guardians, to ascertain from the poor people what their sufferings can be. They won't complain until they are safe out of it and not coming back again."1

We have mentioned one London infirmary where pauper-nursing still survives; the same may be said of many others where the staff of paid nurses is insufficient for the number of patients. But if we include the country infirmaries the case becomes still worse. Almost all provincial infirmaries are nursed by paupers under the control-or not under the control -of one paid nurse, who is herself under the authority of the ignorant matron of the workhouse. The num

ber of nurses is wholly inadequate. Mr. Dolan states that at the Halifax Union Infirmary there is but one nurse to a hundred patients; and this is not an exceptional instance. In one populous town the infirmary consists of twenty wards, holding about 150 sick people. One matron manages the infirmary and the workhouse together. Under her are two paid nurses, assisted by pauper women, who are described as of more or less bad character, and commonly unable to read or write; and there is no paid supervision at night. To this institution all the incurables from the town and county hospital are sent to wear away their painful days in neglect and misery, dependent for every necessary help upon pauper nurses whose attention is directly proportionate to the amount of bribe they can get. One need not go far from London to find an instance of mismanagement in the sick wards of workhouses. In a rich suburb the patients are kept in the workhouse itself there is no separate infirmary-and there is not a single trained nurse in the establishment. Pauper women are selected for nursing by the matron, and all the pay they receive is some beer, and occasionally half-a-crown a week. The master 1 First Report, Association for Trained Nurses, p. 10.

observes that he can manage this sort of women much better than trained nurses, as they are wholly dependent upon his will, and his power over them is despotic. Each of these ig norant women has charge of a ward of from ten to fourteen patients, some suffering from acute complaints.

It is imperatively necessary that the public should take this matter into their own hands. If influential people would visit the infirmaries of their own unions and insist on the employment of trained nurses and the expulsion of pauper nurses, the evil would speedily disappear. If it be objected that trained nurses would add to the cost of the infirmaries it is not hard to expose the false economy of the objection. It is surely cheaper in the end to cure a patient and relieve the poor-rate of the charge for his maintenance and medicine, than to let him linger on at the public expense for want of duly qualified nursing. The expense of good nursing is a foolish argument. The difficulty of getting trained nurses is a much more serious obstacle. Mr. Holmes of St. George's complains of the difficulty of obtaining trained nurses for hospitals; the case is much stronger with respect to workhouse infirmaries, where the work is often very discouraging, the management inefficient and indifferent, and the staff inadequate. Good nurses have not hitherto been attracted to this class of work, though we are glad to learn that at length they are coming forward. But apart from the prejudice against nursing in workhouse infirmaries, there is the fact to be considered that the provision for training nurses is not equal to the demand for them. It is true that the last fifteen years have witnessed great improvements both in nursing and in training nurses. The Nightingale Fund School of St. Thomas's Hospital had the honour of beginning the reform, and the excellent Infirmary of Liverpool, now pro viding for 1,200 patients, was reformed in 1865 by Agnes Jones, a Nightingale

nurse, aided by twelve others from the same school. The new Highgate Central Sick Asylum was also placed under the control of a staff consisting entirely of Nightingale nurses in 1870, and an almost ideal degree of excellence was attained. The Liverpool Infirmary, and the great Infirmary at Crumpsall near Manchester, with its 1,400 beds, are not only admirably managed, but have undertaken to enlarge their useful work by training probationers. These institutions will furnish much of what is needed, but they cannot meet the large demand which a really satisfactory reform of workhouse nursing would make upon them. The low salary of the infirmary nurses (207. a year) is suitable for a class of women socially inferior to the ladies who would volunteer if the remuneration were higher. The women required have not as a rule the means of paying for their training-which costs from 107. a year at Crumpsall to about 307. in London hospitals-and some help from outside is necessary if the requisite number and quality of nurses are to be secured. Besides this, some organisation is needful both to scrutinise the management of the infirmaries and to bring the guardians and the trained nurses en rapport. The guardians ought to know where trained nurses are to be obtained, and then they would not be compelled to fall back upon the common material supplied by the workhouse itself.

With these two objects an association for promoting trained nursing in workhouse infirmaries has been recently organised under the presidency of her Royal Highness the Duchess of Teck, ever zealous for good works. This association places probationers, so far as its funds permit, at the infirmaries where nurses are trained, scatters nurses among the wards of the metropolitan infirmaries, and puts itself in communication with the Boards of Guardians, twenty of No. 261.-VOL. XLIV.

which have already applied for nurses. But the Association has another object which includes the rest. It is certain that although every effort should be made to put trained nurses in the place of untrained women, the work of the trained nurse can never be satisfactory until the matron is taken from a higher class. Whilst we provide for a properly trained and educated medical superintendent, we content ourselves with any old housekeeper as matron of the infirmary. An untrained nurse from the old sick wards of the workhouse sometimes finds favour in the guardians' eyes, and is chosen matron of the new infirmary, with the charge of several hundred sick people. Good nurses will not stay under a woman of this kind, who baulks their every endeavour for improvement. Bad nurses will become worse under such a matron. It is essential that the matron of a workhouse infirmary shall not only be a trained nurse, but also a lady of high moral influence, capable of raising the tone of the whole institution placed in her charge

such a lady as the late Miss Hill of Highgate, who made the Central Sick Asylum the despair of other institutions. The fine influence of a lady at the head of an infirmary has also been exemplified at Kensington, where a thorough change for the better has followed a good appointment. There can be no doubt that the first thing to be aimed at is to fill every matron's post, as it becomes vacant, with a highly educated, medically trained lady, who shall not act merely as the housekeeper of the institution (there is a matron's assistant who can fill that office), but shall be the controlling and purifying influence in the sick wards, the protector not the persecutor of the sick, the director not the accomplice of the nurses, and the cordial co-operator, not the opponent, of the medical officer. When a duly qualified lady is appointed to the head of each infirmary, the rest follows as a matter of course. A fit matron will

Q

only have fit nurses under her, and the pauper system will have received its death-blow. We do not doubt that there will be candidates for this important post. Few nobler fields of work are open to women than the care of the sick and distressed, and no one person can exercise a wider influence for good or ill among the poor than the matron of a workhouse infirmary. We are glad that the Local Government Board and many of the Boards of Guardians are disposed to cooperate with the new Association. No election of matron should henceforward take place without its advice; and guardians will do well to consider

its offer of trained nurses before the public takes it into its own hands to demand a thorough investigation into the conditions of nursing, not merely of the ten thousand sick who lie in the infirmary wards of London, but of the sick poor of all the kingdom. Let it be remembered that the present evils of workhouse nursing are not by law established-that a little inspection and representation would remove many of these evils and that the influence of a true lady at the head of each infirmary would probably meet every requirement.

STANLEY LANE-POOLE.