Florence revived
Dismal outlook
Women in science
Right thinking

Florence revived

It is intriguing to note that, as a review in the British Medical Journal for April 14 put it: “After an absence of more then 30 years, matron is restarching her white hat ready to make a comeback.” That is a line of thought that I have entertained for some years. Indeed, I have always considered that it was a retrograde step in the health service to replace the true Florence Nightingale figure with a grey-suited and grey-minded person wandering about a hospital with a clipboard and ready to report things to a committee but to do nothing until told.

Of course, the matron of this millennium need no longer conform to the old gender distinction, and that is another advance. I can remember, in my own past experience of hospital life, that the matron was always a power in the land and a beacon of efficiency and rectitude. In some ways, like her formidable ancestress Miss Nightingale, she was feared, and to thwart her will was something that only a heroic nurse, or pharmacist for that matter, could face with equanimity.

Yet I admit that one of the night sisters I encountered was more fearsome than any matron with whom I crossed swords. Perhaps that was because what went on in the ward office in the hours of darkness never came to the notice of the matron, unless it was a real scandal, but the night sister was a force to be reckoned with in the small hours. In those days we had no mobile telephones but organised an efficient warning system to tell us of her progress round the hospital, having no wish to explain the coffee and biscuits we shared with the night nurse on ward duty.

What the newly established matron will do is to provide an expert on the spot who can solve problems without taking them to a committee. She (I stick to the old convention) can keep arrogant senior registrars and even consultants under control, back up the ward nurses and see that hygiene, which has sorely lapsed in recent years, is properly maintained. She will respond sharply to patients' complaints about food and visitors. But perhaps her greatest service will be in providing authority and expertise without bureaucratic creakings. That is, provided she is not hamstrung by the boys in grey suits with clipboards. I do not envy her her task.

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Dismal outlook

The stigma attached to mental illness is something which urgently needs to be reduced, according to an editorial in The Lancet for April 7. The World Health Organization is trying to raise awareness worldwide of the problems involved in any consideration of mental illness, and the deplorable prejudice attached to it.

Much of the knowledge which has been gained in recent decades regarding the causes, treatment and prevention of disorders of the mind is being ignored because many countries are reluctant to face the situation and apply the appropriate policies, legislation and services to remedy it. Action is called for to end the social exclusion, moral stigma and discrimination invited by mental disorders.

The WHO has predicted that by 2020 major depression will have become the largest problem faced worldwide. In 1990, of the 10 leading causes of social and physical disability, five were psychotic disorders, including unipolar depression. People in general will have to be shown that mental disorders do not as a rule result from any moral failings or unwillingness to imply willpower, but are legitimate illnesses that will respond to specific treatments. “Far from being an exercise in political correctness, tackling stigma is an important first step in reducing the public-health burden of mental illness.” Nevertheless, so far the message that no distinction should be drawn between physical and mental illnesses in respect of a sufferer's rights has failed to register with the authorities that should be responsible.

In a message from the United States Surgeon General, Dr David Satcher, published in JAMA (Journal of the American Medical Association) for April 4, it is stated that awareness about barriers to mental health and solutions that exist to tackle disorders of mental health, including those arising from substance abuse, is to be advanced, as a response to the WHO's campaign. “Mental health,” writes Dr Satcher, “is now recognised as an essential and inseparable part of health.” The burden, in social, medical and economic terms, when it is allowed to lapse, is enormous, and must be relieved by all means possible.

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Women in science

In a commentary in Chemistry in Britain for April, Julia Higgins, who is professor of polymer science at Imperial College, London, and a member of the Government's Council for Science and Technology, stresses that although nearly 40 per cent of undergraduates in chemistry are female, women make up only about 1 per cent of the occupants of chairs of chemistry in academic institutions.

The deficit of women is most marked in all disciplines in science, engineering and technology, and in chemistry the proportion of undergraduates moving to doctoral students, research assistants and full professors shows a sharp decline. Nevertheless, in engineering and physics, where the proportion of women undergraduates is smaller, a higher proportion hold senior posts.

Professor Higgins asks what can be done to rectify the situation in chemistry. She believes it is time for a change in the culture in universities, which need to become more tolerant of family commitments and to guarantee equal opportunities for advancement to men and women alike. A prevalent culture which demands longer hours spent in the laboratory at the expense of domestic responsibilities results in the loss of much talent in science, not least chemistry.

The Royal Society of Chemistry accepts some responsibility but has limited powers to bring about improvement. It should work together with other learned societies to identify and deal with those factors which either put off or attract women in different scientific disciplines. A body called the Athena Project has been set up and is making efforts to increase the numbers of women academics by helping with the recruitment, retention and promotion of women who are attracted to science, engineering and technology.

As Professor Higgins points out, it is in the universities where men and women gain their first impressions of the culture attached to the subject they will choose to study. It is discouraging for a student arriving in a chemistry department to discover that there is only one woman working there among more than 40 other academics. “Women in science” must surely be one issue which we cannot afford to ignore if we value human knowledge and advances in science.

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Right thinking

It should be one of the aims of education to produce a quality that we may describe as “flexibility of mind”, an ability to try out new ways of thinking and to make unfamiliar assumptions. This means that we must be able at will to put on one side our old thought habits.
— Robert H. Thouless: 'Straight and crooked thinking' (1930).