1284 secondly, in reference to the deficiency of lying-hi cases by for the C.M.B. certificates to those who give an under- the limitation of candidates for the certificates of the taking to engage in the practice of midwifery for not less than Central Midwives Board to pupils who have given under- three years after their qualification. takings to engage in practice as midwives for not less than It also recommends that the attention of recognised three years after qualifying. Thirdly, the difficulty in teaching institutions be again called to the recommenda- regard to instruction could be largely met by the improve- tions of the Council issued to them in 1906, in the hope that, ment in the quality of the teaching at the bedside in lying-in when the present difficulties in training are alleviated, they wards and in out-patient maternity departments. The Com- may be able to carry out these recommendations in their mittee considers that the teaching of midwifery should be entirety, and that the present conditions of training, which as thoroughly practical as that of surgery. in many cases cannot be approved, may be rendered sufficient and such as the Council will be able to as A general discussion on the subject ensued. regard Dr. DEAN (Manchester) assured the Council that the satisfactory. regulations were fully carried out at Manchester The Dental 1’dieea.tion and Examination Committee. University. In fact, many students went there for this’ The discussion of these reports occupied the rest of the training because they could not get the accommodation day’s sitting, and a report of the adjourned proceedings and facilities in their own school. will follow next week. Mr. G. TURNER thought this one of the most important matters which could come before the Council at the present time, because cases of labour among the THE ARMY MEDICAL SERVICE: industrial classes were more and more passing into the hands of the qualified midwife-a beneficial change from A GREAT APPRECIATION. the old septic " handy woman "-with the result that the function of the practitioner was becoming more A DINNER was given in appreciation of the services of than ever that of consultant in the midwife’s cases in the Royal Army Medical Department and the eminent which difficulties presented themselves. This the civilians attached to it during the war on Tuesday last, practitioner in many cases did not favour. at the Connaught Rooms, under the chairmanship of Sir GILBERT BARLING said he hoped they would not Lord MIDLETON. The hosts, many of whom it will wait for the medical millennium before establishing the be seen have held, or are holding, the highest positions proper teaching of midwifery. The Poor-law authorities at the War Office, were the-following :— were anxious to promote what the Council desired. He Viscount Burnham, the *Earl of Derby, the Earl of hoped the teaching of midwifery would not be divorced Donoughmore, Viscount St. Davids, Lord Desborough, Sir from that on the subject of diseases of women. It was John Ellerman, Earl Fitzwilliam, Sir Alan Hutchings, Sir not desirable to train the medical student and the Heath Harrison, Bt., Mr. Vesey G. M. Holt, Lord Harris, Lord Viscount the of midwife in one if such were Inchcape, Knutsford, Marquis institution; any attempt Lansdowne, Sir Walter Lawrence, Bt., Lord Lee of Fareham, made, one or the other would suffer injustice. Pro- the *Earl of Midleton, Sir William B. Peat, Sir Ivor Philipps, vision in this matter should be made at once, otherwise Lord Queenborough, Sir Samuel Scott, Bt., the Marquis of the large number of people now entering the profession Salisbury, Lord Somerleyton, the *Right Hon. J. E. B. could not have the necessary training. Seely, the Earl of Scarbrough, the Hon. Sir Arthur . Dr. MATTHEW HAY said medical men were not too Stanley, the *Right Hon. H. J. Tennant, *Lord Edmund *Sir Edward and Lord Wavertree. ready to certify puerperal fever as a cause of death ; Talbot, Ward, Bt., Those with an asterisk formed the dinner committee. but in Aberdeen for some years he had asked the Sir Edward Ward took on the task of registrar to inform him of the death of any woman secretaryship. within four weeks of whatever After the King’s health had been drunk, Lord occurring child-birth, MIDLETON the toast of the the cause was declared to and cases were found to proposed only evening- be, " The Medical and have been due to fever which were not so namely, Royal Army Department puerperal the Eminent Civilians Attached to the certified. The Poor-law was about to die, and in it," coupling toast with the names of Lieutenant-General Sir Alfred Scotland women showed a disinclination to to strong go Director-General the first four of their institutions; they preferred to go to other places, Keogh, during years the war; Lieutenant-General Sir John Goodwin, his even to be - confined in unsatisfactory lodgings. He would like to be able to choose for work successor and the present Director-General ; and Sir maternity President of the of women who had had a George Makins, Royal College previous hospital training. of and late to Sir GEORGE NEWMAN as to the need to take Surgeons England consulting surgeon agreed the armies in France. practical steps at once. Many proposals came before the of Health for the establishment of Lord MIDLETON said that he believed this was the only Ministry case since the armistice that a branch of the homes, but the of such institu- particular maternity building army had been the object of a public ovation, and that it tions was to be for some time to likely postponed was remarkable when contrasted with the past attitude of the come because of the need of ordinary dwelling-houses. nation to all but the combatant branches of the army in Half the general beds in this country were in the other wars. In every war up to the present the medical possession of the Poor-law authorities, about 90,000, and service had been hurried into the field, although starved in 30,000 of these might be available for hospital purposes. numbers for peace service, insufficiently paid, without leisure or for scientific a Amid difference of on all opportunity training, separated by great opinion nearly subjects, from the civil which that water-tight partition great profession everyone seemed to agree there should be adequate could be its effective with scant for child at the mment of birth. He did only reserve, opportunity provision every for practising modern surgery, and confined to a medical not hope for a proper utilisation of Poor-law accommoda- curriculum the records of which were mainly a study in tion until the supposed stigma attaching to the name erotic literature. There were men in that room who could had been conquered. remember the days when in a large cantonment the only Sir JOHN MOORE said that in the Royal College of site assigned for a hospital, where capital operations were to be was a vacant between a and in Ireland this was a performed, spot dust-heap Physicians very burning question. a and when the last man to hear of He the discontinuance of the use of the term slaughter-house, any urged intended move of the was the senior medical officer. " and asked that Ireland be excluded from army Poor-law," To a department so restricted peace was a necessity. But the recommendation. This was conceded. if a review were to be now held of the departments of the The PRESIDENT said that a change in this regard had army, and the award of excellence given solely for progress come over the local authorities, for, in contrast to the since 1900, he would make bold to say that the Commander-in- condition years ago, the Local Government Board and Chief in ordering the parade would not be unlikely to the Medical on the of the line. the of Health were now anxious that the place Army Department right Ministry the men who held commands in were so Poor-law and institutions should be Nowadays peace maternity fully chosen as to hold the same commands in the utilised for the of clinical war, equip- purposes teaching. ment designed for peace was the same as the equipment for The report and the following recommendations were war, the gap between civilian and professional soldiers was agreed to :- so bridged over that the professional service could be That a communication be addressed to the Ministry of developed into a national force. These principles were so Health and the Board of Health of Scotland begging that steps applied by the Army Medical Department in the years may be taken for the utilisation of existing Poor-law institu- before the war that it conciliated to itself the entire tions for clinical instruction, and that such instruction shall support of the great civilian profession, the most eminent be placed in the hands of experts ; further, calling attention members of which were there that night. The equipment to the desirability of limiting the acceptance of candidates was so overhauled that no change was necessary in it in 1285 any of the campaigns since 1914. A sanitary branch was be said. That night gave the Army Medical Department a organised in 1908, and while typhus was kept wholly at bay triumph after more than 60 years of endeavour on their enteric fever received a knock-down blow, as the figures part to become efficient. The beginning of that endeavour for the South African War showed, compared with British he traced to the influence of the great Sidney Herbert, figures for the recent war. Inoculation had won as who after the Crimean War took the lead in the move- many battles for us as any one of the distinguished ment for army medical reform, and was the mainspring commanders present that night, while the man who dis- of the first Royal Commission on the Sanitary Con- covered the "Leishman bacillus" deserved as much of dition of the Army. The movement thus started, said his country as the man who invented the Lewis gun. Sir Alfred Keogh, did not progress with any strength, and The Royal Army Medical Corps, which consisted of 800 nothing much was done that was practical until God sent officers and 9000 other ranks in July, 1914, was developed to the cause of medical reform two men-Midleton and Haldane. 16,000 officers and 132,000 other ranks in 1919, and exceeded Lord Midleton gave the officers of the Royal Army Medical in numbers the original Expeditionary Force. Beyond Corps the opportunity for post-graduate study which made these, thousands of busy practitioners attended hospitals their scientific position sure, and he founded the school in for hours daily, refusing all remuneration; 18,000 V.A.D.’s London. Lord Haldane brought the Regular medical officer gave their services in these hospitals for years together; of the army into close touch with the civilian branch of his and 2000 masseuses, provided by the public spirit of Lord profession, a thing which the-R.A.M.C. had always craved for. Queenborough, served under the direction of Miss French. Alluding to the conduct of the R.A.M.C. in the war, now Can you, asked Lord Midleton, have a higher tribute receiving a testimony which words failed him to describe, Sir to any corps than that the nation thus mobilised itself Alfred Keogh pointed out that none of their improvements in its support? With these reinforcements the Army in sanitary science or education would have been of the Medical Corps, who having 2000 patients in hospital in least use had it not been for the intelligent sympathy of 1914 attended 577,000 in 1919, and as early as July, commanders in the field, commanders in the air, and 1916, received 48,000 patients in hospital in a single battalion and company commanders, who cared for the week. We owe it to the successive heads of the Army health of their men. He pointed out that in the Mediterranean Medical Department at home and abroad that these area Field-Marshal Lord Methuen, as Governor of Malta, gigantic developments did not lead to hopeless con- had filled the position of a great coordinator of all medical fusion. Our army was the only one of all the com- effort. batants which had to conduct six different expeditions The toast was replied to also by Sir JOHN GOODWIN and at the same time. It would be strange if with the desperate Sir GEORGE MAKINS. The Director-General declared of the the sudden stroke in gamble Dardanelles, Salonika, could the mirage of Mesopotamia, all coincident with overwhelm- that the work of his department not have been carried on with success had it not been for the ing claims in France, we had entirely avoided military mis- any calculations and consequent medical perplexities. But hearty cooperation of the War Office and the devoted through these difficulties the Army Medical Department, industry of his staff, while he took the opportunity of with its immense civilian retinue, marched breast high reminding the audience how much our medical services to ultimate success. Lord Midleton concluded his speech at the beginning of the struggle owed to the voluntary as follows : " There sits upon my right to-night as our chief aid of American Sir Makins, the man who the administrative the surgeons. George reply- guest typifies genius, for the civilians attached to the but executive and the scientific skill which enables us ing corps, briefly efficiency the to to thank our guests not merely for great service to the sincerely acknowledged unique compliment paid Empire, but for the position which they have won for Great medicine on the occasion, and alluded to the advantages Britain in the scientific world. It is due to him, to his able which had accrued to medicine through the wide inter- successor Sir John Goodwin, and to the magnificent civilian change of knowledge in unparalleled conditions. Sir that the assistance, typified by George Makins, magnifi- The at dinner included- cent tribute can be paid to the Army Medical Department company that the Department stands well with the army.’ " Field-Marshals : Earl Haig and Lord Methuen. Sir Ian Lord .rchibaJd Mr. WINSTON CHURCHILL asked when every form of Generals: Hamilton, Horne, Sir Murray, national effort the devices of destruction had Lord Rawlinson. producing Lieutenant-Generals: Sir William Babtie, V.C., Sir T. E. Clarke, received its tribute of popular applause, why should those, Sir John Goodwin, Sir L. Gubbins, Sir Alfred Keogh, Sir G. M. who in equal danger and in equal hardship had been saving Macdonough, Sir Arthur Sloggett. life, not receive their meed? He pointed out that, when Major-Generals: Sir W. G. Bedford, A. P. Blenkinsop, Sir Anthony our island nation, with its Empire gathered about it, plunged Bowlby, Sir David Bruce, G. Cree, Lord Dawson of Penn, Sir W. Sir G. T. R. F. into war, so vast an offensive, Donovan, Evatt, Sir Gallwey, Sir S. Henderson, expansion of everything, Sir M. Sir R. Sir W. W. S. and had to that those were J. Irwin, Jones, Kenny, Macdonald, defensive, protective, follow, Sir W. Macpherson, Sir George Makins, S. Guise Moores, found right in their forecasts who dared to think bigger than Sir Berkeley Moynihan, Sir T. J. O’Donnell, Sir M. W. O’Keefe, Sir anyone else. As a measure of the expansion in bulk of the W. W. Pike, Sir M. Russell, Rt. Hon. J. Seely, Sir G. Stanistreet, work of the medical services, he said, when the war began A. A. Sutton, Sir C. Wallace, Sir H. R. Whitehead, Sir T. Yarr. there were 7000 beds available, and when it ended there were Brigadier-Generals: W. W. 0. Beveridge and M. H. G. Fell. 700,000 beds occupied. In a passage of great eloquence Colonels : Sir H. G. Barling, Sir H. E. B. Bruce-Porter, F. F. he his audience to it must have Burghard, E. F. Buzzard, A. Carless, W. Coates, J. M. Cowan, urged imagine what Maurice S. L. Sir H. R. L. S. homes and hundreds of Craig, Cummins, Davy, Davies-Colley, meant to thousands of thousands of Dudgeon, H. L. Eason, W. McAdam Eccles, T. R. Elliott, Sir men, in periods of the greatest human weakness and T. Crisp English, S. Flemming, Sir R. Firth, J. V. Forrest, misfortune, to know that the great mass of suffering, Sir J. Galloway, G. E. Gask, Sir H. Gray, H. A. Hinge, W. E. misery, and shattered figures, which represented war, could Hume, W. Hunter, H. E. R. James, Sir W. Arbuthnot Lane, cast itself upon the mercy of the Medical Sir W. T. Lister, J. R. McMunn, Sir J. Magill, G. A. Moore, Royal Army Corps, C. K. Bernard Sir T. J. A. T. H. never to find that and he illustrated his Morgan, Myers, Myles, Nixon, mercy lacking; J. H. W. A. G. Phear, E. M. Pilcher, with a remarkable and Openshaw, Parsons, Pasteur, meaning personal picture of a large C. E. Pollock, 0. L. Robinson, Sir A. Mayo Robson, Sir R. Ross, casualty station a few hours after a battle has begun. Mr. A. D. Sharp, J. Sherran, T. Sinclair, S. Maynard Smith, A. B. Soltau, Churchill closed his speech by an acknowledgment of the Sir J. Purves Stewart, W. Taylor, G. St. C. Thom, Sir W. Thorburn, immense services rendered by eminent civilians, and H. H. Tooth, A. H. Tubby, W. Aldren Turner, C. R. Tyrrell, confessed himself to have been in former Sir C. Gordon Watson, C. M. Wenyon, Sir W. I. C. Wheeler, Sir gracefully days Hale W. H. Lisle A. E. Webb Lord Midleton’s and so White, Willcox, Sir Webb, Johnson, critic, "youthful, ignorant, hard," A. S. Woodwark, Sir E. Worthington. that he rejoiced in the opportunity, which supporting the Brevet Lieutenant-Colonel W. C. Smales. toast gave him, of saying that Lord Midleton’s work in the Lieutenant-Colonels: A. Balfour, F. S. Brereton, G. S. Buchanan, organisation of the army, following the Boer war, had been Sir J. R. A. Clark, F. E. Fremantle, M.P., H. French, Sir J. in its most important respects signally vindicated. Kingston Fowler, Wardrop Griffith, Sir A. Garrod, D. Harvey, F. R. Field-Marshal Earl HAm described the work of the Hill, G. M. Holmes, P. S. Lelean, Sir F. Mott, Sir H. M. Rigby, P. A. B. E. C. M. T. E. A. White- medical units attached to own the Sargent, Smallman, Smith, Twiss, his command during Robertson. fighting on the Aisne, and dwelt on the extraordinary Majors: P. G. Easton, R. C. Elmslie, G. A. D. Harvey, A. D.Stirling. difficulty of the circumstances in which that work was Captain A. R. Wright. carried on. He went on to say that the Royal Army Medical Sir Charles Ballance, Dr. C. Hubert Bond, Sir Napier Burnett. Corps throughout the war had been absolutely splendid, Viscount Burnham, the Right Hon. winston- Churchill, M.P., and while as the the medical Sir Herbert Creedy, Sir E. Marriott Cooke, Lord Desborough, the unselfish, devoted, army grew Earl of the Earl Sir W. Lord service had in as well as size. He testified Donoughmore, Fitzwilliam, Fletcher, grown efficiency Harris, Sir J. Hodsdon, Mr. Vesey G. M. Holt, Dr. N. G. Horner, Sir to the happy relations which existed between the Regular Alan Hutchings, Viscount Knutsford. Lord Lee of Fareham, R.A.M.C., the Temporary, and the Territorial officers, and the i Sir W. Lawrence, Dr. V. Warren Low, Sir Ivor Phillips, Sir rest of the army, acknowledging, in conclusion, his personal A. Reid, Marquess of Salisbury, Earl of Scarbrough, Sir Samuel and lasting debt, as Commander-in-Chief, to those in authority Scott, Lord Somerleyton, Dr. S. Squire Sprigge, Sir Arthur Stanley, over the Army Medical Department during the war, making Lord Edmund Talbot, Rt. Hon. H. J. Tennant, Sir J. Lynn Thomas, allusion to Sir Arthur Director-General in Dr. E. B. Turner, Sir T. Jenner Verrall, Dr. N. Walker, Sir Edward special Sloggett, Lord Wavertree. France from 1914 to 1918. I Ward, Sir ALFRED KEOGH said that on such an occasion it was The evening closed with cordial votes of thanks from completely impossible for him, either in the time at his the company to Lord Midleton, as chairman, and Sir disposal or in any unlimited time, to express all that should Edward Ward, as secretary.