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419 Notes and News NURSES FOR THE COLONIES A REPORT on the training of nurses for the Colonies (Cmd. 6672. H.M. Stationery Office. Pp. 65. Is.) comes from the committee who, under the chairmanship of Lord Rushcliffe, have been studying this subject since November, 1943. They point out that no great extension of nursing services could have taken place in the Colonies unless the greater part of the nursing staff had been drawn from native populations ; and they make suggestions for training girls and male nurses. along practical lines so that they can teach their own people, even after they give up nursing as an occupation. - They recommend that nurses recruited in the Colonies should be trained locally in training schools, and that the standard should be such as would render Colonial certificates acceptable to the General Nursing Council of England and Wales for State Registration. This is a little difficult to reconcile with their finding that the general education of girls is backward in most Colonies, and the suggestion that in some backward areas there should be two grades of nurse, those in grade I to take the full training, those in grade II to be taught the same subjects " but with a smaller content, precepts being inculcated by practical demonstration rather than by lecture." They feel, however, that general as well as professional education may be improved by appropriate pre-nursing courses. A four-year training in nursing is proposed, three years being occupied in basic studies, including elementary general science, anatomy, physiology, hygiene, domestic science, nutrition and dietetics, maternity and child welfare, the theory and practice of the various branches of nursing, first aid, pharmacology and therapeutics, psychology, social science, and methods of health education. With such a wide programme before her, the candidate will probably feel thankful her training period is no shorter. Her fourth year is to be spent in training in the special branch in which she wants to nurse, and it is encouraging to note that the training in " community nursing," on the lines-proposed by Dr. Janet Welch (see Lancet 1941, ii, 574), is given special prominence. Midwifery training is also to follow the English pattern. The report proposes that nursing and midwives’ councils should be set up in each territory, to maintain standards of ’ training, and that nurses who qualify in the Colonies should be given the chance to attend refresher courses, and also to come to England for postgraduate training if they seem likely to profit by it. Other recommendations foreshadow experi- ments in joint training colleges for students of nursing and teaching-a plan that might be worth considering in our own country. In the training of British nurses planning to work in the Colonies they suggest more emphasis on the preventive out- look, and a special course of instruction to fit them for work abroad. They urge nurses to " take every opportunity of learning the principal language of the territory in which they are to work " but as things are at present such opportunities must be negligible until the nurse arrives at her station. The committee rightly look towards an expanding and improving service, and have made recommendations in keep- ing with that hope. But their report does provoke the reflection that the British pattern has perhaps been taken too confidently as a model. May not the circumstances in different Colonies call for a more elastic framework with greater liberty for experiment ? There is always a danger that experience gained in one field may be applied too lightheartedly in another. Even Florence Nightingale, it will be remembered, took a lot of convincing that the windows of Indian hospitals, should be kept closed, not open. THE MIDWIFE AND THE MINNITT UNDER the regulations of the Central Midwives Board, the midwife has for some years been allowed to give women in labour gas and oxygen analgesia with a Minnitt or similar apparatus, provided that she has been properly instructed in its use, that a doctor has certified the patient fit to take gas and oxygen, and that a third person with certain specified qualifications is present. The third person had to be one of the following : a state-certified midwife, a state-registered nurse, a senior medical student, a pupil midwife, a retired midwife, or " a woman over 21 years of age," the regulation runs, " who is and has been for at least a year " either a VAD or ordinary member of the British Red Cross Society or the Order of St. John, or an enrolled member of the Civil Nursing Reserve. The Central Midwives Board has several times approached the Royal College of Obstetricians and Gynae- cologists with a view to getting these somewhat stringent. requirements changed ; for at a time when those with any kind of nursing qualification are at a premium, few can spare some hours to attend a confinement in the role of looker-on ; and medical students and pupil midwives are not always at hand. The upshot has been that many women have had to bear their labour pains uneased by the reasonably safe and simple technique possible with the Minnitt apparatus. The College has now agreed to a change in the regulations, and from Sept. 1 onwards midwives have been permitted to give gas and oxygen analgesia provided " one other person, being any person acceptable to the patient, who in the opinion of the midwife is suitable for the purpose, is present at the time of administration in addition to the midwife in charge of the case." This means that any sensible relative or neighbour, whom the patient likes, will be accepted ; and the midwife. will be in a position to relieve pain in childbirth, as a matter of course. MEDICAL PLANS FOR AUSTRIA THE Association of Austrian Doctors in Great Britain has published a collection of essays on medical reconstruction and reablement in Austria (The Health Services in Austria.- : Essays Collected by the Committee for Post-war Medical Relief in Austria, 14, Craven House, 121, Kingsway, London, WC2. Pp. 40. 3s.). As Prof. F. Silberstein says in his preface, for the next few years Austria will need to train doctors as quickly and inexpensively as possible, and hopes of a length- ened medical course with a better grounding of all students in preventive medicine may therefore have to wait awhile. Dr. A. Czech tells of the high standard in public health achieved under the leadership of Karl Seitz aslord mayor of Vienna. The hospital service, he says, was equal to the public needs ; there were antenatal clinics, welfare and child- guidance centres, and a marriage-guidance centre which was doing pioneer work. Young couples could apply, as soon as their first baby was born, for a municipal flat with labour- saving equipment and good balconies ; in the larger blocks there were day nurseries, club-rooms, and libraries, and all were provided with communal laundries. National health insurance had been introduced in 1888, and included all people gainfully employed, regardless of income. In the new service Dr. Czech hopes to see greater emphasis on prevention. Maternity and child welfare were equally well developed.’ Dr. F. F. Tietze has some practical suggestions to make about the stocks of dried milk, cod-liver oil, and concentrated orange juice likely- to be needed during the coming winter, and has worked out the quantities required by individual children of different ages, as well as the bulk amounts for all Austrian children over a period of 26 weeks. Dr. Erich Schindl has considered ways of making economical use of the doctors and specialists available, and finds the best hope in the establishment of health centres offering free treatment to all residents in their area. In the rural areas, he suggests, the mobile units introduced by the Nazis should be taken over and adapted for wider use. Dr. Felix Bauer and Prof. M. Schacherl have constructive suggestions to make on reablement, physical and mental ; Dr. A. Fessler discusses a proposed campaign against venereal disease, and Mr. W. Nuki, LDS, looks forward to a better dental service. This booklet is evidence of the knowledge and devotion with which these exiled doctors have been working for their coun- try’s reconstruction. ---- ------- HOT BOTTLES SINCE hospital demands are failing off and production is already rising, the rubber hot-water bottle is now on sale again to the general public. Sick people and expectant mothers have first claim ; they need only present a medical certificate to an appropriate shopkeeper, and he will get them bottles through his usual supplier. Maximum retail prices have been fixed’ at 7s. 2d. and 8s. 3d. (according to size) for moulded .bottles, and 12s. lId. for hand-made bottles ; but a substantial proportion of available supplies will be on sale at lower prices. Those who have learned to patch nightly a leaking aluminium bottle with flour and water (which bakes into a vulnerable pie-crust over the hole) will await their next illness or pregnancy with enthusiasm. A limited edition of the WELLCOME MEDICAL DIARY for 1946 is now being printed, and will be distributed early in December. Doctors who have not yet ordered their diary should apply to Burroughs Wellcome & Co., 183, Euston Road, London, NW1.
