the whole front of the XVIII. Army. All the repeated French attacks, made with great masses and supported by strong artillery preparations and tanks, were repulsed before the front of the XVIII. Army with heavy losses. The Germans retained the positions captured during the engagements of the gth and loth on the general line of the heights S.W. of Montdidier- Courcelles-Antheuil-northern bank of the Matzbrook.
The German attack undertaken from the district S.W. of Soissons by the VII. Army to relieve the pressure on the XVIII. Army had led to no substantial successes. The flanking artillery fire falling behind the lines and on the French forces fighting E. of the Oise had indeed inflicted severe losses; but the French had placed such strong reserves in readiness on this front that the German attack undertaken between the southern slopes of the Aisne and the forest of Villers-Cotterets had been able to make substantial progress only in the centre and to penetrate into the north-eastern section of the forest of Villers-Cotterets. It was, however, clear on the I2th that the attack begun here would not penetrate farther; very violent Franco-American counter-attacks began on this day, especially opposite the VII. Army and particularly at Chateau-Thierry and W. of the wooded heights of Reims.
In the battle of Noyon the Germans took 15,000 prisoners and 150 guns; but the engagements between June 9 and 13 had not substantially altered the German strategic situation on this section of the front between Soissons and the woods of Villers-Cotterets. (H. v. H.)
NURSING (see 19.914) UNITED KINGDOM. The modern nurs- ing movement has developed from the introduction of a new type of woman. One of the principal points of Florence Nightingale's organization (see 19.684) was that the hospital matron should have complete authority in regard to her own sphere and not be under the direction of the male hospital staff in regard to the training and management of the nurses, and this is now the recognized English system under whose influence the movement for educated nurses has during the last 50 years proceeded apace. Thus nursing has gradually become a fully organized profession. Hospital work is now divided into many sections, and in large training schools not only are there nurses performing administra- tive work alone, but nurse instructors and tutors form part of the staff. There are likewise specialists in electric and other technical work, but these (and also those who take fever and other special trainings) are often postgraduates, while, on the other hand, young women sometimes nurse in children's hospitals as well as in cottage and convalescent hospitals before they are old enough to begin 'their regular training. The age for com- mencing training in recognized training schools (which are roughly those having over :oo beds and a resident medical officer) used often to be 25, but in many hospitals it has been reduced to 21 since there is difficulty in getting older probationers. The length of training varies from three to four years, and examina- tions are held at stated intervals. The nurses usually occupy a nurses' home within the precincts of the hospital, though there has been a movement towards allowing at least some of the staff to live out. The " sister " probably retires at 50 or 55, and a pension is frequently provided, with or without contribu- tion. Postgraduate teaching is developed in the best schools.
District Nurses. If a nurse in England wishes to take up dis- trict work on completing her training she may have her district training and be placed on the roll of the Queen's Nurses (estab- lished to commemorate the Jubilee of Queen Victoria), a body which has done much to ameliorate the lot of the sick poor in the United Kingdom. These nurses are supported and controlled locally but supervised from headquarters where they are trained, and a high standard of efficiency is maintained. In Ireland a special fund was raised to assist in the support of these nurses. Another type of nurse is named the " Cottage Nurse." These district nurses only receive a short training, usually under what is called the " Holt- Ockley " scheme, and the idea is that they should reside in the houses of their patients and be somewhat of their class. It is con- sidered advisable that district nurses should hold the certificate of the Central Midwives' Board, more especially as these nurses are frequently employed in infant and child welfare work.
Public Health Nurses. Public health nursing has developed largely since 1910. Child welfare work is only one of these develop- ments. In Great Britain a large number of nurses are employed
under the county, borough or city schemes for this work and also for tuberculosis visiting. Then education authorities require a large staff for following up the cases of children who have been inspected under their health schemes. There are also nurses in connexion with industrial welfare work. Fever and isolation hospitals supply another form of public nursing work. This form of nursing is sometimes undertaken after graduation, and sometimes the probationer takes her fever training before going on to work in a general hospital. The full course of fever training is usually three years.
There are many large Poor Law infirmaries which give excellent training and are recognized as training schools. The advantage claimed for them over hospitals which are also training schools for the medical profession is that at present, being without students, there is more left for the nurses to do. On the other hand there is a large number of chronic cases, and the number of patients per nurse which in general hospitals may be three is in Poor Law infirma-- ries much larger. The nursing in small infirmaries (called Poor- house or Parish hospitals in Scotland) is done by a superintendent with nurses under her. In the case of there being a single nurse she may be placed under an untrained matron or governor, and this has been the source of complaint. The nursing of the sick poor has greatly improved, but various further recommendations were made by the Royal Commission on the Poor Law (appointed 1905) which involve changes in administration.
Private Nurses. Private nursing in England has expanded enor- mously during recent years, and though there are some " visiting nurses " who come in for the day they are mainly residential. The nurses who undertake this kind of work are to be had either from a hospital which sends out its nurses after they gain their certificate and allows them to return to the wards when free, or from an Insti- tution or Home. There are very few independent nurses working by themselves, but many belong to a " Cooperation," to the head- quarters of which the nurse returns after her case is completed, and to which she contributes a percentage of her earnings. There are many private nursing homes for the well-to-do where nurses are employed. The qualifications of these nurses vary according ta the quality of the home.
Mental Nurses. The training for mental nursing is usually con- ducted in a recognized institution for the treatment of mental dis- orders, where the candidates serve for three years. At the end of this time they may obtain the certificate of the Medico- Psychological Association. The nurses and attendants are of both sexes, but though male patients are usually nursed by male nurses, women are being increasingly made use of even for men, more especially in Scotland, where what is called the " Hospitalization " of instu tutions for the mentally affected is becoming common. It is claimed that the result of employing women (with some male assistance) has been proved to be very satisfactory. When the nurses in train- ing have already taken their certificate in a general hospital they are allowed to enter for their examination at the end of two years instead of three, and are exempt from the examinations at the end of the first and second years. The training is very thorough, and a careful register is kept of those who qualify and in case of misde- meanour the name is erased.
Masseurs and Masseuses. There is a Chartered Society of Mas- sage and Medical Gymnastics (amalgamating the Incorporated Society of Trained Masseuses and the Institute of Massage and Remedial Gymnastics) which grants a diploma to those who have taken their preparatory course at a recognized school or hospital, or who have passed an examination. Soon examination in massage alone will cease, and candidates will be required to sit for a con- joint examination in massage and medical gymnastics, after sched- uled training under recognized teachers.
Midwives and Maternity Nurses. Midwifery is controlled by a Central Midwives' Board established in London and having jurisdiction in England and Wales. There are separate Boards for Scotland and Ireland. The number of midwives now appearing on the Roll in England and Wales is approximately 48,600. This Board, which was established under the Midwives Acts of 1902 and 1918, submitted certain rules to the Privy Council, which were approved by them. Its business is to regulate the issue of certificates and the conditions of admission to the Roll of Midwives, as also to regulate the course of training and the conduct of examination. It has likewise the power to remove a name from the roll, or restore a name removed. In addition it gives directions to midwives in their work.
Though the Act came into operation in 1905 it was only after 1910 that it was forbidden to attend women in childbirth for gain otherwise than under the direction of a qualified medical practitioner, unless certified under the Acts. Certification depends on compliance with the rules and regulations laid down in pursuance of the Act. The midwife acts under the local supervising authority. The number of midwives has of course increased largely ; but still demand exceeds supply, as their emoluments are not Sufficiently large to make the work of district midwife attractive unless supplemented by public or private funds. There is an incorporated mid-wives' institute which has been useful in promoting the interests of midwives. A large number of trained nurses take the certificate after training and work as " Queen's " district nurses or otherwise. Other qualified midwives have a short general training. There arft
