NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
167
Penal Clause.— The only penal clause existing in the Acts of Medical
Registration is affecting persons who falsely pretend to be registered prac
titioners or use in connection with their names or titles any words or
letters representing that they are registered medical practitioners. Such
persons are liable to be punished on conviction with fine that may extend
to Rs. 300.
Control of Councils by Local Governments.— The Madras, Bombay,
United Provinces, Punjab and Central Provinces Acts provide for the vest
ing of overriding, final and residuary powers in the Local Government by
providing that if at any time it shall appear to the Local Government
that the Council has neglected to exercise or has exceeded or abused any
of its powers or has neglected to perform any of its duties, the Local
Government may notify the particulars of such neglect, excess or abuse to
the Council, and if the Council fails to remedy such neglect, excess or
abuse within such time as may be fixed by the Local Government in that
behalf, the Local Government may cause any of the powers and duties of
the Council to be exercised and performed by such agency and for such
period as the Local Government may think fit.
Recognised Medical Qualifications.— The annexed schedule shows the
medical qualifications recognised by the various Provincial Medical
Councils.
SCHEDULE.
1. Medical qualifications granted by medical institutions in British
India which are included in the First Schedule of the Indian Medical
Council Act, 1933 (See page 159).
2. Medical qulifications granted by medical institutions outside British
India which are included in the Second Schedule . of the Indian Medical
Council Act, 1933 (See pages 160-62).
3. A diploma or certificate granted by a Provincial Government in
British India to any person trained in a Medical College or School declaring
him to be qualified to practise Medicine, Surgery and Midwifery.
4. Certificates, diplomas, or licences, granted by the following exami
ning bodies to practise Medicine, Surgery and Midwifery:—
a) The Punjab State Medical Faculty.
b) The State Medical Faculty of Bengal.
c) The College of Physicians and Surgeons of Bombay.
d) The Board of Examiners, Madras Medical College, Madras.
e) The United Provinces State Board of Medical Examinations or
State Medical Faculty.
f)
The Bihar and Orissa Medical Examination Board.
g) The Assam Medical Examination Board.
h) The Central Provinces Medical Examination Board.
5. The M.B., B.S., degrees and the L.M.S. and L.M.P. diplomas
granted by the Osmania University, Hyderabad.
168
6. The M.B., B.S., degrees and the L.M.P. diplomas granted by the
Mysore University.
7.
The M.B., B.S., and L.M.S. degrees granted by the Andhra Uni
versity.
8.
The diplomas or certificates granted by the King Edward Hospital
Medical School, Indore.
N. B.—No. 5 is not recognised by the Bengal and United Provinces, No. 6 by the
Punjab, United Provinces and Bihar, No. 7 by the Punjab and No. 8 by the United
Provinces, Madras, Bengal and Bihar Medical Councils.
169
CHAPTER VI.
Nursing in India.
HISTORICAL.
1. Only a few scattered records of the nursing profession in
India are available so that the history is not easy to investigate, but
although the science and art of nursing has not reached the stage of deve
lopment as in most other countries, it is interesting to note that from
authentic evidence it is certain that provision was made for the sick
and attendants for them were employed, long before the Christian era.
These attendants were placed under the direction of skilled physicians
and surgeons, amongst whom Charaka and Susruta were the most advanced
of their time. Susruta is said to have lived 14 centuries B. C. and
Charaka about 320 B. C. Massage was one of the old practices in use
as a health measure, and there were women practitioners of massage for
attending on the females and men practitioners for men. The ancient
Hindus believed more in the prevention than in the cure of disease, which
belief is again in the 20th century gaining ground steadily. The books
of the Ayur-Veda, believed to be the legacy of Brahma himself, are in 8
parts and cover the whole field of medical science with the inclusion also
of nursing treatment. There are more details of nursing in the old
Indian records than in those of any other country in the world.
2.
The following reference to the nurse and to the patients are to be
found in Lesson IX of Charaka Samhita:—
Nurse.— Knowledge of the manner of preparing drugs, or of com
pounding them, cleverness, devotedness to the patient waited
upon and purity of mind and body, are the qualifications of
a nurse.
Patient.— Memory, obedience, fearlessness and communicativeness
with respect to all that is experienced internally, and done
by him in the intervals between visits, are the qualities of the
patient. Like clay, wheel, stick and threads in the absence
of the potter, failing to produce anything by the combination,
drugs, nurse and patient cannot work out a cure without a
physician.
Later on hospitals were developed by King Asoka in the 3rd century B. C.,
and in one of the records following on that of the description of buildings
used for the care of the sick is written: —
"After this should be secured a body of attendants of good behaviour
distinguished for purity and cleanliness of habits, possessed of
cleverness and skill, endued with kindness, competent to
cook food and curries, clever in bathing or washing a patient,
well conversant in rubbing or pressing the limbs, raising a
patient or helping him to walk, well-skilled in making or
cleaning beds, able to pound drugs, always ready, patient and
skilful to wait upon one who is ailing, and never unwilling to
do what is commanded by the Physician."
Contributed by Miss D. Chadwick, S.R.N., S.C.M., President, Trained Nurses
Association of India.
172
nursing. This is now slowly but surely being broken down and Hindu
girls of good education are offering themselves for training, but the number
of Mohammedan candidates is still almost negligible. In the nurse
training schools under the Madras Government the number of Indian
:pupil nurses is almost 50 per cent, at the present time.
12.
The want of adequate facilities for the training of nurses is one
of the discouraging factors, yet even where the facilities exist, the best
:type of woman is still lacking. Other factors for the shortage may be:
1.
That in only a few hospitals is there sufficient teaching staff.
2.
The bad housing accommodation provided in some institutions.
3.
The long hours of duty as compared with other spheres of work.
4.
The lack of recreational facilities.
5.
The overcrowding of wards with patients, leading to overwork
and overstrain of the nurses.
6.
The present non-recognition of nursing as a profession by the
Central and. Provincial Governments.
There has been a tendency in the past to exploit the nurse probationer as an
essential hospital worker at the expense of her education while in many
hospitals reasonable accommodation, comforts and recreational facilities
are still lacking.
13.
It has recently been said in Europe that the "Nurses are the spinal
cord of the hospital". Would that it were so in India; alas! it is not.
However, during the last ten years, much improvement in nursing has
been carried out. Yet very much more remains to be done before .India
can hope to rank her nurses alongside those of other countries of the world.
14.
Advancement of Nursing .—It is noteworthy that since 1934 a con
siderable change has taken place in the outlook of the Central and Provincial
Governments on the profession of nursing judging by the various Nurses
and Midwives Registration Acts which have been passed and enforced. It
is also being realized that as the populace are, losing their prejudice and
fear of entering the hospitals for treatment more attention must be given
to those into whose hands the people entrust their lives. The Surgeons
General and Inspectors General also are realizing that they have neither
the time to give nor the knowledge of nursing detail necessary entirely
to control the provincial nursing cadre as in the past years and desire
the assistance of well qualified and experienced matrons to help them
in their work.
15.
The Inspector General of Civil Hospitals, Bihar, Patna, in his letter
dated 27th April 1938 to the Trained Nurses Association of India,
wrote:—
"We are interested in the advancement of nursing in Bihar, and should
be glad for information of your association. Meanwhile, Miss Tyzack,
Matron of the Patna Medical College Hospital, is being associated with
the administration of the nurses' work, in the Inspector General of Civil
Hospital's Office."
In Madras a similar scheme is being considered and it is hoped it
will come into force in the very near future.
D. Chadwick.
173
2. STATUS OF NURSES.
The question of the improvement of the status of matrons in particular
and the nursing service in general has been engaging attention for some time.
As their pay compares favourably with that of provincial service medical
officers and they perform duties of a technical nature requiring special
qualifications, thus conforming to two of the main requirements prescribed
by the Government of India for the conferment of a gazetted rank, sug
gestions have been made that matrons working at the larger hospitals and
drawing emoluments at a rate of not less than Rs. 200 p.m. should be
classed as Gazetted Officers. In provinces where strong Provincial Nurs
ing Councils exist arrangements obtain for annual and biennial inspections
of hospitals by Committees with a majority of matrons. This is a useful
idea and might with advantage be followed in other provinces as it is
likely to obviate administrative difficulties.
2. The Council of Medical Women in India consider that action on
the following lines will go a long way towards improving the status of
the nursing profession:—
(1) The Medical profession should do everything in its power to
create a greater feeling of respect in the public mind towards
the Nursing profession and should insist on the need of good
nursing, adequate nursing staffs in hospitals and a correct
attitude towards the sister profession.
(2) Nursing Services, consisting of well educated and well trained .
nurses, should be established in the Provinces from which
Nursing Superintendents and Sisters could be selected for
staffing large hospitals.
(3) The status of Nursing Superintendents should be raised by
giving them proper authority in their own departments.
(4) Trained nurses with the status of gazetted officers should be
appointed as Registrars to all the Provincial Nurses' Regis-
tration Councils.
(5) All training schools for nurses should be inspected by trained
nurses and a proper standard in the training schools should be
insisted upon.
(6) Properly qualified Sister-Tutors and Home Sisters should be
appointed to all large training schools.
(7) On all boards of examiners for nurses a majority of the members.
should be trained nurses.
(8) The scale of pay for Nursing Superintendents, Sisters and staff
nurses should be increased.
(9) The living conditions of nurses, especially student nurses, should
be improved.
(10) Facilities for specialist training for nurses such as for theatre
work, training for Sister Tutors, Home Sisters, etc., should
be provided in India.
174
3. REGISTRATION OF NURSES.
(i) Principal provisions of the Provincial Nurses and Midwives Registration
Acts.
The Madras Nurses and Midwives Act was passed in 1926 and regis-
tration commenced from February 14th, 1928, the date of its coming into
force. In 1936, an amendment was passed entitling the following associa
tions to have a seat on the Council:—
i. The Trained Nurses Association of India.
ii. The Nurses Auxiliary of the Christian Medical Association of
India.
iii.
The Nurses Association of Madras.
Thus 7 out of 14 seats are allotted to nurses and midwives.
The Punjab Nurses Registration Act was passed in 1932. In 1935, an
amendment was passed granting free registration to any nurse registered
under any other Act in force in India. The Punjab Nurses and Midwives
Council have recently been authorised by the Punjab Government to con-
duct the nurses and midwives examinations.
The United Provinces Nurses, Midwives and Health Visitors Act was
passed in 1933 but has not yet been enforced.
The Bombay Nurses, Midwives and Health Visitors Act was passed
in 1935, and the Council was granted reciprocity with the General Nursing
Council of England and Wales in 1937.
The Bihar and Orissa Nurses and Midwives Registration Act was
passed in April 1935 and came into force in June, 1935. This Act is
now, due to the separation of the provinces, in force in Bihar only and
it is probable that a separate Bill will be prepared for Orissa.
The Bengal Nurses and Midwives Registration Act was passed on
February 27, 1934 and came into force officially in February 1936. Since
the rules under the Act were not passed by the Government of Bengal
until the end of 1937 registration has not yet begun. The Bengal Nurses
and Midwives Council is the only one in India as yet to appoint a Nurse-
Registrar.
The Central Provinces Nurses Registration Act was passed in 1936 but
has not yet been put into force.
It is understood that the Government of Assam have a Nurses and
Midwives Registration Bill under consideration.
2. The nurses of India have, as their ultimate objective, an all-India
Nurses, Midwives and Health Visitors Act, but in the meantime it must
be sufficient that the various Provincial Governments are one by one pass-
ing Registration Acts and bringing them into operation. One cannot
overlook the fact that there are omissions in some of the Acts, and it
is unfortunate that the number of seats allotted to nurse members on
some of the Nursing Councils is less than those allotted to the medical
and other members.
175
(ii) Composition of Councils.
The Acts provide for the constitution of Nurses and Midwives Councils
in the provinces. The composition of the councils is shown in the table
below. The term of office of members other than ex-officio members is
3 years in the case of Madras, Bengal, United Provinces, Punjab and
Bihar, while Bombay and Central Provinces provide that members of the
Councils other than ex-officio members shall hold office for a period of 5
years, or such less period as Government may prescribe in this behalf.
Table showing composition of Nurses and Midwives Councils.
Province.
Nominated
President.
Nominated Members.
Elected Members.
Total.
Medical
Person- nel.
Matrons,
Nurses,
etc.
Others.
Medical
Person-
nel.
Nurses,
Midwives. etc. Others.
Madras . . . Surgeon General
5
. . .
2
. . .
7
. . .
14
Bombay . . .
D o . . . .
6
4
. . .
2
8
. . .
21
Bengal . . . To be appointed
by the Local
Government.
5
4
2
2
3
. . .
17
United Pro-
vinces.
I. G. C. H.
5
3
1
2
4
2 18
Punjab . . .
Do.. . .
5
1
13
. . .
3
. . .
23
Central Pro-
vinces.
Do. . . .
9
3
2
. . .
. . .
. . .
15
Bihar. ..
D o . . . .
7
2
3
. . .
2
. . .
15
The figures for 'Nominated Members' include ' ex-officio' members.
(iii) Appointment of Registrars.
The Councils have the power to appoint a Registrar, some with and
others without the previous sanction of the Local Government. The
Registrar acts as Secretary to the Council and in some cases as Treasurer
as well. The Acts do not lay down any specific qualifications for the
Registrar, but nurses themselves consider that the Registrar should be a
fully qualified and experienced nurse and midwife. The Bengal Nurses
and Midwives Council was the first to appoint a Nurse-Registrar and the
Punjab Nurses and Midwives Council has consented to a similar measure,
but the post has not yet been filled. The Madras Nurses and Midwives
Council is not opposed to a Nurse Registrar but the financial position
does not allow such an appointment to be made.
(iv) Constitution of Registers.
All Nurses and Midwives Councils are required to maintain a register
of Nurses, Midwives, Health Visitors, etc., and from time to time revise
the register and publish it in the prescribed manner.
176
These registers are divided into several parts as indicated below:—
Madras—
1. A Register. for Nurses divided into 7 parts.
2.
A Register for MidWives divided into 2 parts.
The 7 divisions of the Nurses Register are:—
"A" Register—for those nurses trained and registered in Great.
Britain or in approved general training schools in the Presi-
dency of Madras.
"B" Register—represents those trained in foreign general training
schools, or in approved general training schools in India
outside the Presidency of Madras.
"C" Register—represents those nurses who have undergone general
training in Madras in the vernacular language.
"D" Register—represents nurses who have undergone training in,
hospitals for women and children in English language.
"E" Register—as "D". except in vernacular language.
"F" Register—represents male nurses trained in the English
language.
"G" Register—represents male nurses trained in the vernacular
language
The 2 divisions of the Midwives Register are
(a) English.
(b) Vernacular.
At the commencement of registration, provision was also made for the
registration of the "existing" nurses during a 3-year period of grace.
Bombay-
1. A Register of Nurses.
2. A Register of Midwives.
3. A Register of Health Visitors.
divided into the following parts :—
(a) General part—for female nurses.
(b) Supplementary part—for male nurses.
(c) Supplementary part—for nurses trained only in the nursing and
care of sick women and children.
(d) Gener al par t —Mi dwi ves.
( e ) G e n e r a l p a r t — M i d w i v e s t r a i n e d a s H e a l t h V i s i t o r s .
177
Bengal and United Provinces—
The Council is authorised to make orders for regulating the formation,
maintenance and publication of registers of nurses, midwives, assistant
midwives and health visitors according to their respective. qualifications.
The registers will be kept in such form or forms as may be prescribed.
Punjab and Bihar—
The Registrar is required to maintain registers showing the name and
address of each registered nurse, health visitor, midwife, nurse dai and
trained dai in the. province.
2. The Madras Register bears on it the names of 1,409 nurses, 2,688
midwives and 7 dais. The number of nurses and health visitors, etc.,
registered with the Punjab Nurses Registration Council is as follows:—
Nurses . . .
761
Health Visitors . . .
101
Midwives . . .
462
Nurse-dais . . .
331
Trained dais . . .
911
Dais . . .
789
With the Bombay Council the following numbers are registered: —
Nurses . . .
832
Male Nurses . . .
48
Midwives . . .
1,033
Health Visitors . . .
4
3. The number of nurses employed in the hospitals is shown in the
following statement:—
L
Statement showing Nurses, Midwives and Dhais employed in Hospitals etc., (1936.)
Urban areas.
Rural areas.
Grand Total.
S t a t e P u b l i c .
S t a t e S p e c i a l .
L o c a l a n d M u n i c i - p a l F u n d s .
P r i v a t e A i d e d .
P r i v a t e N o n - A i d e d .
R a i l w a y s .
Total.
S t a t e P u b l i c .
S t a t e S p e c i a l .
L o c a l a n d M u n i c i - p a l F u n d s .
P r i v a t e A i d e d .
P r i v a t e N o n - A i d e d .
R a i l w a y s .
Total.
M e n .
W o m e n .
Me n .
W o m e n .
M e n
Wo me n .
MADRAS—
558
100
...
...
...
...
5
133
13
32
3
...
83
5 4
2
...
...
2
...
...
678
287
17
6
69 . . .
...
27 . . .
3
371 . . .
23
152
4
68
43
13
8
5
...
. . .
...
...
108
667
17
2
...
. . . .
786
954 3 4
Nurses
Midwives Dhais
BOMBAY—
356
18
1
11 . . .
. . .
200
44
13
9
7
...
58
20
29
26
... 1
12
...
...
648
894 4
... 1 . . .
. . .
. . .
. . .
7
12 7
1
1. . .
10
3 8
... . . .
. . . ... . . .
. . .
18
17
15
12
...
...
666
106
59
Nurses
Midwives
Dhais
BENGAL—
320
24
...
13
...
...
32
65 1 0
178
19
10
108
6
...
27
... 8
33
...
...
645
1142 8
... . . .
. . . ... . . .
. . .
4
19
...
6
4
...
. . .
3
...
6
...
...
...
...
...
16
26
...
33
...
...
661
140
28
Nurses
Midwives Dhais
UNITED PROVINCES— 61
1 1
...
... . . .
29
43
20
181
24
12
39
9
35
24
1
...
:37
4
...
297
74 6 8
...
...
...
. . . 1 0
9
1
37
15
6
11
2
23
8
28
...
... . . .
1
... . . .
29
66
54
38
4
...
326
140
122
N urses
Mid wives
Dhais
P U N J A B —
155 4
4
51
... 1
2
30
...
100
138
10
12
7
1
5
9
12
...
1 6
...
...
3 2 3
2 8
170
...
... 3
...
... 3
2
... 8 0
3
2
5
. . .
. . .
. . .
. . .
. . .
. . .
2 . . .
. . .
3
2
91
18
...
...
326
30
261
Nurses
Midwives
Dhais C E N T R A L P R O V I N -
C E N —
35
3
...
...
... . . .
18
49
2
47
11
...
42
7
1
5 . . .
. . .
4 . . .
. . . 113 70
3
... . . .
. . . ... . . .
. . .
1 6 . . .
4
1. . .
18
... 2
...
... . . .
1
... . . .
22
7
2
5
...
...
165
77 5
Nurses
Midwives Dhais
BIHAR—
83
8
1
...
. . .
...
33
25
26
42
1
...
40
7
29
8
. . .
...
6
2
3
200
39
53
32
...
...
...
...
...
7
21
20
. . .
1
1
1 3
1
4
...
... . . .
... . . . 6
52
23
19
6
2
9
252
62
72
Nurses
Midwives
Dhais
178
ASSAM—
Nurses
6
4
2 1
1
3 2
4
10
1 4
4 6
Midwives
7
3
16
1
1
5
1
7
34
D h a i s
4
1
5
3
3
8
ORISSA—
Nurses
11
34
1
5
6
4 0
Midwives
2 2
4
1
10
1 1
1 5
Dhais
3
12
5
2 0
1
4
14
1
20
40
SIND—
Nurses
50
20
36
11
3
120
1 2 0
Midwives
14
14
9
37
37
D h a i s
4
2
36
16
6
1
6 5
65
NORTH -WEST FR0N-
TIER PROVENCE—
Nurses
14
20
11
26
9
62
9
62
Midwives
3
2
5
1
1
2
7
Dhais
6
14
2
2
1
25
1
2
3
28
BALUCHISTAN—
Nurses
2
3
8
8
5
8
5
Midwives
2
5
7
1
5
6
13
Dhais
1
1
2
2
4. The following are the numbers of nurses employed in Missionary:
Institutions.
Nurses—
European
283
National
781
Student Nurses
1,567
Total
2,631
(v) PRINTING AND PUBLICATION OF THE ANNUAL LIST.
The Acts provide for the printing and publication of lists of the
names with addresses and qualifications of nurses, midwives, assistant
midwives and health visitors every year or at such intervals and in such
form as the Council may direct.
Any person whose name is entered in the latest of such lists is to
be recognised legally as duly registered.
(vi) PRIVILEGES OR DISABILITIES OF REGISTRATION AND NON-REGISTRATION.
The Acts provide that, except with the general or special sanction of
the Local Government or, in case of certain provinces, of any officer
authorised by it in this behalf, no person, unless registered as a nurse,
midwife, assistant midwife, or health visitor, shall hold in or in connection
with any dispensary, hospital, asylum, infirmary, lying-in-hospital or
maternity and child welfare centre, which is supported wholly or partially
out of public funds or local funds, any appointment designated as that
of Matron, Superintendent of Nursing, sister, staff nurse, nurse, midwife,
assistant midwife or health visitor.
(vii) PENALTIES.
The penalty for dishonest use of certificates, procuring registration by
false means and for falsification of register or certificates is a fine not
exceeding
Rs. 200 in Madras.
Rs. 250 in Bombay and Central Provinces, and
Rs. 300 in Bengal, United Provinces, Punjab and Bihar.
The penalty for a person who pretends to be a registered nurse
midwife, or dai, but who is not so registered, is a fine not exceeding
Rs. 50 to Rs. 100 in Madras, Rs. 100 in Bombay and Central Provinces
and Rs. 100 in the case of first offence and Rs. 300 in case of a subsequent
offence in the provinces of Bengal, Punjab and Bihar, while in the
United Provinces the fine is Rs. 50 for first offence and Rs. 300 for a
subsequent offence.