Soon after the close of the Civil War New York City possessed two medical colleges for women. One was the Women's College of Physician and Surgeons, founded by Dr. Blackwell. The other, the New York Medical College for Women, owed its inception and establishment to one of Miss Blackwell's co-workers, Dr. Clemence Sophia Lozier, who had gained her medical degree in the 'fifties, though not in a regular school. She probably knew more of allopathic medicine than the average male practitioner of the regular school began his practice upon, but regular schools had been barred to her. Possibly this irregularity in her professional status influenced her subsequent activities, for after some years of association with the sisters Blackwell, in their allopathic college for women, Dr. Lozier became a convert to homeopathy. For twenty-five years she was the :guiding spirit" of the homeopathic college she founded. In securing charters for these two women's colleges of medicine, these pioneer women physicians won for their sex "the right to equal collegiate advantages with men"; and, in due course, from each college there went into professional life many women possessed of the medical degree. This, however, does not imply that all of the graduates practiced as physicians. The majority, probably, gravitated to nursing, taking hospital status somewhat in advance of women graduates of schools for nurses. The Lozier college went on to sound independent establishment, but the Blackwell school was merged with Cornell University medical college in 1899, when that institution became co-educational.

Some of the regular colleges of medicine opened their doors to women students in the 'seventies, and nay hospital established training schools for nurses. Of course, the hospitals maintained by Roman Catholic sacred orders had been conducting schools of nursing for several decades among the sisterhoods--in their practical hospital work--though their ministration to suffering humanity did not being them the nursing diploma. They ministered indefatigably to the indigent sick regardless of religious belief, and what they lacked of medical knowledge was balanced by sympathetic nursing. Troy Hospital was founded in 1845, and Sisters of Charity took charge of the hospital when built. The same sisterhood founded St. Vincent's Hospital in New York City in 1849. It was the first charity hospital in that city "depending on voluntary contributions" for its maintenance. In the previous year, 1848, the Buffalo Hospital of the Sister of Charity was opened. It was the first hospital established in that city. In the next year, during an epidemic of cholera, its resources were severely strained, but of 1,513 patients admitted only fifty-two died of cholera. However, the epidemic had orphaned many children in Buffalo. These helpless infants were at first cared for in the hospital, but in 1852 other Sisters of Charity opened an infant asylum, also a maternity hospital. These eventually became known as the St. Mary's Infant Asylum and Maternity Hospital. It is till one of the important charitable institution of Buffalo. The Sister of Charity also began a hospital service in Rochester in the 'fifties, founding St. Mary's Hospital in 1857. In the 'sixties several Catholic institution which became large hospitals had their beginning. In 1866 the Sister of the Poor of St. Francis opened St. Peter's Hospital in Brooklyn. In the same year Mother Bernardina of the same order began a private hospital service in Utica. Eventually, it became St. Elizabeth's Hospital. In 1868 sisters of Charity opened St. Mary's Hospital in Brooklyn, "to afford medical and surgical treatment in diseases peculiar to women exclusively." In 1869 Sister M. Irene was instrumental in opening the Foundling Hospital on New York. This institution has saved very many distressed mothers "from the river" and has taken in thousands of foundlings without question. Within a short time of opening, no less than 126 babies had been found on the hospital doorstep by the Sisters. A maternity hospital subsequently established by the Sisters, in connection with the Foundling Hospital, completed a much-needed service. St. Peter's Hospital in Albany had its beginning in 1869. During its first fifteen years the Sisters of Mercy, who operated it, tended more then 20,000 patients. In 1869 the Sisters of the Third Franciscan Order of St. Anthony convent in Syracuse founded St. Joseph's Hospital in Syracuse.

These were institutions in which the nursing service was given exclusively by women before any training school for nurses was organized in New York State. There were many other hospitals, and in some that were conducted under the auspices of other churches or by civic or public aid, the nursing was undertaken mainly by women. The Women's Hospital in New York, "the first of its kind founded by women for the exclusive use of women," had its inception "in the inspiration and genius of Dr. J. Marion Sims, the recognized father of gynecology." It was opened in 1855 by the Women's Hospital Association, thirty-five women constituting its board of managers. It was maintained partly by private contributions, and partly by city and State appropriations. The Albany Hospital was incorporated in 1849. It was established by public subscription. St. Luke's Hospital in New York City had its inception on St. Luke's Day, 1846, when Rev. Dr. W. a. Muhlenberg, rector of the Church of the Holy Communion, set aside $15, one-half of the offertory on that day, toward the erection of a hospital, which he named St. Luke's. Public subscriptions came slowly. It was not until 1858 that patients were admitted into the hospital building, although Sisters of the Holy Communion had, since 1853, been attending to patients in other buildings of the church. For the first twenty years or so, St. Luke's Hospital "fulfilled especially its founder's object, in providing what was essentially a nursing home in which very active medical and surgical work was not required." Later, it expanded its scope, so as to embrace the usual service of a general hospital. One of the oldest New York hospitals of special medicine, one in which a nurses' school for special training has long been conducted, is the New York Eye and Ear Infirmary, the first of its kind to be established in America. It was founded in 1821, and with the exception of a few months during the prevalence of an epidemic fever in 1822, the doors of the Infirmary have never been closed. Women have had important part in its maintenance and operation. An early public charity was the Brooklyn City Hospital. In 1838-40, Mayor Cyrus P. Smith, of Brooklyn, at his own expense and with the aid of friends, male and female, began a hospital service which was taken up in 1844 by the Brooklyn Association for Improving the Condition of the Poor. In the next year it was incorporated as the Brooklyn City Hospital. Benevolent Jews of New York City, in 1851, established the Jews' Hospital in the City of New York. This charity eventually became known as Mount Sinai Hospital, which is said to have been one of the first New York hospitals to admit women physicians to the house staff. Women were also on the general staff, and one division--the Children's Department--was exclusively in charge of women. Mount Sinai Training School for Nurses, organized in 1881, is one of the largest in the country. Long Island College Hospital had its inception in the efforts, in 1856, of several German physicians of Brooklyn. They early contemplated the special training of nurses, though this phase did not develop into an organized school for many years. the buffalo General Hospital was incorporated in 1857, and opened in 1858, with Mr. and Mrs. Dewey, as master and matron. Staten Island Hospital was founded in 1861, and carried through its early years mainly b y women. The Knickerbocker Hospital of New York City had its beginning in 1862, in the Manhattan Dispensary. Roosevelt Hospital, New York City, was founded in 1863. Five years later, the Presbyterian Hospital in the City of New York was chartered, and began its work supported mainly by Presbyterian and Reformed churches, with strong ladies' auxiliaries. This charity, like the roman Catholic medical charities, was entirely undenominational in service; in fact, for many years more than half of its patients were Catholics. St. John's Hospital, Brooklyn, was founded in 1871, and the Hospital of the Good Shepherd, at Syracuse, in 1873. These were charities of the Protestant Episcopal Church, and "the nursing was confided to a religious order of deaconesses." The Hahnemann and flower Hospitals of New York City, founded in 1871 and 1872, respectively, were Homeopathic institutions. They both encouraged Dr. Lozier in her Women's College. One large hospital in the history of which women workers figure importantly is the Rochester (now General) Hospital. It was in process of formation from 1847 to 1859, the main promoters being the Rochester Female Charitable Society. It was not brought into operation until 1862, when the Civil War was at its height. Nursing then necessarily devolved upon women. In 1864, the hospital capacity was overtaxed in the endeavor for all the invalid soldiers that were brought to it. Even since its establishment, the management has been borne by women, the Board of Mangers in 1915 consisting of thirty public-spirited and capable women of Rochester.

It is not possible, within the space available, to even mention al the hospital in New York State, but enough has been shown to indicated that women were actively working as hospital nurses in New York long before the first training school for nurses was established. For Bellevue Hospital is claimed the right of place as the "mother of nurses' training schools" in New York State. Its school was organized in 1873. New York Hospital schools is placed next, with establishment in 1877, though it is doubtful whether either is properly placed. Miss Blackwell's school precedes that of Bellevue, and the records indicate that a school for the training of nurses was established in the Brooklyn Homeopathic Lying-in Asylum in 1873. In the next year this school assumed the name of the New York State School for Training Nurses. Its instruction, however, was probably confined to maternity work; in any case, the institution was not of the "regular" school of medicine. So it may be conceded that of the recognized allopathic institutions, Bellevue was the first to organize a nurses' school in 1873, with New York Hospital next, in 1877.

The impetus given to the new profession for women by the action of these two leading hospitals brought many other training schools into operation. Two Buffalo hospitals--the General and the Homeopathic--organized schools in 1877, the Brooklyn City Hospital opened a school in 1878; and Albany Hospital took action in that direction in the same year. The records show that "through the special efforts of Mr. Archibald McClure, a few trained nurses were brought from Europe" for service in Albany Hospital. They formed "the nucleus of the present splendid nurses training school," which was incorporated in 1897. Schools organizing in the 'eighties include that of the Brooklyn Homeopathic Hospital in 1880; that of Mount Sinai Hospital in 1881; that of Rochester General Hospital in 1881; those of the City Hospital on Blackwell's Island (for female nurses) in 1886; and (for male nurses) in 1887; that of the Syracuse Hospital of the Good Shepherd in 1887; that of Auburn City Hospital in 1887; that of the Syracuse Hospital for Women and Children in the same year; and that of St. Luke's Hospital of Utica in 1888. In 1891 a nurses' school was organized at Faxton Hospital, Utica; another began to function at St. Mary's Hospital, Rochester, in 1892; St. Mary's Hospital, New York, opened one with two nurses in the same year; the Staten island Hospital School began in 1895, that of Flushing Hospital in 1893, that of Roosevelt Hospital, New York City, in 1896, and that of St. Joseph's Hospital, Syracuse, in 1898. In 1900 the German Hospital, of Brooklyn, offered a nurses' course, the Utica General Hospital opened a school in 1905, St., Catherine's Hospital, of Brooklyn, formed on in 1907, and in the next year a school was opened in Canandaigua, at the Thompson Hospital. There were many other successful training schools of m ore recent establishment.

With the drifting of medical practice more and more toward specialization, several graduate schools for nurses came in operation. Among the New York City hospitals that offer special instruction to nurses are the Post-Graduate, Sloane Maternity, New York Eye and Ear and the Manhattan Eye, Ear and throat hospitals.

One New York City medical institution that has directed its efforts particularly to the training of nurses is the park Hospital, which in its early years was known as the New York Red Cross Hospital and Training School for Red Cross Nurses. This institution owes its inception to Miss Bettina A. Hofker, a devoted worker, from 1888, among the poor in the crowded tenement district of New York City. After she had graduated from Mount Sinai Training School in 1894, she, with other nurses, continued her tenement work, but she had in mind, particularly, the forming of a school for Red Cross Sisters. Helped by benevolent friends and workers, she began to operate in that year under the name of the Red Cross Institute. Soon afterwards, she rented a pace to serve as a hospital and school, but before giving the hospital the name "Red Cross" she thought it better to ask the National Red Cross Association for permission to use the name "for the purpose of opening a Red Cross Hospital and Training School for Red Cross Sisters, and also a department which in time of peace, shall work in the homes of the needy sick." Miss Clara Barton, founder of the American Red Cross, encouraged Miss Hofker. Thus the New York Red Cross Hospital began its medical service properly sponsored. Miss Barton regarded the New York institution "as the opening wedge to Red Cross hospital work in the United States." Ultimately, so as not to confuse its operation with the more expansive local work of the great national body, the name of the hospital was changed to its present title, the Park Hospital. No one knows to what extent Miss Hofker's noble work under the Red Cross name in the tenement districts of the great metropolis aided the hospital development of the great national organization whose scope of medical charity has of late years been worldwide, but her effort is worthy of record.

During the twenty years in which Dr. Augustus S. Downing has administered the law governing nursing practice, nursing has been brought from the apprentice shop to the threshold of a profession.

Until 1903 hospital training schools were conducted without the supervision of any educational body. Candidates for such schools were admitted regardless of their educational qualifications and the amount of professional education which the student might receive was depending entirely upon the facilities of the school and the conscientiousness of its management.

The first law governing the practice of nursing in New York State was passed in 1903 and contained a provision that its administration be placed under the New York Board of Regents. This law which was permissive in character may be summarized as follows:

Educational Requirement--

At least one year of high school of an equivalent.

Length and control of Professional Course--

Applicants for admission to the registered nurse examinations must have completed at least two years in a hospital or sanitoruin by the University of the State of New York.

Board of Nurse Examiners--

Five nurses for a term of five years. Immediately after the passage of this bill the Board of Regents called the Board of Nurse Examiners together for the purpose of requesting that it recommend a course of instruction for registered nurse school.

The Board made a thorough study of the curricula of schools of nursing throughout the country and found instead of there being any uniformity that every school was a law unto itself. Some taught much; others gave very little instruction either in theory or practice.

The first Board of nurse Examiners, therefore, submitted to the Board of Regents a curriculum for registered nurse training schools, which was based upon such a low standard that the Nurse Board felt forced to justify its action by explaining in order that the smaller schools and more particularly the hospitals with which they were connected should not be embarrassed.

These first requirements for registration may be condensed as follows:

All training schools registered by the Regents of the University of the State of New York shall require of pupils applying for admission one year of high school or its equivalent, preference being given to applicants who have more than one year of high school and to those who have taken a full course of domestic science in a recognized technical school.

Training schools for nurses registered by the Regents of the University of the State of New York shall provide both theoretical and practical instruction for nurses as follows:

Medical nursing including materia medica.

Surgical nursing with operative technique including gynecology.

Obstetrical nursing.

Nursing of sick children.

Diet cooking for the sick.

Food values and feeding in special cases to be taught in practical classes--not by lectures.

A thorough course of theoretical instruction in contagious nursing when and where practical experience is impossible.

The period of instruction in the training school shall be not less than two full years, during which time students should not be utilized for the care of patients outside of the hospital.

(The reason why this was specified was because it was the custom of some schools to send pupils out for a period of eight months during their training to earn money for the hospital, thereby depriving them of part of their nursing education to which they were fully entitled. They were taken away from lectures, schoolwork and instruction to earn money for the institution when they should be working under careful supervision in the hospital.)

training schools giving a three-year course and wishing to continue the practice of utilizing their pups to earn money for the hospital might send them out to private cases or for district work among the poor for a period not exceeding three months in the third year of their course, but training school with a two-year course wishing to continue this practice must extend their period of training to meet the above requirements.

This first Board of Nurse Examiners urged that school be required to provide better facilities for preliminary training and more through hospital experience, and that this movement for registration under the direction of the Regents might be only the beginning of what it trusted might ultimately lead to the recognition of nursing as a profession for women.

It was not until 1908, however, when Dr. Downing assumed his duties as Assistant Commissioners for Higher Education, that any effort was made to enforce the provisions of the law or the Regents rules governing the conduct of such schools. Nursing was the first of the professions under Dr. Downing's supervision to receive his consideration and as a result of an investigation which he made of the condition of the registered nurse training schools of this State, he called a conference of the nurse advisory council at which plans were formulated for the enforcement of this law. Under the provisions of this first practice act but one inspector and secretary were permitted, thus making it impossible for this Department to give the detailed supervision necessary to these schools, but in spite of this handicap constant pressure was being brought to bear upon the hospitals maintaining nurse training schools in an effort to bring the same influences to bear which shaped the character of t other schools and academic institutions.

On 1912 a notification was sent to all registered nurse schools that from that date on the educational requirements for entrance would be enforced. This stand on the part of the Department brought forth a tremendous storm of opposition from the hospitals conducting such schools and some of those most prominent in the State threatened to withdraw. Dr. Downing stood his ground and an educational standard became established through enforcement.

Realizing the need of compulsory legislation to properly govern nursing practice, Dr. Downing in 1909 joined forces with the progressive members of the nursing profession and introduced into the Legislature a second bill aiming to strengthen the present statue. For eleven consecutive years, or from 1909 until 1920, this amendment was introduced and sponsored by the Education Department at Dr. Downing's request.

In 1920 a compulsory law governing the practice of nursing was passed restricting the use of the terms graduate, trained, certified, and registered nurse to such person as had successfully completed a course of training in a school of nursing under the supervision of the State Department of Education.

Up to this time only the title of registered nurse had been protected by law and inasmuch as the terms graduate, trained, certified, and registered were synonymous in the mind of the public the first nurse practice act failed in its intention to protect the public from exploitation. This amendment further provided for the appointment of an adequate staff of inspectors and office personnel which has enable Dr. Downing to give sufficient supervision to the schools of nursing in this State.

In the two decades which had elapsed since nursing became a candidate for admission to the learned professions, the State of New York and the country at large has witnessed the development of nurse training schools exceeded only by that of the secondary schools during the same period.

In 1924 this Department successfully completed the personal inspection of not only the schools of nursing in its own State, but of four hundred school in other states, and in the Dominion of Canada, thus putting the registration of nurse schools outside the State and in other countries on the same basis as that required for the registration of other professional schools.

For ten years after the first nurse practice act was passed, the standards in the nurse schools were so low that not even ten per cent could be considered schools in any sense of the word--today, eight per cent of them are being conducted in accordance with the minimum requirements of this department.

Dr. Downing has never lost sight of the fact that schools of nursing were not things apart from the standards of the world about them even though our schools of nursing have received no gifts, no endowments, no material recognition, and that along of all students their claim for libraries, laboratories, class rooms, and instruction is a claim hereby tolerated. He has consistently believed that hospital schools could not continue to remain untouched by the influences which shape the character of other schools and academic institution and that this department has a distinct responsibility to the people of the State in giving them an educated, intelligent nursing service and through such services secure for nursing the recognition to which it is rightfully entitled.

Dr. Downing's policy in administrating the law governing the conduct of schools of nursing has differed in no way from the policies maintained in relation to other professional schools which is the keynote to an administration which had done more to bring nursing into its own than any other factor.

The year 1927 marks the fiftieth anniversary of the Nurses' Training School of New York Hospital. During the half-century more than two thousand nurses have graduated from the school, some of its graduates going to distinctive place in the medical world. Among its graduates are Miss Annie Goodrich, dean of the Yale School of Nursing; Miss Lillian D. Wald, who founded the Henry Street Settlement; Major Julia C. Stimson, superintendent of the United States Army Nurses and dean of the Army School of Nursing; and Miss Florence Merriam Johnson, who is of distinguished World War record. She had "charge of the Atlantic Division nursing service during the war and was responsible for the equipment and mobilization of ten thousand nurses. At the end of the war, she was one of the six American nurses to receive the Florence Nightingale Medal from the International Committee of the Red Cross."

The efforts of New York women in Red Cross work during the war period were too colossal to be referred to in detail in this brief review; an indication of the extent of one phase of their work may be gathered from Miss Johnson's war record. Certainly, the women of New York have had appreciable part in medical service during the entire three centuries of New York.

Dental Surgery.--In no country two centuries ago did dentistry hold a place among the recognized "learned professions." At that period, and earlier, dentistry was "the handicraft of vagabonds who traversed the country (Europe) from one end to the other practicing medicine, dentistry, alchemy, chiromancy, and necromancy as occasion demanded. The professional mountebank who presented himself as tooth-puller, barber, leech, and theriac vender has a familiar figure in the market places of the big cities or at the annual fairs of the smaller towns." American records do not show that such a class of itinerants operated on this side of the Atlantic, and when itinerant dentist did begin to practice their profession, they were of a more responsible class, fortunately. Leonard Koeckler, a practitioner of international reputation, described the American situation thus, in 1826: "In the United States, although little or nothing has been done in the way of publishing on the subject of dental surgery yet I feel myself authorized to say that in no part of the world has this art obtained a more elevated station." In thinking of the present standing of American dentistry, dental scientists of today would probably indorse Koeckler's opinion, for in no country in the world has the profession reached such a high standard in practice and scientific knowledge.

There was, no doubt, some crude tooth-pulling in colonial times. Even in the first half-century of the republican period, the turnkey was invariably the instrument resorted to in most endeavors to rid the aching of dental problems. In most cases, however, the wielder of the wrench was the family physician. Dentistry, as a distinct profession, was not practiced in colonial America. Its introduction dates from the first years of the Republic. A French physician, La Mair, of the French military forces of Revolutionary days, was the first to confine himself to dental practice in America. Whitlock, an Englishman, soon followed La Mair, and, in 1788, John Greenwood, the first American to specialize in the dental profession, established himself in practice in New York City.

He comes distinctively into American records, his clientele including even our first President. Between 1790 and 1795, Greenwood built an entire set of artificial teeth for General Washington. They were carved in ivory. The teeth "were secured by spiral springs and the neatness and ingenuity of the work was considered equal to any executed at that period abroad."

Other dentist soon appeared in New York, Philadelphia, and Baltimore. In 1800, the United States could count thirty practicing dentist, their dental knowledge coming more from practice than from scientific research. Even thirty years later, when, it is said, there were about 300 dentist in American practice, not more the one-sixth "were well instructed." As a matter of fact, another decade was to pass before the first dental college was organized. In this respect, the United States led the world, for in no European country was there a school of dentistry in 1839, when the Baltimore College of Dentistry was chartered. Formerly, dental surgery was merely a minor part of the surgical course of medical colleges. The dividing line between medicine and dentistry, therefore, may be considered as drawn in 1839.