it should be in competent trained hands. A thoroughly qualified professional anesthetist is an indispensable member of a modern surgical team. In this country we have too long left this important function in the hands of the junior intern. The difference between the safety of the patient and the comfort of the operator in a clinic in which the anesthetic is in the hands of a trained professional anesthetist, as compared to a clinic in which the anesthetic is in the hands of a junior intern, whose term of office is but a few months, is so enormous that one who has had the services of a skilled anesthetist 'would never voluntarily return to the unskilled intern anesthetist. Every hospital should have trained professional anesthetists. The interns should be instructed by a professional anesthetist, and they should give many anesthetics under supervision so that they can learn how it should be given; in a teaching hospital, senior medical students should be given practical instruction in the use of anesthetics, but the trained anesthetist should be present and be responsible for the anesthesia. Women, I think, make the best anesthetists just as they make the most reliable and conscientious operating-room nurses. In these days of modern surgery, the responsibilities and the functions of the skilled anesthetist and the head surgical nurse are little less important than those of the operator himself. In answer to the question, how we are to secure the safest and most satisfactory anesthesia, I would from this study submit the following conclusions: 1. The anesthesia must be placed in trained professional hands. 2. The methods of giving the anesthetic and the apparatus employed should be as simple and uncomplicated as possible. 3. The anesthetic mixture and sequences, like the old shot-gun prescriptions of the past, should be avoided, and the patient's life not jeopardized by the administration of two or more powerful poisonous agents at the same time one of which might intensify the action of the other or mask the ordinary danger signals. 4. For routine work, ether, by the open or drop method, is the safest and most satisfactory anesthetic and in the usual run of cases in a hospital service the anesthetic of choice, in from 75 to 80 per cent. of the cases. 5. Chloroform must be discarded as a routine anesthetic. It produces too many immediate and late deaths to warrant its gen eral employment. It is only in the exceptional case, as possibly in a laryngectomy in which one might feel that the direct introduction of chloroform vapor into the trachea. might produce sufficiently less irritation to the tracheal mucosa with less risk of pneumonia than ether, that we would be warranted in employing it. 6. Nitrous oxid is the anesthetic of choice for short operations, manipulations and examination. It is also the anesthetic of choice in operations on patients with seriously impaired kidneys and often in cases in extremely bad condition, as typhoid perforations, general peritonitis, etc. It should not be employed in patients with bad hearts. It is not so satisfactory an anesthetic as ether and should not be employed in preference to ether in patients who are good surgical risks. 7. Local anesthesia with cocain and similar agents has a limited field of usefulness. The amount of cocain employed by infiltration should always be short of a toxic dose, from 1/10 to 1/4 of a grain. It should be employed in normal salt solution with small amounts of epinephrin. Where the amount does not exceed 1/10 of a grain it may safely be preceded by a small dose of morphin and scopolamin. 8. Spinal cord anesthesia has to-day no place in surgery. 9. The use of morphin and scopolamin (hyoscin) before a general anesthetic brings with it dangers which are not compensated for by any advantages, and the method should be abandoned or limited to specially selected cases. 10. Finally, I believe that the time has come when we must here in America make a place for the trained professional anesthetist on our surgical team. THE HELIOTROPE CURE FOR TUBERCULOSIS. No, it is not a new kind of perfume, smelling-salts or inhalation, and it doesn't take the patient on a barefoot parade among the flower-beds. It is nothing odd or freakish. It simply carries us back to the origin of the Greek word heliotrope, and it means turning to the sun for relief from tuberculosis of the bones and joints. Dr. Bardenheuer details his experiences with this cure in the Deutsche Zeitschrift für Chirurgie and the Journal of the American Medical Association prints the abstract from which we derive our facts. The au thor has been so well impressed by the effects of sunlight on these forms of tuberculosis that he has been converted from many of his surgical methods. We all know what frightful mutilation is frequently necessary in order to relieve tuberculous conditions by surgery, and what deformity follows the cure. The sunshine method, on the other hand, produces a more satisfactory cure and eliminates the risks that attend surgery. He tells us that joints exposed to the sunshine heal without stiffness, and stiff joints become supple once more. It was in the clinics of Dr. Rollier, at Leysin, near Geneva, Switzerland, that he saw the results which have made him a convert. Bardenheuer now declares that operative treatment can generally be entirely avoided if the patients can have the benefit of mountain sunshine. He was so impressed with the amazing benefit from the sunlight treatment, even in apparently the most hopeless cases, that he applied it in thirty-five cases after his return home to Cologne, and states that he has been delighted with the results. One of Rollier's patients was a woman of 42 with an inherited taint. She came to Leysin in March, 1909, with a tuberculous affection of both sacro-iliac joints with numerous abscesses and involvement of the ilium on both sides. In the course of the year 2 liters of pus were evacuated by puncture repeated forty-five times. However, the patient was completely cured by July, 1911, and then returned home weighing over 37 pounds more than when she arrived. The children run around very lightly clad, even in winter, or lie almost naked, on a balcony. In Cologne Bardenheuer had the lesions on his patients exposed to the sunlight for fifteen minutes three times a day, rapidly increasing to two or three hours, morning and afternoon or all day long, except in midsummer. As he had no facilities for sun baths, he simply had the patients placed at an open window where the sun could reach the lesions. The patients enjoy the exposures and laud the sunlight treatment to their friends. He adds that it may prove a useful adjuvant to operative measures, hastening healing, and he thinks that sanatoriums might advantageously introduce local exposures of the chest in cases of pulmonary tuberculosis. A BUREAU OF HOSPITAL INFOR MATION. By M. E. McCALMONT, R.N., Hospital Specialist and Consultant, Brooklyn, N. Y. HOSPITAL statistics compiled recently tell us that there are about 6000 hospitals, or allied institutions, in the United States, with an estimated investment of $537,500,000, and an expenditure of $170,000,000 per year for maintenance, enlargements and improvements. Inasmuch as there are very few commercial enterprises with such an enormous investment of capital, it would seem logical argument that the establishment of a bureau which would aid in installing better business methods, uniformity of accounting, standardization of equipment, organization, etc., with a probable saving of at least 20 per cent. along these particular lines, would be amply justified. Indeed it would seem as though it were the duty of either state or federal government to establish some supervisory assistance to these great charitable projects. Any savings effected by such agency-and increased efficiency with decreased cost of administration and maintenance would be an unquestionable result-would mean an increase of facilities, and an expansion of usefulness greatly to be desired. The matter has been more or less agitated in the American Hospital Association, and the efficient committee having it in charge has done a great deal of practical work toward the ultimate accomplishment of the project. Several propositions have been under discussion in regard to it-viz., having the bureau with a permanent secretaryship established and maintained by one of the philanthropic foundations-independent of, but co-operative with the association, preferably, because wider in its scope, to have a similar bureau maintained by some department of the United States government. To the last-named end definite measures were taken. Letters concerning it were written by Professor William H. Welch and Dr. Henry M. Hurd, of the Johns Hop kins Hospital; Dr. Washburn, of the Massachusetts General Hospital; Drs. Goldwater, Fisher and Clover, of the Mt. Sinai, Presbyterian and St. Luke's Hospitals; Dr. Babcock, of the Grace Hospital, and others. All of these were presented in due form to the late Surgeon-General of the United States Public Health and Marine Hospital Service, Walter Wyman. The project received very favorable consideration in this quarter, and the following tentative bill was drafted and formally approved by the Secretary of the Interior and the Surgeon-General. "Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That the Public Health and Marine Hospital Service is hereby authorized to collect and receive, and to classify and maintain, in such a manner as may be made accessible to state and municipal authorities and other hospital administrators, plans of hospital or dispensary buildings; descriptive matter relating to their equipment, their rules and regulations; periodical and other reports of individual institutions; reports of committees engaged in the investigation of local and other special hospital problems; and other matters and medical literature relating to hospitals, sanitariums, asylums, homes for convalescents, dispensaries and nursing associations; and to convey the information thus obtained to said national, state and municipal hospital authorities and other hospital administrators, under such rules and regulations as shall be promulgated by the Secretary of the Treasury. "And for this purpose, the Secretary of the Treasury is authorized to submit annual estimates for such clerical help as may be necessary." It is the intention to put such a bill before Congress at the earliest possible moment, and if every hospital trustee, superintendent or other official would do his or her part in bringing this matter to the attention of his Senator or Representative, urging their support, such a bill, protecting, as it does, one of our most popular forms of charity and state aid, would doubtless be enacted into law. By concentration of effort the accomplishment of this bureau should only be a question of a very short time. The following resolution in regard to the foregoing was passed by the American. Hospital Association at its thirteenth convention: "Believing that the close association between hospitals, sanatoria, boards of health, and other agencies for the care of the sick, and the Public Health and Marine Hospital Service, contemplated by the establishment in that service of a Bureau of Hospital Information could not fail to greatly promote the protection of the public health, both by interchange and dissemination of information on current health problems and by the promotion of increased efficiency in institutional administration, this association is heartily in favor of the proposal to establish such a bureau, as outlined in the letter of Surgeon-General Walter Wyman, approved by the Honorable Franklin McVeagh, Secretary of the Treasury; therefore, be it resolved, that the Committee on Permanent Secretaryship and Bureau of Hospital Information is hereby empowered to represent the association, and is instructed to actively cooperate in securing the necessary legislation." 601 Temple Bar Annex. HINTS FOR THE PRIVATE NURSE.* BY ELSIE M. SMITH, R.N., Iowa. A NURSE who is engaged in private work should not register for duty until she is fully prepared to go, and being ready means just that and nothing less. A suitcase should be packed with all requisites in the order in which they will be needed on first going on duty. Those first few minutes sometimes mean a great deal to your patient, and to the physician, if he happens to be depending on you for some emergency or awaiting your arrival. Whenever permissible, answer your call in uniform, wholly or in part, according to the practicability of travelling. Uniforms, of course, should never be displayed in public! My experience has proven that separate waists and skirts are most satisfactory, as you can then wear the waist with a suit, and feel quite properly dressed, at the same Read at the Sixth Annual Convention of the Washington State Nurses' Association, Walla Walla, June, 1911, and reprinted from the Nurses' Journal of the Pacific Coast. time saving the bottom of your wash skirts from the street soil and street germs as well. As you enter upon the duties of the case make yourself at home by finding out where those things are that you will be in need of, and impress upon the family that you came to help, and not to be waited upon. If possible, never leave a trail behind you. Pick up as you go, and everything will seem easier. In order to pack a suit-case completely, it is necessary to provide yourself with duplicate toilet articles, wrappers and slippers. Aim to have all such things of light weight. Wrappers should always be of wash material. My favorite is a black and white nurse's stripe, made in butterfly style and belted in, and having three-quarter length sleeves with narrow wrist band. There are no flowing sleeves to interfere with my work, and in this costume I feel as neatly dressed at night as during the day. For extra warmth at night I wear an ordinary night dress underneath, which also serves as a petticoat, and saves crushing the starched ones. Knit slippers are soft and warm and very light to carry. For extra warmth to feet, wear your street rubbers over the slippers if necessary. For night work on pneumonia cases a sweater is indispensable, and also light to carry. Study to protect yourself in every reasonable way, for your life and health are of equal consequence with the welfare of your patients. The hair should be dressed rather plain and snugly, and in such a way that it will not interfere with comfort on lying down for rest during the day or at night. A tidy head is as much to be desired at night as during the day. Use your knees to save your back and feet; get the habit of kneeling while rubbing a back, combing hair, feeding, etc. When nursing typhoid or any case that requires much stooping, have the bed elevated on blocks or benches. This can be done in a home as well as in a hospital. Learn to use both hands; a nurse should be able to rub backs or feed a patient as easily with the left hand as with the right, or to comb and braid hair on both sides of the head from either side of the bed. A plain thumb forcep from your instrument case is the ideal thing for cleaning the mouths of babies or elders. Use cotton and make a swab on the point by first grasping it between the blades, and then wrapping it around in the usual way. Keep the blades pressed together and there is no danger of the swab slipping off in the patient's mouth. A miniature alarm clock is a valuable addition to your outfit, as it will enable you to get much rest between medicines or treatments. This may be wound in such a manner that a slight ring is produced, being quite sufficient to rouse the ever-watchful nurse at the proper intervals. My little clock has been indeed a friend in the time of need. I also carry with me a small flat alcohol lamp, and find it a prize in homes where there is no gas. Any night light should be screened from the patient's eyes. If it happens to be a lamp this can easily be accomplished by setting the lamp on the floor at the foot of the bed. TO A TRAINED NURSE. (In whose southern home blue and gray uniforms Child of the North, thy father wore the blue, When her brave brother, clad in gray, was slain. Bitter the cup the women only knew! Child of our country-one again in peaceTender thy heart and strong thy steadfast will, Conflict became thy heritage with breath; Faithful to trust, thy vigils never cease, Fearless in war with suffering and ill. Victor ofttimes above the foeman, death. Amherst, Mass. -ANNIE L. CROWELL.. PREPARATION OF THE SKIN FOR OPERATION. THE preparation of the skin for operation has ever since the introduction of antiseptic surgery been looked upon as of vital importance, and inasmuch as sterilization by heat is here impossible we have to trust to mechanical cleansing and to the use of antiseptics. The practice has certainly varied greatly in different parts of the world, and even in the hospitals of the same city, but it has for the most part consisted in the application for 12 hours or more of a compress moistened with some antiseptic after thorough washing of the operation area. This method, though of very definite value, is not free from objections; in the first place, it is not at all rare to find the skin inflamed by the compress, and in some cases the irritation may be great; a further objection is that the method is inapplicable to emergency operations, for sufficient time is not available. Nearly 50 years ago, Dr. Boinet wrote in favor of iodine as a local application in surgery. In 1906 Dr. Chassevant recommended the use of a solution of iodine in chloroform of the strength of I part in 15 for the disinfection of the skin. Dr. Grossich has also employed the tincture of iodine for the same purpose. In the Lancet Mr. H. F. Waterhouse and Mr. W. Stephen Fenwick described the method employed at Charing Cross Hospital. At first the iodine was applied only after thoroughly washing with soap and water and the employment of an antiseptic solution, but the results were unsatisfactory, till it was found that the preliminary washing was not only unnecessary but a positive hindrance to the penetration of the iodine. When the washing of the part Iwas omitted the action of the iodine was very satisfactory, and most of the incisions healed by first intention. The best strength of the iodine solution had then to be determined; an 8 per cent. solution was at first employed, but it was found to cause much irritation, and later a 2 per cent. solution was used, and with the results of this strength they were quite satisfied. They lay stress on the importance of using rectified spirit as the solvent, for if the iodine is dissolved in methylated spirit the eyes of the surgeon and his assistants are liable to suffer. Mr. Waterhouse paints the operation surface first two hours before the operation, and again on the operating table. Many surgeons are now employing iodine in much the same way, but various modifications are used. A slightly weaker solution is equally efficacious, and one painting immediately before the operation appears to be successful. The value of iodine as a disinfectant has long been recognized, and Mr. Paul Reclus has called attention to the great value of iodine in the treatment of wounds of the hands. In the hands of workmen the skin is often thick and covered with a crust of grease and dust, and it is very difficult to sterilize the skin, but if tincture of iodine is applied direct to the wound and its margins rapid healing is the rule. It is worthy of note that in the Russo-Japanese war tincture of iodine was largely used, and this was one of the causes of the success of the treatment of wounds in that war.-The Lancet. POI-THE NATIONAL FOOD OF IN the history of races the food question is always one of interest. If the native of Hawaii takes little thought as to "wherewithal he shall be clothed"-and the climate and customs of his country make that of small moment—there is a matter of great importance to every one of his race, and that is Poi. As the potato to the Irishman, as rice to the Chinaman, so is poi to the Hawaiian; from time unknown it has been his principal food, without it life would not be worth the living, and to obtain it, the hardest work a native ever does is fully worth while. Poi is made from the root of the taro plant, which grows in marshy ground or entirely in water; the root is oblong in |