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was the active agent in the origination and development of the scheme would no doubt be willing to supply any information which might be desired.
3rd. I take the opportunity of stating that my permanert address is now that from which this letter is dated not 13, Eildon Street, Edinburgh.
1016.
SIR,
No. 5.
I have, &c.
ROBERT GRIEVE,
Late Surgeon-General, British Guiana.
DR. CRANE to COLONIAL OFFICE. (Received January 14, 1896.)
7, Albemarle Street, January 12, 1896.
I MUCH regret that I shall not be able to meet Dr. Gage Brown and the other medical gentlemen invited to attend on the 15th instant, as I ain leaving for the south of France on the 14th.
I had assumed, too hastily perhaps, from your letter of the 27th December,* that the discussion would take place soon after the 1st of January, and in that view I had postponed my departure for a week. I am sorry I cannot put it off longer without causing great inconvenience to other members of iny family.
I shall, however, be happy at all times to give any information in writing on the subject under discussion so far as I may be able.
I am happy to say that Trinidad was, when I left in 1893, fairly well supplied with trained nurses available for private employment at a moderate charge. A training school had been established for years in connexion with the large colonial hospital in Port of Spain.
Provision is made in the annual estimates for the employment of from 10 to 12 pupil nurses at a salary of about 21. per month each. One is attached to each ward, under the supervision of the head-nurse of her ward, whom she assists in her duties. Besides the instruction thus obtained, the superintendent of nurses teaches them special nursing, and lectures are delivered to them two or three times a week by the senior assistant surgeon. At the end Examinations are held periodically and prizes given to the most successful.
of the years' course, certificates are given to those who are considered to be competent and efficient nurses.
About one-half of those trained are employed to fill vacancies in the medical institutions and the remainder are available for private nursing.
A few of those who are trained are specially instructed as midwives.
I may mention also that there is a school for training midwives at the Jubilee Lying-in From six to eight Hospital in Kingston, Jamaica, which is becoming quite a success. are trained annually.
2472.
No. 6.
I have, &c.
LEONARD CRANE.
DR. GAGE BROWN and others to COLONIAL OFFICE. (Received February 3, 1896.)
88, Sloane Street, January 31, 1896.
SIR,
In accordance with your letter of 27th December ultimo, conveying to us the wish of the Secretary of State for the Colonies that we should meet to consider the question of providing trained nurses in the Crown Colonies with a view to advising him as to what might be done, we beg to state that we met on the 15th instant, and, having read the memoranda of those officers who were unable to be present, but who kindly favoured us with their experience in their own Colonies and with their opinions, we
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proceeded to discuss the question, each of us being able to supply data concerning the Colonies in which we have severally served.
We soon perceived that it would be difficult to apply a general rule to all Colonies, as the requirements are likely to vary in each.
Some of us were able to show that nursing was very efficiently carried on at present in a few of them.
In Hong Kong, since obtaining a nursing staff from the London Hospital, everything has worked well as to hospital nursing, and official and non-official persons are received into the hospital for treatment at a fixed tariff. Wives of respectable persons, not very well off, are also received for attendance in childbirth, and private wards are obtainable.
The supply of nurses from one training hospital was shown to be advantageous and desirable by the success of the nursing arrangements at Hong Kong. There is a lady superintendent directing the staff.
It is gratifying to have to record that these nurses are received in society, and the isolation complained of in some Colonies is not felt here.
Very good arrangements exist in Jamaica as testified by the statements and memoranda of Drs. Mosse and Crane; and some of the methods there used might be adopted in other places, especially as to the training of midwives for attendance on the humbler classes.
In the Straits Settlements, Hong Kong, and Mauritius, Sisters of Charity have been employed in some Colonies, and in some cases rendering very efficient and devoted to the doctors, service; but in matters of delicacy they would withdraw, thus leaving
or to subordinates partially instructed, to carry out the particular duty.
In British Guiana a system of nursing was attempted, but failed for much the same reasons as stated by Dr. Kynsey with reference to Ceylon, viz., in some cases the isolated life leading to retirement, in other cases marriage, and for lack of public support.
Some of us consider that there should be nursing institutions for supplying nurses to private houses quite apart from hospital nurses. Some think that a supernumerary staff in the hospitals, where hospitals exist, could perform the work of private nursing when called upon. This is known to be done in one Colony, and it may be so in others.
To constitute a nursing institution under a committee of the principal ladies, or ladies and gentlemen combined, would involve the expense of quarters and the up-keep and provisioning of the establishment, whether the nurses were employed or unemployed. Salaries expected would also probably be high. The term of service would also have to be arranged. In India and in some Colonies three years is the terin, open to re-engage ment at the end of that period. The question of pension might also come up. There is this also among the difficulties of such an arrangement that sometimes there would be an active and interested committee who would proinote success; sometimes there would be indifference, and the result, failure. We have come to the following conclusions, which we submit as that which may be done :-
1. That it should be made known in all the Colonies that the Secretary of State wishes to promote a system of trained nursing, and to give such advice and assistance in the matter as any Colony may require.
3. That the Governors should confer with the principal medical officers as to the need
in towns and in districts, and that the principal medical officer should be called upon to state what nurses were required, and how they could be housed, whether in hospital or in separate quarters.
3. That the Governor should requisition the Colonial Office as need arose.
4. That the Colonial Office should enter into arrangements with hospitals and
institutions that might be willing to supply the demand when made.
We believe this would be the simplest and the least expensive course.
In using the term institutions we include therein religious communities which have undertaken nursing, or would add nurses to their staff by agreement, such as the missionary societies; sisterhoods of either the English or Romish Church; and nurses' associations, such as the Registered Nurses' Society.
Where, as in the Straits Settlements, Jamaica, Hong Kong, and any other Colony, the nursing is well carried out, the existing means had better be retained and developed.
Should it be desired of us, we would submit details as to tariffs, terms of service, &c., and should be happy to tender advice on any matters connected with the subject that may not have been dealt with in this Report.
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