly- 
ing principles of successful private nursing and suggest modi- 
fications or adaptations of hospital technic which may be re- 
quired in this work. The course is intended only for those 
students who expect to go into the private nursing field. 

OUTLINE OF CLASSES 

I. Essentials to Success in Private Duty 

Considerations which would determine the choice of this 
branch of work. Demands on health need of special atten- 
tion to rest, exercise, food, etc. Requirements as to personality 
and character. Professional requirements special kinds of 
skill, intelligence and efficiency required. Social requirements 
knowledge of social customs and observances which make 
one at home in good society. Companionship resourceful- 
ness in providing diversion and entertainment for patients 
when necessary. Educational functions of the private nurse. 
Opportunities for teaching and influencing homes and com- 
munities. 
II. Establishing One's Self in Private Practice 

Where to locate? The relative advantages of larger and 
smaller centers. Special needs of the small town. Impor- 
tance of joining a good registry. Rules of the registry. The 
responsibility of the private nurse for the care of sick patients 
of all types and conditions. The ethics of picking and choosing 
among cases. General nursing versus specialization in private 
nursing. How to get in touch with physicians and hospitals. 
Engagements and charges. Identification with local nursing 
interests. Relationship with nurses from different schools, 
practical nurses and attendants. 
III. Living Conditions and Expenditures 

The private nurse's income proportion to be devoted to 
professional and personal expenses. Requirements in clothing. 
Recommendations as to uniforms, street clothes, clothes for 
night duty, shoes, etc. Equipment required for general, spe- 
cial, hospital and country cases. The contents and packing of 
the private nurse's suit case. Problems of living. Choice of 
a room and provision for meals when off duty. The relative 
advantages of the nurses' club, cooperative housekeeping and 
boarding. Importance of good telephone service. Laundry 
problems. Proportion of income to be spent on recreation and 
personal improvement. Importance of the savings fund and 



INTRODUCTION TO PRIVATE NURSING 151 

insurance as investments. (Demonstrate proper costume for 
private nurse out-door and in-door; also private nurse's suit- 
case with outfit.) 
IV. The Nurse in the Home 

The position of the nurse in the family. Relationship to 
the patient, the members of the family, servants and visitors. 
Looking at things from others' point of view. How to secure 
the assistance and cooperation of the patient and family. The 
choice, arrangement and care of the sick room. The ordering 
and serving of meals. Preparation of special diets in the home. 
Economy in sick-room supplies. How to improvise equipment. 
Adaptation of treatment with limited equipment. The im- 
portance of records. The daily routine in ordinary cases. 
V. Special Duty in the Hospital 

Conditions of special duty in various types of hospitals. 
Customary regulations concerning hours, relief, room, board, 
remuneration, etc. Relation of the special nurse to the offi- 
cers of the hospital and training school, visiting and resident 
physicians, pupil nurses, ward-maids and orderlies, and other 
special nurses. Duties of the special nurse on ward or private 
cases. Reportls and records. The use of hospital supplies. 
Night work in the hospitial. Cooperation of nurses on the same 
case. 
VI. Hotel Life and Travelling 

Special difficulties presented by hotel life. Problems of uni- 
form, meals, relief, etc. Relationship of the nurse to hotel 
management, staff and guests. Preparation for travelling at 
home and abroad. Requirements and conveniences for both 
patient and nurse. How to pack a trunk and attend to bag- 
gage. Management of the journey. Arrangements for meals, 
transportation at station, etc. What to do for train-sickness 
and sea-sickness. Special points in travelling with a baby, a 
male patient, a bed-patient, an insane or nervous patient, etc. 
(Demonstration of packing a trunk might be given by an 
expert.) 
VII. Private Duty in the County and under Pioneer Conditions 

Typical cases in camps, isolated districts and country com- 
munities. Conditions which have to be met in the country. 
Necessity of understanding people and their ways. Arrange- 
ments as to food, supplies, relief, etc. Responsibilities which 
rest on the nurse in the absence of the doctor. Disposal of 
excreta and other sanitary precautions in the country. 
VIII. Special Problems in Obstetrical and Surgical Cases 

Preparation for confinement in a private house, especially in 
an emergency case. The care and training of the baby. Pre- 
paring feedings in the home. The surgical case. Preparation 
for operations and surgical dressings in the home. Methods of 
sterilizing under home conditions. 



152 OUTLINES OF SUBJECTS 

IX and X. Special Problems in Medical Cases and Emergencies 

The contagious case. Technic of isolation in private homes. 
Rules for the nurse after caring for different types of infection. 
The care of sick children of different ages management dur- 
ing convalescence. The chronic case special demands on the 
nurse in long continued cases, such as paralysis, tuberculosis, 
heart disease, etc. The care of the aged. Nursing mental 
and nervous patients. Special problems involved in caring for 
male patients avoidance of compromising situations. What 
to do about special forms of treatment for male patients. What 
to do in case of death in private house, hospital, or when 
travelling. 

METHODS OF TEACHING 

1. Class work should be conducted largely by means of dis- 
cussion. Problems and cases should be suggested and pupils 
encouraged to work them out and report on them. 

2. If possible each pupil who expects to do private nursing 
should spend a limited time in the care of special patients in 
the hospital, preferably in general wards. This should cover 
a variety of cases and should not be extended over a period 
of more than a few weeks. The class work should be con- 
nected as closely as possible with this practical work. 

ILLUSTRATIVE MATERIAL AND EQUIPMENT 

Articles and photographs illustrating the subject. 
TEXT AND REFERENCE BOOKS 

De Witt: Private Duty Nursing. 

Lounsbury: Making Good on Private Duty. 

Nightingale: Notes on Nursing. 

Robb: Nursing Ethics. 

Parsons: Nursing Problems and Obligations. 

Back files of the American Journal of Nursing, and other 
periodicals. 

Introduction to Public Health Nursing and Social Service (Elective) 

TIME: 10 hours. Conducted by the head of the social service depart- 
ment, the superintendent of the visiting nurse society or special 
teacher of this subject. Given in the latter part of third year. 

OBJECTS OF THE COURSE 

1. To give the pupil nurse a theoretical background for the 
field work which she is receiving, so she may understand the 
significance and importance of the various problems met in 
practical work whether it is visiting nursing or hospital social 
service work. 

2. To teach her something of the technique and procedure 
to be followed in this type of work, so that she may be ready 



INTRODUCTION TO PUBLIC HEALTH NURSING 153 

on leaving the training school to enter one of the commoner 
fields of public health nursing as a useful staff worker, with 
some general idea of case work and routine visiting in families, 
and with some vision of the ideals toward which she should 
aim in the further development of such work. 

OUTLINE OF CLASSES 
I and II. Introduction 

Brief history of the development of visiting nursing. De- 
fine purpose and principles which underlie public health nurs- 
ing organizations' by whom organized, how supported and 
governed, what elements the Board represents, committees 
and their functions, etc. Function and scope of work care of 
the sick, prevention of disease, constructive social case work. 
Relation to the hospital, to doctors, to municipal, philan- 
thropic, medical and social agencies, to the community and to 
the patient. 

III. Theory and Technique of Case Work 

Meaning of social diagnosis and social treatment. Empha- 
sis on family treatment. Factors to be considered in all case 
work mental and physical heredity, family influences, educa- 
tion and training, occupation, income, recreation. The rela- 
tion of these factors to health. Importance of first interview 
and first home visit. 

IV. Source of Cases and Basis of Selection 

Cases sent by doctors, nurses, private individuals, organiza- 
tion (business, religious and philanthropic,) social service 
workers, and other patients. Methods of referring details. 
Various bases of selection in hospital social service and visiting 
nursing. 
V and VI. Case Work in Visiting Nursing 

Freely illustrated from case histories, showing exact pro- 
cedure and methods in treatment from the first step after case 
is referred to the last step when case is terminated. Home nurs- 
ing technique in various diseases. The nurse's bag its equip- 
ment and care. Special nursing and social problems presented 
by acute, chronic and contagious cases when cared for in the 
the home. Care of children in home vs. hospital care. 

VII. Case Work in Hospital Social Service 

Types of cases especially requiring medico-social treatment. 
Enlarge upon social causes and social results in each instance. 
Medical tuberculosis, cardiac, stomach, diabetes. Obstetri- 
cal prenatal and sex problems. Pediatrics feeding cases, 
instruction in care of children. Orthopedic. Mental and 
nervous. Venereal diseases. Illustrate from case histories. 

VIII. Office Methods 

Records importance and purpose. Study of record sheets 
and history taking. Resource catalogue and other devices 
making for greater efficiency and time saving. 



154 OUTLINES OF SUBJECTS 

IX and X. Modern Tendencies and Special Problems 

Hospital social service shall relief be given by social serv- 
ice department? Limitation of intake of work, preventive 
work, community work. Use of voluntary workers. Visit- 
ing nursing hourly nursing, generalization versus specializa- 
tion, relief-giving, the visiting housekeeper and attendant 
service in connection with Visiting Nurse Association. Pos- 
sibilities of dietary work, surveys, focusing on new problem 
each year, research. Specialization vs. centralization in Pub- 
lic Health Nursing. Community Centers. 

METHODS OF TEACHING 

1. The course should be conducted as a conference rather 
than a lecture course, the person conducting the course pre- 
senting her material first but allowing questions during presen- 
tation and always leaving time for free discussion afterwards. 

2. There should be constant use of cases seen in the ward 
and Social Service Department or Visiting Nurse Society. 
Each nurse might be assigned a particular type of case to- 
present to the group from her own experience either in the 
hospital or Social Service Department. 

3. While of necessity the local situation must figure largely 
in the material considered, each nurse should be required to- 
describe the work done in some other city as discovered through 
annual reports, correspondence, etc., thus bringing out the 
variety of development possible in the work and enlarging the 
nurse's knowledge of other than the local situation. 

4. The ground covered and the emphasis on different topics 
will necessarily vary widely. The above outline is suggestive 
merely. 

ILLUSTRATIVE MATERIAL 

Reports of various Social Service Departments and Visit- 
ing Nurse Societies. Photographs, posters, exhibits, etc. 

TEXT AND REFERENCE BOOKS 

Gardner: Public Health Nursing. 

Foley: Visiting Nurse Manual. 

Wald: The House on Henry Street. 

Cabot: Social Service and the Art of Healing. 

Cannon: Social Service in Hospitals. 

Devine: The Normal Life, Misery and Its Causes. 

Davis & Warner: Dispensaries. 

The Proceedings of the National Conference of Charities and 

Corrections. 

Public Health Nurse Quarterly. 

Publications of the Russell Sage Foundation on Case Work. 
Publications of the State and City Boards of Health. 

See also under Modern Social Conditions, Survey of the 
Nursing Field, etc. 



INTRODUCTION TO LABORATORY WORK 155 

Introduction to Laboratory Work (Elective) 

TIME : 10 hours. Classes, conferences and laboratory work conducted by 
a pathologist an elective course given in the end of the Senior 
year. 

OBJECTS OF COURSE 

1. One of the newer branches of work into which nurses are 
going, is that of assistants to pathologists in hospital and 
Board of Health laboratories, and routine pathological work 
in physicians' offices. The short course here outlined would not 
fit a nurse to assume any responsible position in this field, but 
shouW give her an introduction to this form of work, and if 
she shows unusual ability and interest in it, would probably 
lead to further specialization after graduation, 

2. Such a course would aim to give a greater facility in such 
tests as may be required in any branch of nursing work (for 
example simple urinal ysis), would make nurses more observ- 
ant of abnormal conditions in their more responsible work with 
patients outside the hospital, and would make them more in- 
telligent and efficient assistants in all forms of experimental 
and clinical work. 

OUTLINE OF CLASSES 
I. Introduction 

Equipment, solutions, reagents. Laboratory rules and 
methods. 
II, III, and 

IV. Urinalysis 

Routine tests. Urinary sediments. Quantitative tests. 
Relation to diets. Charting. 
V. Feces 

Routine tests. Parasites and Ova. Charting. Diets. 
VI. Stomach Contents 

Macroscopic and microscopic examination. Qualitative and 
quantitative tests. Charting. 
VII. Sputum 

Macroscopic and microscopic examination. Carbol-fuchsin 
and Gram's stains. Charting. 
VIII and IX. Blood 

Hemoglobin; counting corpuscles; smears, differential count- 
ing. Blood cultures, blood pressure. 
X. Body fluids 

Transudates and exudates. Routine tests. Smears. 

METHODS OF TEACHING 

1. The greatest part of the course would be taught to small 
groups by the demonstration and laboratory method. Stu- 
dents who take this work should have a period of practical ex- 



156 OUTLINES OF SUBJECTS 

pericnce in the pathological laboratory, of from one to two 
months, where they would be under the direct supervision of 
the pathologist. Conferences and short papers will help in 
mastering the principles and readings should be assigned in 
current journals and reference books. 

NOTE: In hospitals where special dietary investigation and 
experimentation is being carried on, selected senior pupils may 
be assigned to this form of laboratory service. In such a case 
the course of study would deal with nutritional principles and 
technic instead of the above. Nurses especially trained in this 
branch of work are beginning to be in some demand. In Board 
of Health work, the routine examination of water and milk 
would be an important part of an assistant's duties. 

EQUIPMENT AND ILLUSTRATIVE MATERIAL 

Laboratory equipment slides, pathological specimens 
charts, etc. 

TEXT AND REFERENCE BOOKS 

Gibson: Chemical Laboratory Technic for Nurses. 

Wells: Chemical Pathology. 

Delafield and Prudden: Pathology. 

Adami: Pathology. 

Wood: Chemical and Microscopical Diagnosis. 

See also under Pathology, Bacteriology, Medicine, etc. 



APPENDIX I 

Bibliography 

The following list of books includes all those mentioned in the preceding 
pages, with publishers, prices and dates of publication. It is suggested 
that this list be used as a basis of selection for the Training School 
Library. 

Abbott, Grace: Women in Industry. Appleton. 1910. $2.50. 

Adami, J. G., M.D. and Macrae, John, M.D.: Text Book on Pathology. Lea 

& Febriger. 1914. $5.00. 
Addams, Jane: A New Conscience and an Ancient Evil. Macmillan. 1912. 

$1.00. 

Addams, Jane: Social Ethics. Macmillan. 1902. $1.25. 
Addams, Jane: The Spirit of Youth and the City Streets. Macmillan. 1909. 

$1.25. 

Addams, Jane: Twenty Years at Hull House. Macmillan. 1910. $2.00. 
Amoss, H. L., M.D. : Chemistry for Nurses. Lea & Febriger. 1915. $1.50. 
Antin, Mary: The Promised Land. Houghton-Mifflin. 1912. $2.00. 
Asher, Phillip, M.D.: Chemistry and Toxicology for Nurses. Saunders. 

1918. $1.50. 

Bacon, Gorham, M.D.: Manual of Otology. Lea & Febriger. 1909. $2.25. 
Balderston, L. Ray: Laundry Manual. (Authors own publication.) 1914. 

$1.25. 

Balderston, L. Ray: Housewifery. Lippincott. 1919. $2.00. 
Bancroft, Jessie H. : Posture of School Children. Macmillan. 1913. $1.50. 
Barrows and Lincoln: Home Science Cook Book. Whitcomb & Barrows. 

1902. $1.00. 
Baruch, Simon, M.D.: Principles and Practice of Hydro therapy. Wood. 

1908. $4.00. 

Barrus, Clara, M.D.: Nursing the Insane. Macmillan. 1908. $2.00. 
Baskerville, Charles: Municipal Chemistry. McGraw-Hill Book Co. 1911. 

$5.00. 
Bastedo, W. A., M.D.: Materia Medica and Therapeutics. Saunders. 1918. 

$4.00. 

Betts, G. H.: The Recitation. Houghton-Mifflin. 1911. .40. 
Beers, Clifford W. : The Mind that Found Itself. Longmans, Green & Co. 

1913. $1.50. 
Berry, J. Me. W., M.D.: Orthopedic Surgery for Nurses. Saunders. 1916. 

$1.00. 
Berdoe, Edward: Origin and Growth of the Healing Art. Swan, Som- 

merischen & Co. London. 1893. 
Bigelow, Maurice A. and Anna M. : Applied Biology. Macmillan. 1911. 

$1.40. 
Bliss, Dr. M. R. and Olive, Prof. A. H.: Chemistry for Nurses. Lippincott. 

1918. $1.59. 

157 



158 APPENDIX I 

Blumgarten, A. S., M.D.: Materia Medica for Nurses. Macmillan. 1916. 

$1.50. 

Boardman, Mabel: Under the Red Cross Flag. Lippincott. 1918. $1.75. 
Bolduan, Dr. C. F. and Grund, Marie: Applied Bacteriology for Nurses. 

Saunders. 1916. $1.50. 
Bradford, E. H!, M.D. and Lovett, R. W., M.D.: Treatise on Orthopedic 

Surgery. Wood. 1915. $3.75. 

Bridge, H. L.: Manual of Practical Nursing. Mosby. 1917. $1.00. 
Broadhurst, Jean A.: Home and Community Hygiene. Lippincott. 1918. 

$2.00. 
Brown, Charlotte A.: The Junior Nurse. Lea & Febriger. (New edition in 

preparation.) $1.00. 
Brunton, T. L.: Lectures on the Action of Medicines. Macmillan. 1903. 

$4.00. 

Brubaker, A. P., M.D. : Anatomy and Physiology. Blakiston. 1916. $3.50. 
Buchanan, Edith D. and Robert E.: Household Bacteriology. Macmillan. 

1913. $2.40. 

Bundy, Elizabeth: Anatomy and Physiology. Blakiston. 1916. $2.25. 
Butler, Alfred M. : Household Physics. Whitcomb & Barrows. 1914. $1.30. 
Byington, Margaret: What Social Workers should know about their own 

Communities. Russell Sage Foundation. (Charity Organization De- 
partment. Publications. 1916. .10. 
Cabot, E. L.: Every Day Ethics. Holt. 1906. $1.36. 

Cabot, Richard, M.D. : What Men Live By. Houghton-Mifflin. 1914. $1.65. 
Cabot, Richard, M.D.: Social Service and the Art of Healing. Moffatt Yard 

& Co. 1909. $1.35. 
Cannon, W. B., M.D.: The Mechanical Factors in Digestion. Longmans, 

Green & Co. (New edition in preparation.) 
Cannon, W. B., M.D.: Bodily Changes in Pain, Hunger, Fear and Rage. 

Appleton. 1915. $2.50. 
Cannon, Ida M.: Hospital Social Service. Russell Sage Foundation. 1913. 

$1.50. 
Carey, H. W., M.D.: A Text-book for Nurses in Bacteriology. F. A. Davis 

Co. 1915. $1.00. 
Carter, H. S. and Howe, P. E. : Nutrition and Clinical Diet. Lea & Febriger. 

1917. $5.50. 

Campbell, H. C.: Household Economics. Putnam. 1896. $1.50. 
Chapin, J. B.: Compendium of Insanity. Saunders. 1898 (out of print). 
Chapin, C. V., M.D. The Sources and Modes of Infection. John Wiley. 

1916. $3.50. 
Chapin, R. C.: Standard of Living Among Workingmen's Families in New 

York City. Russell Sage Foundation. 1909. $2.00. 

Chapim, H. D., M.D. and Pisek, G. R., M.D.: Diseases of Infants and Chil- 
dren. Wood. 1915. $3.50. 
Chapin, H. D., M.D.: Theory and Practice of Infant Feeding. Wood. (Out 

of print.) 
Clouston, T. S., M.D.: Hygiene of the Mind. Dutton. 1907. $3.50. 



BIBLIOGRAPHY 159 

Colvin, S. S. and Bagley, W. C. : Human Behaviour. Macmillan. 1913. $1.00. 

Conn, H. W.: Agricultural Bacteriology. Blakiston. 1918. $2.00. 

Conn, H. W.: Bacteria, Yeasts and Moulds in the Home. Ginn & Co." 1917. 

$1.20. 
Cooke, J. B., M.D.: A Nurse's Handbook of Obstetrics. Lippincott. 1917. 

$2.25. 
Cooke, Sir Edward: Life of Florence Nightingale. 2 vols. Macmillan. 

1914. $7.50. 

Councilman, W. T., M.D.: Disease and its Causes. Home University Li- 
brary. 1913. .60. 

Cragin, E. B., M.D.: Essentials of Gynecology. Saunders. 1913. $1.25. 
Crile, G. W., M.D.: Anoci-Association. Saunders. 1914. $3.00. 
Crowell, Elizabeth: Tuberculosis Dispensary Method and Procedure. Nat. 

Ass'n for the Study and Prevention of Tuberculosis. 1916. .25. 
Curtis, C. C.: Nature and Development of Plants. Holt. 1907. $2.50. 
Cyriax, E. G., M.D.: Kellgren's Manual Treatment. Wood. 1904. $4.00. 
DaCosta, J. C., M.D. : Modern Surgery. General and Operative. Saunders. 

1914. $6.00. 

Davenport, C. B.: Heredity in Relation to Eugenics. Holt. 1911. $2.50. 
Davis, G. G., M.D.: Principles and Practice of Bandaging. Blakiston. 

1911. $1.00. 
Davis, E. P., M.D.: Obstetric and Gynecologic Nursing. Saunders. 1917. 

$2.00. 
Davis, Michael M., and Warner, A. R.: Dispensaries. Macmillan. 1918. 

o 9c 

$-..iO. 

Dawson, Percy, M.D.: Anatomy and Physiology for Nurses. Macmillan. 

1917. $1.75. 

De Lee, J. B., M.D.: Obstetrics for Nurses. Saunders. 1917. $2.75. 
Delafield, Francis, M.D. andPrudden, T.M., M.D. : Pathology. Wood. 1914. 

$7.00. 

Devine, Edward T.: Misery and its Causes. Macmillan. 1913. $1.25. 
Devine, Edward T. : The Normal Life. McMurtrie. 1917. $1.15. 
Devine, Edward T. : Principles of Relief. Macmillan. 1904. $2.00. 
Despard, L. L. : Text-Book of Massage. Hodder & Stoughton. 1914. $4.00. 
Dewey, John and Tufts, J. H. : Ethics. Holt. 1908. $2.25. 
Dewey, John: How We Think. Heath. 1910. $1.28. 
De Witt, Katherine: Private Duty Nursing. Lippincott. 1917. $1.75. 
Doane, R. W.: Insects and Disease. Holt. 1910. $2.00. 
Dock, Lavinia L.: Materia Medica for Nurses. Putnam. 1916. $1.50. 
Dock, Lavinia L. : Hygiene and Morality. Putnam. 1912. $1.25. 
Doty, Alvah H.: Prompt Aid to the Injured. Appleton. 1912. $1.75. 
Dubois, Paul: The Education of Self. Funk & Wagnalls. 1914. $1.50. 
Dubois, Paul: The Influence of the Mind on the Body. Funk & Wagnalls. $.50. 
Dunton, W. R., M.D. : Reconstruction Therapy. Saunders. 1919. $1.50. 
Dunton, W. R., M.D.: Occupation Therapy. Saunders. 1915. $1.50. 
Eliason, E. L., M.D.: Practical Bandaging. Lippincott. 1914. $4.50. 
Eliason, E. L., M.D.: First Aid in Emergencies. Lippincott. 1914. $1.50. 
Ellwood, C. A. : Sociology and Modern Social Problems. American Book Co. 

1913. $1.00. 



160 APPENDIX I 

Ellis, Havelock: Task of Social Hygiene. Hough ton-Mifflin. $2.75. 
Emerson, C. P., M.D.: Essentials of Medicine. Lippincott. 1918. $2.50. 
Emerson, Ralph Waldo: Essays. Hough ton-Mifflin. (Cambridge Classics). 

$1.35. 

Encyclopedia Britannica. : University Press. 1914. 28vol. $126.00. 
Epler, Percy H.: Life of Clara Barton. Macmillan. 1915. $1.75. 
Farmer, F. M.: Foods and Cookery for the Sick and Convalescent. Little, 

Brown & Co. 1912. $1.75. 

Farmer, F. M.: Boston Cook Book. Little, Brown & Co. 1914. $2.00. 
Farr, C. B.: Internal Medicine. Lea & Febriger, 1913. $2.00. 
Fisher, Irving and Fiske, E. L., M.D.: How to Live. Funk & Wagnalls. 

1916. $1.00. 
Foley, Edna: Visiting Nurse Manual. Chicago Visiting Nurse Association. 

1915. .25. 
Foote, John, M.D.: Essentials of Materia Medica and Therapeutics for 

Nurses. Lippincott. 1918. $1.75. 
Fowler, R. S., M.D. : The Operating Room and the Patient. Saunders. 1913. 

$3.56. 
Fox, Herbert, M.D. : Bacteriology and Protozoology. Lea & Febriger. 1916. 

$1.50. 

Friedenwald and Rurah: Dietetics for Nurses. Saunders. 1917. $1.50. 
Gailbraith, Anna M., M.D.: Hygiene and Physical Culture for Women. 

Saunders. 1917. $2.25. 

Gardner, Mary S.: Public Health Nursing. Macrnillan. 1915. SI .75. 
Gerrish. F. R. M.D.: Anatomy. Lea & Febriger. 1902. $6.50. 
Gibbs, Winifred: Lessons in Feeding the Family. N. Y. Ass'n for Improving 

the Condition of the Poor. 1915. .25. 
Gibson, Anna: Clinical Laboratory Technic. Whitcomb & Barrows. 1918. 

$1.25. 
Goldmark, Josephine: Fatigue and Efficiency. Russell Sage Foundation. 

1912. $4.00. 

Gray: Anatomy. Lea & Febriger. (20th edition.) 1918. $7.50. 
Graham, Douglas, M.D.: Massage. Lippincott. 1913. $5.00. 
Grulee, C. L., M.D.: Infant Feeding. Saunders. 1917. $3.25. 
Gulick, L. H. and Ayres, L. P.: Medical Inspection in Schools. Russell Sage 

Foundation. 1913. $1.50. 

Hall, W. S., M.D.: Nutrition and Dietetics. Appleton. 1913. $2.25. 
Hall, Dr. H. L. and Buck, Mettice C.: The Work of Our Hands. Moffatt, 

Yard & Co. 1915. $1.50. 
Halliburton, W. D., M.D.: Hand-book of Physiology. Blakiston. 1917. 

$3.50. 

Hare, H. A., M.D.: Practical Therapeutics. Lea & Febriger. 1918. $4.75. 
Hcaley, Wm.: The Individual Delinquent. Little, Brown& Co. 1915. $5.00. 
Henderson, C. R.: Dependents, Defectives and Delinquents. Heath. 1901. 

$2.00. 
Henry, J. N., M.D.: A Nurse's Hand-book of Medicine. Lippincott. 1913.. 

$2.00. 



BIBLIOGRAPHY 161 r 

Hertar, C. A.: Biological Aspects of Human Problems. Macmillan. 1911. 

$1.50. 

Hill, Charles, M.D.: Histology. Saunders. 1914. $2.25. 
Hill, Charles, M.D.: The New Public Health. Macmillan. 1916. $1.25. 
Hinsdale, Guy, M.D.: Hydrotherapy. Saunders. 1910. $3.50. 
Hiss, Dr. P. H. and Zinnser, Dr. Hans: A Text-Book on Bacteriology. Ap- 

pleton. 1918. $3.75. 

Hopkins, W. B., M.D.: The Roller Bandage. Lippincott. 1911. $1.50. 
Hollander, Bernard, M.D.: Nervous Women. Button. 1916. $1.50. 
Holt, L. Emmet, M.D.: Diseases of Infancy and Childhood. Appleton. 

1918. $6.50. 
Holt, L. Emmet, M.D.: The Care and Feeding of Children. Appleton. 1918. 

.85. 
Hough, Theodore and Sedgwick, W. T.: Human Mechanism. Ginn & Co. 

1918. $2.00. 
Howell, C. H., M.D.: Surgical Nursing and Hospital Technique. Columbus 

Pub. Co. 1913. $5.00. 

Howell, W. H., M.D.: Text-Book of Physiology. Saunders. 1918. $5.00. 
Hughes, D. E., M.D.: Practice of Medicine. Blakiston. 1917. $3.25. 
Hunter, Robert: Poverty. Macmillan. 1904. $1.50. 

Jackson, G. T., M.D.: Diseases of the Skin. Lea & Febriger. 1914. $3.00. 
Jaffa: Standard Dietary for an Orphanage. (Bulletin) California State 

Board of Charities. 1915. 

James, William: Talks to Teachers. Holt. 1899. $1.50. 
James, William: Psychology (Briefer Course). Holt. 1892. $1.75. 
Jordan, E. O.: General Bacteriology. Saunders. 1918. $3.75. 
Kelley, Florence: Modern Industry. Longmans, Green & Co. (temporarily 

out of print). 

Kelly, H. A., M.D. : Medical Gynecology. Appleton. 1912. $6.50. 
Kelly, H. A., M.D.: Operative Gynecology. Appleton. 1918. $16.00. 
Kellogg, J. H., M.D.: Rational Hydrotherapy. Modern Medicine Pub. Co. 

1918. $7.50. 

Kerley, C. G., M.D.: Practice of Pediatrics. Saunders. 1918. $6.50. 
Kimber, Diana C.: Anatomy and Physiology. Macmillan. 1918. $2.60. 
Kinne and Cooley: Shelter and Clothing. Macmillan. 1913. $1.10. 
Kingsbury, Susan: Vocations for the Trained Woman. Longmans, Green & 

Co. 1910. $1.50. 

Kinnicutt, Winslow and Pratt: Sew age Disposal. Wiley & Son. 1916. $3.00. 
Kirkpatrick, E. A. : Child Study. Macmillan. 1917. $1.30. 
Kittredge, Mabel H. : Practical Home Making. Century Co. 1917. .60. 
Knopf, S. A.: Tuberculosis as a Curable and Preventable Disease. Moffatt, 

Yard & Co. 1909. $2.25. 

Kober, G. M.: Industrial and Personal Hygiene. President's Homes Com- 
mission. Washington. 1908. 

Kraeplin, Emil, M.D.: Clinical Psychiatry. Vol. 111. Wood. 1917. $3.50. 
Lacroix: Military and Religious Life in the Middle Ages. Chapman & Hall. 

London. 



162 APPENDIX I 

Langworthy: Food Customs and Diet in American Homes. U. S. Dept. of 

Agriculture. Bulletin 110. 

La Motte, Ellen N.: Tuberculosis Nursing. Putnam. 1915. $1.50. 
Latimer, Caroline W., M.D.: Girl and Woman. Appleton. 1909. $1.75. 
Lee, F. S., M.D.: Scientific Features of Modern Medicine. Lemcke. 1911. 

$1.50. 

Lee, Roger I.: Health and Disease. Little, Brown & Co. 1917. $2.00. 
Lee, Joseph: Play in Education. Macmillan. 1915. $1.50. 
Loch, C. S.: Charity and Social Life. Macmillan. 1910. $2.00. 
Lounsbury, H. C.: Making Good on Private Duty. Appleton. 1912. $1.25. 
Lovett, R. \V., M.D.: Lateral Curvature of the Spine and Round Shoulders. 

Blakiston. 1916. $1.75. 

Lynch, Lt. Col. Charles: Red Cross Text-Book on First Aid and Relief Col- 
umns. Blakiston. 1918. $1.00. 

Lynde, C. J. : Household Physics. Macmillan. 1904. SI. 25. 
MacFarlane, Catherine, M.D.: Gynecology for Nurses. Saunders. 1913. 

$1.25. 
Mackenzie, W. L.: Health and Disease. Home University Library. 1911. 

.75. 

Mackenzie. J. S. : Manual of Ethics. Hinds, Noble & Eldridge. 1901. S1.50. 
Mackenzie, James: Symptoms and their Interpretation. Chicago Med. 

Book Co. 1909. $3.00. 
MacPherson, Wm. and Henderson, W. E.: Elementary Study of Chemistry. 

Ginn & Co. 1917. $1.60. 

Marshall, A. M.: Vertebrate Embryology. Putnam. 1893. $6.00. 
Marshall, C. E.: Microbiology. Blakiston. 1917. $3.00. 
Martin, H. N.: Human Body. Holt. 1917. S3.00. 
Maxwell, Anna C. and Pope, Amy E.: Practical Nursing. Putnam. 1914. 

$2.00. 

May, C. H., M.D.: Diseases of the Eye. Wood. 1917. $2.50. 
McCollurn, E. V. : The Newer Knowledge of Nutrition. Macmillan. 1918. 

$1.50. 
McCombs, R. S., M.D.: Diseases of Children for Nurses. Saunders. 1916. 

$2.00. 

McCunn, John: Making of Character. Macmillan. 1910. $1.25. 
McDougall, Wm. Social Psychology. Luce & Co. 1909. $1.50. 
McTsaac, Isabel: Primary Nursing Technique. Macmillan. 1907. $1.25. 
McKenzie, R. T., M.D.: Exercise in Education and Medicine. Saunders. 

1915. $1.00. 

McNutt. J. S. : Manual for Health Officers. Wiley & Sons. 1915. $3.00. 
McMurry, F. M.: How to Study. Houghton-Mifflin. 1909. $1.50. 
Meachen, G. Norman: Diseases of the Skin for Nurses. (English Importa- 
tion). Chicago Mcd. Book Co. $1.25. 

Miller, Irving, E.: Psychology of Thinking. Macmillan. 1909. $1.25. 
Mitchell, J. L., M.D., and Guliok, Luther, M.D.: Mechano Therapy and 

Physical Education. Blakiston. $300. 
Morley, Edith J. (Editor): Women Workers in Seven Professions. Dutton. 

1911 $2.50. 



BIBLIOGRAPHY 163 

Morse, J. L., M.D.: Care and Feeding of Children. Harvard University 
Press. 1914. $.50. 

Morse, J. L., M.D., and Talbot, F. B., M.D. : Diseases of Nutrition and Infant 
Feeding. Macmillan. 1915. $3.00. 

Morrow, A. S., M.D.: Immediate Care of the Injured. Saunders. 1917. 
$2.75. 

Morrow, Prince A., M.D.: Social Diseases and Marriage. Lea Bros. 1904. 
$3.00. 

Mozans, H. J.: Women in Science. Appleton. 1915. $2.50. 

Mullerheim: Die Wochenstube in der Kunst. F. Enke, Stuttgart. 1904. 

Munsterberg, Hugo : Psychotherapy . Moffatt, Yard & Co. 1909. $2.25. 

Nearing, Scott: Financing the Wage Earner's Family. Huebsch. 1914. 
$1.25. 

Nesbitt, Florence : Low Cost Cooking. American School of Home Economics, 
Chicago. 1915. $.50. 

Newsholme, A., M.D.: The Prevention of Tuberculosis. Dutton. 1916. 
$3.50. 

Nightingale, Florence : Notes on Nursing. Appleton. 1917. (Last printing). 
$.85. 

Nightingale, Florence: Talks to Pupils. A selection of addresses to proba- 
tioners and nurses. Macmillan. London. 1914. 

Nutting, M. Adelaide : Educational Status of Nursing. Bureau of Education. 
Washington. 

Nutting, M. Adelaide, and Dock, Lavinia L.: History of Nursing. 4 vols. 
Putnam. Vols. I-II, 1907, $5.00; Vols. III-IV, 1912, $5.00. 

Oliver, Thomas, M.D.: Diseases of Occupation. Dutton. 1917. $4.00. 

Osier, William, M.D. : Practice of Medicine. Appleton. 1916. $6.00. 

Osier, William, M.D.: An Alabama Student and Other Essays. Oxford 
University Press. 1908. $2.00. 

Osier, William. M.D.: Aequanimitas. Blakiston. 1906. $2.25. 

Otis, E. D.: The Great White Plague. Crowell. 1909. $1.00. 

Paget, Stephen: Confessio Medici. Macmillan. 1908. $1.25. 

Palmer, Margaret D.: Lessons on Massage. Wood. 1908. $3.50. 

Palmer, G. H.: The Teacher. Houghton-Mifflin. 1908. $1.75. 

Parker, S. C.: Methods of Teaching in High Schools. Ginn & Co. 1915. 
$1.80. 

Parker, Linette A.: Materia Medica. Lea & Febriger. 1916. $1.75. 

Parker, E. M., M.D., and Breckinridge, S. D., M.D.: Surgical and Gynecolog- 
ical Nursing. Lippincott. 1916. $2.50. 

Parker, W. H., M.D., and Williams, Anna, M.D.: Pathogenic Micro- 
organisms. Lea & Febriger. 1918. $4.75. 

Parker, T. J., and Haswell, W. A.: Text-book of Zoology. 2 vols. Macmillan. 
1910. $9.00. 

Parloa, Maria: Home Economics. Century Co. 1906. $1.50. 

Parsons, Sara E. : Nursing Problems and Obligations. Whitcomb & Barrows. 
1916. $1.00. 

Pattee, Alida F. : Practical Dietetics. Whitcomb & Barrows. 1917. $1.75. 



164 APPENDIX I 

Paul, G. P., M.D.: Nursing in the Acute Infectious Fevers. Saunders. 1915. 

$1.00. 
Perkins, Agnes F.: Vocations for Trained Women. Longmans, Green & Co. 

1911. $1.20. 

Piersol, G. A., M.D.: Normal Histology. Lippincott. 1916. $3.50. 
Pillsbury, W. B.: Essentials of Psychology. Macmillan. 1911. $1.25. 
Polak, J. O., M.D. : Manual of Obstetrics. Appleton. 1913. $3.00. 
Pope, Amy E. : Anatomy and Physiology for Nurses. Putnam. 1917. $2.00. 
Pope. Amy E.: Physics and Chemistry for Nurses. Putnam. 1918. $2.00. 
Pope, A. E., and Carpenter, M. T. : Essential of Dietetics. Putnam. 1917. 

$1.25. 
Potts, C. S., M.D.: Electricity in Medicine and Surgery. Lea & Febriger. 

1911. $4.75. 
Price, G. M.: Hygiene and Sanitation for Nurses. Lea & Febriger. 1917. 

$1.75. 
Priestman, Mabel T.: Art and Economy in Home Decoration. John Lane & 

Co. 1908. $1.00. 
Putnam, J. P.: Plumbing and Household Sanitation. Doubleday, Page & 

Co. 1913. $3.75. 

Putnam, Mrs. Geo. Haven: The Lady. Sturgis & Walton. $1.25. 
Pyle, W. L., M.D. : Personal Hygiene. Saunders. 1918. $1.75. 
Ramsey, W. R., M.D.: Care and Feeding of Infants and Children. Lippin- 
cott. 1916. $2.00. 

Register, W. R., M.D : Practical Fever Nursing. Saunders. 1907. $2.50. 
Ribot, T. A. : Diseases of the Personality. Boericke & Tafel. 1909. $1.00. 
Ribot, T. A. : Diseases of the Will. Open Court Pub. Co. 1903. $.75. 
Richards, Ellen H.: Home Sanitation in Daily Life. Whitcomb & Barrows. 

1907. $.60. 

Richards, Ellen H.: Euthenics. Whitcomb & Barrows. 1910. $1.00. 
Richmond, Mary: Social Diagnosis. Russell Sage Foundation 1916. $1.75. 
Richer: L'Art et la Medicene. Gaultier, Magnier et Cie. Paris. 1902. 
Robb, Isabel Hampton: Nursing Principles and Practice. Koeckert. 1917. 

$1.75. 

Robb, Isabel Hampton: Ethics of Nursing. Koeckert. 1917. $1.50. 
Robb, Isabel Hampton: Educational Standards for Nurses. Koeckert. 1907. 

$1.25. 

Robb, Hunter, M.D. : Aseptic Surgical Technic. Lippincott. 1916. $2.50. 
Roberts, J. G.: Bacteriology and Pathology. Saunders. 1916. $1.50. 
Robinson and Breasted: Outlines of European History. Ginn & Co. $1.75. 
Roger, George E. H. : Principles of Medical Pathology. Appleton. 1903. 

(Out of print.) 
Rosenau, M. J., M.D.: Preventive Medicine and Hygiene. Appleton. 1918 

$6.50. 

Rose, W. R., and Carless, Albert: Manual of Surgery. Wood. 1917. $7.00. 
Rose, Mary S.: Feeding the Family. Macmillan. 1916. $2.10. 
Rose, Mary S. : Food for School Boys and Girls. (Bulletin) Teachers College. 

Columbia Univ. Series No. 10. 
Rose, Mary S. : Cost of Food. Cornell Bulletin. Food Series No. 7. 



BIBLIOGRAPHY 165 

Rose, Mary S. Handbook of Laboratory Dietetics. Macmillan. 1912. 

$1.10. 

Ross, Edward A. : Social Psychology. Macmillan. 1908. $1.50. 
Sabotta-McMurrich: Atlas and Text-book of Human Anatomy. Saunders. 

(Out of print.) 

Sainsbury, Harrington: Drugs and the Drug Habit. Dutton. 1909. $3.50. 
Sanders, Georgina J. : Modern Methods in Nursing. 1916. $2.50. 
Saleeby, C. W.: Surgery and Society. Moffatt, Yard & Co. 1912. $2.50. 
Schreiner, Olive: Woman and Labor. Stokes. 1911. $1.25. 
Seager, Henry: Social Insurance. Macmillan. 1910. $1.00. 
Sedgwick, W. T. : Principles of Sanitary Science and Public Health. Macmil- 
lan. 1902. $3.00. 
Senn, Nicholas, M.D.: Operating-Room Technic. Chicago Med. Book Co. 

1905. $1.75. 
Sherman, H. C.: Chemistry of Food and Nutrition. Macmillan. 1918. 

$2.00. 
Snedden, F. H.: Problem of Vocational Education. Houghton, Mifflin. 

1910. $.40. 

Slemons, J. M., M.D.: Prospective Mother. Appleton. 1912. $1.75. 
Smith, Richard M. and Mrs. H. Greene : Baby's First Two Years. Houghton- 

Mifflin. 1915. $.85. 

Smith, Amy Armour: The Operating Room. Saunders. 1916. $1.50. 
Sollmann, Torald. M.D.: Text-book of Pharmacology. Saunders. 1917. 

$1.50. 
Starling, E. A.: Principles of Human Physiology. Lea & Febriger. 1915. 

$6.00. 

Starr, Louis, M.D.: Hygiene of the Nursery. Blakiston. 1913. $1.00. 
Stevens, A. A. : Practice of Medicine. Saunders. 1915. $3.00. 
Stevens, A. A., M.D.: Materia Medica and Therapeutics. Saunders. 1909. 

$3.50. 

Steiner, E. A.: Ebb and Flow of the Immigrant Tide. Revell. 1909. $1.50. 
Steiner, G. A.: On the Trail of the Immigrant. Revell. 1909. $1.50. 
Stelwagon, H. W., M.D.: Diseases of the Skin. Saunders. 1916. $6.50. 
Stiles, P. G.: Nutritional Physiology. Saunders. 1918. $1.50. 
Stimson, Julia: Nurses Handbook of Drugs and Solutions. Whitcomb & Bar- 
rows. 1915. $1.00. 
Strayer, Geo. G., and Norsworthy, Naomi: How to Teach. Macmillan. 

1917. $1.40. 

Streightoff, F. H.: Standard of Living. Houghton-Mifflin. 1911. $1.25. 
Struthers, Lina Rogers: School Nursing. Putnam. 1917. $1.75. 
Taylor, F. W.: Shop Management. Harper Bros. 1911. $1.50. 
Terrill, Bertha M. : Household Management. Am. School of Home Economics. 

1910. $1.00. 
Tiffany, Rev. Francis: Life of Dorothea Lynde Dix. Houghton-Mifflin. 

1890. $1.75. 

Tigerstedt, R. A., M.D.: Text Book of Physiology. Appleton. 1916. $4.50. 
Thompson, W. Oilman, M.D.: Practical Dietetics. Appleton. 1909. $5.50. 



166 APPENDIX I 

Thompson, W. Oilman, M.D.: Occupational Diseases. Appleton. 1914. 
$6.50. 

Thorndike, E. L.: Individuality. Houghton-Miffiin. 1917. $.40. 

Thorndike, E. L. : Principles of Teaching, Based on Psychology. Seller. 
1906. $1.25. 

Thorndike, E. L. Elements of Psychology. Seiler. 1907. $1.50. 

Thorndike: Orthopedic Surgery. Blakiston. (Out of print.) 

Tooley, Sarah: History of Nursing in the British Empire. Cassell. London. 

Tracy, Susan E. : Invalid Occupations. Whitcomb & Barrows. 1910. $1.50. 

Tracy, Susan E. : Rake Knitting. Whitcomb & Barrows. 1916. $ .25. 

Tubby, A. H.: Deformities. 2 vols. Macmillan. 1912. (Imported to order 
only.) $16.00. 

Tuker and Malleson: Handbook to Christian and Ecclesiastical Rome. Mac- 
millan. 1897. $2.75. 

Tyler, J. M.: Growth and Education. Houghton-Miffiin. 1907. $1.50. 

Vulte, H. T.: Household Chemistry. Chemical Publishing Co. 1917. $1.50. 

Veiller, Lawrence: Housing Reforms. Russell Sage Foundation. 1910. 
$2.00. 

Waters, Yssabella: Visiting Nursing in the United States. Russell Sage 
Foundation. 1912. $1.25. 

Wells, H. G. : Chemical Pathology. Saunders. 1918. $4.25. 

West, (Mrs. Max) : Care of Children. (Pamphlet) Children's Bureau. Wash- 
ington, D. C. 

West, (Mrs. Max) : Prenatal Care. (Pamphlet) Children's Bureau. Washing- 
ton. 

Wharton, H. R.: Minor Surgery and Bandaging. Lea and Febiger. 1913. 
$2.00. 

Wheeler, Mary C. : Nursing Technique. Lippincott. 1918. $1.50. 

Whipple, G. M.: How to Study Effectually. Public School Pub. Co. 1916. 
$.50. 

White, W. A., M.D.: Outlines of Psychiatry. Nervous and Mental Disease 
Pub. Co. Washington, D. C. $3.00. 

White, W. A., M.D.: Principles of Mental Hygiene. Macmillan. 1917. 
$2.00. 

Wiedersheim: Comparative Anatomy. Macmillan. (Out of print.) 

Williams, J. W., M.D.: Obstetrics. Appleton. 1917. $2.00. 

Wilcox, R. W., M.D. : A Manual of Fever Nursing. Blakiston. 1908. $1.00. 

Wilson, J. C., M.D.: Fever Nursing. Lippincott. 1915. $1.50. 

Withington, Edward T.: Medical History from the Earliest Times. London. 
1894. 

Wood, F. C., M.D. : Chemical and Microscopical Diagnosis. Appleton. 1917. 
$5.50. 

Zinnser, Hans: Infection and Resistance. Macmillan. 1918. $4.25. 

Zangwill, Israel: The Melting Pot. Macmillan. 1914. $1.50. 



APPENDIX II 

Inexpensive and Free Bulletins, Pamphlets and Reports for use in teach- 
ing nurses, may be secured by writing to the following organizations, bureaus 
and firms. By explaining the purpose for which it is to be used, much of this 
literature can be secured in quantities for distribution. 

American Association for Conservation of Life, 1 Madison Avenue, New 

York City. 
American Association for Labor Legislation, 131 E. 23d Street, New York 

City. 
American Association of Societies for Organizing Charity, 105 East 22d Street, 

New York City. 
American Association for Study and Prevention of Infant Mortality, 1211 

Cathedral Street, Baltimore, Md. 

American Home Economics Association, Roland Park, Baltimore, Md. 
American Posture League, 1 Madison Avenue, New York City. 
American Public Health Association, 126 Massachusetts Avenue, Boston, 

Mass. 

American Red Cross, Washington, D. C. 

American Social Hygiene Association, 105 West 40th Street, New York City. 
American Society for Control of Cancer, 25 West 45th Street, New York City. 
American Medical Association, 525 North Dearborn Street, Chicago, 111. 
Association for Improving the Condition of the Poor, 105 East 22d Street, 

New York City. 

Association of Tuberculosis Clinics, 105 East 22d Street, New York City. 
Cornell University, Ithaca, N. Y. (Bulletins for Farmers' Wives.) 
Children's Bureau, Department of Labor, Washingon, D. C. (Pamphlets 

on Prenatal and Child Care, etc.) 
Departments of Health State and City. (Weekly, Monthly and Special 

Bulletins and Reports.) 

Fairchild Foster and Bro., New York City. (Diet Slips.) 
General Electric Company, Cleveland, Ohio. (Pamphlet on First Aid.) 
Health Education League, 18 Beacon Street, Boston, Mass. (24 popular 

pamphlets on Hygiene and Sanitation.) 

Housekeeping Experiment Station, 28 Hoyt Street, Stamford, Conn. (Pam- 
phlets on Efficiency and Household Management.) 
International Child Welfare League, 70 Fifth Avenue, New York City. 
Joint Committee on Prison Reform, 105 West 40th Street, New York City. 
Life Extension Institute, 25 West 45th Street, New York City. 
Massachusetts Society for Mental Hygiene, 15 Ashburton Place, Boston, 

Mass. 
Metropolitan Life Insurance Co., New York City. (Pamphlets on Hygiene, 

first aid, etc.) 
National Association for Study and Prevention of Tuberculosis, 105 East 

22d Street, New York City. 

167 



168 APPENDIX II 

National Child Labor Committee, 105 East 22d Street, New York City. 

National Child Welfare Exhibit Association, 70 Fifth Avenue, New York City. 

National Civic Federation, 1 Madison Avenue, New York City. 

National Committee on Mental Hygiene, 50 Union Square, New York City. 

National Committee for Prevention of Blindness, 130 East 22d Street, New 
York City. (Pamphlets and posters.) 

National Conference of Charities and Corrections, 315 Plymouth Court, 
Chicago, 111. 

National Consumers' League, 105 East 22d Street, New York City. 

National Organization of Public Health Nursing, 156 Fifth Avenue, New 
York City. 

National Housewives' League, 25 West 45th Street, New York City. 

New York Committee on the Prevention of Blindness, 105 East 22d Street, 
New York City. 

New York School of Philanthropy, 105 East 22d Street, New York City. 
(Pamphlets on Social Work.) 

Russell Sage Foundation, 130 East 22d Street, New York City. (Bulletins 
on Education and Social Welfare.) 

Rockefeller Foundation, 66th Street and Avenue A., New York City. (Bulle- 
tins on Medical Research.) 

Teachers College, Columbia University, New York City, (Technical Edu- 
cation Bulletins on Nutrition, Diet, Clothing, Etc., including "Anno- 
tated list of text and reference books for Training Schools for Nurses," 
and "Opportunities in the Field of Nursing.") 

U. S. Bureau of Education, Washington, D. C. (Bulletins on Education, 
Medical Inspection, Rural Problems, etc., including "Educational Status 
of Nursing.") 

U. S. Department of Agriculture, Washington, D. C. (Bulletins on Foods, 
Food Adulteration, Food Preparation, Household Pests, Disinfectants, 
etc.) 

U. S. Department of Labor, Washington, D. C. (Bulletins on Industrial 
Conditions, Safety, Industrial Poisons, Fatigue, etc.) 

U. S. Public Health Service, Washington, D. C. (Bulletins on Sanitation, 
Preventive Medicine, Infectious Diseases, etc.) 

See also list of firms supplying equipment and illustrative material. 



APPENDIX III 

Some Firms Supplying Equipment and Illustrative Material of Use in 
Schools of Nursing. Sample exhibits from commercial firms can sometimes 
be secured free if it is understood that they are to be used for educational 
purposes. 

American Red Cross, First Aid Dept., Washington, D. C. (Charts and First 

Aid Outfits.) 
American Social Hygiene Association. 105 W. 40th Street, New York City. 

(Series of colored posters on social hygiene. May be sent as loan exhibit 

on request.) 

American Posture League. 1 Madison Avenue, New York. (Charts on Pos- 
ture.) 

Arnold, E. J. and Son, Leeds, England. (Food Charts.) 
Baker and Company, 159 Franklin Street, New York. (Sample exhibit, 

cocoa and chocolate, crude materials and preparations.) 
Bausch and Lomb. Rochester, N. Y. (Microscopes, Lanterns, etc.) 
Berlin Photographic Company. New York. (Prints and Photographs.) 
Betz, Frank S. and Company. Hammond, Ind. (Hospital and Laboratory 

Supplies.) 

Bridgman, E.G. 86 Warren Street, New York. (Beef Chart.) 
Burnett, Joseph and Company. Boston, Mass. (Samples of vanilla bean 

and pamphlet.) 

Caxton School Supply Company, Chicago, 111. (Blackboards, Erasers, etc.) 
Chase, M. J. Pawtucket, R. I. (Hospital Doll or Model.) 
Colgate and Company. New York. (Samples of Soaps, Talcum Powders, 

etc., with Pamphlets.) 

Cosmos Picture Company. New York. (Inexpensive Prints.) 
Curtis and Cameron. Boston, Mass. (Copley Prints.) 
Educational Equipment Company, 70 Fifth Avenue, New York City. (School 

and College Outfitters.) 
Educational Exhibition Company. Providence, R. I. (Material for graphic 

presentation of facts.) 

Eimer and Amend. 205 3d Avenue, New York. (Laboratory Equipment.) 
First Aid Equipment Company. New York. (First Aid Outfits.) 
Coder, Heinman Company. Chicago, 111. (Charts and Models.) 
Hammond Attilliers. Chicago, 111. (Specimens, Skeletons, Models, etc.) 
Harvard Apparatus Company. Cambridge, Mass. (Scientific Laboratory 

Supplies.) 
Hecker Milling Company. New York. (Educational Exhibit of Flour and 

Cereals.) 

Huyler's. 64 Irving Place, New York. (Educational Exhibit Cocoa, Choco- 
late, etc., and Charts.) 
Johnson and Johnson. New Brunswick, N. J. (Surgical Materials, First 

Aid Cabinets with booklets on First Aid.) 

169 



170 APPENDIX III 

Knott Apparatus Company. Boston, Mass. (Bacteriological and Patho- 
logical Supplies.) 

Kny Scheerer Company. New York. (Hospital Supplies, Models, Skele- 
tons, Microscopes, Slides, and Laboratory Equipment.) 

Lippincott Company. Philadelphia, Pa. (Piersol Anatomical Charts.) 

Louis Company, O. T., 59th Street and 5th Avenue, New York. (Mannikins, 
Laboratory Equipment, etc.) 

Lowney's. Boston, Mass. (Educational Exhibit, Chocolate, Cocoa, etc.) 

Mclntosh Stereoptican Company. Chicago, 111. (Lantern Slides.) 

Museum of Natural History. New York. (Slides, Cultures, etc.) 

National Child Welfare Exhibit Association. 70 Fifth Avenue, New York 
City. (Series of 25 colored Posters on Baby Welfare.) 

Nystrom and Company. 623 South Wabash Avenue. Chicago, 111. (Charts, 
Skeletons, Models, etc. Agents for W. and A. K. Johnston's and the 
Frohse Charts.) 

Parke, Davis and Company. Detroit, Mich. (Drugs, Cabinets of Crude 
Drugs, etc.) 

Postum Cereal Company. Battle Creek, Mich. (Postum, Cereal Exhibit 
Free.) 

Proctor Gamble Company. Cincinnati, Ohio. (Laundry Materials. Sam- 
ples of Soaps, Starches, etc., and pamphlet on Laundering.) 

Royal Baking Powder Company. 135 William Street, New York. (Sam- 
ples showing composition of Baking Powder, Free.) 

Scientific Instrument Company. Chicago, 111. (Laboratory Supplies.) 

Sheldon, E. H., and Company. Muskegon, Mich. (Laboratory Tables for 
Cooking, Physics, Biology, Chemistry, etc.) 

Spencer Lens Company. Buffalo, N. Y. (Microscopes, Delineascopes.) 

Stickney and Poor Spice Company. Boston, Mass. (Sample Case of Spices.) 

U. S. Depart, of Agriculture. Washington, D. C. (Charts on Metric System, 
Food Composition and Values and Measuring Systems.) 

U. S. Public Health Service. Washington, D. C. (Stereopticon Loan Li- 
brary on Public Health Subjects.) 

Ward Natural Science Establishment. Rochester, N. Y. (Skeletons, Cul- 
tures, Slides, etc.) 

Washburn and Crosby. Minneapolis, Minn. (Samples of Food Stuffs. 
Free.) 

Whitcomb and Barrows. Huntington Chambers, Boston, Mass. (Food 
Charts.) 

Women's Home Companion. 381 Fourth Avenue, New York. (Baby Charts 
and Bulletins from Better Babies Bureau.) 

Worcester Salt Company. New York. (Salt Samples and booklet.) 



APPENDIX IV 

Physical Exercises 

A few suggestions for simple exercises which are designed especially to 
meet the needs of nurses. May be given early in the course in connection 
with classes in Hygiene or independently. 
General Exercise 

1. Take good standing position. Hands to shoulders, elbows 
bent. Extend arms slowly sideways and bend knees. Bring 
arms to shoulders and straighten knees. 

2. Standing erect. Hands on hips. Draw head slowly 
backward horizontally, keeping chin drawn in. 

3. Standing erect. Place hands on top of head. Stretch 
body upward as far as possible keeping heels on the floor; 
extend arms upward, then press arms slowly sideways down- 
ward to side of the body (hands facing floor) . 

4. Standing erect. Hands on hips. Bend trunk forward 
from hips, keeping the back flat. Do not curve the back. 

5. Standing erect. Arms extended sideways. Bend trunk 
to each side. 

(Exercise to be done from 8-10 times each.) 
Exercises for Posture and Walking 

1. Practice standing erect, as tall as possible without strain 
and without hollowing the back. Abdomen drawn in, waist 
muscles firm; head easily poised, and arms hanging freely at 
sides. Relax body then take position time after time, till 
habit of correct posture is established. 

2. Take posture as in 1. Raise arms slowly sideways to 
horizontal and raise heels. Chest high. 

3. Position as in 1. Hands on hips. Place one foot forward 
sway weight of body to forward foot, by lifting the backward 
heel. 

4. Position as in 1. Hands on hips. Sway body backward, 
forward, and to each side, keeping good posture. 

5. In walking let weight fall on the ball of the foot, turn 
toes straight ahead, and preserve spring. 

Breathing Exercises 

1. Standing. Arm raising sideways with deep inspiration. 
Return to first position with expiration (8-10 times.) 

2. Standing. Raise arms slowly forward upward, allowing 
hands to droop, keeping them close to the body, till extended 
above the head. Deep inspiration. Return to first position 
sinking slowly sideways. Expiration. (5-8 times.) 

3. Standing. Arms extended sideways. Rotate arms in 
large circles and breathe deeply. (8-10 times.) 

171 



172 APPENDIX IV 

4. Lie on the back' hands behind the neck knees slightly 
bent feet on floor. Practice taking long, deep breaths to 
establish a longer deeper rhythm. 
Exercises for Arms 

Sitting Erect. 

1. Arms extended upward, hands clenched. Draw arms 
slowly and forcibly downward, as though pulling heavy weight. 
Extend upward without force. 

2. Hands at shoulders. Push forcibly upward, as though 
lifting heavy weight, and return to first position without force. 

3. Hands at shoulders. Extend arms slowly and forcibly 
sideways. 

(Each exercise 5-10 times.) 
Exercises for Legs and Feet 

Position standing erect. 

1. Hands on hips. Heel raising. 

2. Hands on hips. Alternate heel raising and toe raising. 

3. Hands on hips. Bend knee upward to right angles with 
the body. Stand firmly on opposite foot. 

(Each exercise 10-15 times.) 

Position with feet parallel or slightly turned in. 

1. Raise on toes; bring heels to floor again rolling slightly 
on outer borders of feet. (10-20 times.) 

2. Roll feet on outer borders. (15-20 times.) 

3. Walk on outer borders of feet with toes turned in. 

4. Sitting. Raise arches by drawing toes toward heels, 
keeping both toes and heels on floor. (Valuable because it 
may be done indefinitely with shoes on. 

Exercises for Constipation 

1. Lie on back knees bent feet on floor. Draw knees to 
chest, making pressure on abdomen. Very slowly. (8-10 
times.) 

2. Lie on back' legs extended. Draw knees upward rolling 
toward right swing knees in circle across to left side, keeping the 
upper part of the body from turning, then extend legs slowly 
to first position. (5 times.) 

3. Sitting hands on hips. Bend body forward. Relax, 
then circl'j to each side. (8-10 times each side.) 



APPENDIX V 




Scheme Number 1 
Credit of 9 months. Period of training covers 2 years and 3 months (#7 months) 

Service or Department. Month. 

Preparatory 4 

Medical 5 

Surgical 5 

Children '3 

Maternity 3 

Operating room. 

Accident ward , . , , , . . , ,, 

^. , a choice of 3 months is given m any one of these _ 

Dispensary and . } 3 

,, f , . services 

Social Service or 

Visiting Nursing 

Night duty 2 

Vacation 2 

27 
Scheme Number 2 

Credit of 9 months. Period of training covers ffl months 

Preparatory 4 

Medical 4 

Surgical 4 

Children 4 

Maternity 2 

Contagious 3 

Mental 3 

Night Duty (to be included in above services) 

Opeiating room If 

Vacation If 

Dispensary (students to be sent to dispensary in last months of various 
services) 

27 
Scheme Number 8 

Credit of 8 months. Period of training covers 28 months 

Preparatory (including Diet School and surgical supply room) 4 

Medical (including contagious services and 1 month's night duty) 6 

173 



174 APPENDIX V 

Surgical (including operating room or accident ward, or surgical dispen- 
sary and 1 month's night duty) 5 

Children 4 

Maternity 3 

Social service or visiting nursing 2 

Mental 2 

Vacation 2 

28 

Scheme Number 4 
Credit of full calendar year. Period of training covers 2J+ months 

Preparatory 3 

Medical 4 

Surgical 4 

Children 3 

Maternity 3 

Operating room or surgical dispensary, choice of 1^ months ^ 

Social service or medical or children's dispensary, choice of 1 months. . / 

Night duty 2 

Vacation 2 

24 



APPENDIX VI 

Hour Schedules from Hospitals in which an Eight Hour Day 
is in Operation 

No. 1 8 hour day 

10 hour night 

Day, 7.30 a.m. to 9.30 p.m 14 hours to cover 

Night, 9.30 p.m. to 7.30 a.m 10 hours to cover 

Hours on duty 

a.m. p.m. 

7.30 4 

7.30-10.30 4-9.30 

7.30-1 4-7.30 

7.30-2.30 6-7.30 

7.30-12 4-8 

7.30-10.30 12.30-6 (occasionally) 

$ hour allowed for meals 
No. 2 8 hour ddy 

10 hour night 

Day, 7 a.m. to 9 p.m 14 hours to cover 

Night, 9 p.m. to 7 a.m 10 hours to cover 

Hours on duty 

a.m. p.m. 

7-9 1-7 

7-1 7-9 

7-1 5^-7 

7-11 3-7 

7-12 1-4 

7-12 5-6 off 7-9 

1 hour allowed for meals. 
^ day on Sunday and usually on holidays. 
No. 3 8-hour system. 

Day, 7 a.m. to 11 p.m 16 hours to cover 

Night, 11 p.m. to 7 a.m 8 hours to cover 

Large ward of 60 patients, some in private rooms. 



Hours on duty 
1 senior 


a.m. 

7 


p.m 
to 3 


1 intermediate 


7 


to 3 


1 intermediate 


7-12 


3-7 


1 Junior 


7-11 


4-7 


1 junior 
2 probationers 


7-1 
7-1 


5-7 
5-7 



At S p.m.. a senior head-nurse comes on with 2 junior assistants who work 
through until 11 p.m. 

175 



176 APPENDIX VI 

At 11 p.m. a night head-nurse comes on with 2 juniors who take the floor 

until the day nurses report. 

In operating rooms, diet kitchens and contagious wards the 
service is 10 hours with half-days. 
Half-days also are given weekly and Sundays. 
No. 4. 8-hour system three shifts 

Day, 7 a.m. to 3 p.m 8 hours to cover 

3. p.m. to 11 p.m 8 hours to cover 

11. p.m. to 7.a.m 8 hours to cover 

Hours on duty 

a.m.. p.m. 

7-1 4.30-7 

7-10.30 2-7 

7-2 5-7 

7 3.30 off for day. 

At 3 p.m. a night nurse comes on and stays until 11 p.m. 
At 11 p.m.. another night nurse comes on and stays until 7 a.m. 

From 7 a.m. a nurse may be on duty in accordance with needs 
and off from 12 midnight to 4 a.m. 

days off on holidays and Sundays. 

1 hour for meals. 
No. 5 8 hour day 

12 hour night. 

Day, 7 a.m. to 7 p.m 12 hours to cover 

Night, 7 p.m. to 7 a.m 12 hours to cover 

Ward. 30 beds. 

4 students 
Hours on duty 

a.m.. p.m. 

7-11 1-5 

7-12 4-7 

7-1 2-4 

7-1 5-7 



APPENDIX VII 

Suggested Basis of Credit for Nursing Schools 

A number of nursing schools are already connected with universities, and 
many more are planning their work more or less on the credit basis of the 
higher technical schools and colleges. Such a system makes it more possible 
for other educational institutions to interpret and accredit the work done in 
nursing schools and also provides a basis of comparison between the work of 
one nursing school and another. 

The system of credits used by most colleges and technical schools is on the 
basis of the term's work 1 a term representing a period of approximately 15 
weeks. For 1 hour of lecture or class per week during one term (or 15 hours), 
the student would receive 1 point or 1 credit. (This would presuppose 2 hours 
of outside preparation for every hour of class or lecture work.) About 2 to 
3 hours of laboratory or class-room practice is usually credited as equal to 1 
hour of regular class or lecture work. 

On this basis the theoretical work of the nursing school could be evaluated 
easily, the subjects covered in this curriculum amounting to about 36 points, 
or one college year of work. It is much more difficult to arrive at a satisfactory 
system of accrediting the practical work. Valuable as we feel this to be, we 
cannot claim that it is of such intensive educational value, hour for hour, as 
organized class or laboratory work which progresses steadily from one new 
project to another and which is under constant supervision and criticism by 
the teacher. 

It must be understood that the work of vocational schools, such as music 
or art schools, is not usually allowed full academic credit even in the most 
liberal colleges. The maximum of academic credit .which would probably be 
allowed for practical work of the type represented by nursing schools, would 
be at the rate of from 1 to 1J points per month. There is no accepted basis 
however for accrediting practical work. 

It is suggested that nursing schools with university affiliations should ar- 
range all their theoretical work on the credit basis. This would mean some 
adjustment of the course of study as outlined here. All 10-hour courses should 
be raised to 15 hours, so that they may qualify as 1-point courses; all 20-hour 
courses should be raised to 30 hours (or where laboratory work is included, to 
45 hours), to count as 2-point courses, etc. Examination periods would be in- 
eluded in the 15 or 30 hours. This increase would mean 6 hours of class and 
lecture work a week (after the first year), instead of 4 hours, which was con- 
sidered the minimum for the average school. Several schools are already 
working on this basis. 

Many universities refuse to credit any courses of less than 30 hours or 2 
points, hence it would be well where possible to combine two or more closely 
related short courses into one which would represent at least two points 
of credit. 

177 



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