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Prof. Dr. Remmelts, in thanking the speakers,pointed out that while the practical application ofthe discovery was still uncertain, the prospects whichthe discoveries of Frosch and Dahmen had openedout in microbiological research were anyhow ofoutstanding value.

BRITISH HOSPITALS ASSOCIATION:ANNUAL CONFERENCE.

THE fourteenth annual Conference of the BritishHospitals Association was held on June 12th and 13that Victory House, Leicester-square, Sir Arthur Stanley,the President of the Association, being in the chair.Some 260 delegates from all parts of the UnitedKingdom were present.On the opening day the delegates were formally

welcomed to London for the Conference by SirHumphry Rolleston. In the course of his address,Sir Humphry Rolleston said that the voluntaryhospital system was characteristic of the Britishtemperament. Individual effort had done incalculablework in raising the standard of clinical medicine toits recognised high position. Formerly the voluntaryhospitals had acted individually, but that Associationhad brought them into close contact and enabledthem to work as a whole. Instead of no policy orindividual and varying policies, it should now bepossible by means of those Conferences to have aunited and strong policy on the various knottyproblems arising between the staffs of the voluntaryhospitals and the hospitals themselves, in connexionwith the receipt by the hospitals of direct contributionsfor benefits conferred. i

Dr. F. N. Kay Menzies read a paper on theFuture Relations of the Voluntary Hospitals to the

-Ilunic4pa,l Authorities. i

Having passed in review the remarkable developmentswhich have taken place during the last 15 yearsin the relations between voluntary hospitals andpublic health and education authorities, he pointedout that in London alone at least four-fifths of thetreatment available for the sick was provided for outof rates and taxes. Those services were likely toexpand in the near future in certain directions whichhitherto had either not come within the scope, oronly slightly so, of local authorities, such as municipalmaternity hospitals, treatment of certain diseases ofchildhood-for example, chorea, rheumatism, infantileparalysis, &c., and advanced cases of tuberculosis.Further developments in the Poor-law medicalservice might prove to be a big factor in deter-mining the ultimate relationship of the voluntaryhospitals and the municipal authorities. Probablythe future development of the Poor-law infirmarywas in the direction of a municipal hospital.Were those infirmaries to become merely competitorswith the voluntary hospitals, or were they towork in coöperation with them ? He believedthat every right-thinking man and woman in thecountry was beginning to realise that the presentposition with regard to the prevention and treatmentof disease, whether by voluntary or public authorities,required review. The time had, in fact, come tomake a careful, comprehensive, and detailed surveyand study of the situation. He could not see anyreason why such a scheme when drafted should notprovide : (1) for the preservation of the best featuresof the present voluntary hospital system ; (2)’ foradequate accommodation, equipment, and finance ofthe hospitals generally; (3) for the geographicaldistribution of hospitals so as to avoid unevennessand overlapping ; (4) for a closer relationship betweenvoluntary hospitals themselves, between voluntaryhospitals and the various classes of hospitals providedby local authorities, and between general practitionersand all the various institutions which treat the sick.

Lord Hambleden, in opening the discussion, saidthat Dr. Menzies’s paper had been both interesting andsuggestive. He agreed with Dr. Menzies that thevoluntary hospitals would have to face the questionof their future relations to the municipal authoritieswithin a comparatively short time. He (LordHambleden) did not know whether a further develop-ment of the health insurance scheme would lead toa larger demand for institutional treatment. If itdid it would, of course, lead to the necessity of a verylarge increase in the hospital beds throughout thecountry. One important point to be considered waswhether, supposing grants were made either by thelocal authority or the central government to thehospitals, they were likely seriously to affect thevoluntary subscriptions. Personally, he doubtedwhether such grants, if given, would be likely to affectthe teaching hospitals in the same way as theymight hospitals which had no medical school attachedto them. It was important that they should get toknow what was likely to be required of the voluntarysystem in the future in regard to hospital accommoda-tion, and how best that system could take a part inany scheme which might be devised but it wouldbe a very great mistake to suggest that they wouldnot work in with any general policy which theGovernment and the country might decide to pursue.Lord Armstrong set out the experience of Newcastle-

upon-Tyne, where the people gave very liberally tothe Royal Infirmary. There was, he said, a greatprejudice on the part of patients against going intothe Poor-law hospitals, and he was afraid thatprejudice was pretty general in the north of England.The corporation of the city were giving his hospital2500 a year for looking after the street accidents, butthat was as far as they could assist them under theirpresent powers. On the other hand, the ManchesterInfirmary got 98000 a year from the city. Whatwas wanted was a short Act of Parliament removingthe restriction imposed by law against local authoritiessubscribing to hospitals.

Mr. H. M. Crouch (Bath) moved, and Dr. C. E. S.Flemming (Bradford-on-Avon) seconded, the followingresolution, which was passed : " That the time hascome to make a careful, comprehensive, and detailedsurvey and study of the hospital situation in thecountry, and to formulate an adequate and coordinatedscheme for the prevention and treatment of diseasethroughout the whole country; and that the Councilof the Association be instructed to consider how thesurvey can best be made, and to give all the assistancein its power to any body that makes it."

-

In the afternoon Sir Wilmot Herringham spoke onthe

Training of’ Nurses.He recalled that the first serious training school ofnursing in England was set up at St. Thomas’sHospital in 1860, in commemoration of Miss Nightin-gale’s work in the Crimean War. In 1877, when thespeaker went to St. Bartholomew’s Hospital as a

medical student, the first regulations for the trainingof nurses were introduced. The period of trainingwas one year, the age of admission was 20, and twoinspectors were employed-one from the medical, onefrom the surgical side. In 1882 the period wasextended to three years, and the age of admission wasraised to 23, an examination now being instituted atthe end of the first year, and another when the coursewas completed. In 1914 the admission age waslowered to 22, in 1918 to 21, and in the following yeara committee reported on the nursing curriculum, withthe result of producing the present nursing curriculumof the General Nursing Council. Ho well rememberedthe old type of sister, a very capable and practicalperson; very often kind and compassionate, butquite unfitted to do the work required of the modernnurse. In one respect, however, modern nursing wasrather at a disadvantage in comparison with theformer time. Formerly many educated women tookup nursing, largely because that was practically theJnly means for them to earn a living. As there were

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now many business and professional openings, it wasnot surprising that fewer of these women entered thenursing profession, and nursing was the poorer fortheir absence. The General Nursing Council had todetermine what policy ought to be adopted in regardto the training of nurses. The syllabus which theCouncil drew up was, in essence, that which had beenobtaining for three or four years at the best trainingschools. When the Minister was asked to sanctionthis syllabus, as a result of Parliamentary pressurehe declined to do so. That turned out to be a

fortunate circumstance, because if the Minister hadsanctioned the scheme it would have become law, andnot only would it have become compulsory on theschools, but, like all legal things, it would have beenunchangeable, and the last thing those who formulatedthe scheme wished was to stereotype the method ofeducation provided. In both cases when the syllabuswas submitted to an outside body-in one case a

general meeting of nurses and in the other theMinistry of Health-it was the outside body whichdemanded additions, not the Nursing Council. Somemight object that the syllabus embraced too muchtheoretical knowledge, that it was unnecessary toteach the nurse anatomy, physiology, pathology, andbacteriology. It was true that Miss Nightingale’s" Notes on Nursing " was one of the best books everwritten on nursing, and contained very little patho-logy and no bacteriology. It consisted in injunctionsto nurses to be kind and sympathetic, not despoticor tyrannical; incidentally, of all the despotic ladieswho ever made men shake in their shoes, MissNightingale was the most relentless. Though she laiddown a standard of excellence which no period couldexcel, Sir Wilmot Herringham combated the ideathat the modern nurse should have no theoreticaltraining ; she should know of the ubiquity of micro-organisms and of their virulence, and this aspect ofmedicine could not possibly be omitted from her Icourse of training.In the course of the discussion on Sir Wilmot

Herringham’s address, Dr. H. L. Eason referred tothe affiliation of the larger hospitals with some ofthe smaller ones for the purpose of giving theirnurses a wider experience. For example, Guy’sHospital was being affiliated for this purpose withthe Royal Sea Bathing Hospital of Margate, withthe Cancer Hospital, and with the Evelina Hospitalfor Children. Dr. Eason discussed also the reporton Nursing and Nursing Education in the United IStates, published by the Rockefeller Foundation.The schedule outlined in this report was far tooextensive for the proposed two years’ course. Ameri-can visitors were very critical of the training ofnurses in British hospitals, but they,’all agreed that theEnglish nurse produced by our system was a typethey could not beat. "

Sir Wilmot Herringham, in reply, said that heentirely shared Dr. Eason’s view of the Rockefellerreport. Nursing was an art which had to be learnedby patience and by practice, and could not be taughtby intensive methods. In answer to other questionsas to the recognition of certain hospitals as training

1centres for nurses, he explained that where theinterests of the hospitals clashed with the interestsof the public they were bound to consider the public.That was the whole gist of the case for the GeneralNursing Council. Every case that came up wastreated on its merits.The following resolution, proposed by Mr. John

Barker (Grimsby), and seconded by Mr. Watts(Great Yarmouth), was carried : "This Conference Irequests the committee of the British Hospitals IAssociation to consider the ruling of the GeneralNursing Council as to the number of medical bedsand also medical cases at present required to obtaintheir certificate, and if there should not be an amend-ment of the rules so that smaller hospitals which doimportant surgical and medical work and affordadequate training can be duly approved."

1 See THE LANCET, 1923, ii., 1203.

I At the Friday morning session, Sir Arthur Stanleyagain occupying the chair, a paper was read byMr. R. J. Meller, M.P., on

Approved Societies in Relation to VoluntaryHospitals.

Mr. Meller said the relationship existing at presentbetween that Association and the approved societieswas a cordial one. There was a close affinity betweentheir work, because the main work of the approvedsocieties was not to pay cash benefits, but to see thatevery assistance was rendered to the sick and suffering.The approved societies regarded the convalescenthome aspect of hospital work as of the utmostimportance. The scheme of health insurance providedfor only such treatment as could be given by thepractitioner selected by the insured person. Thehospitals not only trained the practitioners, but alsoenabled them to keep in touch with medical advances.The hospital stood in the same relation to the insuredpopulation as did a nursing home to people morefortunately placed, and there was now no hesitancyon the part of the mass of the people to enter ahospital. The Cave Report in 1921 stated that in theMetropolitan Police District there were 117 hospitals,in the rest of England and Wales 728, in Scotland 107,totalling 952. The number of beds available were :London 12,797, England and Wales 31,265, Scotland8132, just over 52,000 in all. There were 15,000,000insured people to be catered for, apart from womenand children. If the contributions from approvedsocieties could increase the number of beds available,or reduce the deficiency, there was ample justificationfor the support now being given. In the Cave Reportit was stated : " While we hold that the approvedsocieties are not under any obligation legally or

equitably to provide the whole cost of the maintenanceand treatment of their members in hospital, we arestrongly of opinion that they do owe to the hospitalsa large measure of support." That view, Mr. Mellersaid, he accepted. The group of societies with whichhe was connected was able, during the year 1923, todistribute .8170,000 to the voluntary hospitals, andhe anticipated a similar sum would be available for thepresent year.

Mr. G. Q. Roberts (St. Thomas’s Hospital) spokewarmly of the zeal in the cause of the hospitals whichhad been displayed by Mr. Meller at the numerousconferences and meetings he attended. Mr. Robertsthought much more should be done by the approvedsocieties in helping the hospitals, and it was necessaryto disabuse workers of the belief that the contributionmade to their hospital treatment was a defraying of thecost, especially in the cases of serious illnesses. Thepayments made were not insurances carrying theright of entry of the payee into a hospital. There werestill many societies which did not make a hospitalgrant. There was a growing number of personscoming forward for hospital treatment in respect ofwhom no payment was received, and that was ananomaly which must be tackled. The preventivework being done in the voluntary hospitals was ofincreasing importance; responsible men were in chargeof out-patients, for whom all the agencies of thehospital and its apparatus were enlisted.

Mr. S. R. Lamb (Sheffield) said it was found difficultto convince business men, particularly in the provinces,that in contributing to hospitals they were not payingtwice over for the medical benefit received by theworker. The Prudential group had shown them-selves very willing to provide convalescent service.It was said that if a patient seeking hospital treatmentwas not a panel patient, he must be turned away,but that would be found very difficult in practice.Many approved societies had not yet been made tounderstand what were their responsibilities to thehospitals. The voluntary hospital accommodationin this country for insured persons cost 7 millionpounds per annum, and a reserve fund was being setaside of 7 millions a year.—Mr. E. C. Lindsav (PoplarHospital) said the Friendly Societies used the PoplarHospital more than did any other class or section of

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the community, and its application for help had beenturned down. He asked that the executive wouldtake the case of that hospital into consideration.-Lord Hambleden expressed his gratitude for the wayin which the approved societies had acted ; in con- -sequence of that action the position of the voluntaryhospitals was now much stronger than four or fiveyears ago. It was hoped that at the next valuationthe societies would be able to increase their grant, andthis hope was increased by the general agreement thatthe voluntary system was the best for the hospitals.

Mr. Meller replied that he had long realised thatsomething additional was required to the benefitsprovided under the panel system. To those whothought something should have been done by theapproved societies under Section 21, he would replythat in the first few years of the Insurance Act thematter was in an experimental stage, as all lives, notselected lives, had to come into the consideration.He thought it would be seen that the greatest advan-tage was to be secured not by giving additional cashpayments, but by giving such benefits as would bestconserve and improve the health of members of thesocieties. Not every insured person was entitled toadditional benefits. Again, it must not be assumedthat large reserves meant enormous profits whichwould never be distributed ; but he could say thatthe improved condition of matters would probablyresult in the societies becoming liberal instead ofconservative. A Royal Commission was to beappointed to go into the whole question of NationalHealth Insurance, to consider its defects and itsvalues, and to recommend, if necessary, extensionsand improvements, and he urged that this Associationshould seek to give evidence before that Commission. f

Br2tis Hospitals AssoGÍation Dinner. ILord Hambleden presided at the dinner held at the IRoyal Automobile Club, London, on June 19th, inconnexion with the annual conference of this Associa-tion. There was a large attendance. The dinnerwas good, the speeches short and witty, and theguests went home at a reasonable hour well satisfiedthat the function had further cemented the bonds Ibetween all those interested in the hospital problem.The toast of the Association was allocated to Lord iStuart of Wortley, who praised not only the efficiency Iof British hospitals, but their independence of spirit. IThis very independence, however, made it difficultfor them to find a medium of common expression and,when necessary, a means of common defence. TheBritish Hospitals Association would presently subservethese functions ; no attempt at unification would bemade, but at least the first step towards collectiveaction would be provided. The voluntary hospitalsystem had been challenged ; many of the ideals setout by those who challenged it were shared by its Isupporters and were undisputed, but some of them i

at least were not at present compatible with the i

national resources. ]

Sir Arthur Stanley, responding to the toast, i

referred to the superannuation scheme for nurses 1

which would soon be adopted by all hospitals.Lord Hambleden, toasting the guests, noted that i

this was the first regular conference to be held 1in London, and expressed appreciation of the <

interest shown by distinguished bodies and persons in 1their deliberations. Sir Humphry Rolleston replied, ‘referring gratefully, on behalf of the medical staffs of shospitals, to the efforts made by the administrative officers to cope with the many difficulties now besetting tthese institutions. Sir Wilm.ot Herringham, who also 1

replied for the guests, said that as chairman of the tGeneral Nursing Council he appreciated the cordial B

cooperation of the hospitals throughout the country c

in the attempt to improve the training of nurses. r

Lord Knutsford, who proposed the health of the c

chairman, and Lord Hambleden, who replied, valluded merrily to the claims for support of the great i

institutions with which each was specially connected, and in this friendly rivalry the guests found much I amusement.

VOLUNTARY HOSPITALS COMMISSION.

THE Conference of the Voluntary Hospitals Com-mission with the Local Voluntary Hospitals Com-mittees was held on June 18th at the Ministry ofHealth, Lord Onslow, chairman of the Commission,presiding. In THE LANCET of last week we gave abrief resume of the morning’s proceedings, the prin-cipal points brought forward by representatives ofthe Local Voluntary Hospitals Committees in replyto the inquiry into the extent of voluntary hospitalaccommodation in England and Wales, and the bestmeans of providing and maintaining it. Towardsthe close of the discussion, Lord Cave said he wasglad to think the system of mass contribution, thecontribution from workers and employers, hadgrown and prospered. He thought that the amountcollected in that way annually would be a veryconsiderable one. He referred to Sir Walter Kinnear’sreport dealing with contributions from the approvedsocieties (which was read at the meeting by LordOnslow), and said that this system, which nowbrought some &pound;200,000 annually to the hospitals,had become a vital part of the whole organisation.A great Friendly Society had set the example in thisrespect, an example which had been widely followed.Referring to the need of further beds, the speakerthought that the need existed more in the case ofthe larger hospitals which served a large surroundingarea than in the case of the small cottage hospitalswhich were strongly supported locally. While theinquiries are being made into the needs of eachcounty, he thought the committees ought to take awider view and consider not only what the hospitalswanted in the way of further beds, but what thecountry wanted in the way of further hospitalaccommodation, which at present was not sufficient.In concluding, he expressed his feeling that even ifthese committees were to be dissolved forthwiththey had done admirable work throughout thecountry, but he hoped that for years to come theywould continue to render useful services.The Chairman, in summing up the discussion, con-

sidered that all the points raised would furnish mostuseful information for the further inquiry which theCommission was going to undertake. It was veryimportant to remember, he said, that the hospitalneeds of various areas differed very widely.At the afternoon session a discussion took place

on the

Future Functioyas of the Local Voluntary HospitalsCommittees,

which was raised by the Worcestershire and SomersetCommittees. Mr. Crouch, of the Somerset Com-mittee, said that he wished to put forward the ideathat the Voluntary Hospitals Committees shouldregard themselves as guardians of the public in

regard to hospitals generally, and he understoodthat the Minister of Health approved of that idea.We should not, he said, seek to criticise or interferewith existing hospitals, but we should make it ourbusiness to see what the country wanted in respect)f hospital accommodation and in respect of hospitaltreatment, and take such steps as are reasonablyvithin our province in order to get that hospitalservice provided. The Commission should formulate

policy and a detailed programme. The speakerihen gave some comparison between the existingiospital position and the ideal one. Early hospitaltreatment would save a great deal of suffering. Thevhole country wanted hospital treatment, middle-&deg;,lass people as well as the poor, but at present it waslobody’s business to get it for them. From experi-nce in Somerset, in his opinion, in order to discovervhat additional accommodation was needed, it wasnecessary to know not what the hospitals were

Loing, but what they were not doing. In conclusion,Ir. Crouch said that it appeared the committeeswere expected to try and effect some coordination