- Email: [email protected]
THE NURSING DIFFICULTY IN FRANCE.
1342
destroyed by the disease or was sacrificed in extracting the sequestrum. In our experience sequestra involve either the vestibular region or the cochlea, or both. While we have met with sequestra of both parts in the same labyrinth we have not met with a case in which the whole labyrinth formed a continuous massive sequestrum. Sequestra of the cochlea readily separate, consisting generally of the promontory and first half turn only. The converse is the case with sequestra of the vestibule and canals. Tnese are deeply
the inner side of the facial nerve and involve the wall of the internal auditory meatus. Such sequestra lie posteriorly against the dura mater covering the cerebellum. Sequestra of the vestibule and canals must be sought for, and should be sought for, when there is reasonable ground for suspecting their presence. They may be discovered by probing fi,3tulous tracks and may be suspected where granulations are persistently re-formed. The sequestrum must be freely exposed before attempting to dislodge it. It may be necessary to cut away apparently intact portions of the labyrinth before the dead mass of bone is exposed, for the typical sequestrum does not include any part of the outer surface of the labyrinth. Three of our cases (Cases 25, 26, and 14) were examples of seqnestrotomy, the sequestra being removed in each case by the posterior route-i.e., behind the facial nerve. Case 29 was an example of spontaneous exfoliation of the cochlea. In addition to the 26 cases illustrating operative procedures on the labyrinth our knowledge of infective labyrinthitis was extended by other cases which were not operated upon. We quoted four of these cases (Cases 27, 28, 29, and 30) which appeared to present important clinical or pathological features bearing on the surgery of the
situated
on
posterior
labyrinth. Results.-The .cases submitted to operation on the labyrinth have healed with such absolute uniformity that we are led to suspect that the cause of some at least of the failures after the radical operation may be due to disease of the labyrinth. In every case in which vertigo was present it has been completely and permanently relieved. We have been fortunate in having no case of permanent facial paralysis. In only one case has there been a death due to the operation, this being after an inadequate operation, superior vestibulotomy. We lost two other cases through not operating on the labyrinth. In conclusion we would assimilate the grounds for operation in labyrinthitis with those justifying the radical mastoid operation, and we believe that the time will come when no aural surgeon will be content to leave an infective cavity in such perilous proximity to the meninges.
THE NURSING DIFFICULTY IN FRANCE. BY J. DARDEL, M.D. PARIS. FOREIGNERS visiting the French hospitals have often heard the medical officers complain of the nursing staff. These complaints are well founded, but to what may we attribute them and how may they be remedied ? In former times the French hospitals were served by nuns. In Paris, above all, many communities of religieuses undertook the nursing required by the Assistance Publique. It is a wellknown fact that the Assistance Publique is entirely taken up with the care of the very poor, their nursing, &c., and visiting them in their own homes, for the French law makes the working of independent hospitals an affair of extreme
difllcnlty.
Municipal Council of Paris decided hospitals. This was a very tedious and difficult undertaking, for it concerned no less than 15 of the larger hospitals. At the present moment an almost complete change has been effected and the towns and the provinces are also following suit in the example given by Some 30 years ago the
to secularise the
The new enactments of the French Government make it simply a question of time when, in the not very distant future, the nursing of the nuns will become simply a remembrance of the past. What object had Paris in view when she decided upon so sweeping a reform ? The secularisation of the hospital staff is merely a political move. Let us just touch upon the fundamental cause for this great reform. First and foremost, it was a question of dealing a blow at a party which had been defeated in the electoral struggles. It is worthy of remark that in the discussions of this period (1880-85) questions of a technical Paris.
(1901)
occupy but little space. In fact, there was small of complaint against the nuns. They fulfilled the rôle of sisters and staff nurses. They were few in number, about two for each ward ; they did all the waiting and were held responsible by the medical officers and the administration. Under them a non-religious ataff rendered valuable assistance to the sick. This assistant staff was badly recruited, badly paid, and without training. The faults which they committed were often attributed to the nuns and cleverly brought home to them. The nuns were also accused of being too conservative. This is quite possible, for these religieuses were far from being perfect and there was much room for improvement in their training. But we must not overlook a date which was of great importance. The secularisation of the hospitals in France coincides with the period of antiseptic treatment. The idea of antiseptic and of septic treatment was taught as something new. It was a period of transition and the medical corps, as well as the nursing staff of the hospitals, had to adapt itself to new ideas. The old nuns, like all the others, had to go through a special technical training. The religious influence exercised on the conscience of the sick was of rare occurrence. On the other hand, the nuns knew how to suppress all licence and evil tendencies in the wards ; they knew how to comfort the sick, by whom they were held in great esteem, as also by the doctors and medical students. No one ever dreamt of taking any liberties with the nuns. When in the year 1880 the secularisation of the hospitals was decided upon, a thoroughly trained staff not being available, the administration accepted the first comers, whether competent or not, who nursed the sick-without even the most elementary ideas of the work-under the supervision of the nuns. This staff, somewhat domestic, was given almost the entire control of the wards. It was soon noted that they stood much in need of instruction. Schools for the nurses and staff were founded where, in certain cases, they had to be taught how to read. Those schools have now been open for 27 years and the results may be well guessed at. The technical instruction given there has borne fruit, but young girls with a sufficient moral education have not been attracted to them. They have turned out nurses capable of good work, their education has been improved, but the social position of the nurses has not changed. Now, so long as this is so really good nurses will be at a premium. What lowers the nursing profession in France is not the poor salary which they receive but the inferior rank of the nurses themselves, combined with the arduous work required of them and the little compensating comfort. The nurses in the Paris hospitals are badly paid when they enter. The salary gradually rises and the remuneration becomes equal to that obtained by nurses in England. This salary cannot be looked upon as a fortune but it is sufficient to permit of a woman living in comparative comfort if she is not encumbered with a family. What kind of life is led by the nurses ? They are lodged in dormitories which are both dirty and dismal, often mere garrets. Air is wanting and heating is unprovided. Furniture is very scanty, a wardrobe or a chest of drawers for little personal effects being all that is supplied-less comfort than in the room of a general servant. There is not a corner where the unfortunate woman can perform her most private toilette. The water-closets-common to both sexes -are very badly kept. There is no bathroom and no recreation or rest room. The dormitories are the same for those working during the day or the night, which means that in them perfect rest is almost impossible. The food is very bad and very badly served. To ask for better is out of the question. The director is an official of high importance and he, like the others, is but a tool of the great administrative machinery. It is necessary that there should be no trouble and no complaint. Neither can he ask for supplementary credit. In short, the nurse, no matter what her class is or her degree, is treated as a servant. All may be traced back to this mistake which is fundamental-the little consideration shown to the staff of nurses. The sick, the management, the medical officers, one and all are allowed regrettable familiarities with these poor women. The directors of the hospitals have always mixed up the classes, when a very clear line of division should be drawn between them. Young servants become nurses in the course of time by means of examination or by protection. This lamentable confusion prevents young girls who have had a certain amount of education from entering the hospitals. This staff, so badly treated physically and morally be it order
cause
1343
said, is forced to
overwork itself. The wards often contain hospital nurses. Quite recently the administration: of the Night duty is relegated to perfect beginners, Assistance Publique tried to improve the condition of the First and foremost, they tried to increase the without experience and without ability, quite unaccustomed nurses. to hospital discipline. The natural result of these bad salary of the nurses, so that they might be able to raise sanitary conditions in the hospitals of Paris is that the themselves, put something by-in a word, accomplish a mortality from consumption is something appalling. The moral reform. staff has only a very hazy idea as to its moral responsibilities. Many practical reforms have recently been attempted in Tips are allowed as quite a matter of course. Be it said, the private hospitals of Paris with reference to the creation however, that these women are at heart extremely good- of a staff upon the new lines. It is to be hoped that this natured. The evil lies in their social position. Tips do not example may be followed by the large hospitals. These
40 or 50 beds.
humiliate them. Permission to marry is disastrous. The efforts should receive the encouragement of the doctors and result is additional fatigue and overwork, for these women of the public and have no sectarian interest ; still less must must use up their leisure moments in looking after their they be anti-sectarian. homes. A serious omission in the organisation of the hospital staff is the absence of a woman at the head of affairs-the matron of the English hospitals. The result is that the promotion of a nurse is more often due to political influence than to personal merit. This, no doubt, is a matter of astonishment to the English, but as the municipal authorities are at the head of affairs in the French hospitals their great object is to stand well with their electors rather than to consider the rights of the nursing staff. To rightly judge it is above all expedient to take into consideration the ways of the country ; thus, what would cause astonishment in England comes as a matter of course in France. This will account for the fact that in all the wards of the French hospitals men nurses work side by side with the women nurses. Do not let us overlook the fact that in the French hospitals men-nurses and employees of all sorts-are very numerous. Thus often the women nurses are married and are lodged with their husbands in the hospital. These are the things which render it so difficult rightly and properly to recruit the hospital staff. Let us examine for a moment how this situation may best be remedied. Reform is possible, but there must be less centralisation, requiring everywhere an identical organisation. As to the Parisian hospitals one must not seek to reform them all at once. At first the reform should only be applied to one single hospital, for preference a new one, for it naturally follows that a staff recruited according to the new régime cannot have mixed with the existing one. The wisest thing to do would be to adopt the English system, which is the best-offer to young girls the means of acquiring a diploma which would enable them to earn their living and in return require of them their services in looking after the sick. The question of money is a secondary consideration. Above all, a moral reform is
Aix-les-Bains. _________________
Clinical Notes: MEDICAL, SURGICAL, OBSTETRICAL, AND THERAPEUTICAL. SPONTANEOUS RUPTURE OF THE HEART. BY A. F. THEOBALDS, M.B., CH. B. EDIN., PATHOLOGIST AND ASSISTANT MEDICAL OFFICER, WEST RIDING ASYLUM, WAKEFIELD,
THE
following
case
of
a
patient surviving spontaneous
rupture of the heart for six days is worth recording. The patient was an inmate of the West Riding Asylum for 26 years and died in November last, aged 65 years. He suffered from chronic mania, and on the whole was fairly quiet and in good health. About a year ago he was found to have a mitral systolic murmur but it did not seem to inconvenience him. One Tuesday he was seized suddenly with what was thought to be an ordinary syncopal attack and was put to bed. He soon recovered, however, but on Sunday morning died suddenly while still in bed. At the post-mortem examination the pericardium was found to be distended with fluid blood ; the heart was enlarged and weighed 375 grammes. On the anterior surface of the left ventricle near the middle and to the outer side was seen a small sub-epicardial hæmorrhage of about the size of a halfpenny, on the outer side of which was the external aperture of the rupture of about the size of a pin’s head. On cutting through this the rupture was seen to extend from the inner surface of the ventricle and to be V-shaped. The wall of the ventricle was fully half an inch thick, but was pale, soft, absolutely essential. To turn out a good nurse we must take her from surround- and flabby. The coronary arteries, however, were apparently ings entirely different from the present one. We must try to healthy. The mitral valve was dilated and there was slight get young girls who have received a certain amount of thickening of the aortic valves, the first part of the aorta also instruction and a fair education. The celibacy of the nurse being slightly roughened. The vessels at the base of the must be insisted upon. This reform is absolutely imperative brain were markedly atheromatous and the choroid plexuses in spite of the prejudices existing in France on the subject. were calcareous. A somewhat similar case, also in an insane patient, was There must be a woman at the head, answering to the " matron," who shall be held responsible for the stafE and published by Dr. H. Kerr in THE LANCET in 1904in which shall be in direct touch with them. The nurse must undergo he refers to the rarity of the condition. In his case, however, a practical training, given in the wards by other nurses who the patient apparently succumbed immediately, although, as have themselves passed through the training that they are in the one above, there was no history of sudden exertion’or imparting to the beginners. The theoretical teaching of the strain. doctors is but the complement and not the principal. In I am indebted to Mr. W. Bevan-Lewis for permission to France, too, much importance is laid upon theoretical publish this case and to Dr. J. A. Creighton, assistant medical instruction to the exclusion of the practical. The duties of officer, for the clinical notes. a nurse are quite different and quite separated from those of Wakefield. the domestic "ward maids." The number of men and, above all, lodged in the hospital should be greatly NOTE ON A CASE OF OSTEO-FIBROMA OF THE reduced. A certain number of male employees is, of course, MAXILLA. necessary but only women should be called upon to nurse the BY ANDREW WYLIE, M.D., C.M. GLASG., sick. Sweeping changes must be made in the treatment of ASSISTANT SURGEON, CENTRAL LONDON THROAT AND EAR HOSPITAL, the nurses, both physically and morally. As in the English hospitals, they must no longer be treated as servants. They Vith a Pathological Report by V. H. WYATT WINGRAVE, must have every consideration and, at the same time, gain M.D. Durh., Pathologist to the Hospital. an honest livelihood, both as to salary and as to food. Above all, they must have comfortable quarters, cheerful THE patient, a man, aged 53 years, consulted me on and bright, where, after their many hours of hard work, Jan. 9th complaining of a " growth in the palate " of 25 they may retire and feel at home. years’ duration. He suffered no pain and very little dis. Now, these reforms would not be very costly : it means comfort ; in fact, he stated that beyond a certain amount of changing the hospital into a training school, teaching the anxiety it gave him no trouble, and having grown slowly and staff hospital and private nursing, and, in return for such gradually he had got quite used to it. Mastication and teaching, having a call upon their services in nursing the deglutition were performed without any difficulty, and with sick, as is done in England. Their training once acquired, the exception of a slight " thickness " or impaired resonance these nurses would gain their diplomas and be capable of 1 THE looking after the wards and in the end become fully qualified LANCET, Dec. 31st, 1904, p. 1832. .
employed
’
destroyed by the disease or was sacrificed in extracting the sequestrum. In our experience sequestra involve either the vestibular region or the cochlea, or both. While we have met with sequestra of both parts in the same labyrinth we have not met with a case in which the whole labyrinth formed a continuous massive sequestrum. Sequestra of the cochlea readily separate, consisting generally of the promontory and first half turn only. The converse is the case with sequestra of the vestibule and canals. Tnese are deeply
the inner side of the facial nerve and involve the wall of the internal auditory meatus. Such sequestra lie posteriorly against the dura mater covering the cerebellum. Sequestra of the vestibule and canals must be sought for, and should be sought for, when there is reasonable ground for suspecting their presence. They may be discovered by probing fi,3tulous tracks and may be suspected where granulations are persistently re-formed. The sequestrum must be freely exposed before attempting to dislodge it. It may be necessary to cut away apparently intact portions of the labyrinth before the dead mass of bone is exposed, for the typical sequestrum does not include any part of the outer surface of the labyrinth. Three of our cases (Cases 25, 26, and 14) were examples of seqnestrotomy, the sequestra being removed in each case by the posterior route-i.e., behind the facial nerve. Case 29 was an example of spontaneous exfoliation of the cochlea. In addition to the 26 cases illustrating operative procedures on the labyrinth our knowledge of infective labyrinthitis was extended by other cases which were not operated upon. We quoted four of these cases (Cases 27, 28, 29, and 30) which appeared to present important clinical or pathological features bearing on the surgery of the
situated
on
posterior
labyrinth. Results.-The .cases submitted to operation on the labyrinth have healed with such absolute uniformity that we are led to suspect that the cause of some at least of the failures after the radical operation may be due to disease of the labyrinth. In every case in which vertigo was present it has been completely and permanently relieved. We have been fortunate in having no case of permanent facial paralysis. In only one case has there been a death due to the operation, this being after an inadequate operation, superior vestibulotomy. We lost two other cases through not operating on the labyrinth. In conclusion we would assimilate the grounds for operation in labyrinthitis with those justifying the radical mastoid operation, and we believe that the time will come when no aural surgeon will be content to leave an infective cavity in such perilous proximity to the meninges.
THE NURSING DIFFICULTY IN FRANCE. BY J. DARDEL, M.D. PARIS. FOREIGNERS visiting the French hospitals have often heard the medical officers complain of the nursing staff. These complaints are well founded, but to what may we attribute them and how may they be remedied ? In former times the French hospitals were served by nuns. In Paris, above all, many communities of religieuses undertook the nursing required by the Assistance Publique. It is a wellknown fact that the Assistance Publique is entirely taken up with the care of the very poor, their nursing, &c., and visiting them in their own homes, for the French law makes the working of independent hospitals an affair of extreme
difllcnlty.
Municipal Council of Paris decided hospitals. This was a very tedious and difficult undertaking, for it concerned no less than 15 of the larger hospitals. At the present moment an almost complete change has been effected and the towns and the provinces are also following suit in the example given by Some 30 years ago the
to secularise the
The new enactments of the French Government make it simply a question of time when, in the not very distant future, the nursing of the nuns will become simply a remembrance of the past. What object had Paris in view when she decided upon so sweeping a reform ? The secularisation of the hospital staff is merely a political move. Let us just touch upon the fundamental cause for this great reform. First and foremost, it was a question of dealing a blow at a party which had been defeated in the electoral struggles. It is worthy of remark that in the discussions of this period (1880-85) questions of a technical Paris.
(1901)
occupy but little space. In fact, there was small of complaint against the nuns. They fulfilled the rôle of sisters and staff nurses. They were few in number, about two for each ward ; they did all the waiting and were held responsible by the medical officers and the administration. Under them a non-religious ataff rendered valuable assistance to the sick. This assistant staff was badly recruited, badly paid, and without training. The faults which they committed were often attributed to the nuns and cleverly brought home to them. The nuns were also accused of being too conservative. This is quite possible, for these religieuses were far from being perfect and there was much room for improvement in their training. But we must not overlook a date which was of great importance. The secularisation of the hospitals in France coincides with the period of antiseptic treatment. The idea of antiseptic and of septic treatment was taught as something new. It was a period of transition and the medical corps, as well as the nursing staff of the hospitals, had to adapt itself to new ideas. The old nuns, like all the others, had to go through a special technical training. The religious influence exercised on the conscience of the sick was of rare occurrence. On the other hand, the nuns knew how to suppress all licence and evil tendencies in the wards ; they knew how to comfort the sick, by whom they were held in great esteem, as also by the doctors and medical students. No one ever dreamt of taking any liberties with the nuns. When in the year 1880 the secularisation of the hospitals was decided upon, a thoroughly trained staff not being available, the administration accepted the first comers, whether competent or not, who nursed the sick-without even the most elementary ideas of the work-under the supervision of the nuns. This staff, somewhat domestic, was given almost the entire control of the wards. It was soon noted that they stood much in need of instruction. Schools for the nurses and staff were founded where, in certain cases, they had to be taught how to read. Those schools have now been open for 27 years and the results may be well guessed at. The technical instruction given there has borne fruit, but young girls with a sufficient moral education have not been attracted to them. They have turned out nurses capable of good work, their education has been improved, but the social position of the nurses has not changed. Now, so long as this is so really good nurses will be at a premium. What lowers the nursing profession in France is not the poor salary which they receive but the inferior rank of the nurses themselves, combined with the arduous work required of them and the little compensating comfort. The nurses in the Paris hospitals are badly paid when they enter. The salary gradually rises and the remuneration becomes equal to that obtained by nurses in England. This salary cannot be looked upon as a fortune but it is sufficient to permit of a woman living in comparative comfort if she is not encumbered with a family. What kind of life is led by the nurses ? They are lodged in dormitories which are both dirty and dismal, often mere garrets. Air is wanting and heating is unprovided. Furniture is very scanty, a wardrobe or a chest of drawers for little personal effects being all that is supplied-less comfort than in the room of a general servant. There is not a corner where the unfortunate woman can perform her most private toilette. The water-closets-common to both sexes -are very badly kept. There is no bathroom and no recreation or rest room. The dormitories are the same for those working during the day or the night, which means that in them perfect rest is almost impossible. The food is very bad and very badly served. To ask for better is out of the question. The director is an official of high importance and he, like the others, is but a tool of the great administrative machinery. It is necessary that there should be no trouble and no complaint. Neither can he ask for supplementary credit. In short, the nurse, no matter what her class is or her degree, is treated as a servant. All may be traced back to this mistake which is fundamental-the little consideration shown to the staff of nurses. The sick, the management, the medical officers, one and all are allowed regrettable familiarities with these poor women. The directors of the hospitals have always mixed up the classes, when a very clear line of division should be drawn between them. Young servants become nurses in the course of time by means of examination or by protection. This lamentable confusion prevents young girls who have had a certain amount of education from entering the hospitals. This staff, so badly treated physically and morally be it order
cause
1343
said, is forced to
overwork itself. The wards often contain hospital nurses. Quite recently the administration: of the Night duty is relegated to perfect beginners, Assistance Publique tried to improve the condition of the First and foremost, they tried to increase the without experience and without ability, quite unaccustomed nurses. to hospital discipline. The natural result of these bad salary of the nurses, so that they might be able to raise sanitary conditions in the hospitals of Paris is that the themselves, put something by-in a word, accomplish a mortality from consumption is something appalling. The moral reform. staff has only a very hazy idea as to its moral responsibilities. Many practical reforms have recently been attempted in Tips are allowed as quite a matter of course. Be it said, the private hospitals of Paris with reference to the creation however, that these women are at heart extremely good- of a staff upon the new lines. It is to be hoped that this natured. The evil lies in their social position. Tips do not example may be followed by the large hospitals. These
40 or 50 beds.
humiliate them. Permission to marry is disastrous. The efforts should receive the encouragement of the doctors and result is additional fatigue and overwork, for these women of the public and have no sectarian interest ; still less must must use up their leisure moments in looking after their they be anti-sectarian. homes. A serious omission in the organisation of the hospital staff is the absence of a woman at the head of affairs-the matron of the English hospitals. The result is that the promotion of a nurse is more often due to political influence than to personal merit. This, no doubt, is a matter of astonishment to the English, but as the municipal authorities are at the head of affairs in the French hospitals their great object is to stand well with their electors rather than to consider the rights of the nursing staff. To rightly judge it is above all expedient to take into consideration the ways of the country ; thus, what would cause astonishment in England comes as a matter of course in France. This will account for the fact that in all the wards of the French hospitals men nurses work side by side with the women nurses. Do not let us overlook the fact that in the French hospitals men-nurses and employees of all sorts-are very numerous. Thus often the women nurses are married and are lodged with their husbands in the hospital. These are the things which render it so difficult rightly and properly to recruit the hospital staff. Let us examine for a moment how this situation may best be remedied. Reform is possible, but there must be less centralisation, requiring everywhere an identical organisation. As to the Parisian hospitals one must not seek to reform them all at once. At first the reform should only be applied to one single hospital, for preference a new one, for it naturally follows that a staff recruited according to the new régime cannot have mixed with the existing one. The wisest thing to do would be to adopt the English system, which is the best-offer to young girls the means of acquiring a diploma which would enable them to earn their living and in return require of them their services in looking after the sick. The question of money is a secondary consideration. Above all, a moral reform is
Aix-les-Bains. _________________
Clinical Notes: MEDICAL, SURGICAL, OBSTETRICAL, AND THERAPEUTICAL. SPONTANEOUS RUPTURE OF THE HEART. BY A. F. THEOBALDS, M.B., CH. B. EDIN., PATHOLOGIST AND ASSISTANT MEDICAL OFFICER, WEST RIDING ASYLUM, WAKEFIELD,
THE
following
case
of
a
patient surviving spontaneous
rupture of the heart for six days is worth recording. The patient was an inmate of the West Riding Asylum for 26 years and died in November last, aged 65 years. He suffered from chronic mania, and on the whole was fairly quiet and in good health. About a year ago he was found to have a mitral systolic murmur but it did not seem to inconvenience him. One Tuesday he was seized suddenly with what was thought to be an ordinary syncopal attack and was put to bed. He soon recovered, however, but on Sunday morning died suddenly while still in bed. At the post-mortem examination the pericardium was found to be distended with fluid blood ; the heart was enlarged and weighed 375 grammes. On the anterior surface of the left ventricle near the middle and to the outer side was seen a small sub-epicardial hæmorrhage of about the size of a halfpenny, on the outer side of which was the external aperture of the rupture of about the size of a pin’s head. On cutting through this the rupture was seen to extend from the inner surface of the ventricle and to be V-shaped. The wall of the ventricle was fully half an inch thick, but was pale, soft, absolutely essential. To turn out a good nurse we must take her from surround- and flabby. The coronary arteries, however, were apparently ings entirely different from the present one. We must try to healthy. The mitral valve was dilated and there was slight get young girls who have received a certain amount of thickening of the aortic valves, the first part of the aorta also instruction and a fair education. The celibacy of the nurse being slightly roughened. The vessels at the base of the must be insisted upon. This reform is absolutely imperative brain were markedly atheromatous and the choroid plexuses in spite of the prejudices existing in France on the subject. were calcareous. A somewhat similar case, also in an insane patient, was There must be a woman at the head, answering to the " matron," who shall be held responsible for the stafE and published by Dr. H. Kerr in THE LANCET in 1904in which shall be in direct touch with them. The nurse must undergo he refers to the rarity of the condition. In his case, however, a practical training, given in the wards by other nurses who the patient apparently succumbed immediately, although, as have themselves passed through the training that they are in the one above, there was no history of sudden exertion’or imparting to the beginners. The theoretical teaching of the strain. doctors is but the complement and not the principal. In I am indebted to Mr. W. Bevan-Lewis for permission to France, too, much importance is laid upon theoretical publish this case and to Dr. J. A. Creighton, assistant medical instruction to the exclusion of the practical. The duties of officer, for the clinical notes. a nurse are quite different and quite separated from those of Wakefield. the domestic "ward maids." The number of men and, above all, lodged in the hospital should be greatly NOTE ON A CASE OF OSTEO-FIBROMA OF THE reduced. A certain number of male employees is, of course, MAXILLA. necessary but only women should be called upon to nurse the BY ANDREW WYLIE, M.D., C.M. GLASG., sick. Sweeping changes must be made in the treatment of ASSISTANT SURGEON, CENTRAL LONDON THROAT AND EAR HOSPITAL, the nurses, both physically and morally. As in the English hospitals, they must no longer be treated as servants. They Vith a Pathological Report by V. H. WYATT WINGRAVE, must have every consideration and, at the same time, gain M.D. Durh., Pathologist to the Hospital. an honest livelihood, both as to salary and as to food. Above all, they must have comfortable quarters, cheerful THE patient, a man, aged 53 years, consulted me on and bright, where, after their many hours of hard work, Jan. 9th complaining of a " growth in the palate " of 25 they may retire and feel at home. years’ duration. He suffered no pain and very little dis. Now, these reforms would not be very costly : it means comfort ; in fact, he stated that beyond a certain amount of changing the hospital into a training school, teaching the anxiety it gave him no trouble, and having grown slowly and staff hospital and private nursing, and, in return for such gradually he had got quite used to it. Mastication and teaching, having a call upon their services in nursing the deglutition were performed without any difficulty, and with sick, as is done in England. Their training once acquired, the exception of a slight " thickness " or impaired resonance these nurses would gain their diplomas and be capable of 1 THE looking after the wards and in the end become fully qualified LANCET, Dec. 31st, 1904, p. 1832. .
employed
’