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288 288 A Short History of Nursing radical changes and modifications. Such are France, Italy, and Belgium. French hospitals had been nursed almost entirely by religious orders up to the opening of the twen- tieth century. Two important excep- France tions were the H6tel-Dieu or Lyons, which was staffed by a secular order peculiar to that hospital, and the Salpetriere, in Paris, which had lay nurses of a superior type under a Matron and head nurses. They were of the old school, un- trained, but had their traditions. The work of the nuns had fallen behind, and various efforts were made by progressive Catholics to instill a more practical quality into their nursing. From the visible conditions under such of those orders as had survived at the end of the twentieth century, it was clear to modern nurses that the French nuns were not as efficient as the Austrian and German and Swiss Catholic Sisters, and could not be compared with the Irish and American Sisters of Charity and Sisters of Mercy. There was also much to be condemned in the policy and attitude of secular administrations as regarded nursing in hospitals. From 1862 to 1909 special efforts were made by the Paris department of public charities (I'Assis- tance publique) to train a lay personnel for the