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THE GENERAL MEDICAL COUNCIL.

THE LANCET.

LONDON SATURDAY, DECEMBER 1. 1923.

THE opening of the 118th session of the GeneralMedical Council on Tuesday last, Nov. 27th, waspresided over by Sir DONALD TAGALISTEP, whosedevotion to duty must entail considerable personalsacrifice and whose recovery from his recent illness isa matter of great and common congratulation. Theaddress from the chair, which was briefer than usual,took particular note of the position of the medicalprofession in India, where the conditions for the

recognition of Indian medical degrees upon the BritishRegister are attended with difficult and delicatecircumstances. The Government has, however, z,

placed Lieut.-Colonel R. A. NEEDHAM, I.M.S., onappointment by the Indian Government and with theapproval of the General Medical Council as official

inspector of Indian universities and colleges, on specialduty in order that he may attend the meetings ofthe Executive Committee of the Council at thissession to discuss all the questions. As Sir DONALDMAcAusTER pointed out, and as is too often forgotten,there are two sides to these, as they refer to practicein India or practice in Great Britain. While as faras the first category is concerned the Empire of Indiamay be considered autonomous, as regards qualifica-tions for registration in this country Acts of Parlia-ment compel inquiry into the qualifications for prac-tice. Difficulties will arise, and have arisen, whichare not readily capable of solution, and we are gladthat the Council, owing to the valuable interventionof Sir NORMAN WALKER, will be able to obtainfirst-hand advice from Colonel NEEDHAM.

Most of the time of this session will be occupied inhearing cases of discipline under Section 29 of theMedical Act, 1858, and after the President’s addressthe business of the Council was directed immediatelyto the hearing of these cases.

THE SUPPLY OF NURSES.SOME three years ago Mr. E. W. MoRRis, house

governor of the London Hospital, pleaded for a

thorough investigation of the reasons why womenwere not entering the nursing profession in sufficientnumbers. The shortage of probationers of a typeacceptable to matrons of hospitals still remains acute,and though in this country no steps have yet beentaken to organise such an inquiry, the problem hasbeen tackled with considerable skill and understandingin America by a committee appointed by the Rocke-feller Foundation. The main outcome of the laboursof this committee, a section of whose report wesummarise on p. 1203 of this issue of THE LANCET, istheir conviction that little improvement will resultuntil the conflict is recognised and to some extentresolved, which at present exists between two of thefunctions of a modern hospital-viz., that of economichospital administration, which aims at caring forthe sick at minimum cost, and that of cateringadequately for the educational requirements of nurses.

1 THE LANCET, 1920, ii., 1293.

No one who studies carefully the documented evidenceon which this conclusion is based can doubt its truth.

Among the constructive suggestions to which it givesrise are : (1) That training schools should be under thedirection of a board organised for the primary purposeof education, and (2) that adequate funds should beavailable not only for the educational expenses of theschool itself, but also for the replacement of studentnurses by graduate nurses and hospital help in theexecution of routine duties of a non-educationalcharacter. It is idle for hospital administrators andsenior members of the nursing profession to regret thedays when nursing made a strong appeal to the

highly-bred educated woman, who adopted it as a

pious vocation rather than as a profession. These

days will not return. The sane young woman of

to-day differentiates clearly between her desire toserve the community and the need first to equipherself speedily and adequately to do so. Sincemany professions giving opportunities of service arenow open to her, factors in her choice will, doubt-less, include conditions of training which are not

unnecessarily strenuous or autocratic, as well as

prospects of reasonable remuneration, status, andemployment when training is complete. While thedifficulties of the authorities responsible for staffinghospitals with probationers of a type most likely todevelop into reliable staff nurses and sisters receiveuniversal sympathy, the point of view of otherinterested parties-the medical practitioner, the

patient, and the nurse herself-have not always beentreated with the same respectful consideration. Mayit not be that the leaders of the nursing professionhave ideals for its development which rise above theeffective demand of the average practitioner andpatient, and moreover require a degree of intellectualability which will not be satisfied by the conditions ofwork open to any but the very few?

This is a view which has influential medical backing.Among the Collected Papers of the Mayo Clinic for19212 is a report of an address by Dr. C. H. MAYO toa hospital conference, in which he sharply criticisedthe conditions of training of the hospital nurse in thissense. He complained that the nurse who, havingachieved a high standard of general education, haslaboured diligently in hospital for three years, emergesovertrained as a nurse and undertrained as a physician.He contended that the requirements are too high forthe average work demanded of the nurse after registra-tion, holding that they should on the one hand be raisedfor those who are capable of acting as responsibletechnical assistants or specialists in various branches.of nursing, and on the other hand that the period ofcompulsory training should be made shorter in con-formity with requirements for general nursing. Hesuggested the reduction of the course of training totwo years, with a third year of post-graduate study,which should be optional. This extra year should not

necessarily follow directly on the early training,but those who wished to do so might be allowed toreturn to hospital at any time to qualify for higherservice. " Chief nurse in the hospital, chief surgicalnurse, nurse in dressing service, anaesthetist, county,city, and school nurse, industrial and child welfarenurse, dentist’s aid, physician’s aid, and laboratorytechnician " are among the positions suggested forthose who have completed the advanced course.The dual difficulty has received attention from

the Rockefeller committee, who recognise it by thesuggestion, which is more likely to find acceptance

2 Collected Papers of the Mayo Clinic. Vol. XIII.-1921. Editedby Mrs. M. H. Mellish. London and Philadelphia: W. B.Saunders. 1922. Pp. 1318. 60s.