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THE GENERAL NURSING COUNCIL.
1201 accounts of the current year cannot be ready by Jan. 1st, that only a formal application is to be This appears to be reasonmade before that date. able enough, and the rates proposed, if they do not cover the cost of treatment in an individual hospital, can presumably be refused by it without its incurring any blame or obloquy on that account. The charity accepting them will make a bargain with the State under which it will be recouped up to a known figure but not beyond it. The maximum allowed for in-patients is to be 11s. per day paid upon a sliding scale, varying according to the circumstances of the hospital and its cost of maintenance. For out-patients the existing fiat rate of 2s. per attendance is continued, and in order to encourage evening clinics the Ministry guarantees a minimum total payment of £22s. per session per clinic, irre. spective of the number of attendances. Also, in the case of aural or ophthalmic clinics, at which the nature of the disability requires active attention by the medical man personally on each occasion of the patient’s attendance, the rate of pay is to be 5s. per attendance as long as the number is below 12, and for any number above 12 payment will be at the rate of 3s. per attendance, while the Ministry will guarantee a minimum total payment of JE33s. per session per clinic. When we consider that a large proportion of those permanently affected by wounds, or otherwise
suffering from disability due to the
common-place and indicate a puerile mentality, thus differing widely from the ingenuity of the malingerer attempting to escape from service. As a general rule there is a reluctance to use methods which require the endurance of even a slight degree of pain. Hunger strikes only individual knows that it is power to make a recovery, owing to the existence of a relative abundance of food. Cases of simulation are extremely rare unless there is a real illness prevalent in the camp. The principal diseases simulated by the prisoners were tuberculosis, epilepsy, nocturnal enuresis, and ankylosis of the limbs from immobilisation ; the production of bullous eruptions by hot fluids was the most obvious of the auto-mutilations. occur
when
the
always in his
EPSOM COLLEGE.
time
wider culture is being to be desirable, the public school education which should ensure it is steadily retreating from the grasp of those with moderate means. Our grandfathers, to whom we owe a debt of nlial gratitude, foresaw this and founded, in the year 1855, on the breezy Surrey Downs, and in pleasant proximity to a famous racecourse, a public school providing, amongst other things, free educationtogether with clothing, maintenance, and pocketmoney-for 50 necessitous sons of medical men. Sir Henry Morris, the present honorary treasurer of Epsom College and of its Royal Medical Foundation, in a letter this week exhorts the present generation to emulate the generosity and foresight of their ancestors, and to give according to their means to keep up and to extend the benefits of the Foundation. On p. 5 of our advertising columns are set forth for all to see what uses will be made of the contributions sent to the treasurer. They will afford no mere gilt-edged security. The value of the training at Epsom College is sterling through and through. AT the
same
as a
generally recognised
war, are under 25 years of age, and that some of these may require constant or intermittent treatment during the rest of their lives, we realise that the definite establishment of a principle of national responsibility for their benefit has been just and necessary. These sufferers will keep alive tbe memory of the killing and maiming inseparable from war in all our minds. They will form a class of patients who will recall to us what science did to preserve life while the great struggle = lasted, and may yet be called upon to do. The letter of the British Hospitals Association informs us that the improved arrangement now entered THE GENERAL NURSING COUNCIL. into is the result of negotiations initiated ENACTMENTS for the State registration of nurses by it with the Ministry of Pensions, and it is in all three constituent parts of the United Kingdom to be congratulated upon what it has achieved. The sanction of the Treasury had not been obtained havebeenhurriedthroughbothHousesof Parliament. when the Association’s letter was printed, but pre. In each case the Act provides simply for the enrolment of names on a list, and leaves it to a General sumably it will not be withheld in the circumstances. It will remain for the Ministry of Pensions Nursing Council to define the standard of training The first English to carry out its own conditions in a just and and other important matters. Council to be will held office for not appointed generous spirit, asking only for such evidence of than two and not more than three less years to its own is and cost as, word, "reasonable," quote and will consist of 25 members, two to be years, and its with fulfilling obligations ascertaining " appointed by the Privy Council, two by the Board reasonable " promptitude. of Education, five by the Minister of Health after consultation with training authorities. The remain. SIMULATION AMONG PRISONERS OF WAR. ing sixteen members, also to be appointed by the As the result of his observations in the prisoners Minister of Health, must be, or have been at some of war camp at Celle (Hanover), which mainly con- time, actually engaged in nursing the sick, and the sisted of officers, and in the adjacent hospital, in be made after consultation with will appointments which Belgian, French, and Russian soldiers were the Central Committee for the State Registration treated, Pellegrini1 came to the following con- of Nurses, the College of Nursing, the Royal British clusions. Simulation among prisoners of war is Nurses Association, and other bodies desiring to be uncommon. The rarity of its occurrence is consulted in the matter. After the first Council . very not due to fear of punishment or to a lofty moral has held office for three years the constitution will standard, but mainly to a peculiar state of anaphy- remain the same, except that the sixteen nurse laxis or hypersensitiveness to pain and to the lack members will be elected by the nurses on the of physical and moral energy to which the prisoner The members of this second, and finally register. soon becomes a victim. When simulation does constituted, Council will remain in office for five occur it is only found in isolated cases, and hardly years. Since Parliament, when establishing any ever in epidemic form, as it is seen at the front. State register, must safeguard the interests of The methods employed are often extremely those already in practice, there is a " loose clause in the Bill which covers the admission of 1 Gazetta e delle 828-332. -
"
degli Ospedali
Cliniche, 1919, xl.,
1202
existing nurses to the register during a period of two years, subject to the approval of their claims by the General Nursing Council. Rules made by the Council will not come into operation until they have been approved by the Minister of Health I The register is to and laid before Parliament. consist of a general and a supplementary part, the latter to include male nurses, mental nurses, and The Fever Nurses Associa- ’ nurses of sick children. tion has not asked for a separate register, nurses qualifying at a fever hospital merely having this fact noted on the register. It is quite evident that the question whether State registration of nurses as granted by this Bill is to be a help or not to the nursing profession and to the sick public will depend entirely upon the General Nursing Council, its wisdom and its strength. The one essential thing, registration, having been obtained, we may reasonably expect the pioneers of the movement to lay aside their armour and assist each other in peaceful legislation for the common good.
therefore thinks that there should be no hesitation in adopting this treatment, which completely transforms a disease of serious prognosis. VOLUNTARY WELFARE WORK IN LONDON. A DEPUTATION from the London Federation of Infant Welfare Centres was recently received by the Minister of Health, and the work carried out by maternity and infant welfare centres in London The situation in London is comwas discussed. the exceptionally large number (154) plicated by of voluntary infant welfare centres compared with the 41 municipal ones. It was urged by the
deputation that the voluntary centres should be encouraged to continue their work as part of properly coordinated borough schemes, in order to preserve the good-will with the mothers which those centres had acquired. The methods of organising the work vary in form and efficiency in different metropolitan boroughs, and there are three ways in which the municipalities have dealt with voluntary centres in the THE PROLONGED SERUM TREATMENT OF past : (1) by taking over the centres; (2) by giving help in kind-allowing the use of premises; HÆMOPHILIA. or (3) by repaying the centres for work done. FOR the serum treatment of haemophilia we are The second way is a compromise, and unsatisindebted to M. P. Emile-Weil. At a meeting of the at that. The third course is that advo. Academie de Medicine of Paris on Nov. 25th he factory the members of the deputation, who laid cated by returned to the subject and showed the value of stress on the retention of the personal prolonged administration. In 1907 he reported to great touch between the voluntary workers and the the Congress of Medicine at Paris the case of a mothers, and seemed to think this is imperilled man. aged 26 years, who since infancy manifested where the centres are taken over by the muni.. haemorrhages with quasi-regularity-hæmarthroses cipality. The alternative, suggested by the depu every month and hæmaturia four times a year. He tation-namely, the allocation of a grant sufficient was injected six times during a year with serum, to enable the voluntary centres to employ a number human or animal, and the haemorrhages ceased. At of skilled health visitors-might equally put the same time his blood, which coagulated in an highly end to the existence of the personal touch. But 42 hours before the treatment, showed only the we find it difficult to see how the taking over of slightest delay in coagulation. The case was the centres by the local authority would destroy followed for five years, during which 20 c.cm. of the confidence of mothers and midwives, provided serum were injected every three months at first due care were taken to prevent sudden changes in No spontaneous and then every two months. personnel. One of the drawbacks of the present haemorrhages occurred, but the blood did not system is the wide variety in methods between become altogether normal, and the haemophilia different districts, and the best way of ensuring persisted in slight degree, for when he cut himself some standard in the conduct of welfare centres he bled more than a normal person, but never would surely be their assimilation by the local dangerously. Of the great number of haemo- authority under the advisory control of the Ministry philiacs who have been under M. Emile Weil’s of Health. care only six others submitted to prolonged treatment. Five obtained the same attenuation THE new scale of pay in the Royal Army Medical of the disease and the complete disappearance on p. 1209, comes into force with the of recurrent hæsmorrhages (hæmarthroses, haemato- Corps, given New Year. Officers may now hold, and draw the The abnormalities of the blood greatly mata, &c.). to the rank of diminished but never disappeared. In the sixth pay of, specialist appointments up full colonel, while the specialist pay is double the case the amelioration was the least; the recurrent ____
____
former rate in several of the subjects. This is a haematomata continued. The curative action of move in the right direction. serum injections in hemophilia is generally admitted, but what M. Emile-Weil insisted on was THE subject set for the Liddle Triennial Prize the preventive action of continuous treatment. for 1919-20 is the Ætiology of Epidemic Influenza. By it the diathesis can be made to " age " arti- The value of this prize is JE120,and it is open to public ficially in a few months, a process which naturally competition, the number and importance of original requires years. It is curious that although the observations being chiefly considered in the award. injections give the most favourable conditions for The examiners are appointed by the Medical severe manifestations of anaphylaxis such never Council of the London Hospital, and essays, disoccurred. One patient received 30 injections in by a motto or device, should reach the six years, others 20, and still others 12 without tinguished Dean of the London Hospital Medical College by ever being really ill. Nothing more serious than June 30th, 1920. some fever, slight artbropathy, or urticaria was These complications appeared most observed. INDEX TO " THE LANCET," VOL. II., 1919. irregularly. One patieut showed them on the THE Index and Title-page to Vol. II., 1919, seventeenth injection, though be never had them before e or afterwards. Others had them after the first which is completed with the current issue, will and not after the later injections. M. Emile-Weil be published in THE LANCET shortly.
suffering from disability due to the
common-place and indicate a puerile mentality, thus differing widely from the ingenuity of the malingerer attempting to escape from service. As a general rule there is a reluctance to use methods which require the endurance of even a slight degree of pain. Hunger strikes only individual knows that it is power to make a recovery, owing to the existence of a relative abundance of food. Cases of simulation are extremely rare unless there is a real illness prevalent in the camp. The principal diseases simulated by the prisoners were tuberculosis, epilepsy, nocturnal enuresis, and ankylosis of the limbs from immobilisation ; the production of bullous eruptions by hot fluids was the most obvious of the auto-mutilations. occur
when
the
always in his
EPSOM COLLEGE.
time
wider culture is being to be desirable, the public school education which should ensure it is steadily retreating from the grasp of those with moderate means. Our grandfathers, to whom we owe a debt of nlial gratitude, foresaw this and founded, in the year 1855, on the breezy Surrey Downs, and in pleasant proximity to a famous racecourse, a public school providing, amongst other things, free educationtogether with clothing, maintenance, and pocketmoney-for 50 necessitous sons of medical men. Sir Henry Morris, the present honorary treasurer of Epsom College and of its Royal Medical Foundation, in a letter this week exhorts the present generation to emulate the generosity and foresight of their ancestors, and to give according to their means to keep up and to extend the benefits of the Foundation. On p. 5 of our advertising columns are set forth for all to see what uses will be made of the contributions sent to the treasurer. They will afford no mere gilt-edged security. The value of the training at Epsom College is sterling through and through. AT the
same
as a
generally recognised
war, are under 25 years of age, and that some of these may require constant or intermittent treatment during the rest of their lives, we realise that the definite establishment of a principle of national responsibility for their benefit has been just and necessary. These sufferers will keep alive tbe memory of the killing and maiming inseparable from war in all our minds. They will form a class of patients who will recall to us what science did to preserve life while the great struggle = lasted, and may yet be called upon to do. The letter of the British Hospitals Association informs us that the improved arrangement now entered THE GENERAL NURSING COUNCIL. into is the result of negotiations initiated ENACTMENTS for the State registration of nurses by it with the Ministry of Pensions, and it is in all three constituent parts of the United Kingdom to be congratulated upon what it has achieved. The sanction of the Treasury had not been obtained havebeenhurriedthroughbothHousesof Parliament. when the Association’s letter was printed, but pre. In each case the Act provides simply for the enrolment of names on a list, and leaves it to a General sumably it will not be withheld in the circumstances. It will remain for the Ministry of Pensions Nursing Council to define the standard of training The first English to carry out its own conditions in a just and and other important matters. Council to be will held office for not appointed generous spirit, asking only for such evidence of than two and not more than three less years to its own is and cost as, word, "reasonable," quote and will consist of 25 members, two to be years, and its with fulfilling obligations ascertaining " appointed by the Privy Council, two by the Board reasonable " promptitude. of Education, five by the Minister of Health after consultation with training authorities. The remain. SIMULATION AMONG PRISONERS OF WAR. ing sixteen members, also to be appointed by the As the result of his observations in the prisoners Minister of Health, must be, or have been at some of war camp at Celle (Hanover), which mainly con- time, actually engaged in nursing the sick, and the sisted of officers, and in the adjacent hospital, in be made after consultation with will appointments which Belgian, French, and Russian soldiers were the Central Committee for the State Registration treated, Pellegrini1 came to the following con- of Nurses, the College of Nursing, the Royal British clusions. Simulation among prisoners of war is Nurses Association, and other bodies desiring to be uncommon. The rarity of its occurrence is consulted in the matter. After the first Council . very not due to fear of punishment or to a lofty moral has held office for three years the constitution will standard, but mainly to a peculiar state of anaphy- remain the same, except that the sixteen nurse laxis or hypersensitiveness to pain and to the lack members will be elected by the nurses on the of physical and moral energy to which the prisoner The members of this second, and finally register. soon becomes a victim. When simulation does constituted, Council will remain in office for five occur it is only found in isolated cases, and hardly years. Since Parliament, when establishing any ever in epidemic form, as it is seen at the front. State register, must safeguard the interests of The methods employed are often extremely those already in practice, there is a " loose clause in the Bill which covers the admission of 1 Gazetta e delle 828-332. -
"
degli Ospedali
Cliniche, 1919, xl.,
1202
existing nurses to the register during a period of two years, subject to the approval of their claims by the General Nursing Council. Rules made by the Council will not come into operation until they have been approved by the Minister of Health I The register is to and laid before Parliament. consist of a general and a supplementary part, the latter to include male nurses, mental nurses, and The Fever Nurses Associa- ’ nurses of sick children. tion has not asked for a separate register, nurses qualifying at a fever hospital merely having this fact noted on the register. It is quite evident that the question whether State registration of nurses as granted by this Bill is to be a help or not to the nursing profession and to the sick public will depend entirely upon the General Nursing Council, its wisdom and its strength. The one essential thing, registration, having been obtained, we may reasonably expect the pioneers of the movement to lay aside their armour and assist each other in peaceful legislation for the common good.
therefore thinks that there should be no hesitation in adopting this treatment, which completely transforms a disease of serious prognosis. VOLUNTARY WELFARE WORK IN LONDON. A DEPUTATION from the London Federation of Infant Welfare Centres was recently received by the Minister of Health, and the work carried out by maternity and infant welfare centres in London The situation in London is comwas discussed. the exceptionally large number (154) plicated by of voluntary infant welfare centres compared with the 41 municipal ones. It was urged by the
deputation that the voluntary centres should be encouraged to continue their work as part of properly coordinated borough schemes, in order to preserve the good-will with the mothers which those centres had acquired. The methods of organising the work vary in form and efficiency in different metropolitan boroughs, and there are three ways in which the municipalities have dealt with voluntary centres in the THE PROLONGED SERUM TREATMENT OF past : (1) by taking over the centres; (2) by giving help in kind-allowing the use of premises; HÆMOPHILIA. or (3) by repaying the centres for work done. FOR the serum treatment of haemophilia we are The second way is a compromise, and unsatisindebted to M. P. Emile-Weil. At a meeting of the at that. The third course is that advo. Academie de Medicine of Paris on Nov. 25th he factory the members of the deputation, who laid cated by returned to the subject and showed the value of stress on the retention of the personal prolonged administration. In 1907 he reported to great touch between the voluntary workers and the the Congress of Medicine at Paris the case of a mothers, and seemed to think this is imperilled man. aged 26 years, who since infancy manifested where the centres are taken over by the muni.. haemorrhages with quasi-regularity-hæmarthroses cipality. The alternative, suggested by the depu every month and hæmaturia four times a year. He tation-namely, the allocation of a grant sufficient was injected six times during a year with serum, to enable the voluntary centres to employ a number human or animal, and the haemorrhages ceased. At of skilled health visitors-might equally put the same time his blood, which coagulated in an highly end to the existence of the personal touch. But 42 hours before the treatment, showed only the we find it difficult to see how the taking over of slightest delay in coagulation. The case was the centres by the local authority would destroy followed for five years, during which 20 c.cm. of the confidence of mothers and midwives, provided serum were injected every three months at first due care were taken to prevent sudden changes in No spontaneous and then every two months. personnel. One of the drawbacks of the present haemorrhages occurred, but the blood did not system is the wide variety in methods between become altogether normal, and the haemophilia different districts, and the best way of ensuring persisted in slight degree, for when he cut himself some standard in the conduct of welfare centres he bled more than a normal person, but never would surely be their assimilation by the local dangerously. Of the great number of haemo- authority under the advisory control of the Ministry philiacs who have been under M. Emile Weil’s of Health. care only six others submitted to prolonged treatment. Five obtained the same attenuation THE new scale of pay in the Royal Army Medical of the disease and the complete disappearance on p. 1209, comes into force with the of recurrent hæsmorrhages (hæmarthroses, haemato- Corps, given New Year. Officers may now hold, and draw the The abnormalities of the blood greatly mata, &c.). to the rank of diminished but never disappeared. In the sixth pay of, specialist appointments up full colonel, while the specialist pay is double the case the amelioration was the least; the recurrent ____
____
former rate in several of the subjects. This is a haematomata continued. The curative action of move in the right direction. serum injections in hemophilia is generally admitted, but what M. Emile-Weil insisted on was THE subject set for the Liddle Triennial Prize the preventive action of continuous treatment. for 1919-20 is the Ætiology of Epidemic Influenza. By it the diathesis can be made to " age " arti- The value of this prize is JE120,and it is open to public ficially in a few months, a process which naturally competition, the number and importance of original requires years. It is curious that although the observations being chiefly considered in the award. injections give the most favourable conditions for The examiners are appointed by the Medical severe manifestations of anaphylaxis such never Council of the London Hospital, and essays, disoccurred. One patient received 30 injections in by a motto or device, should reach the six years, others 20, and still others 12 without tinguished Dean of the London Hospital Medical College by ever being really ill. Nothing more serious than June 30th, 1920. some fever, slight artbropathy, or urticaria was These complications appeared most observed. INDEX TO " THE LANCET," VOL. II., 1919. irregularly. One patieut showed them on the THE Index and Title-page to Vol. II., 1919, seventeenth injection, though be never had them before e or afterwards. Others had them after the first which is completed with the current issue, will and not after the later injections. M. Emile-Weil be published in THE LANCET shortly.