The scheme for a Territorial nursing service was taken up with enthusiasm both by matrons and nurses, and when war broke out in 1914, and the nurses were called up along with the Territorial Force, the staffs of the hospitals were in their places as soon as the hospitals were ready to receive them, i.e. within ten days. The scheme provided for each hospital having 520 beds, and 2,783 nurses were required, but it was not long before it became evident that the number would have to be increased. After nine months of the war the original staff had to be increased to 4,000, and by the end of the war 8,140 had been enrolled, of whom 2,280 served abroad. In order to supplement the trained staff " assistant nurses " holding certificates of special training (fever, etc.) were brought in, as well as members of Voluntary Aid Detachments (see RED CROSS). Trained nurses were dispersed throughout the hospitals where they were most needed, and two V.A.D. members replaced each trained nurse taken away. For the future the general hospitals will be much larger than before, and there will be units ready to proceed abroad requiring nursing staffs (casualty clearing stations, hospital ships, etc.). The total number required for foreign service will probably be about 4,000. The system of giving short training in military hospitals during peace-time will be further developed.
Queen Alexandra's Royal Naval Nursing Service. This service is not a large one, being composed of three head sisters, seven super- intending and 65 nursing sisters, all ranking as officers and taking a position immediately after the surgeons. There is also a reserve carried on through the civil hospitals which are asked to guarantee a number of nurses who will be available on the outbreak of war. The number recruited is 250. The nursing sisters are assisted in the wards by stewards and attendants of the sick-berth staff, and they give them what instruction in nursing is necessary. The latter serve on board ship. The duties of the sisters are limited to the hospitals to which they are attached, but they may be transferred to other naval hospitals at home or abroad as well as, in exceptional cases, to hospital-ships. It may be mentioned that there is not much opportunity for male nurses (excepting mental nurses and masseurs) obtaining training unless they get it through the services. It may, however, be also obtained through the National Hospital for the Paralysed and Epileptics.
Royal Air Force Nursing Service. This service was established in Jan. 1921, and consists of a matron-in-chief, matrons, senior sister, sisters and staff nurses. A certificate of training for at least three years in a large civil hospital is required from candidates. Members must be over 25 and under 35 on entry and they may retire at 50: retirement is compulsory at 55. (E. S. H.)
United States
Increased interest in preventing disease and promoting health; the war; the influenza epidemics; the organized efforts of the nurses themselves; all contributed to the rapid development of nursing in the United States in the years 1910–21. The number of trained nurses has greatly increased; they have done good service in positions of many new kinds; standards of train- ing have been raised and opportunities multiplied.
By 1920 about 1,600 accredited training schools were connected with hospitals, with an annual enrolment of 40-50,000 ; and at least 120,000 “registered” nurses were entitled by the registration laws of their states to use the designation “R.N.” The usual educational requirement for admission to training in 1921 was one year of high school or its equivalent. To encourage preparation by more mature and better educated girls many universities (beginning with the university of Minnesota in 1909) established schools of nursing as part of their curriculum, and there were in 1920 ten which offered to high school graduates a five-year course combining work for the Bachelor's degree with specific training in nursing.
Trained nurses were classified in 1920 according to the kind of work done by them in three groups: (i) those who attended private pa- tients; (2) those attached to hospitals and other institutions, for service to the patients in the institution; and (3) "public health nurses." While no exact statistics were available, it was obvious that all three groups had increased in numbers and had shared in the rising standards and growing prestige of the profession. The services of a private nurse were no longer regarded as a luxury, but were more and more recognized as a necessity in serious illness among families of moderate means. The surprising growth of provision for the sick in hospitals greatly increased the number of positions for nurses in institutions ; while differentiation and specialization among hospitals, together with advances in methods of treatment, created specialized positions for nurses in connexion with X-ray work, electrotherapy, hydrotherapy, massage, anaesthetization, occupational therapy, men- tal illness, tuberculosis, the care of children, and other classes of patients for whom differentiated institutional provision was made. It is the third group, however, which especially demands considera- tion, because of the novelty of much of its work, and because of its vitality and promise of further extension.
The term ' public health nursing " covers all the forms of nursing by which social action endeavours to promote health whether such work by nurses is undertaken by a private society or settlement, a hospital
or clinic, or the Board of Health or Board of Education or other pub- lic authority. It may thus be supported by public funds or by pri- vate contributions, and some part of its cost is defrayed by fees from patients. It includes actual care of the sick, but is more gen- erally an educational and preventive service, extending to members of the patient's family and designed to improve their general health. It includes the sub-divisions summarized below which deal with services of no little importance.
District, or visiting nursing, which provides service for the sick in their homes, is the oldest form, dating from 1877 in New York City. Most charitable organizations of importance now have one or more nurses attached to their staff. The visiting nursing associations usu- ally charge a fee, according to the circumstances of the patient, based on the cost of the service (in 1921 50 cents or Sr.oo a visit).
Industrial nursing provided for employees of manufacturing and commercial establishments was introduced in the last decade of the igth century; it commended itself by its results and was stimulated by the workmen's compensation legislation, which indirectly puts a premium on safety and health-promoting conditions. In recent years one or more nurses have come to be regarded as an essential element in the staff of a well-organized factory or business which employs many persons ; there is every reason to expect that this serv- ice will become more and more common. It is still far from stand- ardized, being in some places limited to first-aid during working hours ; in others extended to a complete visiting nursing system both for employees and for their families. In 1920 it was estimated that there were about 1,320 industrial nurses, employed by mills, fac- tories, department stores, hotels, laundries, mining operators, insur- ance companies, and banks.
Nursing service for policy-holders was instituted as an experiment in 1909 by the Metropolitan Life Insurance Company of New York, and rapidly extended to cover all its millions of industrial policy- holders. This service usually is provided by arrangement with exist- ing organizations, the Company paying for the cost of the visits made on its behalf. In 1918, after the system had been in operation nine years, a careful statistical study was made, which convinced the officers of the Company that the innovation had been a marked fac- tor in the decrease of mortality among policy-holders and had more than paid for itself.
Public school nursing, beginning with an experiment in New York City in 1903, had become by 1920 common in the large cities, some- times under the educational, sometimes under the health authorities.
A plan for providing visiting nurses for rural districts was made by the American Red Cross in 1012, and there were some 1,300 nurses engaged in this kind of work in 1920.
Other specialties in public health nursing were the care of tuber- culosis patients at home, pre-natal and maternity work, child wel- fare and infant welfare, work with mental disorders, with venereal disease and in connexion with the bureaus of communicable and contagious disease in departments of health. The special nurse for tuberculosis, appearing with the anti-tuberculosis movement early in the present century, is coming to be the general guardian of the health of all members of the household into which she goes, and this is more or less true of other specialized visiting nurses. The develop- ment of public health nursing has been rapid, the number of nurses so engaged having increased from 130 in 1890, to 1,413 in 1909, to 6,019 in : 9 T 6 and to 11,000 in 1921, an increase out of proportion to that of population.
Nurses have three professional organizations of national scope: the American Nurses' Association, with a membership of 45,000; the National League of Nursing Education, including about 1,200 of the teachers and educational leaders in the profession; and the National Organization for Public Health Nursing, organized in 1912 to assist in the development of public health nursing, especially along the lines of education and legislation ; to this lay members are eligible as well as nurses, and it has a membership of over 7,500. These organizations have had a large part in arousing public interest, in securing registration laws, in increasing and improving opportunities for training, and otherwise raising and maintaining the standards of the profession. (X.)
Bibliography. M. Adelaide Nutting and Lavinia L. Dock, A History of Nursing (2 vols., 1907) ; the same edited and part written by Lavinia L. Dock in 4 vols., 1921; Lavinia L. Dock in collaboration with Isabel M. Stewart, A Short History of Nursing (1 vol., 1920) ; Sarah Tooley, History of Nursing in the British Empire (1906) ; Sir Henry Burdett, The Nursing Profession (1915) ; “Queen Alexandra's Imperial Military Nursing Service,” an address by the chairman, Surgeon-General W. Taylor, Director-General A.M.S., on the history of the Army Nursing Service, delivered at the first meeting of the Nursing Board, April 21 1902; Queen Alexandra's Imperial Military Nursing Service “Nursing in the Army,” reprinted from the British Medical Journal (April 1905) ; Sidney Browne, The Science and Art of Nursing (4 vols., vol. 1 “Army Nursing”). (E. S. H.)
NYASALAND PROTECTORATE (see 4.595.)—The pop. at the 1911 census was: natives 969,183, Europeans 766, Asiatics 481. In March 1920 Europeans numbered 1,015 and Asiatics 515. The natives were estimated (1919) at 561,600 males and 664,400
