THE HOSPITAL DIETITIAN

365

THE LANCET LONDON:SA TURDA Y, AUGUST 12, 1933

THE HOSPITAL DIETITIAN THE scope of the

hospital

dietitian and the

to fit her for her duties

are training required questions which are now engaging the attention of authorities of municipal as well as of voluntary hospitals. At a recent meeting the central public health committee of the London County Council reported to the Council the results of an inquiry into the usual conditions of training for a type of office not long established in this country, though

in American hospitals. The outcome is recommendation for the training in dietetics, as an experiment, of six State-registered nurses chosen from among those already employed at the Council’s hospitals. It is proposed that the selected candidates should take advantage of a special diploma course to be inaugurated at King’s College of Household and Social Science in October next; the course is for one year only, the first half being spent at the college and the second half in the main kitchen (one and a half months) and special dietetic kitchen (four and a half months) of a hospital. The fee for the course is 30, to be paid by the Council for their six selected candidates, who will undertake to work in their service for three years after obtaining the diploma. The permission to reside in the hospitals to which they are at present attached for the first part of the course, and the allowance of full pay during training, will enable the nurses to take advantage of the opportunity without substantial outlay; presumably they will be given board and lodging at the hospital which receives them for the second part, since they will give service under supervision while studying the administrative work and practising the calculation and preparation of special diets. It is noteworthy that this brief course of training is expected to produce a dietitian fit to undertake responsibilities far greater than those entrusted by most of the voluntary hospitals to the head of the department. The scope of such departments in this country is generally limited to the management and organisation of a special diet kitchen ; the calculation of special diets ordered, and their preparation and service, in cooperation with the vard sister ; the instruction of certain patients leaving hospital and of out-patients-for example, those with diabetes and ansemia ; and the teaching bf nurses in the theory and practice of dietetics. The duties of the officer in charge do not yet as a Tule extend to the main hospital kitchen, to the purchase of food, or to the planning of menus for patients or nursing staff. It must surely be only matter of time before the services of an expert are enlisted in large resident institutions not only common a

to

superintend laboratory - prepared

and

experi-

mental diets, but also to take charge of the whole of the food-supply ; for it is not the quality of the foodstuffs purchased but the lack of imagination in their choice, and of attention to variety, cooking, and service that is the subject of legitimate complaint in most institutions. The London County Council show wisdom in proposing that " thoroughly responsible and well-qualified officers " shall undertake the general organisation of the feeding arrangements in hospitals, as well as the provision of special diets for special patients, and we are in cordial agreement with this wide view of their responsibilities. It seems exceedingly doubtful, however, whether a short course of training will fit even a nurse of quite unusual abilities for such complex duties. The supply of eligible candidates will not, we imagine, be great, for we understand that admission to this special diploma course is limited to those State-registered nurses who can satisfy the authorities that they have spent at least two years in studying science at courses of a university standard. It seems that better results would be obtained likely two at as do least of the by insisting, voluntary hospitals St. Bartholomew’s and University College Hospitals-on the possession of high qualifications, notably a science degree as well as special experience, in their dietitians who, by the way, are not trained nurses. Doubtless, other things being equal, a trained nurse would have preference in such appointments, if only on grounds of enlarging the scope of the work available to a nurse after registration. But the real essential is a thorough training in domestic economics and the chemistry of foodstuffs, as well as in the science of nutrition and its intelligent application. The latter depends not only on knowledge of the basic sciences, but on a cultural background which cannot hastily be acquired. It would be most unfortunate if the organisation of a much needed hospital department were to fail because the persons chosen to inaugurate it had not the equipment and status required to carry through necessary changes. It is to be hoped at least that the shortened course at King’s College will not attract students to the disadvantage of their admirably planned degree course, and that the standards of previous education required in candidates admitted to it will be maintained at a -

high level.

,

INDUSTRIAL PULMONARY DISEASE

highly industrialised country such as Great an enormous variety of raw materials and employing perhaps an equal number of manufacturing processes, there is little need to emphasise the importance of the study of occupational disease. Certainly it has not been overlooked by the compilers and interpreters of our IN

a

Britain, dealing with

national statistics, for the valuable series of studies of occupational mortality, issued at ten-yearly intervals by the Registrar-General, was initiated by FARR as long ago as the middle of the last century. On the other hand, workers in this particular field of hygiene will be the first to admit that the detection of the industrial risk, its isolation from other environmental and, possibly,