Nursing Arrangements in Up-Country Hospitals and Infirmary Wards

Sir,?The question of adequate nursing arrangements m up-country hospitals, and also in the chronic wards ?* the more important institutions in large centres, is one which seems to have hardly received sufficient attention. In many cases the general attitude has been to press for a regular nursing service on European lines, and in the meantime to be content with the ordinary untrained ward attendant?ward-boy or ayah?who is usually little better than a hamal. It seems clear that Under ordinary conditions the average up-country civil hospital will never be able to afford highly trained nurses on any reasonable scale, and it is therefore worth While to consider whether some more economical substitute cannot be devised. A scheme for improving the status and efficiency of ward attendants has been under the consideration of the Bombay Government for some time past, and although, owing to financial stringency, tunds have not yet been provided, I hope it may shortly come into operation. Some of your readers may possibly Care to know the rough details, and I append them, in case anyone may care to give the proposals a trial elsewhere. The main factor which should make a policy ?.t this kind practicable is the spread of primary education, which is now making large numbers of literate Persons available at comparatively low rates of pay. The *dea is by offering a small advance on the salaries of the Present ward attendants?who are in my experience mostly entirely illiterate?to obtain men and women who Can read and write in their vernaculars, and also of a somewhat superior social status to those at present eruployed. Immediately on entering the hospital, these People start an elementary course of training, with the aid of a simple vernacular manual which would have to be specially prepared, and suitable models and diagrams, uiany of which are already obtainable from the Red Cross and St. John's Ambulance Associations, a skeleton, and necessary apparatus which would already be available in the hospital. The course would include elementary practical anatomy and physiology, hygiene, and in fact most of the subjects which are taught to regular nurses, but on much simpler lines, and would be carried out under the supervision of the medical staff, and the matron or other trained nurse if available, and would conclude with a viva voce examination on very Practical lines. On passing this examination the attendants would be entitled to a small increase in pay. Further, in order to encourage the recruitment of the right type of people, the housing question would have to be reconsidered in most of the hospitals with which I