on properly the medical work of a hospital, with perhaps one exception in the four hospitals. Now, and for perhaps ten years past, I have been in the habit of saying that the one almshouse hospital which remains, at Tewksbury, is the best I have ever seen. The principle which Mrs. Lincoln lays down has been acted on for ten years in Massachusetts in that Tewksbury hospital; for it is no longer called an almshouse, but a state hospital. It is not a mere vestibule to death and vice, but an admirable hospital.

In medicine, as in many other things, the great vice is exclusion. If you begin by exclusion, there is no knowing where you will stop. The peculiarity of the Tewksbury hospital is that it cannot exclude any class of patients. The general hospitals exclude certain diseases, and most hospitals receive only certain kinds of patients; but the state hospital excludes no one. It has been obliged to receive all kinds for the thirty-eight years that I have known it, has received every disease which ever appeared in Massachusetts, not excepting leprosy; for we have had several cases of leprosy there. If you will consider what that signifies to the medical profession and the training of nurses, you will see how important it is that their training should go on where no disease is excluded. Insanity is treated there, in separate buildings, to be sure; but, when the patients become ill with other diseases, they are transferred to the general hospital. I think we now treat between two and three thousand patients yearly in this hospital. You can see what an opportunity for the study of nursing that gives.

I will digress, to speak of an interesting subject wherein a long memory enables me to narrate a fact exceedingly curious, but little known. District nursing had its origin and inception entirely with one person, Miss Florence Nightingale. It did not exist before her time; nor would it have existed, if she had not been precisely the person she was. She is still living, an old lady, as you know, and has never visited this country. But, at a critical moment in her life, when she was deciding what she should do with her future, she consulted an American, my old friend Dr. S. G. Howe, who was in England at that time; and, apparently guided by his opinion, she went to Germany, and took the training which qualified her for nursing, and which enabled her to make that great impression on the British nation. Mrs. Howe, who is still living, refreshed my mind about this story not long ago. In 1843 she and her husband were visiting in England, and were invited to a country house where Miss Nightingale was also visiting a relative of their hostess,-Dr. Howe was an early riser; and, while the other guests were preparing for breakfast, the doctor had the habit of going into the garden of this country house strolling about and meditating. Miss Nightingale seems to have had the same custom; for, as Dr. Howe was walking along the alleys one morning, she met him, and introduced her subject. She said, "Dr. Howe, you have had a good deal of expe

rience," she knew his remarkable career,- "and I would like to ask you whether you think it is incompatible with my position as an English lady to learn the profession of nursing?" Dr. Howe said: "By no means incompatible. There is no reason in the world why you should derogate from your position by learning the business of caring for the sick and unfortunate. It is the noblest work that any one can do, and no one is better qualified for it than an English lady." She appeared relieved in her mind, because, it seems, her relatives had been telling her it was out of the question for her to undertake such a work. Soon afterward she did go to Germany, and qualified herself; and, when the Crimean War came on, nearly ten years later, she became illustrious therein. And from that time hospital nursing and district nursing have gone on everywhere. So that New England, even Boston, may claim some share in setting Florence Nightingale on her providential course.

Another old fact might be mentioned to show how things established without any forethought of the future may lead to important results. In 1865, finding that our almshouse hospitals were not all they should be, we also thought it often a great hardship to have very sick persons transported from distant parts of Massachusetts to the hospitals,-a law was passed providing for the care of certain persons, those with contagious diseases, or who for any other reason could not well be removed in their own towns and even their own homes. This began at first very moderately, but presently, on a larger scale, this system of medical outdoor relief was carried on by the state; and out of it has grown, in one way and another, the interest now taken in Massachusetts in this business of district nursing.

When our committee was discussing the matter of concentrating the supervision of charities in a single board for a whole state, I was reminded of this fact. Out of the comparison, the friction, and even the conflict, of two of our boards in Massachusetts, a better system has been produced than can be expected of the best men and women you can find if put on a single board. It is only by comparison of views that you can reach the best administration of charity in any branch. I am therefore fundamentally opposed to the concentration of power in a single board. Better too many

boards than too few.

Dr. ROBERT W. HILL, New York. There has been a special development of the almshouse hospital outside of the great cities. This development is of interest as an illustration of the tendency of the times. We have reason to expect that in large cities all public charities will keep pace with modern ideas, for in the cities large funds are available for use in improvement. Even when people are slow to tax themselves, philanthropists are to be found ready to supplement public efforts with their private benefactions. Hence we may reasonably expect all large cities to follow the lead of New York, Buffalo, and Boston in equipping the public hospitals thoroughly for

efficient work in the care of the sick poor. Outside of the great cities, however, the people are compelled to depend entirely upon public funds for all improvements, and progress is slower. In spite of this we find in the rural districts of the State of New York, where the almshouses are comparatively small, that the necessity of a hospital in a separate building, as a part of the almshouse group, is being generally recognized. About 30 per cent. of all the almshouses in the state have now a separate well-equipped hospital for the care of the sick. Within the past three years the movement for these almshouse hospitals has made rapid progress. In a number of the smaller counties, where the total number of inmates seldom reaches one hundred, the supervisors have made provision of this kind. In all the new almshouses lately erected, the special care of the sick has been provided for; and these small hospitals have been put in charge of trained nurses, under the supervision of the physicians who regularly visit the institutions and minister to the sick. The same tendency has shown itself in the second-class cities; for Albany, Utica, and Syracuse have added hospitals to their relief agencies for the sick poor. Their almshouses have equipped within a year new and commodious buildings for the exclusive use of the sick among the inmates. They have the conveniences, the attendants, the sanitary arrangements, and the space essential to the proper care of the sick. Above all, these hospitals assure the desirable and necessary separation of the sick and helpless from the ordinary inmates of the almshouse.

Under the system now so rapidly passing away, the sick were cared for in the general dormitories of the almshouse, to the great discomfort of all. The patients were more or less neglected because compelled to depend upon the ordinary attendants and other inmates. The atmosphere was poisoned with foul odors, and disease thrived in consequence among all the inmates. Under this new system more humane treatment is given to the sick. The attendants are trained, and have no other duties than those connected with the hospital. The patients are never left dependent upon inmates for the little attentions which are so grateful to the sick. The wards are ventilated; and the whole atmosphere is that of a true hospital, where the one consideration is the proper care of the sick. I have said that the small almshouse hospital in the rural districts marks the present tendency, and there is no doubt this movement will continue until every almshouse is properly equipped to take care of the sick; for behind this tendency is a sense of public responsibility which will not be satisfied with anything short of humane methods and ample provision for the care of this and other classes of public dependants. The cities may lead, but the rural districts must follow. The public conscience is awake and responsive to all the proper demands of humanitarians, and nowhere is it to-day so thoroughly responsive as in the great State of New York.

Mr. C. L. STONAKER, Colorado. The almshouse idea will be pretty well ventilated at the next Conference. I am strongly of the idea that the almshouse should be improved. The old idea should be abandoned, and it should become in every community a hospital for the care of the sick. The almshouse should no longer be simply a place for the segregation of any class that we do not like to have about us.

Mrs. Lincoln thanked all who had taken part in the discussion, and the Conference adjourned at 12 M.

LAST GENERAL SESSION.

Tuesday night, June 3.

The last session of the Conference was called to order at 8 P.M. by the President. Prayer was offered by the Rev. Reed Stuart, pastor of the Unitarian society of Detroit. After the singing of a solo from the "Messiah," "Come unto me, all ye that are heavy laden," the report of the Committee on the Treatment of the Criminal, by Judge John W. Willis, of St. Paul, was read in his absence by Mr. James Leonard, of Mansfield, Ohio, a member of the committee (page 315.)

The following resolutions were read by Mr. A. W. Butler, of the Committee on Resolutions:

Resolved, That this Conference renews the hope expressed at the Washington Conference last year that the new United States prison at Atlanta, Ga., may be organized and administered in accordance with reformatory principles, and that character and fitness only shall be considered in the appointment of officers.

The Secretary is directed to transmit a copy of this resolution to the President of the United States.

Resolved, That the thanks of this Conference be voted to Rt. Rev. John Lancaster Spaulding, of Peoria, Ill., for his powerful Conference sermon, presenting so fully, clearly, and forcefully existing anti-social conditions, their causes and recognized means of prevention.

At the close of this most successful Conference in this beautiful city it is fitting that we should formally record our appreciation and express our gratitude for the favors we have received and the hospitality we have enjoyed.

Therefore be it Resolved, That the thanks of the Conference are hereby tendered to his Excellency the Governor of Michigan and to his Honor the Mayor of Detroit for the cordial welcome accorded us by each; to the excellent local committees, including the ladies' auxiliary committees and the organizations they represent, and particularly Mrs. Stephen Baldwin, their efficient chairman, for such

complete arrangements for the proper work of the Conference and for provision in many ways for our entertainment; to those persons who have favored us with such excellent and appropriate music; to the pastor and officers of the Central Methodist Church for the use of its building as a place of meeting; to the Wayne County Home and Asylum, the Detroit House of Correction, the Insane Asylum at Pontiac, the Children's Free Hospital, the Detroit Police Commissioners, and to all other local institutions for their hospitality; to the railroads for special rates, the hotels, the press, the high school band, the faithful ushers, and to all organizations and individuals who have contributed to the success of this meeting and to our personal pleasure.

F. B. SANBORN.—It has not been my good fortune to be present at all the sessions of this Conference, but I can heartily subscribe to all that has been said in the resolution of thanks. I am much struck with the progress of Detroit since our Second Conference was held here in 1875. This progress is seen not only in its material aspects, which are visible to every eye, but in the extension of the civilizing influences which must go forth from any modern city which lives according to the principles of Christianity and civilization.

I have been particularly impressed during this Conference with the new subjects and novel mode of presenting them exhibited here, and I want to express my particular obligation to the Detroit lady who spoke this morning on the interesting subject of district nursing. I think Detroit, the Conference, and all of us have reason to be proud of a city which can establish an institution so interesting and have its scheme of action presented with so much simplicity and force, and so much to the mental and moral approval of her hearers. I move that the resolution be adopted.

Dr. GILMOUR, Toronto, Can.—I voice the sentiments of my fellow-countrymen when I speak in support of this resolution. I have been particularly touched by the cordial reception, the kindly treatment, and the generous support and sympathy which this Conference has had from the citizens of Detroit. This is more than encouraging to all sociological workers, and I hope that in return they may receive some benefit from the work of the Conference. The citizens of Detroit have exemplified in a very practical and delightful manner the saying, "Blessed are the happiness-makers," they represent the grandest forces of civilization.

Mr. C. L. STONAKER, Denver, Col.- We came here to invite the Conference into the West, where we feel that we have many new problems to solve, and we need your inspiration and counsel. But it was decided to go in another direction, a decision which we have accepted. But we in the West, with all our new life, feel like confessing that it is good, after all, to come down into the East, for this is "God's country"; and we thank you for the reception you have given us here.

Mrs. KINNEY, of Michigan, said that she wished on behalf of the