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A STUDY IN CONTRASTS
During the last five years my particular job in nursing has given
me the opportunity of actually doing some work in eleven different
countries on two continents*
In addition to that privilege my work brought me into touch with
interesting men and women from many lands - the Fellows of the Rockefeller Foundation, who were sent to countries other than their own
for purposes of study in science, in medicine and in nursing.  This
group was truly cosmopolitan in that it included Chinese, Japanese,
Siamese, Filipinos and Negroes as well as Britsh, Europeans and Americans*  By listening to their animated discussions, usually in groups
of two or three, it was possible to get, not only a vivid insight into
conditions in their respective countries, but occasionally a new point
of view on onefs own*
^S  One heard, for example, just how the Toronto public health nursing
system strikes a Pole, &A Hungarian, a Roumanian and a Frenchwoman
respectively, or how a hospital in Montreal looks to a nun In Yugoslavia.  These comments were intelligent and searching.  They were
indeed a study in contrasts in ideals and practice.
fit  was even more illuminating to actually do nursing work in so many
countries.  Yeu k=ao»-Jtow> much easier fefe^s to get the "feel" of things
when you are actually on the job.  The field of observation is narrowed - but the experience is all the more intense.
What I have to offer you then, this afternoon, is simply a study in
contrasts based on actual experience. It most emphatically is not
an attempt to evaluate various national nursing ideals in education
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and practice and to say: "This is good: this is bad"*  Conditions
differ so widely in the various countries that it is impossible to
arrive at a just basis of evaluation even if it were not an impertinence to sit in judgment without full knowledge*  All I shall try to
do therefore is to tell you very briefly what Ideals English nurses
seem to treasure most, and how these compare with the aspirations of
nurses In some European countries such as France and Austria, Poland,
Hungary and Roumania.
It is obvious that differences in national temperament, habits of
thought and social customs exist as between these countries.  These
differences profoundly affect nursing ideals and practice and, to some
extent, account for the fact that nursing as we conceive of it flourishes in England and developes more slowly In Latin countries such
as France*
The Minister of Health in Roumania was talking one day about the
difficulties of training nurses in his country.  "Quf est ce vous
voulez, Madame5 cfest une chose Anglo-Saxonne" said he - meaning
thereby that the mental and temperamental "set" of English, American,
Scandinavian and German women favours the acceptance of discipline
and the willingness to perform disagreeable routine duties which are
irksome to the Latin group*
Or to put it another way - I might quote a French nurse who said -
'WMF
"But of course the English make better nurses than we do.  jpjt j|t is
easier for them to submit to authority, to do what they are told.
The English are so much less intelligent than the French".
Just where does the strength of the English nurse lie?  Are we to
agree with the courtly Roumanian Minister or with the straightforward
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French woman?
To one observer it seemed that the strength of the English lies in
their common sense and in their deep devotion to duty.  I cannot
do better than pass on to you this estimate of English nurses made
by a religious Sister from one of the Balkan countries.  Just in
passing I should like to explain that, when she wrote this letter
she had been studying the English language for only six months and,
at the time, was observing in the wards of a large London hospital*
She writes:  "We are thinking that English nurses is a little like
the London poiicemans*  When the policemans is holding up his hand
in the street all the peoples is stopping, even the busses* They is
liot going on like in our Balkan countries.  But the English peoples
is not afraiding of the policemans.  They is liking of him very much
because in England the peoples is loving always the order with the
kindness.  When did we go on night duty we is afraiding a little
that .we do not know to work well but Head night Sister is always
saying: fSteady, now, steady1 - and so we steady like she says.  I
think in England all patients is knowing that some one is always steady
for him even in the night".
So much for ideals*  What about practice?  The legal control of professional practice in England is, as you know, vested In the General
Nursing Council, but lay and medical opinion make themselves strongly
felt In nursing affairs in England just as they do, more or less, in
all European countries.  The influence of tradition and of social
prestige must always be reckoned with*  Change, when it comes at all
comes slowly*  Some nursing critics deplore this conservatism and
deference to lay opinion, others consider it a wholesome check on
undue professionalism*
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Ia^fee^^^^^^B^a^^iisa^^e^ more stress is laid upon practice rather
than theory.  Requirements for admission emphasize character and
temperament rather than intelligence.  Nursing is still, to some extent at least, a vocation in the religious sense.
It Is perhaps true that hospital nursing is that phase of professional
work In which English nurses find their best expression.  Public
health nursing Is developing relatively slowly both in England and
in Austria and does not, as yet, constitute the "growing point" of the
profession as it does in France and in the Balkan countries*  Many
causes have contributed to this situation but the English and German
temperament and character play an important part*
The private duty nurses in England have gone further toward developing
a basis of co-operative practice than any other group in the various
countries I visited.  Their system might not bear transplanting but
it is well worth study.  Incidentally they emphasize the importance
of supervision in private duty practice and have even achieved a measure of it.
/**     * Continental nurses criticize the English indifference to formal well
organized courses of theoretical study.  The thorough Germans and
Austrians are just as shocked as the French at what they consider
failure to give good instruction in the underlying sciences*
As illustrating the English point of view I can only quote an English
nursing Fellow who, on her return from a visit of observation in the
United States and Canada was asked what had impressed her most forcibly
in those countries*  Her reply was: "I think perhaps it was their
almost pathetic belief in the virtues of education"*  She was not
speaking in any snobbish or condescending way*  She meant what she
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said, that is, that what is learned cannot always be measured in
terms of what is taught.
I am sorry to say that I had no opportunity of observing nursing in
Germany - but German influence is strong in Austria and many of the
leaders in Vienna had obviously been affected by German thought and
tradition in nursing.
As one would expect, in the more progressive schools, grounding in the
basic sciences is thorough, the teaching is systematic and the discipline strict. The very best ward teaching I have ever seen anywhere
was at the Kinderklinik in Vienna. Here nursing technique of the
most highly skilled order is systematically taught by nurses to nurses
on the wards regularly, daily, by the clock* Busy or not* Canadian
hospitals please take notice.
Professional organization however has not as yet gone very far in Austria.  Unfortunately, the difficult political situation of the country
since the war, has caused nursing associations to crystallize on
political rather than on professional lines.  No one regrets this more
than the Austrian^ themselves and they look with pathetic envy at the
countries in which nurses are free to organize as they will.
Public health nursing is not altogether in the hands of nurses in Austria.  There Is a tendency to emphasize its social aspects and, for
that reason, a social service worker with some health background is
more commonly found in the field than the graduate nurse*
In France, on the other hand, the public health field is preferred by
nurses to all others.  The best French schools prepare women specifically for the various phases of public health and are inclined to let
the huge city hospitals get along with the services of women of the
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trained attendant type*
The French nurse takes naturally to publich health especially in its
social aspects* A remarkable group of hospital social workers, most
of whom are nurses, staff the social service department of the enormous Assistance Publique Hospitals of Paris. The influence of these
women makes itself felt in the wards to an extent which justifies the
belief that it may some day play a considerable part in raising professional standards among hospital workers themselves.
State registration of nurses in France is conducted under one of the
governmental departments.  The Conseil de Perfectionment brings together not only the nurse educators of the country but also heads of
hospitals and physicians.  The French National Nurses Association
in collaboration with the Belgian Nurses Association is making itself
responsible for the next International Congress.
Poland has made astonishing progress since the war in the development
of Schools of Nursing.  In most of the Central European countries
the maintenance of public health services Is a matter of government
concern.  It is said that the attempts to conserve the younger
generation by means of infant welfare programs and by combatting tuberculosis are not wholly disinterested but are inspired by militaristic
motives.  Whether this is true or not excellent policies in public
health have been formulated and are in process of being put into practice in Poland, Yugoslavia and Hungary.
Considerable assistance has been forthcoming from American maawM**,
especially the American Red Cross and the Rockefeller Foundation.
The School of Nursing in Warsaw which has served as a model for Poland
was financed for some years by an American nurse and has also been
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assisted by the Foundation*  Its former very able director Helen
Bridge, is an American nurse.  Upon her marriage and retirement the
direction of the School was placed in the hands of Polish nurses many
of whom had benefited by study abroad*  This school is organized on
the American plan, has a high standard of admission requirements and
attracts a good type of student*  One of its graduates holds a position
in the flLnistry of "Health which makes it possible for her to exert considerable influence on nursing developments throughout the country*
Another notable Polish School is the University School of Nursing in
Cracow*  This school has, from its beginning, been under the direction of Polish nurses.  Its director.Miss Maria Epstein and her staff
have done a remarkable piece of work under exceptionally difficult
circumstances.
Polish nurses are primarily interested In public health but not to the
exclusion of other branches of nursing.  Some of them have done fine
work as teaching supervisors in the School wards of the great hospitals.
The conditions under which some of these women work would appall most
of us.  Nevertheless, they say, and they are right, that unless the
general standard of nursing in the hospitals can be raised it is hopeless to expect that really sound training can be given to student
nurses specializing in public health.
The National Nurses Association in Poland is organized on professional
lines and is very active.
-In Hungary two schools have recently been organized under the Ministry
of Publie Health which constitute training centres for nurses associated with the official public health program of the Institute of Hygiene.  These Institutes of hygiene are found not only in Hungary but
 In Yugoslavia and Poland*,&bA*>€^^ The
directors are men of outstanding ability and interesting and original .
work is being done especially in the rural districts*
The program could be expanded much more rapidly if more nurses were
available*  Naturally, under such circumstances, emphasis Is placed
on the public aspects of nursing and the unfortunate hospital patient
is relegated to the care of attendants*
A close observation of the situation in Central Europe inevitably leads
one to the question whether eventually there may not be in these coun-
tries a more or less dissociation between hospital nurses and public
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health workers*  Such a contingency seems disturbing to the more conservative among us but it apparently has no terrors for some of the
younger generation on either side of the Atlantic*  The question which
inevitably suggests itself is: Can we all remain bound together in
one sheaf?  That is what nurses are asking themselves the world over*
Consciously or not that question is being asked on this side of the
Atlantic as well as on the other.
Nursing is a thing of infinite diversity.  In some countries the
necessity of training and licensing different grades of workers is
recognized, in others it is ignored*  We find that in a country like
England, where, to quote an observing Fellow: "Nurses are trained on
the slow system" it is an honorable and satisfying career for a woman
to be Head Sister of the same ward for thirty years and that a woman
forty five years old is considered rather young to be a matron.
On the other hand, there are countries in Central Europe where most
of the important posts are held by women in their late twenties and
early thirties.  Does that mean that England is wrong and the Central
 European countries right? , Not necessarily*  It may simply mean that
maturity and youth haves certain qualities of their own which fit best
into a given situation in different cotintries*  To quote Miss Lloyd
Still, Matron of St* ThomaB's Hospital: "No country has the right to
impose Its standards on another country"*  No nation is pre-eminent
in nursing.  Do not let us be unduly impressed by long and honorable
tradition - nor by mere size and numbers and excellence of organization.  These are things well worth striving for^but in themselves
are not sufficient unto salvation*
The wind bloweth where it listeth and perhaps some experiment in education is now being worked out in an obscure corner of China or Bulgaria or Spanish America which some day may affect nursing all over
the world*  So great an authority as Dean Goodrich of the Yale University School of Nursing, who returned recently form the Orient, said
that in Peking she had found what she considers "one of the very few
real Schools of Nursing in the world".
In spite of its diversities and its contrasts or, perhaps because of
them, the practice of nursing constitutes a great international bond.
Such ties are not altogether broken even in time of war*  It is to
be hoped that we shall continue to hold fast to our sisters in other
lands so that we may preserve our common heritage*
I cannot do better than close with another quotation from one of the
Fellows, - from a Balkan country where frontiers are frontiers and
hard to get by*  "When I did leave my country in order to study, I
did think that frontiers were very high*  Now that I have worked and
learned in countries which once were our enemies, I am thinking that
no frontier is so high or any language so strange that nurses cannot
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meet  and speak together.