the better care and good moral results attendant upon the presence of women nurses.

It is doubtful whether the employment of women will effect a greater economy. For the head nurses must be graduates of the very best type and ought to command as good wages as men. It is quite likely that the employment of these head nurses and their assistants together with the necessary orderlies will bring the cost of ward management up to as high a figure as if there were only men attendants. Motives of economy should not lead us to staff men's wards with women nurses, but rather the desire for a better service independent of the pecuniary item.

Neither do I have any sympathy with the attempt to decry the hospital idea on the ground that it is a mere passing fad. If anything has been established by the experience of the last few years it is the fact that insanity is disease. As far as is practicable insanity should be managed like any other disease. Wherever and whenever it is possible patients thus afflicted should be accorded the same skilful care and kindly nursing that is accorded any ailment. The hospital treatment of insanity is not a fad, and that the nursing of this disease should proceed as far as is possible on the lines of the hospital nursing of general sickness is to my mind an evidence of our better understanding of the real character of mental alienation.

The idea that the employment of women nurses on wards for men will discourage desirable male attendants from seeking these positions, and that as a result the character of the latter will deteriorate, will not in my estimation hold true in the United States. As previously mentioned, good male attendants are none too common in this country. It is because too few really good men are attracted into this service that good trained women nurses are desired. Experience has already demonstrated that trained women nurses on the male wards not only leads to better care of the patients, but that their presence has been a positive benefit to the men attendants themselves. Unless I am very greatly mistaken, an intelligent women-nursing staff on selected male wards will result in a better morale among the male attendants and a greatly improved condition in the patients.

My own personal experience has thus far extended to the employment of women in the convalescent building, the hospital

ward and the summer cottage occupied by quiet, intelligent male patients of the chronic class. The results have been so gratifying that an extension of this service seems not only feasible but eminently desirable along the lines suggested in the earlier pages of this paper. The subject is not new. Many institutions have for some years had men's wards staffed with women. Still the employment of women nurses on wards for men has not by any means become general. The institutions adopting this system of nursing are the exception. Has not general experience demonstrated its practicability and has not the time arrived when it is desirable that every well appointed hospital for the insane should have certain wards for its men patients staffed with women nurses?

In conclusion I must repeat that when women nurses are placed on wards for men, I believe that they should occupy not a subordinate position. They should have charge of the ward and its management, the medical officer should give his orders to the head nurse, and she and her assistant nurses should be held responsible for their execution. The selection of these nurses is important. Not every woman is fitted for these places. Only such nurses as are thoroughly imbued with the hospital spirit, are dignified and possessed of superior judgment, tact and nursing qualifications should be selected for these important positions. With judicious selection of the proper individuals I feel that the employment of women nurses on the sick wards, the admission wards and the convalescent wards, will be attended with the very best results, and the extension of the service to wards for quiet chronic and only partially demented men, while not so sure of success, is certainly worthy of trial.

THE MALE NURSE.'

BY GEORGE T. TUTTLE, M. D.,

Medical Superintendent McLean Hospital, Waverley, Mass.

Men are employed in the care of the sick-in general hospitals chiefly as servants of the women nurses, in hospitals for the insane as attendants or nurses for the men patients, and in private families for certain cases. Is there a need for such service? Is it satisfactory? If not, what can be done to improve it?

There is no question that men are needed in the care of the sick in general hospitals, to move patients from place to place, e. g., to and from the operating-room, to give baths to men for cleanliness or for therapeutic purposes, to assist them in the use of urinals and bed-pans, to give enemata, to prepare them for certain operations, to change certain dressings, in exceptional instances to pass the catheter and wash out the bladder, and for other like service which is more properly rendered by a man than by a young woman.

There would also seem to be a similar need for his services occasionally in the care of those sick of acute general diseases in their homes when strength is required-of old men who are partially helpless, of genito-urinary cases, of active delirium, and especially of insanity. The home treatment of the insane has increased considerably in the last 15 or 20 years, and there probably would be a still greater demand for men nurses for this work if an adequate, a satisfactory and not too expensive supply were available.

In hospitals for the insane there is an increasing tendency to employ women nurses in the men's wards. There is no doubt that this can be done more extensively than has been the custom heretofore except in a few hospitals, perhaps to the greatest advantage in reception wards, in those for the physically sick and infirm, and for the convalescent. The benefits of such service are many and some can scarcely be over-estimated. Among them

Read at the sixty-second annual meeting of the American MedicoPsychological Association, Boston, Mass., June 12-15, 1906.

are the better and more attractive serving of food; the making of special articles of diet for the sick; economy of hospital property; better housekeeping generally and a more domestic atmosphere to the wards which contributes to comfort and contentment; the entertainment of patients; the more careful supervision of their clothing; the prevention of a tendency to degeneration in dress, conduct and conversation which is certain to result when men are associated without the presence of women; the more natural fitness of women for nursing because of their motherly instinct and their readiness to respond to the appeal of sickness and suffering; the giving a greater prominence to the hospital idea and the corresponding lessening of the custodial feature of hospital life; the tendency to prevent harsh treatment of patients; the reassuring effect on the friends of patients, and the tendency to lessen the distrust and prejudice which the public has toward hospitals for the insane. The employment of women also offers a partial solution of the problem of securing an adequate number of satisfactory men for nurses in these hospitals.

The argument that modesty would forbid placing an infirmary ward in the charge of women might be made with nearly equal fairness against the nursing of men by women under any conditions. The nurse learns things and has experiences in her vocation, from which young women in ordinary life are most carefully shielded, but she should not be subjected to the ordeal of trying to care for the highly excited and wholly irresponsible; certain erotic patients; the very untidy, who require frequent tub baths and changes of clothing; or the more intelligent but actively suicidal men who must be under constant observation, especially while bathing; neither is it fitting that she should be the nurse or companion of those patients who engage much in out-of-door games or who take frequent excursions from the hospitals, sometimes of several days or weeks duration; nor can she take charge of working patients. It is more appropriate for women to direct and nurse men sick of bodily disease, confined to the bed, who are to be under their care but a short time, than to live intimately associated with, and to have the sole direction and personal care of, men who are physically well, who stay in the hospital a long time, perhaps the remainder of their lives, and who need only a judicious direction of their conduct rather than