visitors ad hoc in all three schools, and the keeper in general superintendence. In addition to these three special schools, there is a newly established school for all, that of design, 'for the use of students practising composition, and for miscellaneous work of various kinds.' Visitors are to give subjects for designs in this schcol and to examine and comment on them. It is also to be used for 'lectures on landscape, and on animal painting, and for any other cognate purposes.' At the end of three years those students who desire a further extension of their studentship for two years are required to submit to the Council certain works done during the previous three months. These include: for painters, a drawing and a painting from the life, a painted sketch for a design to fill a given architectural space, and the result of a year's work in the school of design; for sculptors, a model and a drawing from the life, a model in low relief of a given subject to fill a given architectural space, a sketch composition in the round, and the year's work in the school of design. They must also have attended one course of the appointed lectures, and have passed an examination in those lectures. A scholarship of 40l. for one year is given to the students in painting and sculpture respectively who shall pass the best examination. Regular attendance in the schools, subject to certain exemptions, is insisted on, systematic irregularity disqualifying the student for competing for any of the prizes. Some alterations have been made in the number and value of these prizes, but the fact in connection with them chiefly worthy of note is that all intending competitors for the gold medals and travelling studentships in painting and sculpture, and for the design for a mural decoration, have to submit to a preliminary examination before being allowed to compete. The admission of students to the school of architecture is, mutatis mutandis, on the same lines as those which govern the schools of painting and sculpture, stress being laid especially on design; they must also pass a qualifying. examination in the history of architecture.

It is of course too early yet for any opinion to be pronounced. on the merits or demerits of this new departure. Experience in the working of the various changes can alone show wherein they succeed and wherein they fail. But whatever may prove to be the measure of success or failure in this particular instance, the account here given of its schools, incomplete as it is, will perhaps serve to show to all unprejudiced persons that the Academy, now and in the past, has always striven to do its best for the art student both in its corporate capacity and through the individual exertions of its members.

The account does not pretend to be more than a dry recital of facts; but at any rate they are facts, which is more than can be said of some of the statements that have recently been made about the Royal Academy.

FRED. A. EATON.

THE STATE REGISTRATION OF NURSES

ALTHOUGH many careers have been thrown open to women during the last half-century, and although the proportion of those pressing into clerical and office life is increasing, yet nursing remains one of the leading professions for educated women-whether regarded from the point of view of the numbers engaged in it, or from that of its suitability as a field for the exercise of their special gifts and capabilities.

It is also unique in being perhaps the only profession unreservedly assigned to women-in which their pre-eminent fitness is not disputed, and in which they occupy all the higher positions. In every other line of life women either struggle in ineffectual competition with men or occupy the subordinate and less well-paid posts.

The nursing profession has practically been created in our own day; it dates from after the Crimean War, when Miss Nightingale organised the first training school in St. Thomas's Hospital. She herself, and Miss Agnes Jones, the pioneer of Poorhouse Nursing, had to find their training in the Kaiserswerth Deaconesses' Home on the Rhine, where the care of the insane and the teaching of children alternated with attendance on the sick. The training organised by Miss Nightingale was more strictly professional in character, and lasted for one year, a period which has subsequently been extended to meet hospital necessities and. the growing demands on nurses' skill and knowledge, till to-day no fully trained nurse has had less than two years in a general hospital.

Meanwhile the scope of the profession has enormously increased, and some of its latest developments, which bring it into direct contact with the homes of the people, have converted it into a potent instrument of social progress. Mr. Charles Booth states in his book on London that it is almost true to say that wherever a nurse enters the standard of life is raised;' and he speaks of the advance in this direction as 'perhaps the best fruit of the past half-century.' The public has not been behind the scientific inquirer in fully appreciating the value of district nursing, and there will soon be scarcely a country town or village without its Queen's or parish nurse, while the quality of the services employed has been considerably raised through the impetus given to the movement by Queen Victoria, when she dedi

cated her Jubilee Gift to the training of highly skilled nurses for the poor. Continuous efforts are being made to secure trained nurses for our poorhouses and workhouse infirmaries. Certain London schools now employ visiting nurses to inspect and attend ailing pupils, and it may be expected that the Scottish Report on the physical condition of children will lead to further employment of nurses in connection with our elementary schools. In other directions new spheres of usefulness are opening before them. The imperialist wave has swept them into the service of the Empire, and newly formed societies have organised Nursing Associations for India, South Africa, and the Crown Colonies. While on the one hand, therefore, the sensitiveness of the public to political and social questions is encouraging the development of nursing, we find, on the other, that the progress of scientific surgery and the increasing numbers of special treatments and curative processes are entailing fresh calls upon the profession and necessitating a rising standard of skill and knowledge.

But though in so many ways this great profession is growing so rapidly and daily occupying a wider and more important field of work-though the typical nurse has evolved in our own day from the Mrs. Gamp' or religious deaconess to the highly trained and scientific sister of our large hospital wards; yet on the other hand the profession is, as regards its internal organisation, in a state of chaos and confusion. It has no governing body; no standard of training; no corporate existence. Every hospital-whatever its size and standing-is a self-constituted training school. Each works as a separate unit, carries out its own theories of training, and confers its own certificate. A woman who has been two years in a small cottage hospital, six months in a lying-in hospital, or some such specialised institution, will emerge from it as legitimately a 'nurse' as a woman who to her three years in a general hospital has added experience in fever and obstetric wards, and passed through the courses of theoretical instruction in bacteriology, physiology, and sanitary science, which form part of the training in many of our large institutions.

In these latter hospitals the period and character of the training are more or less assimilated; but even in their case the terms and conditions of service are very varied. Everything depends on the matron. She can curtail or lengthen the period of probation; she can so arrange the work that her nurses will pass successively through the medical, surgical, and other wards, gathering all kinds of experience; or she may so legislate that her nurses will leave the hospital having seen but one department of work, and remain therefore practically untrained in every other important direction. The certificate earned in either case will be of precisely the same value, will carr the same consideration, and entitle its recipient to the same remuneration. As a result, the prizes of the profession are distributed haphazard among the fully trained and partially trained. Private

nursing institutions, from which the general public draw their nurses, are staffed with nurses of every kind and degree of training, the one point of similarity being reserved for the fees they demand.

This state of matters is not only unfair to the nurses themselves, but unfair to the public. The latter have no means of judging of the quality of the article supplied to them. They generally accept the uniform and the appellation of Nurse' or 'Sister' as proof positive of the fitness of the individual for the duties undertaken, and they cheerfully pay down their 21. 2s. a week in blissful ignorance of the fact that the nurse they have called in for a typhoid case has never seen or attended a single fever patient. During the late war, when the supply of Army Nurses and their reserves had become exhausted and a call came for volunteers, the absence of a register and the impossibility of discriminating between the qualifications of applicants was a serious handicap, and resulted in the employment of many partially trained nurses, to the exclusion of those who were equally willing and more efficient.

From another point of view the employing public may be considered to suffer injury, for, thanks to there being no stimulus in the shape of hope of promotion and financial reward for those who have striven hard to acquire the highest professional skill, the average standard is lower than it would be otherwise, and even the best trained nurses are apt to be stunted in mind and character for want of that wider outlook and those diversified interests which come from an all-round well-balanced training, based on a good secondary education. This aspect of the question acquires special importance through the peculiar conditions of a nurse's life, which bring her professionally into close and intimate contact with those she serves, thus enabling her to exert an influence on the home-life, and even on the character of her patients. And though this by-product of nursing is more apparent in the homes of the poor, it is a constant accompaniment of a nurse's work, whether carried on in a private house, hospital, or workhouse. In few other walks of life is the worthiness as well as the fitness of the individual so professionally important, and yet it is the one calling without a recognised standard of capacity, and without the means of enforcing discipline.

The legal and medical professions can, through their Councils, insist on a certain level of attainment, and they have the power of enacting disciplinary measures. Neither lawyers, doctors, chartered accountants, nor chemists and druggists can enter the fold except by the legitimate door; once within they must accept and adopt the professional ethics of their order.

Nurses alone are perfectly irresponsible to any authority, their professional skill is vouched for by no recognised certificate, and though the scope of their influence for good or ill is far greater than that of any medical attendant, there is no Council behind them to

safeguard the interests of the public, and no fear of professional shipwreck to deter them from unprofessional conduct.

But this state of affairs, if unfair to the public, is equally injurious to the prospects of a fully trained nurse, whose career is hampered by a competition founded on the absence of all tests which the public can understand, and who must therefore compete in the same market, for the same remuneration, with nurses who have had a minimum of training and experience. These difficulties are increased by the existence in the public mind of a vague impression that a good nurse is 'born and not made,' and that the former being cheaper has decidedly the advantage. This general impression makes it easy for nursing institutions to put an inferior article on the market, and greatly facilitates the competition of the untrained, while it also leads local committees and county associations to employ a growing number of six months' trained nurses, a tendency which culminated lately in the attempt of the Local Government Board to create an order of so-called 'qualified nurses' to staff our workhouses, who were to earn this comprehensive title by a year's service in any kind of hospital.

The object of registration, however, is not to hinder the employment of such nurses-for there is ample room for the work of every grade of nurse, from the invaluable mother's help to the fully trained and scientific sister-but merely to insist that it shall be made perfectly clear that the former stand on a totally different professional footing from the fully trained and experienced nurse, and to make it impossible for them to compete on exactly the same terms with their better equipped sister. As it now stands, the moment the short engagement of a village nurse is ended she enters the ranks of the nursing profession, and becomes indistinguishable from every other type of nurse.

Both types are needed in different spheres of work; but their departments should be clearly defined and easily distinguished. The one should not overlap the other, and employers should be able to select between the qualities of service offered them.

This can only be secured by establishing a register for the fully trained nurses, and by according to those on the register a definite and distinguishing title. Such a register need not arrest the supply of a cheap order of home helps, capable of nursing chronic cases, while undertaking the household duties of their patients, but should rather tend to open up new spheres of usefulness for such women.

Throughout the community there are cases which do not demand a very high order of nursing skill and experience, and for Queen's nurses to undertake such cases, in addition to those of more serious illness, is to bring about a certain waste and misdirection of energy which a better sub-division of labour would obviate while tending to promote a more effectual occupation of the whole field of work.