812

glad to see the end of them. On the face of it, the con-templated measure of giving more adequate compensationthrough official channels seems as good a way as any ofattacking this nuisance. " PRACTITIONER."

BEDS FOR TUBERCULOSIS

SiR,-Dr. Bentley’s article of May 8, on the shortageof sanatorium nurses, and how to do without them,will be widely read, and we shall leave the duty ofdetailed criticism to pens more fluent than ours. Butthe methods of treatment he hails are those of yesterday,and have failed in and out of sanatorium. The art ofcavity closure is not the whole or even the greater partof sanatorium treatment, and we need not tremble forthe seduction of the well informed, be they tuberculosisclinicians or administrators. But practitioners ’wholook to such as Dr. Bentley for guidance, yet have seenthe excellent progress made by numbers of their patientswhen kept strictly in bed while waiting admission to sana-torium, will be mystified. Circumstances may defeatthem, but let neither them nor their colleagues in practicecease to recommend complete rest in bed for patientson the waiting-list; for that offers more hope, whencollapse therapy is not indicated, than admission to anysanatorium run, as Dr. Bentley describes it, et la Suisse.If his advocacy of exercise in active tubercle gainsground, there will be indeed no need for the indefatigablesanatorium patient to turn his mattress ; such views areenough to make mattresses turn in their beds.

Chelmsford.

W. L. YELLR. S. MCDADE.

THE NURSE IN PREVENTIVE MEDICINE

SiR,—It seems to us that Dr. Booth has raised a veryimportant issue. The Working Party on the Recruit-ment and Training of Nurses, as a result of the teststhey undertook, pointed out that some 16% of femalehospital nurses are in the top tenth of the population asregards intelligence. It is reasonable to infer that atleast as large a proportion of the nurses who work inthe public-health services are in that same top tenth.

Health visitors, particularly, add a training in publichealth to general hospital training ; most of them aremidwives and many of them hold additional certificatesin specialised fields. Yet they are too often used asunskilled labour. Almost every public-health nurse hasmoments of deep disillusionment and frustration whenshe realises that only a fraction of her capacity is madeuse of. It is no question of a desire to be a lesser doctorbut a sense of a wide field of public health which cannotbe fully tilled unless the brains and knowledge andtechnical skills of every worker are used to the full.

If, as Dr. Booth seems to think, the scope of public-health nurses will be narrower in the future and notwider, these well-trained professional women will haveno incentive to remain in a service where they are notfully used ; standards of training will inevitably fall,for the best type of candidate will no longer be forth-coming. It must be remembered that the professionsand industry are competing for the group from whichthese girls come.With regard to the special case of diphtheria immunisa-

tion, it seems incredible that section 26 of the NationalHealth Service Act really means that in future healthvisitors will be precluded from giving injections inschemes of mass immunisation which will surely still berequired. If it does we agree that amending legislationto permit local health authorities to use their staffs tothe best advantage is necessary. The National HealthService courts failure from the beginning if children dieof diphtheria, who should have been immunised, becausethe health team may not work as a team.

In our commentary to the Ministry of Health on theworking Party’s report 1 we pointed out that theprecise duties of any member of a hospital team is largelya matter of convenience, determined by the type ofpatient, the nature of his illness, the knowledge andexperience of available staff, and the ever-changing modesof treatment. This we think is equally true of the teamin the field.

1. This commentary was reviewed in THE LANCET of April 10, p. 565.

We consider that an inquiry into the work of public-health nurses is overdue, both as regards relieving themof duties which could be performed equally well by lessskilled workers and maximum utilisation of their abilityand special skills.London, W.2. THE TEN GROUP.

Parliament

FROM THE PRESS GALLERY

Allowance for Rehabilitation .

IN the House of Commons on May 12 Mr. JAMESGRIFFITHS, Minister of National Insurance, moved thesecond reading of the National Insurance (IndustrialInjuries) Bill, which he explained was intended toremove a defect in the main Act. Rehabilitation wasmaking great strides, and men were being restored tofull capability for work after sustaining injuries whichonly a few years ago would have left them crippled forlife. Doctors might therefore be reluctant to certifythat a man was likely to be permanently incapable offollowing his old occupation-at any rate until all thepossibilities of rehabilitation had been tried and hadfailed. That would mean that this section in the mainAct would become a dead letter. The Governmentwere adding in this Bill an alternative condition to thecondition of permanent incapacity. Thus, if at the endof the first six months during which a man had receivedinjury-benefit he was for the time being still incapableof resuming his old job, the Ministry would be able togrant an allowance for the period while the possibilitiesof treatment were being considered. Once a man hadbeen found capable of rehabilitation, resuming his oldoccupation, or taking up one of equivalent standard,he would cease to be entitled to the allowance. Theregulations which he would make under this provision,Mr. Griffiths continued, would be submitted to theIndustrial Injuries Advisory Council.

QUESTION TIMEChoice of Doctor

Sir JOHN MELLOR asked the Minister of Health why hispamphlet on the new National Health Service contained aparagraph headed, " Choose your doctor now," in view ofthe inability of executive councils to supply a choice -ofdoctors as promised in the pamphlet.-Mr. ANEURIN BEVANreplied : I need hardly say that a scheme of this magnitudeinvolves an enormous amount of detailed organisation in thebackground, and if both doctor and patient are to be able totake advantage of the new arrangements as from July 5 itis essential that they help us to make an early start. Inview of the increasing number of doctors applying to partici-pate in the service, executive councils should soon have nodifficulty in putting in touch with such doctors patients whocannot find one themselves. Sir JOHN MELLOR: Is not this

paragraph at the present time completely meaningless, andis the Minister aware that the London executive council are

advising inquirers to call again in a month’s time, when theyanticipate that the dimr-ulties will be removed ? Does theMinister share that view ?-Mr. BEVAN : I will make inquiriesat once to find out whether the London executive council isgiving that advice, but I am fairly certain that it is untrue.At any rate, I think that all Members of this House are nowanxious that we should facilitate the starting of this Act onJuly 5, and I hope that hon. gentlemen opposite will be ashelpful in this matter as other people are trying to be.

Mr. RALPH AssSHETON: Does the Minister know that,whereas some of the propaganda put forward by his depart-ment advises the public that there will be lists of doctorsfound in the post offices, in fact they cannot be found thereat present ?-Mr. BEVAN : There will be lists in the post officesand in the town halls as the lists are filled up by the doctorswho are applying to join the service. There is obviouslysome delay among certain doctors at the present time, butthey are participating in larger and larger numbers. Indeed,it is to the financial interest of the doctors to get these listsfilled up as early as possible. Mr. AssHETON: The lists arenot now in the post offices, and can we be assured that theywill be in the post offices ?-Mr. BEVAN : As soon as thedoctors have indicated their intention of participating in the