also maternity or monthly nurses who can be engaged, as required, by members -of the more opulent classes, and they frequently have a midwifery training as well as some general training; but their qualifications vary.
Nursing Organization. As regards the organization of nurses, the British Nurses' Association was set on foot under the presi- dency of Princess Christian in 1888. The goal of the advanced party was to establish a minimum of training, and to do this through a central governing body appointed by the State and thus to pre- vent untrained women claiming the position of trained. Those who opposed the view asserted that in the nursing world efficiency could not be tested by examination nor its continuance guaranteed. The Association obtained a Royal Charter in 1892. But serious dissen- sion soon arose, which emanated from those who were strongest in affirming the necessity of the registration being carried on by the State, for at first the British Nurses' Association was content with advocating a voluntary register. In 1894 a Matrons' Council of Great Britain and Ireland was set on foot by the advanced party, and in 1902 a Society for the State Registration of Trained Nurses was established. A bill for State registration was introduced into the House of Commons in 1903, and another the following year. As there was strong opposition to the project a select committee of the House of Commons was appointed to investigate it, and its findings were more or less favourable to the scheme. After it reported in 1905 the warfare continued with extreme vehemence (on the registration side later on with the help of a central com- mittee founded 1910) until the outbreak of war, when a truce was declared. In the year 19163 College of Nursing was established which was designed to form a centre for all nursing activities and to direct nursing education on proper lines. It has branches throughout the United Kingdom, and in 1921 had 20,000 members. The College supported a scheme for registration somewhat different from that of the central committee, and as it proved impossible to obtain agreement the long struggle over registration was brought to an end by the Minister of Heajth deciding that the Government would bring forward its own bill. This was done, and the Nurses' Registration Act became law in the end of 1919.
The nursing profession, after a long time of controversy, was thus in 192 1 entering into a new phase in which it had obtained powers of self-government. It had already through its organiza- tion claimed and secured a considerable increase in pay and decrease in hours of duty ; * but it considers that there is much work before it, if wholly satisfactory conditions are to be obtained. It is esti- mated that there are about 40,000 fully trained nurses in the United Kingdom, although there may be double that number eligible for State registration during the period of grace. The Act of 1919 establishes a General Nursing Council for England and Wales and another for Scotland. Of the 25 members of the English Council 16 must be registered nurses elected by persons registered under the Act. It provides for three supplementary registers (for male, mental and sick children's nurses) as well as the general register, and it regulates the admission to and removal of names from the register, as well as the training of registered nurses. The Act thus gives to the nursing profession a status and power which it never had before. So far there has not been much connexion between the nurses' training schools and the universities in Great Britain, though this is being discussed, and in 1921 the university of Leeds decided to grant a university diploma in nursing.
Nursing in British Dominions. Nursing in the Overseas Domin- ions is developed on lines similar to those in the United Kingdom; but there is a Colonial Nursing Association which sends trained hospital and private nurses to the Crown Colonies and small British communities in foreign countries. There is also an Indian Nursing Association (Lady Minto's) for Europeans in India.
In most civilized countries in Europe and elsewhere the Night- ingale tradition has taken root, but in very many cases the idea of a controlling matron with executive powers has not been developed, and this militates against the success of the hospital as a professional training school. During the year 1920-1 the League of Red Cross Societies sent 16 nurses of different nationalities to study in a course specially arranged at King's College for Women, and this experiment may be expanded.
British Military Nursing. In 1901, during the South African War, the Secretary of State for War (Mr. St. John Brodrick) appointed a committee to consider the reorganization of the Army and Indian Nursing Service and advise as to its recon- struction, he himself being chairman. From it originated Queen Alexandra's Imperial Military Nursing Service (1902). Hitherto the service had been under a lady superintendent at Netley, and the power and responsibilities of the women nurses were much restricted, since it was considered that male nurses would be paramount in time of war. Under the new constitution a Nursing Board was established with the Queen as president and the director-general of the Army Medical Service as chairman, and
1 Recommendations on this subject were issued after full enquiry by a committee appointed by the College of Nursing.
it advised the Secretary of State on all matters connected with the service and its organization at home and in India. The India Office, however, decided to carry on its own service, and therefore references to India are thereafter omitted. There had been a service called the Indian Nursing Service since 1881, and this remained separate from the home service. It is now named Queen Alexandra 's Military Nursing Service in India, and numbers 95 members.
Queen Alexandra's Imperial Military Nursing Service was organized with a matron-in-chief at its head, and principal matron, matrons, sisters, and staff nurses subordinate to her. The duties and pay of the various grades were laid down at the time of its foundation, and regulations made as to the qualifica- tions for entry into the service. A scheme was also formed to develop the training of orderlies for the R.A.M.C. The re- sponsibility for carrying out the recommendations of the Nurses' Board rested with the director-general of the Army Medical Service, whose principal officer in the nursing branch of the War Office was the matron-in-chief. Reports on the nursing equip- ment and requirements in the various hospitals were also made by the matron-in-chief and the principal matron. Ward masters were abolished and the wards were managed by the sisters. A scheme was drawn up for the training of non-commissioned officers and men of the R.A.M.C.
In 1897 an " Army Nursing Reserve Service " was also estab- lished; it was associated with the name of Princess Christian and constituted by Royal warrant. This reserve was absorbed into the Q.A.I.M.N.S. Reserve in 1908. The principle of a standing reserve of nurses was not originally adopted by the Nursing Board as it was believed that civil hospitals and nursing associations would provide the necessary means when required, and a further reserve of this kind was established in 1910. The number of nurses in the Q.A.I. M.N. Service (Regular or First Line Nursing Service) was 290 in 1914 at the beginning of the war. Of the Reserve 200 were enrolled individually as members of the Q.A.I.M.N.S. Reserve and 600 were provided by civil hospitals and associations. Later on all became one reserve, and this reserve was expanded as required. In the first year of the war there were 2,323 fully-trained reserve nurses enrolled, and the number reached 10,304 by 1918. These were distrib- uted throughout all the areas of war and in hospital-ships.
Queen Alexandra's Military Families' Nursing Service. The Q.A.M.F.N. Service was set on foot in 1921 with the view of taking over the permanent nursing establishment of the military families' and military isolation hospitals, and it consists of matrons, sisters-in-charge and staff nurses, the rates of pay and pension being the same as those laid down for the corres- ponding ranks in the Q.A.I.M.N.S.
Territorial Force Nursing Service. This service was established in 1907-8 in connexion with the Territorial Army that was then established, and it supplied the largest number of British nurses available at the outbreak of the World War. The purpose of the service was to maintain a staff of nurses willing, in the event of mobilization of the Territorial Army, to serve in the general hospi- tal of the district to which they were attached. Of these hospitals 23 were instituted in various centres in England and Scotland under the scheme for medical organization. They were buildings ear- marked for the purpose, though at the time used for other objects. The staff were engaged in civil pursuits, but were ready to serve whenever called upon to do so. The service had at its head an advisory council at headquarters, in order to provide for the estab- lishment of a similar system of control in each hospital. It framed rules and made recommendations for the administration of the service, and the appointment of matrons, sisters and nurses thereto. At the head of the service is a matron-in-chief. Each hospital centre had a local committee to receive the names of nurses wish- ing to join the service and an organizing principal matron. The Territorial Forte Association of the county was requested to assist in the appointment of this committee. The roll of sisters and nurses for each hospital was forwarded for approval to the advisory council, which was composed of professional and lay members equally. Queen Alexandra was president. The understanding as regards the Territorial Force Nursing Service was that, like the rest of the Territorial Force, it would serve only in case of invasion, or when the Territorial Force was called up. The period of train- ing necessary for a nurse was the same as for the Q.A.I.M.N.S., i.e. three years. The uniform is blue-grey material edged with scarlet, and a silver T is worn as well as the service badge.
