NURSING IN THE ROYAL NAVY.

819 the best, for they also fulfilled this latter condition. conclusion, he summed up his thesis as follows :-l. Cold rarely an exciting cause of pulmonary inflammation. 2. Strong individuals are less frequently attacked than the weakly. 3. Antiphlogosis in the old sense must be rejected. Herr FRAENKEL (Berlin) followed by expounding the present were

THE GERMAN MEDICAL CONGRESS.

In is

Debate on Pne1tmonia. THE proceedings of the Medical Congress, held last week in Berlin, opened on Monday, the 21st ult., with a brief state of the question of the micro-parasitic origin ot pneuaddress from the President, Prof. Frerichs, who, after monia, and spoke especially on the differential diagnosis welcoming the members, referred to the work done at the between the pneumonia cocci and similar organisms (sputum cocci) which he had discovered in sputa. The previous sessions in Wiesbaden, where the subjects of tuber- septicaemia from which we quotestates that a lively and interestculosis, diphtheria, and the abortive treatment of infectious report debate followed, which was shared in by Friedlander diseases have been discussed. He then glanced at the pro- ing Gerhardt (Wurzburg), Riihle (Bonn), Fiantzel (Berlin), gramme before them, and concluded by nominating as vice- (Berlin), Rosenstein (Leyden), Baumler (Freiburg), and presidents Drs. Leyden (Berlin), Riihle (Bonn), and Noth- Nothnagel (Vienna), the main result being that the influence nagel (Vienna) ; and as secretaries Drs. Senator, Brieger, of cold in causation could not be completely set aside, since cases occurred which could not be explained on any other Ehrlich, and S. Guttmann. Nor was the unity of the virus considered as hypothesis. Dr. JuMENSEN (Tiibingen) opened a debate upon genuine established in view of the large number of cases sufficiently Pneumonia, remarking that not long since it was thought of secondary that arise in the course of chronic It was con. diseases. Butpneumonia that the study of pneumonia was closed. there was a general concurrence in the therasidered as established that its cause was exposure to cold, peutic view propounded by Jiirgensen. In the afternoon its nature a local inflammation, its issue a crisis, and session Herr Rosenthal (Eriargen) spoke on Reflexes, and its treatment antiphlogosis, especially venesection. Laennec Herr Pfeiffer (Weimar) on Vaccination. and Skoda by their research in physical examination, Rokitansky by his anatomical studies, and Dietl in his opposition to venesection led the way in a conversion of opinion, NURSING IN THE ROYAL NAVY. Gradually another conception of the disease arose-viz., that in croupous pneumonia we had to do not with a local but THE report of the committee appointed to inquire into the with a general disease, which is mainly, but not solely,I localised in the lungs. This conception must now be furtherr system of nursing in the Navy, to which reference was extended to the admission that it is an infective disease.i. made by Mr. Campbell-Bannerman in bringing forward the Ten years ago it was difficult to establish this ; but modern has been to Parliament. It would be estimates, experimental pathology has come to its support, so that the difficult to devise a presented more inefficient system than that at old contention of cold being the sole cause of pneumonia bids fair to disappear, and Dr. Jiirgensen did not believe thatt present in operation as described in the report now before us. of the cases could now be} The sick-berth staff is recruited from lads presenting themmore than 4 per cent. assigned to this cause. - It has also been shown, contraryr selves on board the various depot ships, " the only qualifica. to former notions, that the weakly are more liable to) besides passing the medical examination, being that be attacked than the strong; that most cases occur tion, must be eighteen years of age, able to read and write, between the ages of one and fourteen, and that those and numerous as ; the are twice as those above possess a fair knowledge of keeping accounts." They age of forty-five between fourteen and forty-four years. As to atmospheric: are never sent to a hospital to learn their duties, and the influences, it had been proved, at least-in Tiibingen, that; only instruction they receive is such as the medical officer of scanty rainfall increases and heavy rains hinder the develop- the ship to which they are drafted may think fit to give ment of the disease. From his experience he had traced a them, and what they may pick up from the sick berth parallelism between pneumonia and enteric fever as regards; steward. If on their return from foreign service they are, their relation to the humidity of the soil. A further analogy between these diseases is to be found in the influencei in accordance with the hospital instructions, sent to the exerted on them by insanitary dwellings. He referred to hospital of the port-a regulation which is by no means conEmmerich’s discovery at Munich of the pneumonia micro- stantly enforced,-they are there principally employed as coccus beneath the floors of a barrack, where the disease scrubbers and on labourers’ duties, instead of being instructed had much prevailed ; and considered that much light had in such work as might be useful in fitting them for their been cast in this direction on the pathogeny of the disease, position when serving afloat. But while this is the mode of Whether pneumonia was supplying the sick-berth staff for ships, that in force for the as well as on its treatment. contagious could not be stated with certainty. Dr. naval hospitals is equally unsatisfactory. The staff is almost Flint was disposed to think so ; but in so widely spread a entirely composed of men without any previous trainingin the disease more direct evidence of its transference was re- duties or special fitness for them-mostly seamen or marines, quired, since cases of supposed contagion might be referred pensioners or discharged soldiers. The only qualifications to exposure to similar insanitary surroundings. Was the demanded are that they must be in fair health, of good pneumonic virus single or multiple? The answer to this character according to their certificates (by no means always question might be found in the study of the "pneumonia satisfactory evidence), and not under twenty-three nor coccus" and the results of its inoculation in animals. above fifty years of age. "No systematic attempt is made Clinically, the unity of the disease would seem tobe to give them training or instruction after entry, and there is established, and the occurrence of a typical case was not nothing to prevent men totally ignorant of their duties from opposedtothis anymore than it was in the case of the specific being placed in charge of serious cases of disease or injury fevers. It seemed likely that the virus circulatesin the blood, within twenty-four hours of their engagement." It is far and is especially prone to settle in the lungs and pleura ; from creditable to the service that such a system should but under certain conditions it may manifest itself in other have been allowed to continue in operation without any regions also. Xauwerk (Tubingen) had found in thirteen attempt at improvement up to the present time. The cases of pneumonia the "cocci" " of Friedlander in the committee are certainly fully justified in the opinion they kidneys; and Jurgensen, in one case marked by cerebral have expressed, " that these men nurses are unfit for the symptoms, found them in the brain. Clinically he would care of our sick, and that a complete change of system group all cases into those (1) of general infection, (2) with is necessary." They recommend, therefcie, that the present cardiac lesion, and (3) with pulmonary lesion predomi- division into a staff for the hospitals and another for nating, although in the last instance the heart always service afloat should be abolished; that the sick-berth staff suffers. Treatment then should be prophylactic, especially should be recruited, as far as possible, from the boys of in improving the sanitary condition of the dwelling. Iodine Greenwich Hospital School; that these boys should in the had been strongly recommended as aborting the disease, but first instance uudergo the usual training in seamanship on Jurgensen was not able to confirm this. Beyond such board the training ships ; fiat on attaining the age of attempts to arrest the disease at its onset, treatment must seventeen they should be sent to Haslar Hospital for be symptomatic; and numerous views were held as to the eighteen months for special training, which would include most appropriate means, all recognising the importance of 1 Berl. Klin. maintaining the force of the heart. Antipyretic measures Wochenschrift, April 28th.

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820 and and a half years of age they ASSOCIATION OF MEMBERS OF THE ROYAL are to be put on a roster for sea service ; and it is COLLEGE OF SURGEONS. recommended that arrangements shall be made to ensure that each man receives a fair share of home and foreign I A MEETING of Members was held on Wednesday, April service in ships and hospitals. Promotion to be generally 30th, at the temporary offices, 3, New Inn, W.C., when the by seniority, but also to depend on good and meritorious following resolutions were passed :conduct. A staff of nursing sisters is to be established 1. " That we form ourselves into a body to be called’ The in certain hospitals, and on them is to devolve the training of Members of the Royal College of Surgeons’ Association of the lads who are sent from the training ships for that for the express purpose of obtaining certain rights and The committee examined existseveral men of the purpose. in reference to the management of the College of ing sick-berth staff, and obtained written answers to a series privileges which we do not at present possess." of questions addressed to a number of naval medical officers. Surgeons, Proposed by Dr. T. STRETCH DOWSE; seconded by Dr. A majority of these were adverse to the introduction of :female nursing into the hospitals; but the success which has COLLUM 2. " That the above resolution be communicated to Mem. attended it at Netley appears to have satisfied the committee that it might be adopted with great benefit to the bers residing in the chief towns of England and Wales, who and to enrol service. The committee also recommend that the cooks in shall be requested to act as localin secretaries, their names of Members residing the respective towns; the naval hospitals receive special instruction in cooking. the local secretaries be asked to forward The scheme for the reform of the nursing appears to us and, further, thatconsidered at the next meeting of the com. to be to have been well considered, and to be calculated to pro- suggestions on Wednesday, May 14th." mittee mote the welfare of the sick and wounded, while the rates 3. " That a report of this meeting be sent to the medical of pay and the regulations for the management of the corps " newspapers." of sick berth attendants seem calculated to induce a good class A proposal of Dr. HICKMAN (who was unavoidably absent) of men to join it. If the selection of the female nurses is well was mentioned by Mr. FORREST, to the effect that it was made, and the service is conducted as judiciously as it now is desirable that a joint association should be formed of Mem. at Netley, we confidently look for a great improvement in this bers of the Royal College of Surgeons and Licentiates of the important branch of the service, and most beneficial results Royal College of Physicians. as regards the treatment of the sick. Dr. DOWSE observed that the former stood in an entirely different position from the latter, inasmuch as they formed a portion of the body corporate, whereas the Licentiates ot the Royal College of Physicians merely possessed a SUPERANNUATION OF POOR-LAW licence to practise, and were not members of the College. MEDICAL OFFICERS. Dr. WARWICK C. STEELE thought that vigorous measures should be taken to suppress unprofessional conduct, such as A MEMORIAL, of which the following is a copy, has been advertising. He had sent advertisements he had received sent to the President and Fellows of the College of to the College of Physicians, the College of Surgeons, and the Society of Apothecaries, but one and all said they could Physicians, to the President and Council of the College of do nothing and to the Warden and of Surgeons, Society Apothecaries :- ! Dr. FOSTER MAcGEAGH said that in conversation with been the have Council of GENTLEMEN,-We deputed by him Fellows themselves had admitted that their exclusive the Poor-law Medical Officers’ Association to apply to you was a matter of luck, and they could give no reason under the following circumstances. In the year 1870 an Act position Members should have no privileges. why was passed called the Poor-law Medical Officers’ SuperMr. M. G. BIGGS was of opinion that the Association annuation Act, whereby it was enacted that on and after a should be based upon broad principles, and that their course given date Boards of Guardians might at their discretion of action should not be at first too closely defined, pending grant superannuation allowance to Poor-law medical officers suggestions to be received from the general body of who had been in office a certain term of time, or who had Members. reached sixty years of age, or who, not being of that age, The following were appointed on the Committee :were incapacitated by infirmity from performing their duties M. G. Biggs, M.R.C.S. ; Robert Collum, M.D., M.R.C.P., with efficiency. Under the provisions of that Act some of T. Stretch Dowse, M.D., F.ltC.P., M.R.C.S.; the members of the Poor-law medical service have been M.R.C.S.; Alexander S. Faulkner, LM.D., M.R.C.S. ; William Hickgranted superanuation allowance, but, owing to the fact man, M.B., M.R.C.P., F.R.C.S.; J. Brindley James, that the Act is merely permissive, many aged and indigent M.R.C.S.; Foster MacGeagh, M.D., M.R.C.S. ; F. St. members of the profession, after holding office for periods George Mivart, M.R.C.S., L.R.C.P. Edin.; James Newvarying from twenty to forty years, have been refused by ham, M.R.C.S.; Edward Semple, M.R.C.S. ;Warwick C. the Board they have faithfully served any superannuation M, R. C. P., M. R. C. S. Steele, allowance whatever. In some instances the refusal has been At the suggestion of Dr. COLL UM, it was determined to call accompanied by an offer of the workhouse or out-door the attention of Members to the fact that the whole managerelief. Many of these aged or broken-down ex-Poor-law ment of the College is in the hands of the 1166 Fellow, medical officers have in consequence been compelled to the Members being absolutely precluded from ex16,258 to be pensioners of the Medical Benevolent Coltheir views, except through the medium of the lege, or become recipients of the bounty of the Medical pressing public press. Benevolent Fund. We believe that it was the intenMr. James Rocheid Forrest was elected Honorary tion of the Legislature, in passing the Poor-law Medical to the Association. Secretary Officers’ Superannuation Act, that all Poor-law medical officers who had complied with the conditions contained in the Act should receive superannuation allowance ; but as the Act has lamentably failed in such respect, we have to respectTHE BRIGHTON IMPROVEMENTS BILL fully ask you in your corporate capacity to memorialise the Local Government Board and to petition the House of A LARGE meeting was held at the Pavilion, Brighton, on Commons, praying that the Act may be amended so as to Wednesday, April 30th, to discuss those clauses of the We would render its permissive clauses compulsory. Bill which are concerned with the respectfully point out that a precedent for such action exists Brighton Improvement of notification infectious diseases. The meeting the of in Ireland, where Colleges Physicians and Surgeons compulsory have severally memorialised the Local Government Board of was widely representative of the various professional and Ireland and the House of Commons in favour of a Bill trade interests of the town. Mr. Wallis was voted to the having such object in view for the benefit of the Irish chair. dispensary medical officers. The following resolution was moved by Mr. E. TURNER, We are. Gentlemen, yours obediently, F,R.C.S., and seconded by the Rev. T. H. BELCHER, PrinJOSEPH ROGERS, Chairman cipal of Brighton College :-IThat in the opinion of this J. W. BARNES, Hon. Sec. Poor-law Medical Officers’ Association, meeting the clauses in the Brighton Improvements Bill Bolt-court, E.C., April 28th. relating to the compulsory notification of infectious diseases

compounding drugs, cooking, nursing, bandaging,

dressing.

apply

When

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