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JUL 29 15:0

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Professor of Medicine, Cornell University Medical College, and Attending Physician to the
New York Hospital

It is quite in accord with the traditions of this and every other well managed hospital, at such exercises as these, to take advantage of the opportunity to fire a last, parting shot at the graduating class of nurses with missiles heavily charged with good advice. It is argued that the range is so short, the target is so clear and all chances of escape are so completely shut off, that such a shot cannot fail to do great execution. I am sure that I should be accused of having failed entirely in my responsibilities at such a time if I should allow any natural kindness of heart to interfere with the carrying out of this solemn duty. I confess that the matter has seemed to me a little bit one sided. It might be only fair play, to invite some old and experienced nurse to address a graduating class of doctors. She could, I am sure, if she were not too polite, give much pertinent and useful advice to them as a result of her experience with the profession. But since neither you nor I can escape tonight, the attack I suppose must proceed, although I promise that it will be subject to all the rules and amenities of civilized warfare.

It may have occurred to some of you of the Graduating Class, on the threshold of your professional career, to wonder just exactly what your relationship is to be to

An address to the Graduating Class of Nurses of 1920, of the New York Hospital.

that great profession of Medicine with which you are to be so closely associated.

That relationship, as I conceive it, is something quite different from that of the old fashioned, untrained nurse whose functions were chiefly those of serving as a sort of maid to the sick. Your three years of training in the various departments of a great hospital and your systematic course of study in many of the subjects related to medicine gives to your diploma something of the nature of a university degree. You are now part of the profession of Medicine, bound by much the same obligations, and subject to the same rules of conduct and ethics.

It might be interesting, if it were possible, to analyze the various motives which have prompted you to undertake this three years of hard work of training as a nurse. Some few of you probably have been led to do so purely from humane and philanthropic motives, from an earnest desire and a determination to be of some real help to suffering humanity. Some few, perhaps, have done so with the idea that nursing will provide you with an interesting, or perhaps exciting, occupation and at the same time will enable you to live your own life, free from the narrow restrictions of the home circle. For the majority of you, probably, the choice has been made.

because it seemed to offer an honorable and dignified means of earning a decent livelihood. Whatever the motive, it may be well to remind you again that the bestowing upon you of a diploma as a graduate nurse not only gives you a certain desirable status, and endows you with certain privileges, but also lays upon you certain very distinct obligations-obligations which in many respects are comparable to those of the physician himself.

It is generally admitted, I think, that the profession of medicine has imposed upon itself, or has had imposed upon it, ethical standards higher than those of any profession except that of the clergy. And it is easy to see why this should be so. The very nature of a physician's work requires that he shall look upon it as something much more than merely a means of securing a livelihood. And these same standards, it seems to me, are imposed upon the graduate nurse. Her work must be inspired by something much finer and better than the mere desire to make a good living. It is that obligation that makes it incumbent upon her to respond to a call no matter how inconvenient it may be, to accept a case which may seem not in the least a desirable one and to remain at her station no matter how trying and disagreeable the work may be. It is that obligation that exacts of her a standard of conduct and bearing much more fastidious than would be demanded in ordinary business relationships. It is noblesse oblige.

You have all, I dare say, heard of the Hippocratic Oath, which for many generations and until recently all graduates in medicine were called upon to take in order to receive their degree; that creed or pledge of the medical profession which has been handed down from the father of medicineHippocrates. While certain parts of the oath are hardly applicable to the physician of the present time, other parts are still as pertinent and timely as they were 2500

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two passages which it seems to me apply with the same force to graduate nurses as to physicians. "Into whatsoever houses I enter I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief or harmfulness "and, whatever, in connection with my professional practice, or not in connection with it, I see or hear in the life of men, which ought not to be spoken abroad. I will not divulge, as reckoning that all such should be kept secret." I will go into such house "for the benefit of the sick "—not primarily for the purpose of earning a living, not in order to display before the family my understanding of the mysteries of medicine, not to assert my rights and privileges as a graduate nurse, but for the benefit of the sick. And whatever "I see or hear in the life of man, which ought not to be spoken abroad, I will not divulge, as reckoning that all such should be kept secret." When we, as physicians, and you, as nurses, enter a household in which there is serious illness we take the family, as it were, at an unfair advantage. In their anxiety to do the utmost for the patient they submit to an invasion of the intimacies of family life such as would not be tolerated under any other such circumstances. Moreover, under the strain of anxiety the behavior and bearing of the members of the family, as well as of the patient himself, may be quite different from what is usual and normal with them. And it needs. no argument to show that both the physician and nurse should scrupulously respect the privacy in which they are of necessity made to share. Even the Law recognizes that the relation of the physician. to his patient is confidential and sacred, and the relation of the nurse is, it seems to me, no less so.

If we turn now for a moment to a con

sideration of the qualities which go to make a skilful and successful nurse we shall find that some of the most important of these

in the doctor himself. Apart from the question of adequate professional training and experience, these qualities include character, good judgment, sympathy, poise and tact. Character, which enables the doctor or the nurse to win the confidence of the patient and to deserve that confidence; judgment, which is only another name for common sense; sympathy, which enables one to put himself in the place of the patient and to get his point of view; poise, which means self control and balance and steadfastness in emergency; and tact, that rarest and most precious of all jewels.

The help which the nurse can render to the physician is not limited to the mere carrying out of his orders or the ministering to the physical needs of the patient. An appreciation of the mental and moral factors in the problem is often of the utmost importance. She is frequently better able to understand what these factors are than is the doctor himself and sometimes is better able to deal with them. Very often the most important part of the treatment is that of influencing the patient's mind. Encouragement, reassurance and a cheerful, hopeful atmosphere may be the chief ther

apeutic agents and upon their skilful administration by the nurse. may depend much of the success of treatment. And sick people are often wonderfully quick to receive impressions; a look, a chance remark, may bring depression and gloom, or fortify a patient with fresh hope and encouragement. In your work thus far in the hospital wards you have had little opportunity to develop this important part of a nurse's equipment. To some of you it has doubtless come as a natural endowment, but for many it is something that must be gained by slow and patient effort. A knowledge of psychological values, however, you must acquire if you hope for success with private patients.

You will need a full complement of enthusiasm in your work, for the demands upon your physical endurance, your patience, your self restraint, and upon your optimism will be constant and severe. In that work it should fortify you to feel that you have won and possess membership in that great fraternity of men and women who are graduates of the New York Hospital.

Red Cross Makes Medical Survey of Haiti

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to fight social diseases, hookworm, malaria and laws, to establish anti-tuberculosis measures and to teach personal hygiene. There is every opportunity for the pioneer in all fields of philanthropic endeavor."

For the past four years the United States has taken an intimate interest in the affairs of the island. Under the administration of the Navy and the Marine Corps revolutions. have been prevented and the activities of bandits held in check. Roads, telegraph and telephone lines, and schools are being established. Public philanthropic measures on the other hand are greatly needed.


A Constructive Work for Civilian Cripples


UCH has been said and considerable done for the disabled war hero. Comparatively little has been said and still less done for the disabled civilian. The man injured in industry or disabled by disease is an unheroic figure, frequently uninteresting. Because he is prosaic and still more because his number is very great, is his need pressing.

Our disabled soldiers are counted by tens of thousands, and we are spending millions upon them. This is right. We owe it to them. Our industrial cripples number hundreds of thousands. The number of industrial accident cases each year, counting only those in which the worker is laid up for a month or more, amounts to 700,000. This does not include the victims of industrial or occupational disease. The little that we are spending upon them does not make a dent" on the resources of the country, yet it is producing results that are inestimable. Why not have more of it?

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In New York City, Cleveland, Milwaukee, St. Louis and Cinncinnati, definite work is being undertaken for the handicapped civilian and real results are being obtained. Boston and Chicago are also starting similar work. All of these organizations make some endeavor to teach occupations to men who need them and can be induced to take some training. All endeavor to find jobs for disabled men, and all of them work earnestly toward a real and complete rehabilitation of the handicapped. In New York quite a large part of the work is done through the Hospital Social Service Exchange, 405 Lexington Avenue, whose employment bureau alone last year placed about 1,400 men in industry. They include in their work cardiac and tubercular cases, as well as the more obvious physical disabilities.

Men, of New York City, has arrived at the mature age of three years. It was founded in May, 1917, by Mr. Jeremiah Milbank, who gave the use of a building in the heart of the city, corner Twenty-third Street and Fourth Avenue, New York City, and a $50,000 endowment. It bore the name of the American Red Cross until October, 1919. It is now a private corporation. Mr. Douglas McMurtie, well known as an authority on cripples, was until recently its director, and is still on its board.


The original design of the Institute was to help work out the problem of the disabled soldier, which was temporary, but acute and spectacular; and its plan was through this to find a solution for the problem of the disabled civilian, whom we have always with In actual fact, the Government asked for and received from the Institute much advice and help for the war cripple, but the work at the Institute has been and still is primarily for the civilian. At the present time there are about two thousand men and boys on its lists, ranging in age from 15 to 80 years old. There is among them a sprinkling of ex-service men.

The educational department is an essential feature of the Institute. It has been found in every country that while a large proportion of men who were badly disabled could go back to their former jobs or make some simple readjustment, a certain number needed special help or even re-training. The Institute has therefore selected, one by one, occupations which appeared suited to certain types of cripples, and has begun to teach them. "The first consideration in training a cripple who has been a wageearner is to put him back as soon as possible upon the payroll. Thorough trade training is out of the question because of his economic necessity and his adult attitude to

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