620 TRAINED NURSES FOR WORKHOUSES.

his second letter; "then take a stroll through the streetsaround Cavendish-square, and you will not be surprised toread on the brass plates the names of many physicians whomthe public has never heard of and probably never will hearof." The third letter is on "The Surgeon," and the gistof it may be gathered from the characteristically outspokensentence : "If you ever hear it said of one that he

owes his success to social influence, or to the help of

influential people, you may rely upon it (whoever says it)that it is utter rubbish." Another little fallacy, exceedinglycommon among laymen and occasionally promulgated bymembers of the medical profession, is also exposed in thisletter. It is undoubtedly common belief that a surgeon mustpossess extraordinarily good nerve, but, as Sir William Dalbypoints out, the necessary coolness and calmness in emergencywill always be present in exact proportion to the surgeon’sintimate acquaintance with his subject. It is knowledgewhich gives nerve to the surgeon, not, at any rate as a rule,come constitutional form of callousness. The fourth letteron "The Specialist," and the fifth on "The General Prac-titioner" are equally marked by their combination of senseand humour. ’’ Dr. Chesterfield’s Letters on Medicine as aCareer " have not been written as a parody of the eighteenthcentury style-in fact, Sir William Dalby’s pen is as modernas it is correct : Addison would have found him flippant,and .to what Dr. Johnson would have compared him weshudder to think-but in their bland, practical wisdom theyjustify the introduction of the name of Chesterfield into theirtitle. As will be gathered, we have read this little book withgreat pleasure, and we believe that the advice contained init, whether stated out or implied only in some funny littleanecdote or comparison, is on the whole undoubtedly sound.

TRAINED NURSES FOR WORKHOUSES.

IN former numbers of THE LANCET 1 we referred to the

recently formed Workhouse Infirmary Nursing Association,and we briefly noticed its purposes and the necessity whichgave rise to its institution. We have now before us

the report of the association for 1893, and are once morereminded of its objects. Of these, two are essentiallyimportant and comprehensive as describing the work of thisuseful organisation. They are: (1) the appointment of

trained ladies as matrons in all separate infirmaries, and

’(2) the training and supply of skilled nurses to workhouseinfirmaries in London and the provinces. The latter will bedrawn from the ranks of probationers educated in suchinfirmaries. The report contains a reference to the factthat the past year has witnessed the introduction into- workhouses of trained instead of untrained nursing, andit mentions, by way of suggestive inference, a reductionin workhouse mortality of 34 per cent. There is still,however, an immense disparity in the proportion of’skilled nurses employed to the inmates who require their services, many local guardians being wedded to the belief that the nurse ought to be nothing else than a species of,officer in command of a detachment of pauper women

- employed in waiting, when required, upon the sick. We ]

’have no wish to discourage this belief if it could be reducedto practice with benefit to the suffering poor. We must 1

:admit, however, and so must those guardians who have S

watched the effects of such a system in the past, that the "workhouse poor have not shown, even under competent ;supervision, a capacity adequate to the work in question.As ward servants they are useful, no doubt, but they are not (’for obvious reasons adapted as a rule for the more responsible >duty of nursing the sick. Apart from the fact that we should mot naturally expect to find in a workhouse the most capable i,or the most industrious of the population, we have to remember

1 Feb. 6th and 13th, 1892.

FOR WORKHOUSES. [MARCH 10, 1894.

that many of these inmates are persons of advanced age.This would by no means aid their power of acquiring a newart, especially one which makes heavy demands on the intelli-gence, tact, and manual nicety of its practitioners. Again,the pauper population is a floating one and a nurse inmate,especially if young, might at any time return to the generalcurrent of human life, when her services would be lost to theinfirmary. Clearly then we need more than a scanty officer-hood of trained attendants. Under the older and still generalsystem a skilled nurse is employed virtually to render ineffec-tive service and to be herself half killed with over-work. The

appointment of lady matrons is certainly very desirable. Atthe present time the arrangements made for the bare subsist-ence of nurses are in some workhouses, probably in many,shamefully inadequate. Their necessary interests and thoseof the poor inmates also would gain much from the oversightof capable and well-educated persons. We have not spaceavailable for further discussion of this subject, but enoughhas been said to show for what reasons the associationdeserves the liberal and friendly support of the publicgenerally and of parish guardians in particular.

CHILD-LIFE IN THE SICILIAN SULPHUR MINES.

IT is at once a startling and a reassuring fact that thelabour question in Sicily seems mainly to have interested themedical philanthropist, such well-known biologists as AngeloMosso of Turin, Cesare Lombroso of the same school, andNapoleone Colajanni of Messina having each from his ownstandpoint contributed powerfully to its elucidation. We say"startling" because a social evil that makes the medicalman intervene is one that affects the vitality of the popula-tion, and we say "reassuring " because when such interven-tion has come about there is hope that the condition of thingswill be improved. We leave on one side for the presentDr. Colajanni’s luminous exposé of the horrors of the

sulphur mines in Sicily, and we also postpone considerationof Dr. Lombroso’s psychological study of the effects of thesystem on character and development. Our present purposeis rather to draw attention to Dr. Mosso’s instructivefacts and figures as to the physical deterioration induced bysuch labour on the Sicilian proletariat. Take, for example,the province of Caltanisetta in the heart of the island andponder the following statistics. In the four years from 1881to 1884 the officers of the military levy had 3672 youngsoyarari under scrutiny. Of these only 203 were foundto be fit for service in the army ; 1673 were riformati-that is, were tentatively declared to be fit, then broke downafter the regulation trials and had to be dismissed; and1835 were remanded for further inspection at the next

levy. Of the riformati 1249 proved to be defective as

to stature, 69 were incurably narrow-chested, 64 hadconstitutional debility, 25 developed malformation of the

thorax, 48 were hunchbacked, 20 had other corporealdeformities, 18 laboured under the malarial cachexia,18 became blind, and 80 suffered from diverse ailments."And this," says Dr. Mosso, "in a province under theresplendent sky of Italy, on a soil bursting with fertility, ina land prolific in intelligent sons-out of 3672 young men oftwenty only 203 found capable of military service. It is with

reat grief and dismay that we peruse these figures and think?n our native land." Other provinces of Sicily showingabout a third fewer rejections for the military levy thanCaltanisetta were still far from presenting the normal

ievelopment proper to youth mainly agricultural in

occupation ; but the nadir of physical and mentalabasement was reached in the mining districts, whereGhe number of analfabeti (unable to read and write) is

about 90 per cent. But there is an antecedent condition evenworse than want of education. The lives led by the poorchildren of the mines are in point of decency, to say nothing