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experts such as nutrition workers, social workers, occupational therapists and the like.

"That as soon as may be practicable all agencies, public or private, employing public health nurses should require as a prerequisite for employment the basic hospital training, followed by a postgraduate course, including both class work and field work, in public health nursing."

The American point of view is also clearly stated in the following comments by Miss Clara D. Noyes, Director of the American Red Cross Nursing Service :

"The accepted standard in the United States as well as in the American Red Cross for a public health nurse is based on a foundation of careful preparation in a School of Nursing connected with a general hospital, under continuous professional direction, for a minimum period of two years. The applicant must meet a definite requirement as to preliminary education, age and health. The hours of work and the conditions under which the student lives are frequently defined in the laws which govern State Registration. Superimposed upon this foundation is the eight months training in public health nursing. This must cover theory and practice under suitable and welldefined conditions. Experience in the development of public health nursing in this country has led us to believe that a less comprehensive preparation than this for a work of such vital importance cannot hope to bring results of a lasting character. Preparation in one branch only, such as tuberculosis, would, I believe, be unfortunate both for the individual and ultimately for the family. A nurse who had been solely trained in tuberculosis work would be seriously hampered not only as far as her own development and opportunities for advancement were concerned as an individual, but her sphere of usefulness would be seriously crippled and the family, which is after all the unit in civilized society, needs and should have and wants, at least in this country, experienced visitors, with as wide a knowledge and background of experience as possible.

"Those of us who have spent years in directing Schools of Nursing have come to believe that it takes about a year in which to train the hands of an individual student to become skilful in the

various nursing procedures, and to accomplish the necessary adjustments which an individual must make to a life calling for a complete change of occupation and habits of thought. At the same time the hands are being trained, the eyes, the ears, the mind and the heart must be educated to act in unison. Much more than skill is acquired in this period of close application and instruction; the lessons in self-control, self-reliance, self-effacement that are learned during this period are quite as valuable, or at times even more so, than the acquirement of technical skill. "

ENGLISH HEALTH VISITORS

From England we have received a note from Miss Halford, Hon. Secretary of the National League for Health, Maternity and Child Welfare:

"Public health nursing, or Health Visiting, as it is called in Great Britain, has always been a skilled profession in this country and several recognized training schools have been at work for many years, turning out, except during the war, quite as many health workers as could be employed. At the present time, owing to the insistent call for economy, there are not many new openings for health visitors and the consequence is that many of those who have recently qualified have considerable difficulty in finding employment. On this account one would hesitate to advocate the extension of the present facilities for training or to approve any scheme that would lessen the chances of professional workers obtaining the posts on which they must rely for their means of living. At the same time there is no doubt but that in this country there are plenty of subsidiary openings for voluntary workers in connexion with the Public Health Service, especially if they have undergone some training and are willing to work under professionals, undertaking rather the social welfare aspects than the technical. Many Red Cross workers are already engaged in the child welfare movement in Great Britain and although far fewer came forward for this purpose at the end of the war than had been hoped, their help is much appreciated."

The economic point raised by Miss Halford is an interesting one, and several other commentat

ors also draw attention to it. Confusion may easily arise, however, in discussing this problem from a certain difference in the use of the terms "Public health nurse", Health visitor" and "Visiting or District nurse" in the various countries. Dr. Kuss' "Public health nurse" is to receive definite training in nursing technique and is, in fact, what is known to the British public as a dispensary or district nurse, whereas Miss Halford is discussing Health Visitors, who work in England side by side with nurses but do not as a rule themselves engage in nursing.

The position of public health nurses in Switzerland is explained by Dr. Vuilleumier, Director of La Source training school in

"With us", he writes, " the semi-official training schools, that is to say, those subsidized by government funds, are under the immediate direction of the Red Cross, which acts as a centralizing body for all medical relief work, in wartime as in peacetime. All these schools require three years' theoretical and practical training before granting a certificate, without taking into account any previous experience which the candidate may have had. "I do not see, therefore,

how the Red Cross can enter into competition with itself, so to speak, by giving a two years'

course.

"On the other hand, I appreciate the guarantees of a high recruiting standard which Dr. Kuss' methods would ensure; this is most important in visiting nursing. But to consent to a shortened period of technical training would, in my opinion, be to fall into an old error which has definitely been condemned. "

In Belgium the Red Cross does not itself train public health nurses but it actively encourages public health nursing. Dr. René Sand explains the situation as follows:

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"In 1920 a training school for public health nurses was founded in Brussels, under the patronnage and with the financial help of the Red Cross. Training, both theoretical and practical, was temporarily limited to six months, this departure being taken in order to give a practical demonstration of the utility of public health nurses, hitherto unknown in Belgium.

"In the meantime the National Health Council, an advisory board to the Minister of the Interior and of Health, was discussing new regulations for the training of nurses. Dr. Depage, as President of the Red Cross, worked actively to have this training brought up to the right standard. His efforts were completely successful and the royal decree of September 3rd, 1921, orders that the training of nurses shall last three years, the first and second year being common to all kinds of nurses, and the third year being different for hospital nurses and for public health nurses. Schools must be attached to a hospital and the probationers must live in a home. The practical training for public health nurses includes, in the third year, four months in child welfare institutions, one month in a tuberculosis dispensary, one month in a sanatorium, one month in a venereal disease dispensary, one month in the school medical service and one month in an out-patient medical and surgical department.

'Consequently there was no opening for the Red Cross in this special field. However, when the Belgian Red Cross, with the support of the League of Red Cross Societies, started a permanent Health Demonstration in Jumet, special attention was paid to the public health nursing service. It was established according to the Toronto system, which means that nurses were no longer specialized but that each of them was put in charge of a district, where she has to cover the whole field, including child welfare, school medical service and tuberculosis work. In this way the nurse becomes familiar with every household in her district and acquires a much better grasp of the situation. "

The Countess d'Ursel, President of the Belgian Professional Nurses' Union, also comments on Dr. Kuss' article and shows how the Belgian Red Cross, without actually engaging in the training

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The Marchioness of Targiani Giunti, President of Italy's National Association of Nurses, after expressing great interest in Dr. Kuss' article, describes the organization of public health nursing in Italy:

"In Italy the results obtained by public health nursing have been remarkable, especially in the campaign against malaria, work which requires exceptional energy and devotion. Up till now the best recruiting has been done among Red Cross voluntary personnel. Many of these nurses, who have already become accustomed to severe discipline and self-sacrifice, have agreed to follow a supplementary course of instruction in theory and practice in order to obtain the Visiting Nurse's diploma.

"The examination gives right only to a certificate while the diploma of the Italian Red Cross Public Health Nursing Schools is only given after six months of supervised work. The Italian Red Cross also accepts certificated hospital nurses from other schools of high professional standing as pupils.

"In my opinion the training of the specialized nurse can only take place after a minimum of two years' practical and theoretical hospital work, under the direction of an experienced superintendent, who can single out from among her pupils those candidates best suited to become visiting nurses. The rôle can only be well filled by a nurse with a deep sense of social duty, a true knowledge of her profession and sure judgment from the moral point of view.

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Hungary is making every effort to improve its public health, and Madame de Ibranyi, Chief Nurse of the Hungarian Red Cross, sends some interesting comments on Dr. Kuss' article :

"The Ministry of Health, being perfectly aware that this important preventive work can only be done by well-trained personnel, has asked the Hungarian Red Cross to organize special training schools for public health nursing.

"The first was opened at the University of Debreczen. Following this initiative, a similar school will shortly be opened in Budapest. The length of the course is three years; two years are devoted to general theory and practice in all branches of the nursing profession and the third is given over to specialization in public health nursing. The pupils are instructed in all public health laws and regulations and gain practical experience in all branches. Hungary being an

agricultural country, the pupils are also taught elementary horticulture and agriculture. This knowledge enables them to get into contact with the peasants and directly to encourage the planting of trees, which is one of the first conditions of health in the country.

"At present the Stefania Association trains social workers but has no nursing courses. This lack is felt by those who are keen to improve their work and they welcome the offer which has been made by the Red Cross to complete the instruction by courses in nursing, which is indispensable in their work."

RECRUITING PROBLEM

Finally, coming back to France, we have the comments of two of Dr. Kuss' fellow-countrywomen. Dr. Krebs-Japy, who has devoted a great deal of study to the question of training nurses, says:

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In the United States where many nurses undergo a three years' training course it is possible for the Red Cross to employ only certificated nurses. In France it is not the same: the problem with us is to recruit enough nurses and then to train them. This would appear to be the double rôle of the Red Cross. There is no doubt that it has exercised a great influence on the recruiting of nurses and consequently on the raising of the standards of the profession.

"The Red Cross, by recruiting voluntary workers, appeals specially to the richer and better. educated classes who are ready to devote themselves to social work. Their help has never been a financial burden to the state and has been most valuable.

"The training of nurses, particularly public health nurses, by the Red Cross is essential, but it is a delicate problem for it is considered necessary to give public health nurses at least a year's hospital training before specialization, and it is not always easy to arrange this in a country where all big hospitals are affiliated to the Poor Law system. In addition to this, the Red Cross has to adapt itself to the requirements of its voluntary personnel. It is essential, nevertheless, for not only the reputation and future of our Red Cross

Societies depend on the solution of this problem, but also the raising of our national standard of nursing and the maintenance of its independence, the development of our public health work which constantly demands new and capable recruits, and our whole national influence in the field of social welfare. It is important for us French people that our Red Cross should be ready to take a place worthy of the nation in the national and international humanitarian peacetime work which is being carried on all over the world. Our French Red Cross Society should be held in the same esteem by other Red Cross Societies as we desire to see France herself held.

'This is why the question of the training of nurses by Red Cross Societies is so important and why our national societies are right in wishing to give their personnel the same technical training as is given in our best public health nursing schools and to obtain the necessary sanction for a state diploma. "

Mademoiselle Chaptal, Directrice of a Paris training school for nurses, writes:

"Dr. Kuss' very interesting and suggestive article brings us to the question of the payment of salaries in voluntary organizations. Too often we find the survival of an ancient prejudice which dates from the time when all charitable workers could afford to remain volunteers. To day, unfortunately, the situation has changed. This is less. to be regretted when one realizes the difficulty of running certain services entirely with voluntary helpers. They are not generally free to dispose of all their time, and have certain family ties, especially during the holidays. Under these circumstances, would it not be well to encourage Red Cross Societies to organize their services in a methodical way by the addition of a permanent staff, which, being paid, would not be the less skilled or devoted if its members had been well trained, and which would serve as a foundation for the less regular help of voluntary workers?

"In wartime as in peacetime this plan would ensure the regular carrying on of the public health and dispensary work which has been undertaken by the Red Cross Societies."

PLAY AND CIVIC EDUCATION

by W. A. WIELAND

The modern tendency in the education of children is to forsake the old tried-and-found-wanting method of pouring information into the more or less receptive minds of passive classes of children, and to adopt what are called active methods. The programme of the new school is a programme of activities related to the real interests of the child at his various ages. The slogan of the proponents of active methods in education is "Educate for life". One of the basic principles of this method is first to arouse in the child a desire for knowledge or the need for it, and only then to give the information that will satisfy this desire.

The first contribution of play to civic education

is precisely that it creates the desire for the knowledge of civic processes and principles. That is one of the reasons for the support which Junior Red Cross workers in many countries have given to the organization of playgrounds. In order to play games, the child needs organization; he wishes to form a group or team, and he wishes that group to be directed in a manner that will ensure success. The play group is the first social group the child enters by his own wishes. He is born into a family, which may not be at all to his taste. Elder brother may be a tyrant, and Father a grumbly monster who doesn't understand children. He has had no say about the choice or the form of the

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