text-books and lecture notes, it is always a mystery to the nurse and to everybody else how she manages to find time in a busy hospital.

This problem is solved in some large institutions by devoting a few months at the beginning of the course to theoretical instruction exclusively, after which the pupil is initiated into the practical work of the hospital ward. In the vicinity of universities or other advanced teaching institutions the nurse may take advantage of those courses of study that are helpful to her and thus relieve the hospital of a part of the instruction that it would otherwise be obliged to furnish within its own walls.

Few towns, however, are favored by the presence of an institution of learning where young women can study the essential branches of a nurse's curriculum. For places so situated a very practical plan has been devised whereby the nurses of several hospitals can come together and study at a minimum of effort and expense. A distinguished surgeon, who for years managed a small hospital and trained many excellent nurses, is the originator of this idea, and it is a matter of deep regret that his life was not spared until he could perfect his plan and apply it to the hospitals of his city. He proposed to gather all the probationers from the dozen or more hospitals in this city and organize them into a school of nursing, meeting in some central location for a portion of every working day. In this school the theoretical part of nursing could be taught by lectures and recitations under a competent staff of instructors. It would not be necessary for every hospital to hunt the city over for an available lecturer on physiology or hygiene, but one lecturer could instruct all the pupil nurses of the city at one time, and do it better than some of the cooperating hospitals would be able to do it. Without doubt, the doctor who accepts the responsibility of giving a course of instruction on some branch with which he is more or less familiar will spend more time and thought on his preparation if he has a

class of 100 than if he were to talk to. three or four nurses in the parlor of a small private hospital.

This, then, is merely a project for securing the best possible education for the greatest possible number of probationers. It is to be hoped that neighboring hospitals would be able to lay aside their petty jealousies, ignore their differences and all unite to support this probationers' school in order to attain a greater degree of efficiency than is now possible under the policy of every hospital for itself.

Combination is better and cheaper than competition. Let us have combination in the important work of training nurses.

TO DRINK OR NOT TO DRINK.

THAT is the question that the physiologists of the old régime debated and settled. long ago-settled for themselves and for us, until there is not a school child to-day who does not know that water is quite out of place at meal times. No matter how much the juvenile throat may crave a few swallows of water, it is a temptation of the evil one and must be resisted until the meal is well over; it is very prejudicial to good digestion, as hath been set forth in many worthy books. An old English writer on hygiene is especially positive on this question, assuring us that water, when taken with food, "confoundeth the concoctions" and is a source of all sorts of dyspeptic disturbances. It is worthy of note, however, that the cautious author mentions a long list of wines and liquors which are beautifully adapted to the needs of the palate that cannot endure water. In our day the physiologists are certainly moreconsistent, for they would keep all beverages away from the table.

The nonconformists who are not willing to give up their glass of water at meal time for the sake of any pretty theory of physiology, will rejoice to know that science is looking more closely into this question and testing the merits of the "dry meal." The American Journal of Clinical Medicine gives a resume of recent experiments per

formed on sixteen medical students in Atlanta, and another squad of men in the University of Illinois. Of the sixteen medical students, all of whom had been accustomed to drinking water or other beverages with their meals, the Journal says:

Eight of these young men were instructed to drink no water or other fluid with their meals, and between meals to drink no more than demanded by actual thirst. These eight young men all lost in weight-from two to eight pounds-with one exception, the exception being a young man employed in the railroad mail service, whose habits with regard to eating and drinking were so irregular that cutting off his water supply did not seem to make much difference. In addition to this loss of weight, each of these young men complained of headache and more or less constipation, barring the one exception mentioned.

The other eight students were directed to drink four glasses, or one quart, of water with each meal, and between meals to drink, or not, as desired. Theoretically all the men in this set should have suffered from indigestion, but strangely enough they did not. All gained in weight from 21⁄2 to 4 pounds, except one, whose weight remained the same. None of them reported headache or constipation or any form of digestive discomfort, and the single one who was constipated at the beginning of the experiment found his bowels more regular in five days.

Dr. Niles attributes the improvement in digestion and nutrition, when an aqueous beverage is taken with meals, to the facts that a certain amount of gastric distention is necessary to stimulate muscular function; that food when it reaches the stomach, instead of being speedily mixed, is arranged in definite layers, that first taken being in contact with the stomach-wall; that the liquid contents of the stomach are first evacuated into the duodenum, these being followed by the carbohydrates, which are first to be digested, these in turn by the proteins, and last the fats. Water finds a ready exit when taken at any stage of the meal, and does not to any extent permeate a mixed meal or dilute or interfere with the potency of the gastric juice.

Finally, when an abundance of water is injected into the intestines, it is quickly absorbed, and by temporarily increasing the fulness of the blood-vessels, it promotes the intestinal secretion and peristalsis, to say nothing of its cleansing properties.

The Illinois squad, after similar experiments, proved to the satisfaction of the physiologists in charge that intestinal putrefaction is decidedly lessened by the drinking of "copious" volumes of water with the meals. They add, further, that copious drinking of water with the meals stimulates the function of the pancreas, and by this means quickens and improves the digestion and absorption of fats and carbohydrates. These conclusions are not theories, but have been demonstrated by laboratory methods.

Perhaps, after all, our aboriginal forefathers were right when they lugged their food down to the bank of the stream and facilitated the feeding process by copious gulps of water. As good drinking water could never be very much out of place in the human stomach, we suggest that our readers experiment for themselves and find out what effect the mixing of water with food will produce in their own stomachs. Naturally, the proof of the water is in the drinking.

PRELIMINARY

TRAINING OF

NURSES AS A FUNCTION

OF THE HOSPITAL.

THE hospital training school will be obliged in the future not only to train nurses, but to prepare its candidates to begin the training that fits them for nurses. This is a different problem from nursetraining, and it requires different handling. So we conclude from the utterances of Dr. Babcock, the president of the American Hospital Association, in his address at the opening of their recent conference in New York City. We quote from the International Hospital Record:

The lack of proper material for pupils in our training schools is so great that it has become necessary in most schools to accept for training material lacking a good English education and much of the fundamental training of life. To prepare this raw material for nurse training bids fair to become an important function of the training schools of our hospitals or of special schools independently maintained, or allied to a group of

institutions organized for the care of the sick. The preliminary training of nurse pupils is as essential to the foundation of good nursing as the preliminary training of doctors is to the efficiency of scientific medicine. If you have not established a preliminary course of training for nurse pupils in your hospital, of from three to six months' duration, it will sooner or later be forced upon your attention as a distinct evolution in the progress of our work. The recommendations of the special committee on training school curricula and organization of three years ago marked the beginning of this elementary work for most hospitals.

Since the report of the special committee referred to above, practically one-third of our hospitals are said to have adopted one of the curricula recommended by the American Hospital Association. This is certainly a most promising sign, and we can only express the hope that the Association will go right ahead and formulate other courses and recommendations by which this problem of preliminary training can be more efficiently worked out. Judging from the suggestion of President Babcock, the hospitals will improve their present opportunity by some sort of cooperative movement, and we submit the plan proposed in the preceding editorial for their consideration. Let the probationer be a mere school girl for the first few months of her course instead of an understudy to the junior nurses and hospital attaches. What of it? The hospital will lose but little by being deprived of her services in the wards, and she herself will gain a grasp on the preliminaries that will make one hour of her time worth more to herself and her employers than three hours under the haphazard system that is all too prevalent to-day.

The more you investigate the more you will be convinced that, in spite of all our "entrance requirements," the average training school is booking very few college graduates and too few high school graduates as probationers. Why not admit the fact frankly and make amends by strengthening the course of study at the very threshold of the probationer's career?

The training schools have developed most excellent methods of educating nurses who have a sufficient foundation to begin on. Now let them prepare to lay this foundation broad and sure; there will be less wailing then over the dearth of "good material" for making our future nurses.

CONCERNING THE BLACK PLAGUE

EVERY one should be interested in the communication from Mr. Lawrence Irwell, published on another page of this issue. We thank him for calling attention to this matter and for stating a few unpleasant facts so clearly and emphatically. We have not much to say at present concerning the education of children and laymen on this danger that threatens society to-day. But this one thing we do advocate most earnestly -that the trained nurse should use all means in her power to learn the facts concerning sexual health and sexual disease. To this end we offer our pages, and we hope to be of some service in this campaign of education during the coming year.

After reading Mr. Irwell's letter you will be interested in the outspoken words of Dr. Marion Andrews, quoted in the British Journal of Nursing, and you will be doubly cautious with regard to what you believe and what you ask other people to believe on this topic, so carefully avoided by many respectable and elegant people.

"There has been a conspiracy of silence towards women with regard to certain facts most intimately associated with their own and their children's health. The truth on these matters (venereal disease) should not be withheld from them. If it were known, there would be such an awakening of public opinion among them that they would not rest until one social evil at least, productive of untold misery and disease, had ended."

WHEN CAN I GO HOME? BATTERED, defeated, "down and out," the helpless patient is bundled to the hospital, thinking of it often as a place of refuge and relief or, quite as often, as a place where he will have to die without the little ministrations that only his own home

the darkest dejection, and the nurse who in the afterglow of life would look on her work with joy must realize that not only the needs of the body, but also the moral and spiritual diseases of her patients cry aloud to her for healing and comfort.

THE BEST ANESTHETIC AND WHO GIVES IT BEST.

In a recent number of the Journal of the American Medical Association a writer on the editorial staff, after discussing the various anesthetics, makes the following observations on the administering of the anesthetic :

It has previously been remarked that the anesthetic should be administered by a physician. Recently several distinguished surgeons in various parts of the country, have made use of a nurse as anesthetist and have advocated the training of nurses for this work. While it is unquestionable that a welltrained nurse may in ordinary cases administer an anesthetic quite as satisfactorily as can an untrained or imperfectly trained physician, and perhaps more satisfactorily, it nevertheless seems a reasonable contention that a function of as great importance as that of administering an anesthetic, and one in which the administrator holds the life of the patient in his hand, should be entrusted only to an educated and trained physician. By a not dissimilar process of reasoning it might be shown that the ordinary uncomplicated cases of obstetrics might be attended by a midwife quite as satisfactorily as by a physician. Doubtless also it might be proved in academic discussion that an experienced nurse might perform ordinary operations in surgery as well as an experienced surgeon, yet the present tendency to make much of general scientific training for persons who expect to minister to the sick in positions of responsibility would seem to render questionable the propriety of withdrawing the administration of anesthetics from the medical profession and entrusting it to the nurse. Although a nurse of experience and training under watchful and skillful surgeons may have an experience of several thousand cases without a death, without even a scare, still, the possibility that a dangerous condition may arise even when least expected would seem to prove that an office of this importance should be trusted to a carefully trained, skillful and watchful physician.

On another page of the same journal Dr. Arthur Dean Bevan, of Chicago, compares the merits and demerits of the various methods of anesthetics now in vogue, and expresses his agreement with this statement of Dr. Keen:

The ideal anesthetic will not be one which will abolish pain without abolishing consciousness. To have the patient aware of surgical emergencies which test even a veteran operator's skill and resources to the utmost would frequently invite death by the terror which it might occasion. The ideal anesthetic will abolish pain by the abolishment of consciousness, but without danger to life.

To those who have been awe-struck by the impressive battery of paraphernalia recently introduced into some of our severely "up to date" operating rooms and lauded for their scientific accuracy and mechanical perfection, the doctor's whimsical comment will bring relief:

I wish to protest against the complicated expensive apparatus for nitrous oxid, oxygen, ether and chloroform sequences and mixtures, which are now being foisted on the market by instrument makers. They are too complicated and cumbersome. It would be necessary only to add to some of these a carbureter and a magneto, and you would have as complicated an apparatus as a 1911 model automobile. The simple cheap stands for gas-tanks and face-mask are much to be preferred.

The doctor pleads for simplicity in the management of anesthesia and argues against some of the methods that have been followed as fads by his surgical brethren, but he insists upon the most perfect teamwork on the part of all those who have any place in the operating room. He also has an encouraging word for those women who make the best use of their natural talent for administering the anesthetic. It should be remarked, however, in justice to the writer quoted above, that the doctor's anesthetist is a woman with a medical degree, Dr. Isabella Herb. We will quote a few more paragraphs from the close of Dr. Bevan's article:

The giving of the anesthetic in a surgical operation is a very important function and