CORRESPONDENCE.

RED CROSS TRAINING FOR WOMEN. [TO 1111 EDITOR or TB. "seserArea.']

Sin,—The Territorial Red Cross Brigade has now come into being, many detachments have been formed, and considerable enthusiasm is being shown in the organizing of the scheme. It is much to be hoped that in a few years' time it will come to be as much a part of the national life as such work is in other countries—Japan, for example, or, to take an instance nearer home, France.

Some of the Voluntary Aid Detachments have already attained a considerable degree of efficiency, a degree quite wonderful in some cases, when the serious practical difficulties to be surmounted are taken into account. For after the hold- ing of the First Aid and Elementary Nursing classes, and the enrolling of members, commandants and superintendents find that the real work then begins. Practices must be held, interest must be maintained, some sort of discipline must be set up, and a desire for a high standard of efficiency must be evoked. And when it is evoked, how is it to be met P In towns and in thickly populated districts there are not generally wanting medical men, nurses, and, perhaps, service men willing to give valuable instruction and help. But in more rural and out-of-the-way places the want of such help is a serious drawback. And in both instances, sooner or later, it will be felt that no amount of book teaching or of practice with dummies and sham patients will produce that confidence and prompt resourcefulness which contact with real experience, with real physical hurts and ailments, engenders. An ounce of practice is worth a pound of theory. So mach has this been felt that in a few detachments in England arrangements have lately been made for members to attend in the out-patient depart- ment of hospitals in order to acquire some insight into the practical application of what they have learnt theoretically. But it would be desirable to get facilities for putting oppor- tunities for such practical experience within the reach of every women's V.A.D.

In France the membership of the Red Cross is taken quite seriously, and a much higher standard of training is exacted. It is true, of course, that there is not in France such a highly trained and sufficient organization for military nursing as with us, and in the event of war the Red Cross members would at once be liable for service, and they are always called upon in cases of great public disasters, such as inundations and so forth. The supply of thoroughly trained nurses is not so large there as in this country. There is thus a difference in the re- quirements for, and the position of, the Red Cross companies. There are three large separate societies supplying recruits for the French Red Cross : La Societe Franeaise de Secours aux Blesses militaires, L'Union des Femmes Franeaises, L'Union des Dames de France. These societies contain women of various religious and political views, and their objects are charitable and philanthropic, besides definitely for nursing. But all are affiliated in the Societe de la. Croix Rouge Franeaise, and all members fraternize and co-operate in times of national trouble. And with regard to the training, all are obliged to adhere to the requirements of the Reglement General. This document lays down rules for the establish- ment of training schools—the Dispensaires-Ecoles—and for the courses of instruction required to obtain the first and second diplomas of the Society. It is issued by the Central Council in Paris, and it must be adhered to by all local committees. Every considerable town in France appears to have one or more of these Dispensaires-Ecoles, worked by one or other of the affiliated societies, and they not only do a most valuable philanthropic work among the very poor, but are an admirable school of training for the women who are taught there. The dispensary is truly democratic, it knows no distinction of rank, it is a bond of union for all who love to serve their country and the poor and buffering.

Local committees desiring to set up a Dispensary School must fulfil the following requirements laid down in the Reglement General, the Central Council accepting no pecuniary responsibility :- (a) There must be a suitable building in which to hold con- sultations and do dressings. (b) There must be the necessary "plant" for sterilising all

articles used in dressing and treating surgical cases, and a sufficient water supply. (a) The co-operation and assistance of at least one surgeon and physician must be secured.

(4) A Directress must be appointed who has had full training in one of the dispensary hospitals in Paris or the provinces.

Only the indigent are admitted as patients, and all treatment is free. Contributions, however, may be placed by those visit- ing the dispensary in a box provided for the purpose. Unless specially sent and recommended by their medical attendant, men who are medically insured are not received.

Where space and funds and other considerations permit, the dispensary may have a small operating theatre and a small ward for in-patients, necessitating, of course, one or two nurses as a resident staff. This was the case at Toulon, where at the time of the writer's visit there were three women in-patients. Two nurses lived in the place, and some of the pupils took turns in helping with the night duty. At Nimes, again, there was a beautiful little operating-room, but only for such cases as could be removed the same day to their own homes. In a country where, as yet, hospital accommodation is scarcer and rougher than here, these facilities must be an inestimable boon to the poor. For ordinary hurts and ailments the dispensaries are largely frequented, not only by the poor of the immediate neighbourhood, but also from quite distant villages in the country round. Unless the case is quite trifling the patient coming without a doctor's recommendation

is sent or to one of the medical men of the dispensary service, or told to wait till the regular hour for consultations. These are held either daily at stated times or so many times a week. In the larger places there is perhaps one doctor for each day in the week.

Provided that the Reglement General is adhered to, there appears to be plenty of latitude allowed in the arrangements in different places, and a good deal of difference in the degrees of formality and rigidity of discipline are observable. But even in one of the smaller and more homely types of Dispensaire-Ecole the tact and discretion of the Directress should prevent unconventionality from degenerating into disorder and waste of time. This was notably the case in the small dispensary in the South of France with which the writer has some acquaintance, and it is a good example of the useful work that may be done in an unpretending way, and the valuable practical training it gives to pupils attending it.

This Dispensary School is established in a wing of the house of the Sisters of St. Vincent de Paul, and the Directress is one of the Sisters, a clever and thoroughly trained nurse. • It is in a very poor part of the town. The premises consist of (1) a small waiting-room for patients, (2) a large sane with a long green-covered table, where lectures and examinations are held, where pupils sit when not on duty, and where there are cup- boards for keeping their uniforms, &c. At one end stands a life-size dummy, the mannequin, known as Mona. Anatole, used for bandaging lessons, &c. There is also a wheeled couch occasionally required for patients. (3) The dispensary itself, a lofty good-sized room, white-painted and white- tiled, very light and airy. In one corner is the sterilizing apparatus, beside it a fixed basin with two foot taps, one for sterilized water, the other for eau oxygen6e (peroxide of hydrogen). On the glass shelf above the basin are also glass vessels, with taps, containing carbolic and other anti- septic solutions. Everything in the room is made of glass or white enamel, and washed thoroughly every afternoon after

hours. The dispensary is open from 8 to 11 or 11.30 a.m.,

the morning hours being the coolest in that southern region. Instruments are in a glass cupboard, sterilized dressings in covered glass jars on the table. Scissors, probes, forceps, &c., are rendered as far as possible aseptic by holding them in a flame of methylated spirit before using. The dressings are lifted with forceps. The nurses are required to wash their hands carefully between each case, sometimes oftener. In fine, every effort is made to carry out the first principles of the modern aseptic methods. The patients are principally women and children, but there are also men and lads pretty often. Cases such as the following are common, and might all be seen in one morning's work :-

A child with tubercular wounds on hand and arm.

A woman with an abscess on her breast. • A woman with a huge open sore on her neck, a sort of goitre. A youth of eighteen for massage to a sprained ankle. A boy with poisoned wound on his foot, owing to being pricked by palm leaves through the holes in his shoes.

A sempstress with festered fingers, one to be lanced. A little girl with a skin affection on the head, requiring an all- over starch poultice.

A woman with badly ulcerated leg.

A. wagoner with a crushed hand.

A child with a burn.

.f boy with a badly cut knee. Two anaemic girls for hypodermic injections of a preparation of arsenic.

To obtain the "Diplome Simple" a pupil must attend a course of lectures and pass an examination. She must also have served a certain number of times as assistant in the dispensary and done a certain number of dressings. Each pupil arranges with the Directress which days she will attend, and thus each morning there are at least three on duty. After she has passed and received her diploma, she is expected to make a certain number of attendances as assistant at the dispensary. She will then be required to help the probationers who are being trained. The Directress generally tries to arrange for at least one diploma holder to be present each morning, for if there are a great many patients the latter can thus relieve the pressure on the Directress by attending to the smaller ailments.

Those who wish to obtain the Diplome Superieure, which is not obligatory for Red Cross membership, have to take a further training in a hospital and pass a higher examination. The pupils in these dispensaries have, it will thus be seen, an opportunity of acquiring at first hand practical experience which they find invaluable in private life, and which also renders them much more efficient in the public services of the Red Cross whenever it may call upon them. Each dispensary has an equipment and stores all ready to hand for an emergency, and at all times a personnel available at short notice.

Here in this country we aim at the same thing. When the scheme has had a little more time to get into working order there will doubtless be bodies of Red Cross women as well equipped and as patriotic as those of France ; but unless they are provided with as good a practical training, will they be as [Practical training for the Red Cross Nurses is clearly of the utmost importance, but so also is careful organization of the Voluntary Aid Detachments. Unless such organization is provided the Red Cross Nurses will have no field in which to use their skill and experience. It is difficult to say bow far this organization has been successfully accomplished through- out the country, but if a Voluntary Aid Detachment which the present writer has observed at work in two Surrey villages is typical there is good ground for satisfaction. In the case named, the Voluntary Aid Detachment can within a very few hours convert two parish halls into efficient temporary hospitals of thirty beds each, provided not only with doctors and nurses and all necessary appliances, but with cooks, clerks, messengers, and a simple but efficient system of transport. Several of the nurses are " trained," and of the rest not a few have attended an out-patients' department at a hospital and dealt with just the kind of cases mentioned in the list above. Though people in Surrey are not pricked in their feet by "palm leaves" they undergo minor injuries which if less picturesque are no less painful.—En. Spectator.]