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doctor on his long rounds leaves during the visits which he is only able to make at rare intervals. The terror of helpless loneliness is added to the misery of a wasting disease.
From time to time in the past, efforts have been made in various places to secure a private nurse, and sufficient money has been raised to get one from England; but, as a rule, these attempts have failed, owing to the impossibility of making satisfactory investigations and engaging the nurse under a proper guarantee, or from other causes. The money once expended could not be replaced, and those who had tried in vain to make this provision were discouraged.
Such a condition of affairs as this prevailed in the Island of Mauritius when Mrs. Francis Piggott, whose husband is a distinguished member of the Colonial Service, went to live there. The crying evil that, in a colony where the well-to-do classes could afford to pay for the services of a trained nurse, there were no adequate means of nursing cases of serious illness, was brought forcibly home to her mind by the death of three young Englishmen on one plantation alone. In each case it was evident that, had proper care been available, there would have been every chance of recovery. Her own experience in going to the assistance of friends—a young officer whose wife was ill, and whose child was at death's door, while their only attendant was an ignorant native woman-still further convinced her that the time had come to make an organized effort to supply a deficiency which was fraught with such serious consequences to the lives of our fellow countrymen abroad.
She immediately began to gather information from Colonial Governors, medical officers, and others competent to give her advice in working out the problems with which she had decided to deal. By the time she came home, in 1895, she had already formed the basis of a scheme, and it only remained to enlist the sympathy and support of those who could help to make it successful. Mrs. Piggott's private friends did much to assist her at the outset, and it was not long before a fund of several hundred pounds was raised with which to begin work. But more than this was required. She felt that, in attempting to carry out an experiment of this kind, it was essential to success to have the moral support which the Colonial Office could give. Accordingly, while the scheme was still in its infancy, it was submitted to the authorities, who saw that the need which she described was great, and that there was much scope for useful work in the direction she proposed. They promised to do all in their power to assist her, and suggested some slight alterations calculated to make the plan more practicable. These were accepted, and in the summer of 1896 the first general meeting of the Colonial Nursing Association was held. Already it had begun its work; for, during the spring, Mauritius had benefited by the first contributions which Mrs. Piggott had received, and two private nurses had been sent out, their passages being paid and their salaries of £60 a year guaranteed by the Association. At this meeting it was announced that the Secretary of State for the Colonies had given his official recognition to the scheme by sending a circular despatch to all the Governors of the Crown colonies, inclosing the papers of the Colonial Nursing Association, and recommending it to their consideration.
This led to renewed interest in the subject of nursing within the colonies themselves. The Gold Coast voted money for the establishment of three trained nurses in the Government Hospital, and before the end of the year the Colonial Office applied to the Colonial Nursing Association to select them. Lagos, where there had already been two English nurses, asked for a third, and Sierra Leone soon followed this example. The Colonial Nursing Association thus received an impetus which has been of the utmost value to it; for, though its main object from the first has been to provide private trained nurses for the Crown colonies and British communities abroad, it is a great advantage to be called upon by the Colonial Office to recommend nurses for the various Government hospitals. It helps to give wider experience of the requirements of the different colonies, and may, in the future, pave the way for placing private nurses where they are most needed. On the other hand, the Colonial Office is relieved of the difficult task of interviewing and selecting nurses; and, as long as the Association exercises a wise discretion in the recommendations it makes, there is every reason to believe that this official co-operation with a private enterprise is likely to continue.
When the Association was originally started, Mrs. Piggott was fortunate in being able to interest H. R. H. the Princess Henry of Battenberg, who consented to become its Patron, while Lord Loch, whose experience in colonial affairs made him a most valuable acquisition, undertook to be its President. A small Com
mittee of Management, with Mrs. Piggott as Honorary Secretary, was the working body, and for three years this arrangement was not disturbed. These three years witnessed a great advance in the development of the work. Private nurses were applied for by many colonies, and the Colonial Office made further requests for hospital nurses. The increase of work made it necessary to enlarge the committee, and in 1899 more formal rules were adopted. The Association was inaugurated under the same President, with a Council, an Executive Committee, and honorary officers. The Executive Committee then appointed three sub-committees—the Colonial, Finance and Nursing Committees—which now deal with the details of the work that formerly devolved upon the Committee of Management, and leave the present Executive Committee free to devote itself to the larger questions of principle and administration.
Through the medium of the Colonial Committee, the Association is placed in communication with the colonies requiring nurses. It conducts the correspondence with the people interested in the project, induces them to form local committees to undertake the supervision of nurses and to raise funds, and is often able to stimulate them to make efforts in this direction, which would be impossible had they no assurance that the arrangements on this side would be satisfactory. Success in raising money varies with the resources of the different colonies, but when the Association is satisfied that all has been done which is possible under the circumstances it endeavors to meet the local committee by making a grant to it. Sometimes the committee on the spot undertakes to
pay the salary and maintenance of the nurse, while the Association pays her passage out or guarantees this last until it can be repaid by the colonists; sometimes, the colony is only able to provide the maintenance, and the rest of the cost falls on the Association; or else the Association binds itself to provide any deficit there may be, within certain limits. Each agreement differs a little from the other, and it is the aim of the Association to help people to help themselves, rather than to make it easy to receive such a boon as it gives without any personal sacrifice on the part of the recipients. At the same time, experience shows that when once a nurse is installed she soon wins her way to the gratitude of the residents, who discover the blessing of the trained care she can give; and the contrast to the former state of absolute helplessness
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is so great that they are much more ready to contribute to her support than when the proposal to do so is first suggested to them. Accordingly, when a new nurse is called for, the Association is encouraged to be as generous as its means will allow in making the arrangements for the first year.
A monthly column in a paper called Nursing Notes helps to make the Association known in the nursing world; but from the beginning there has been little difficulty in the supply of nurses, who apply, as a rule, on their own initiative. The candidates are interviewed before their names are taken, and there is now a long list on the books of the Association of nurses who may be called upon at short notice.
Whenever a vacancy or a new demand arises, the nurses available are sent for by the Nursing Committee, and the utmost care is taken to ascertain not only their professional qualifications, as to which a three years' certificate from one hospital and a midwife's certificate are required, but also their antecedents and everything which can bear upon their personal character, as this is a most important element for consideration before sending them so far away from the restraining influences of home. If it be possible to secure the advice of any lady from the colony who may happen to be in England at the time, she is invited by the committee to be present at the interview with the nurses, in order that full information may be given as to the climate and conditions of life in the place to which they are to be sent. When the appointment is for a Government hospital, the Association assumes no financial responsibility in regard to it. As soon as the nurse takes it up, she comes under the regulations for Government servants, and her salary and all expenses are paid by the colony in which she is employed. If, on the other hand, it is for a private nurse, she is obliged to sign an agreement to abide by the terms and regulations of the Colonial Nursing Association and to obey the rules of the local committee. These afford sufficient guarantees that in the event of her breaking her engagement without due cause, the Colonial Nursing Association will not suffer financial loss—a provision which the past experience of benevolent individuals who had occasionally attempted to get a nurse from England showed to be most necessary. The salary of these nurses is never less than £60 a year, and whether it is paid by the Association or the colonists depends on the particular arrangement which has been arrived at between the Colonial Nursing Association and the local committee. The selection of a nurse by the sub-committee is always subject to her being declared medically fit for the post to which she is going, and in order to insure that no woman shall be exposed to an unhealthy climate without the sanction of a medical officer who has experience of the tropics, the Association requires that she shall be examined by a doctor of their own choice. Dr. Patrick Manson, Medical Advisor of the Colonial Office, who examines all candidates for the Colonial Service, has kindly undertaken this task for the private nurses as well, and thus the Association is able to discharge a responsibility which it feels to be a great one, with full confidence that the nurses sent out under its auspices will not be submitted to physical risks which can be avoided. When the candidate is finally chosen, an allowance for her outfit is sometimes made, and the Association arranges for her passage out, a second-class ticket being provided. In some cases, through the liberality of the steamship companies, her fare is at a reduced rate.
It is a satisfactory sign that so many highly qualified women are ready and eager to take posts in unhealthy climates, under conditions so different to those to which they have been accustomed. How different can best be gauged by the accounts which they themselves send home. Letters from Nassau, Perak and Kwalor Lumpor in the Malay States, Mauritius, Ceylon, Lagos in the West Coast of Africa, Gebba and Lokoja in Nigeria, coming from private as well as hospital nurses, tell of the details of their work, and the obstacles which they encounter. For instance, the hospital nurses speak of their laborious efforts to train and make use of the native attendants, who, after long hours of patient teaching, are discovered manufacturing poultices with tepid water and applying them to the unfortunate patient at random; and of the hopelessness of instilling any lasting knowledge of the simplest processes into the native mind, so that constant supervision and unflagging vigilance are necessary. Cases of all kinds come to them, from the Englishman who has fallen a prey to the ravages of fever, to the poor young native woman whose husband had tried to murder her, and who lay for eight hours more dead than alive before she was brought into hospital to have her thirty wounds bound up and treated, and her fractured arm set. Her nurse writes: "I am very proud of her, as no one but myself has touched her since the