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Cloud Computing Nayan Ruparelia Digital Instant
Download
Author(s): Nayan Ruparelia
ISBN(s): 9780262376211, 0262376210
Edition: Illustrated
File Details: PDF, 8.02 MB
Year: 2023
Language: english
CLOUD COMPUTING
CLOUD COMPUTING
REVISED AND UPDATED EDITION
NAYAN RUPARELIA
All rights reserved. No part of this book may be reproduced in any form
by any electronic or mechanical means (including photocopying, recording,
or information storage and retrieval) without permission in writing from
the publisher.
The MIT Press would like to thank the anonymous peer reviewers who
provided comments on drafts of this book. The generous work of academic
experts is essential for establishing the authority and quality of our
publications. We acknowledge with gratitude the contributions of these
otherwise uncredited readers.
This book was set in Chaparral Pro by New Best-set Typesetters Ltd.
10 9 8 7 6 5 4 3 2 1
CONTENTS
1 Introduction 1
2 A Historical Perspective 25
3 Types of Cloud Computing 33
4 Cloud Native Foundations 61
5 Microservices and Their Design Patterns 77
6 Cloud Computing: A Paradigm Shift? 101
7 Price Models 117
8 Data 141
9 Security 161
10 Transitioning to the Cloud 183
11 Public Cloud Examples 203
12 Reference Architectures 223
13 Future Outlook 243
Acknowledgments 255
Appendix A: Common Security Terms 257
Glossary 263
Notes 273
Further Reading 277
Index 279
SERIES FOREWORD
x Preface
computing. Thus no prior knowledge of cloud computing
or any of its related technologies is required in reading
this book. I advise strongly, however, that you read the
first chapter of the book as a prerequisite so that we may
have a shared, common vocabulary and understanding of
cloud computing. This will prove useful when you read the
succeeding chapters. You may read any of the chapters of
the book in any order after the first chapter. A glossary
is provided at the end of the book for some of the main
terms and acronyms used in cloud computing and related
technologies. I wish you all the best on your cloud comput-
ing journey. May it be an exciting one!
Preface xi
1
INTRODUCTION
Average resource
capacity the business
Wasted investment can afford
as resources are
underutilized
Time
2 chapter 1
servers so that you could utilize them more efficiently;
otherwise, as in figure 1, you will need to invest up-front
in computing resources that may be used only occasionally.
The extra pooled resources that are unused by you could
then be used by others in your company through your
company’s network. Alternatively, if your company ap-
points a third party to provide resource pooling, then you
would access your computing resources over the internet.
But what if your company or department paid only for
the computing resources that it uses? Then your company
would not have to invest up-front, as a capital expendi-
ture, in purchasing the computing but simply sign up with
a service provider on a pay-as-you-use billing model. This
effectively means that your company changes from a capi-
tal expenditure (CapEx) model to an operating expendi-
ture (OpEx) model for meeting its computing needs. This
is where cloud computing comes in.
Introduction 3
that during the formative stage of a technology, much of
the attention given to it borders on hype. Consequently,
everyone from the technologist to the salesperson is keen
to jump on the bandwagon by labeling anything with the
remotest resemblance (often exaggerated or extrapolated)
to cloud computing as being part of the cloud computing
domain. This creates obfuscation and results in several
definitions of cloud computing. The best definition is that
provided by the National Institute of Science and Tech-
nology (NIST), a technology agency that is part of the US
Department of Commerce and works with industry to
develop and apply technology, measurements, and stan-
dards. The NIST definition of cloud computing is:
4 chapter 1
book follows the NIST’s definition to describe, one by one,
the essential characteristics, deployment models, and ser-
vice models of cloud computing.
Before delving into the characteristics of cloud com-
puting, let us first delve into virtualization and cloud ser-
vices because these form the basis of cloud computing in
two distinct manners: virtualization from a technical per-
spective and cloud services from a conceptual perspective.
Virtualization
Introduction 5
Machine 1 Machine 2
6 chapter 1
into fewer physical machines that host the VMs. This in-
crease in computing efficiency results in lower space, main-
tenance, cooling, and electricity costs, besides the obvious
reduction in the procurement costs of the machines. An
additional benefit is that fewer physical machines and
lower electricity consumption translate to environmental
friendliness.
When the VMs are pooled together such that they
may be instantiated—that is, activated and switched on—
instantaneously in such a manner that they can join or
leave the pool, you will be able to scale your resources to
meet any change in demand, whether that change is an
increase or a decrease. This instantaneous change in the
number of VMs within a pool is known as elasticity and
can be achieved in a cost-efficient manner owing to server
virtualization.
Now, what is the difference between virtualization and
cloud computing? Let us recall from the NIST definition
of cloud computing these characteristics: on-demand self-
service, rapid elasticity, and measured service provision.
None of these features is provided as a matter of course by
virtualization. Virtualization acts as an enabling technology
to facilitate these features, but many additional enablers
are required, such as reporting, billing, demand manage-
ment, and various other business processes and tools.
To truly deploy a cloud, you need to consider how
to employ virtualization and standardize your service
Introduction 7
To truly deploy a
cloud, you need to
consider how to employ
virtualization
and standardize your
service offerings.
offerings, make them available through simple portals,
track usage and cost information, measure their avail-
ability, orchestrate them to meet demand, provide a se-
curity framework, provide instantaneous reporting, and
have a billing or charging mechanism based on usage.
Another way of looking at deployment is to understand
that virtualization per se is not a service. It can be used, in
conjunction with other tools and processes, to create an
Infrastructure-as-a-Service offering.
Containerization
A container represents a partitioning of a server’s re-
sources such that it can run an application and thereby
provide a service. The container is a run-time application
that is built and run from a container image. This provides
a cookie-cutter approach since you can build the same
containers during run time from a single image. The im-
ages are stored in a registry that acts as a repository of
all types of container images. You can have public image
repositories, such as Docker Hub, or private ones that you
create and make available only to developers in your own
organization.
You could use a VM instead of a container to provide
the same service. However, the container is lightweight
compared to a VM and so you can deploy it from a cold
start much faster than a virtual machine. This is because
the container runs on the server within the server’s
Introduction 9
environment—albeit within a jail—whereas the VM has
its own environment that is created from a partition of
the physical server’s memory, disk space, and central proc-
essing unit (CPU) resources, as figure 3 shows.
This means that a container can run on a VM as well
as on a physical one. Indeed, since cloud computing itself
is predicated on VMs, almost all containers that run in
public clouds have historically run on a VM that itself is
hosted on a physical machine. (For performance reasons,
public cloud providers favor physical machines to host
containers these days.) As figure 4 shows, VMs running on
a physical server are used to host containers that in turn
run applications; the single-purpose applications and con-
tainers, when bundled, are the microservices that cloud
service providers enable you to create.
Chapter 4 delves deeper into containers and contain-
erization.
Cloud Services
10 chapter 1
Containerized applications Virtualized applications
App n
App 1
App 2
App 1
App 2
App n
Infrastructure
Introduction
Figure 3 Difference between containers and virtual machines.
11
12 chapter 1
Micro- Micro- Micro- Micro- Micro- Micro- Micro- Micro- Micro-
service service service service service service service service service
Physical server
Introduction 13
internal to the company, such as a marketing department,
then the internal agreement between the supplier and the
consumer departments of that company is called an op-
erational level agreement (OLA). A cloud service therefore
is the implementation of a business process—provided
through a set of related functional components and
resources—that provides business value to its consumers.
Continuing this analogy, let’s suppose that the accoun-
tancy firm wishes to ensure that it meets the SLA condi-
tions agreed on with you. It could put in place various
metrics internally that it could use to monitor its perfor-
mance while creating the accounts. For example, the met-
rics could be that the audit needs to take three days, or the
cash book needs to be reconciled within a week. The firm
may agree to share these metrics with you, although usu-
ally they are used internally as objectives to ensure that the
firm meets the overall SLA. These objectives, or metrics,
are referred to as service-level objectives (SLOs). From an
IT standpoint, SLOs are specific, measurable characteris-
tics of the SLA such as uptime, throughput, available re-
source capacity, response time, and delivery time.
14 chapter 1
A cloud service therefore
is the implementation
of a business process—
provided through a set
of related functional
components and
resources—that
provides business value
to its consumers.
accountants as its customers. These accountants have a
choice in the way they interact with their IT department:
1. They could get down to the nitty gritty and specify the
hardware and software in terms of the type and version
of software to use, the operating system that hosts the
software, the hardware’s memory, storage space, and so
on and so forth.
16 chapter 1
If the IT department were required to decide the right
software and computing platform to use on behalf of the
accountants, as in the third choice, such that the accoun-
tants only need to care about the accuracy and timeliness
of the data returned to them, that level of abstraction
would be Software-as-a-Service (SaaS). These three lev-
els of abstraction—IaaS, PaaS, and SaaS—are the service
models referred to in the NIST definition.
What if our accountancy firm decided to outsource
the entire auditing function to another firm so that it
could concentrate on advising you on tax matters? Our ac-
countancy firm would agree to an SLA and the cost with
the other firm, which would then audit the accounts ac-
cordingly. This amounts to outsourcing an entire business
function, or process, to another firm.
That other firm could just as well be replaced by a cloud
service. Thus the cloud service, when providing a business
function, is providing a Business Process- as-
a-
Service
(BPaaS).
Suppose that our accountancy firm wished to obtain
the latest tax regulations. It could then commission an in-
formation service. This would be akin to Information-as-
a-Service (INaaS). Since the tax codes and regulations are
updated regularly as the law changes, this is a service that
relies not only on the storage of data, which would then be
IaaS, but also on the manipulation of that data to provide
meaningful information. Hence INaaS is distinct from IaaS.
Introduction 17
BPaaS
Business architecture
(Business Process-as-a-Service)
INaaS
Information architecture
(Information-as-a-Service)
SaaS
Applications architecture
(Software-as-a-Service)
PaaS
(Platform-as-a-Service)
Technology architecture
IaaS
(Infrastructure-as-a-Service)
18 chapter 1
their management; business architecture translates the
business strategy to an IT strategy, relevant governance
framework, and definition of business processes. Each of
these domains in the enterprise architecture stack maps
to and aligns with the cloud service models shown in the
right column of figure 5.
Introduction 19
from its own private network. Usually only large enterprises
can afford to have private clouds. Small or medium-size en-
terprises have the option of using a community cloud.
A community cloud provides a middle ground between
a private cloud and a public one. Various entities, rang-
ing from individuals to enterprises, that have a common
interest can pool their resources to create a hybrid cloud.
Such clouds take various shapes: a banking cloud in Swit-
zerland serving the cantonal banks (Switzerland is divided
into administrative units called cantons), a paper indus-
try cloud in the Nordic countries, or a health cloud for the
health industry in the United States. However, there could
also be community clouds for various interest groups, for
instance for chess players or numismatists.
A hybrid cloud is essentially a conglomeration of the
other types of clouds. Its use is necessary mostly when a
cloud service needs to use computing resources from other
clouds because its own resources are being utilized at full
capacity. Such a concept is known as cloud bursting be-
cause the service bursts out of its cloud to utilize resources
from other clouds to meet its SLA.
20 chapter 1
Table 1 Characteristics of cloud computing
Introduction 21
1. The service will be available to you even when you are
not using it so that it will be ready for you to use when
you request it (thus the uptime of the cloud computing
services must approach 100 percent).
22 chapter 1
scale out when demand is high and then scale in when it is
low. To implement this, computing resources are pooled.
The resources normally tend to be virtualized because you
can use software to pool and scale them automatically.
Just as virtualizing the hardware allows you to pool and
share the resources in an elastic manner, you can have vir-
tual applications that can be shared even though a single
instance of the software runs on the pooled VMs. This tech-
nology, however, is still in its formative stage as the biggest
constraints are commercial issues such as the licensing ar-
rangements and billing model. When multiple users use the
same virtual resources in the cloud, such as the software,
storage, or VMs, those resources have multiple tenants. The
pooling of resources to provide a shared, common service
to each user of the cloud service is known as multitenancy.
A major disadvantage of current public cloud services
is a lack of transparency in terms of the resources con-
sumed and the costs incurred.3 Yet these are distinct char-
acteristics of cloud computing insofar as the consumer
ought to know what computing resources are being con-
sumed as and when they are consumed, and the instanta-
neous concomitant costs of the consumption. (Of course,
this factor becomes less relevant if the charging model is
based on a “consume as much as you want” pay monthly
basis.) That is why it is important for a cloud service to
measure the consumption of the service and make that
metric transparent to the user in real time.
Introduction 23
2
A HISTORICAL PERSPECTIVE
Internetworking
26 chapter 2
To ensure that the whole gamut of networking opera-
tions was addressed—including how data should be pack-
etized, addressed, transmitted, routed, and received—so
that no other variance could be used to whittle the specifi-
cation, the internet protocol was designed to specify end-
to-end data communication. The internet protocol suite
(often referred to as TCP/IP) is organized into four ab-
straction layers: the link layer (which provides the com-
munication methods for data within a single network
segment, or link), the internet layer (which specifies inter-
networking between independent networks), the trans-
port layer (which handles host-to-host—i.e., computer-
to-computer—communication), and the application layer
(which handles how the data are processed by applica-
tions). The last two layers are referred to as TCP and the
first two layers as IP. The IP layers have the task of deliver-
ing packets from the source host to the destination host
using only the IP addresses in the packet headers. To ac-
complish this, the IP layers contain packet structures that
encapsulate the data to be delivered, as well as the labels
for the datagram containing the data’s source and destina-
tion information. The IP protocol is complemented by the
TCP protocol, which is a connection-oriented service.
Among the first corporations to adopt TCP/IP were
IBM, DEC (formerly Digital Equipment Corporation), and
AT&T. Beginning in 1984, IBM started releasing TCP/IP in
various systems such as MVS, VM, and OS/2. At the same
A Historical Perspective 27
time, TCP/IP stacks began to be offered for MS-DOS and
PC-DOS by several smaller companies. Thus the internet
as we know it today became commercially available in the
mid-1980s.
Virtualization
28 chapter 2
Scalable Multiprocessors,” a paper published in the ACM
Transactions on Computer Systems in 1997; the authors of
the paper were Edouard Bugnion, Scott Devine, Kinshuk
Govil, and Mendel Rosenblum. They described a prototype
hypervisor—software that sits between the hardware and
the operating system—which they named Disco. Disco
used the TCP/IP protocol to couple operating systems run-
ning on different machines, and so allowed them to scale
horizontally. In 1998, three of the paper’s authors co-
founded VMWare, a company that provided the very first
commercially available VMs that ran on Intel microproces-
sors, referred to as x86 machines. These were stand-alone
VMs running on workstations. In 2002, VMWare released
the first commercially available hypervisor, the ESX Server
1.5, which allowed users to consolidate physical devices by
creating a greater number of VMs on them.
The next major milestone was to have a free, open-
source hypervisor that made virtualization cost-effective.
In 1998, the same year that VMWare came on the scene, a
demonstration of Simics was presented at the USENIX 98
conference. This was followed by Xen, an open-source pro-
ject allowing multiple operating systems to be run on the
same hardware concurrently. It was created as a research
project at Cambridge University and released on October
2, 2003. Xen is currently part of the Linux Foundation and
has Amazon AWS (Amazon Web Service) and Citrix as its
project members, among others.
A Historical Perspective 29
To end our discussion of the historical aspects of vir-
tualization, let us not forget containers. They came a little
later when, with the release of FreeBSD 4.0 in 2000, jails
were introduced. A jail is a partition of various system re-
sources that share the same operating system kernel and
so imposes limited overhead on the hardware. This paved
the way for containers, which were introduced in Linux on
August 6, 2008.
Cloud Computing
30 chapter 2
Today, three major cloud
providers have the lion’s
share of the public cloud
computing market:
Amazon, Microsoft, and
Google.
by Amazon creating application programming interfaces
(APIs) and tools to interface with its Amazon.com web-
site catalog in 2004, and Amazon internally became a ser-
vice company that used decoupled APIs to access services.
However, in 2003, the concept of what AWS could be was
formulated at an executive retreat. Indeed, it was one of
the first businesses that considered the use of 10 percent
of its computational capacity as a financial problem that
needed to be solved.
On March 14, 2006, AWS was launched as a public
cloud by making storage available as S3 (Simple Storage
Service), which was followed by the launch of Amazon SQS
(Simple Queue Service) and Amazon EC2 (Elastic Com-
pute Cloud) in August 2006. Others, such as Oracle, IBM,
Microsoft, and Google, followed with their own offerings
in later years.
Today, three major cloud providers have the lion’s
share of the public cloud computing market: Amazon, Mi-
crosoft, and Google. Although Amazon’s AWS has around
90 percent of the market share, Microsoft has the poten-
tial to press ahead (provided it revises its pricing model and
creates lightweight Windows servers) as it has a few sticky
technologies, such as Microsoft Office, Microsoft Active
Directory (for security), and Exchange (email server), that
create a compulsive ecosystem for businesses.
32 chapter 2
3
2. on-demand self-service,
5. measured service.
Exploring the Variety of Random
Documents with Different Content
of absolute importance to the internes, and of the greatest value to
the nurses.
Not less interesting or successful is the maternity work of these
hospitals. A great deal of the chronic trouble from which working
women suffer so severely comes from want of proper care while they
are exercising the functions of childbearing. The poor applicant to
the maternity department is seen by the woman physician, who gives
her advice as to previous care of herself, and she has in the hospital
that thorough rest and care which are indispensable to full
restoration to health.
A great moral question forces itself on the consideration of the
managers of these hospitals. The applicants to the maternity are very
often unmarried girls. Does true humanity require us to refuse help
to such women? It is evident that care must be exercised to give no
encouragement to immorality, while we must not refuse the aid
which is so often absolutely necessary to save life. The problem is a
difficult one, but the managers have tried to meet it. They usually
make a distinction between the first offense—which is often rather
due to weakness and folly than to depravity—and confirmed habits of
immorality, and do not receive unmarried women a second time. In
one hospital, at least, the directors find the greatest assistance from a
committee of ladies who look after the maternity patients, both
before they enter and after they leave the hospital. They endeavor to
procure work for the mother, and watch over her welfare and that of
the child. But they make it their invariable rule to give aid only on
condition that the mother makes every effort to fulfill her maternal
duties; for they believe there is a regenerating power in motherhood,
and that care for her child is the surest safeguard against a mother’s
committing a second fault.
To many women of good position the maternity is a great blessing,
if they have not comfortable homes and friends to care for them. The
expense in the hospital is much less than the price for which good
medical attendance and nursing can be secured at home.
I need only say of the medical care of women by their own sex in
hospitals that its value has been fully proved. Women of all classes
seek this aid eagerly, and show full confidence in their physicians
and obey them quite as implicitly as they do those of the other sex.
Women often say that they have suffered for years without medical
or surgical assistance, that might have relieved them, from
unwillingness to reveal their troubles to men. The greater freedom of
the relation between patients and physicians of the same sex, enables
the doctors to exercise much influence over their patients, who learn
many good sanitary lessons in housekeeping. A physician was
surprised to find the sick room of a poor patient carefully aired:
“Why, you know they always do so at the hospital,” was the
explanation given.
These hospitals have also done much to dispel among the poor the
fear of going to hospitals.[199] Finding their friends kindly ministered
to by their own sex, they come to regard the hospital as a kindly
refuge in sickness, not as the last resort of a homeless and deserted
sufferer who will die unfriended and alone.
Besides these hospitals, especially adapted to assist in the medical
education of women, are others established by women mainly in the
interests of charity. I have, for instance, the twelfth annual report of
“The Home of Mercy,” in Pittsfield, Mass. It contains about thirteen
beds, and the number of patients in a year was one hundred. It was
established by a small body of women who felt the need of a place for
the victims of accident or disease. Sixty-eight per cent. of the patients
are women, and all the officers but the physicians. This institution
seems to present a good model for smaller cities and towns where,
especially among a manufacturing population, hospital
accommodations are often much needed. A training school for
nurses is added to its work.
Another step has been taken in the medical education of women in
the employment of women physicians, (made obligatory by the
Legislature in some States) in State institutions, thus giving them
management of the women’s infirmary. At the Reformatory prison at
Sherburne, Mass., the resident physician has charge of the health of
two hundred prisoners. The good care and treatment given them is
apparent in the improvement of the health of prisoners during their
stay, and in the small number of deaths.
The employment of women physicians in insane asylums is a very
valuable measure from which we may hope great good in the future.
At present, the most interesting instance of such work that has come
to my notice is in the State Hospital for the Insane at Norristown,
Pa., where Dr. Alice Bennett, with two women assistants, has charge
of over eight hundred patients. Her carefully tabulated statistics
throw much light on important questions regarding the causes of
insanity and the probability of restoration. Dr. Bennett has
introduced beneficial improvements in the treatment of patients in
the direction of more freedom and more social life and opportunity
of employment. She says in her last report, “No mechanical restraint
(by which is meant enforced limitation of free movements of the
body by means of jackets, muffs, straps, etc.) is at any time made use
of in this department.... There are times in the history of many cases,
when temporary separation from external cause of irritation is
beneficial and necessary.... Brush making, basket making, sewing
and mending, kindergarten occupations for the feebler-minded and
melancholy, and the ever-present “housework,” in all its forms,
engage about half the whole number of patients at one time or
another. The officers and patients have also organized a ‘Lend a
Hand Club.’ Dr. Bennett has arranged for a large number of patients
to take their meals together, and finds the arrangement very
beneficial.”
Some of those who are working for the sick have preferred the
name of “Hospital Association.” Such is the St. Luke’s hospital in
Jacksonville, Fla., said to be the first one in the State. The officers are
women, but the physicians and a board of trustees are men. The
main purpose of this association seems to be to relieve the wants of
strangers, who so often go to Florida seeking health, but sometimes
in vain.
The Women’s Homœopathic Association of Pennsylvania was
formed for a distinctively reformatory purpose. Its government is
composed of women, with the exception of an advisory board of men.
The medical faculty is composed of both men and women. This
account is given of its origin:
“The motive of starting a women’s association was, largely, to
correct the abuses that grow out of institutions managed by men. It
is here now and has been for many years the custom for hospital or
other charitable institutions to have an auxiliary board of women
managers, whose duties are to look after the housekeeping
department and raise money either by giving entertainments or
begging—the expenditure of the money so raised, and general
management of hospital work, is considered beyond a woman’s
ability. This prevents a voice in the higher administration. Some of
the women, whose names appear as incorporators of the hospital of
this association, desired to open an institution where women could,
when in sickness and sorrow, be in the care of women. Out of 213
patients cared for during 1888, 153 were charity cases, 45 partial pay,
and 15 cases full pay.”
The “Philadelphia Home for Incurables” was established by
women, but its bounty is not confined to them; it admits men as
patients. With the exception of a superintendent of the men’s
department, the management is entirely in the hands of women. This
is an effort to meet the crying need of a home for chronic sufferers.
Each patient pays one hundred dollars and is kept during her life.
Much other work of the same nature as that I have described is,
doubtless, doing in our vast country, of which no account has
reached us. One of the many “Women’s Clubs” has taken the subject
of hospitals into serious consideration. While rejoicing in every such
effort, I would like to add a word of caution that every enterprise
should be most carefully considered, and the work never allowed to
fall below the recognized standard of merit.
When the pioneer hospitals were opened, no other clinical
advantages were free to women; now the hospitals are beginning to
open their doors to them. The report of the city hospital of Boston
says, “The propriety of women practicing as physicians or surgeons,
and their comparative ability and fitness to pursue this profession,
are not questions for the trustees to consider in the official
management of the hospital; they must recognize the fact that
women are becoming practitioners in all the schools of medicine;
that they are admitted to the Massachusetts Medical and other State
societies, and are recognized as practitioners by the community at
large; and that they are admitted in common with male students to
other leading hospitals of the country. The trustees therefore feel
that there is no sufficient reason why women should not be admitted
to the public instruction in the amphitheater on the same terms as
men, except as to certain operations from which a reasonable sense
or regard for propriety may exclude them.” This advance in public
opinion is most gratifying; but, even when all hospitals are open to
women students, the value of those of which I have spoken will not
be lost; they will still have special work to do, both in education and
charity.
This movement for the clinical education of women in hospitals
begun in America, has extended to Great Britain, Switzerland, and
Germany, and is now being rapidly introduced into India, where the
Women’s Hospital is found to be a most important agent in
educating and elevating the women of India.
The lamented Dr. Amandibai Joshee, who was the pioneer of
medical education for Hindoo women, was a student at the
Philadelphia college and an interne at the New England Hospital.
An excellent hospital in Burlington, Vt., was planned and endowed
by a woman (Miss Mary Fletcher), who gave it her personal
supervision. It had no direct bearing on women’s education, but was
open to all classes of patients. Since Miss Fletcher’s death it is called
by her name. It is mainly intended for residents of the State,
although other patients are received if it is not full. It has no women
physicians, but a board of women visitors. It has an amphitheater for
clinical instruction, and its buildings are large and convenient.
All these hospitals maintain the principle that those who are
treated in them should pay for the care they receive according to
their ability. The price of board and treatment varies from five to
forty dollars per week, according to the service required and other
circumstances; but in all the institutions are free beds, endowed or
supported by charity.
Out of this hospital work has grown another very important
branch of service in the training schools for nurses. While estimating
this new departure at its full value, I wish to pause a moment to pay a
deserved tribute to the “old-fashioned nurse.” In New England,
especially in our country towns, and I presume no less in other parts
of the country, the nurse was an important and honored member of
society. Although not regularly trained according to the modern
demands, she was generally a woman deeply read in the great school
of life; often a widowed mother, who earned her bread by giving to
others the fruits of her own blighted family life; sometimes a maiden,
who, losing the hope of a home of her own, found a wide and useful
sphere for her energies and affections in care of the sick; sometimes
the girl who had wrecked her life by youthful indiscretion (like Mrs.
Gaskell’s “Ruth”), in the ministry of help to others found a life which
soothed her own sorrows and restored her to the respect of society.
The nurse then gathered her knowledge as she could, watching
through long winter nights with sick friends, and visiting among the
poor when disease came upon them. Dickens has drawn cruel
portraits of the nurse of olden time, true, perhaps, to flagrant
instances, but forming a pitiful caricature of the whole class. The old
nurse was more often the true friend of the family, summoned in
every time of trouble, and loving the children whose birth she had
watched, almost as if they were her own.
But with the advance of scientific medical practice it became
necessary that the physician should have an assistant fitted to carry
out his views skillfully as well as faithfully; and the trained nurse was
called into being. She, as well as the physician, must have clinical
education. How strongly this need was felt is shown by the almost
simultaneous establishment of training schools in various countries.
To Miss Nightingale is due the impulse which started the general
movement.
The New England Hospital claims priority in this country, in
announcing the training of nurses as an important part of its work in
1863; but its school was not fully established until the return of Dr.
Dimock from Europe in 1869, who placed it on its present
foundation. The methods pursued in the various training schools
now in operation are very similar, showing that the work has been
carefully considered and is being satisfactorily done. Similar
difficulties presented themselves to those found in all industrial
education, of which one of the greatest was the impossibility of
finding teachers trained for the work. Such women as I have
described might be very valuable nurses, but they had not acquired
their knowledge systematically, and were not skilled in the art of
teaching. The doctor knows what qualities are wanted in a nurse, but
cannot always give the instruction and discipline which will secure
their development. The women physicians had some advantage in
this respect. The very general employment of women as teachers has
helped to supply this need. A young woman who had a natural
aptitude for nursing, and the high moral qualities necessary for a
superintendent of nurses, and who also had the experience of a few
years of teaching, became well adapted to the new profession, and
after a few years the training schools began to furnish graduates who
could carry on the work as teachers.
Another difficulty was in the amount of time required for thorough
training. The pupils seldom had resources to support them during
one or two years of training. It is quite necessary, therefore, to pay
the pupils a small salary, after their first month of probation, in
addition to their board and lodging. This is sufficient to provide for
their inexpensive clothing and all other necessary expenses, so that
the graduate leaves the school without arrears of debt and able to
look cheerfully forward to the exercise of her profession. A great step
has been gained for women in thus raising this humble labor to the
dignity of a profession. The woman who has given one or two years
to preparation for her life-work, looks upon it very differently from
one who has taken it up only on the pressure of necessity and has to
learn her business in the doing of it. She feels a conscious strength in
her position, which ought to stimulate her intellectual powers and
elevate her moral character. It is true that the school gives her only
the preparation for her work, and she must get the best part of her
education from life, but she goes to her task with tools well
sharpened for use, and a trained power of observation which should
make every experience doubly valuable. Let her not lose in the pride
of her acquisition the lovelier spirit and conscientious fidelity which
made the old nurse the useful and trusted friend of the family.
The well-trained nurse is like another eye and hand to the
physician. She notes with reliable accuracy the changes of pulse and
temperature, keeps the record of nourishment and sleep, watches
every vital function with a practiced eye, and thus can give to the
medical attendant a photographic picture of all that has occurred
since his last visit. She carries out his directions intelligently, and
thus enables him to calculate on strict application of the means he
wishes to use.
In 1886, by the report of the Bureau of Education, there were 29
training schools for nurses, 139 instructors, 837 pupils, 349
graduates, in twelve different States and the District of Columbia.
Some of these schools are connected with public hospitals, others
with private charities. In a few cases the schools are independent of
any institution, but the pupils are employed both in hospitals and
private families.
The rules of admission are very similar in all schools. The
minimum age ranges from twenty to twenty-five, the maximum from
thirty-five to forty. As a general rule, twenty-five is a good age at
which to enter a training school; the constitution should be well
established, the character formed, and some experience of life gained
before entering upon this difficult work. Good education and
character are required, and in most cases certificates of good health
and ability for the work.
The wages paid to pupils vary from seven dollars per month the
first year, and twelve dollars the second year, to sixteen dollars per
month for the highest grade of nurse, in a New York hospital. The
time required for study ranges from one to two years, the last being
the rule in a majority of cases. The Philadelphia school, which
demands only one year, has an additional course of one year to train
superintendents.
The expense of supplying the nursing of the hospital by a training
school, in the only case known to me, is found to be about the same
as by the old method of hired nurses. Trained nurses receive good
pay in comparison with that of the ordinary employments of women,
ranging from ten dollars per week upward to twenty, thirty, or even
forty dollars, according to the difficulty of the case. While these
prices are by no means higher than should reward a nurse who has
given years to preparation for her profession and who works
faithfully in it, they are yet burdensome to many families. A surgeon
will sometimes refuse to take a case unless he can have the skilled
nursing that he believes essential to success, and yet the pay of the
nurse will take all the earnings of the father, on which the family rely
for support.
But, on the other hand, the saving of expense in the number of
physician’s visits is to be considered, since he can trust the report of
the nurse, and so the patient is better cared for, without additional
expense. During the last months of study, the nurse’s work is among
the poor, under the direction of the dispensary physicians. Not only
are the patients much helped by this arrangement, but the
experience is of great value to the nurses, as they see a greater variety
of work than they can in a hospital and under differing conditions of
life, and are thus fitted to meet what comes to them in their future
practice.
Societies are also formed by women for supplying nurses to the
sick poor. Such associations employ a number of trained nurses in
attendance on patients who are unable to pay full price. They work
both in connection with dispensaries and independently of them.
Usually a nurse makes two visits a day to her patient, doing for her
whatever members of the household cannot do, but she is always
required to instruct some of the family, if possible, in the simple
methods of care of the sick. She also uses her opportunity to enforce
common rules of hygiene and sanitary care on all the household. In
this way it is hoped that much may be done for the prevention of
disease as well at its cure.
The “Visiting Nurse Society, of Philadelphia,” may serve for a good
model of such associations.[200]
While it has been impossible in limited space to do full justice to
all the good work now doing in the training of nurses, there are yet
two directions, of which I wish to speak, in which it should be
extended. It is desirable that women should be especially trained for
the care of insane patients, who need peculiar care both in
institutions and in private life. The extreme watchfulness and the
power of control required for this service seem to demand a special
training, which would be unnecessary or even prejudicial in ordinary
nursing. This subject is already engaging the attention of those
having the care of the insane, and I doubt not they will find means to
carry out their ideas.
Again, I believe that nursing would afford a wide field of
usefulness for the colored women of our Southern States. Their
qualities of patience, sweetness, and affection are well adapted to
this profession, and when to these is added the intellectual education
which is now within the reach of many of them, there is no reason
why, with good training, they should not do excellent service. Many
of the best nurses in our Southern cities are of this class. The
University of Atlanta, Ga., has made some attempt to introduce
nursing into its practical education, and I hope other experiments
will soon be made. So far as I know the New England Hospital is the
only one that admits colored pupils to its training school. Here this
measure has been entirely successful, and no disagreeable feeling has
arisen on the part of patients or any one else. The colored students
have maintained a fair average in their standing, and some have been
superior. A good education is the most important prerequisite to the
entrance of colored women into this field.
While my fruitful theme is by no means exhausted, I wish in
conclusion to add one thought, viz., that however decidedly these
hospitals of which I have spoken owe their existence to women,
either as originating or endowing them, in every case within my
knowledge there is a union of both sexes in the management of the
institution. The arrangements are very various; in some cases the
managers are all women and the physicians are men; in others all the
physicians but the consulting staff are women, while the board of
management is divided between the sexes; in others we find the
women have full charge, with an advisory board of men. This proves
that women have been more anxious to secure good management
than to establish their own claims. It is an earnest of future
improvement when both sexes shall work together in all departments
of life, each bringing her or his peculiar talents to the work, either as
individuals or as representing a part of the community.
XIV.
CARE OF THE CRIMINAL.
BY