THE UNTRAINED NURSE. The Medical Times holds that in not a few instances the physician is relieved of a disagreeable responsibility by the availability of a near relative of the patient, as a nurse. Perhaps, in the future, it will be a common custom for families of moderate means to send one of their girls to a training school, with no thought of professional career, but simply to provide for emergencies. Still, there are general objections to such a course, as for medicine, law and other professions. Constant practice is necessary for the best efficiency. Moreover, the average girl will, whatever her original intentions, be very apt to contract domestic ties of her own, and white such a one may be extraordinarily prepared for wifely duties, there will obviously be times when she herself will require care by another nurse. We recollect a superior girl who married soon after leaving the training school. She lived in a farming community and was constantly called to act as nurse as a matter of charity, until it became evident to her husband and herself, that, however much she was needed in this way, she was neglecting the place where charity is said to begin.

As we have previously declared, there is a field for the untrained or partially trained nurse, not as an ideal fulfillment of a want, but as a practical compromise with necessity. But there must also be some practical provision for highly skilled nursing in the families of independent, but small means. All things considered, we are inclined to think that this demand must be met, as are other emergent, accidental demands far beyond the probable immediate resources of the average family, by some form of insurance. As counter-insurance against the temptation to demand nursing for trivial conditions, we are inclined to think that the insurance should not be in full, but simply for the delivery of services at a reduced rate, say $5 a week and board. Just how such insurance

should be conducted is, in itself, a complicated problem. Off hand, we should say that it should not be conducted as a business interest, but that it should be connected with hospitals or guilds, to which the beneficiaries contribute, and

that the services of the nurses should be available for general philanthropic purposes when not needed by the members.

THE FARM BABY.

Its Advantages and Disadvantages. Of all the products of the modern farm, the baby crop is by far the most valuable, and calls for the greatest exercise of care in the raising. There are certain reasons why the farm baby starts out in life with an advantage over his city cousin; and, because we are often prone to overlook our own advantages, and so to miss availing ourselves of them, it may not be out of the way to point out some of the respects in which the baby born and reared on the farm has the better of the offspring of the city.

To begin at the beginning, the farm baby usually not always, but usuallyhas the benefit of good, healthy stock. The rugged, simple life of the farm generally insures in the parents a sturdy strain which is an inestimable physical capital to the child of such parentage. And the value of this kind of a foundation is seen in the fact that the men who weather the strenuous, nerve-racking life of the city best, and last the longest under it, are always the men whose boyhood was spent upon the farm. So, even before it is born, the farm baby has the goods on the city baby.

Then the farm baby has all the advantages of pure air, fresh milk, and later, good farm food, all of which, intelligently utilized, reinforce the healthy stock inherited by the child, and make a strong, healthy man or woman out of it. It is not alone that these advantages are obtainable in the country, which are so hard to get in the city, but they are within the reach of every farmer, no

matter how modest his circumstances, being, indeed, part and parcel of the necessary product of his farm.

In addition to these material advantages, the farm baby enjoys the tremendous benefits of the simple life. The fet and fever and stress of the city, with its struggle for existence and its artificial conditions, neither hamper nor unnaturally force the growth of body or mind. The child of the farm is brought up in quiet, restful, elementary surroundings, which best conserve the nerve energy and favor normal, wholesome development. The farm boy and girl come into touch, from the earliest dawn of consciousness, with the simple, real things of nature, and acquire right ways of thinking and the habit of looking on the natural side of everything. They get very close to the heart of things— which, undoubtedly, accounts for the solid success that they usually achieve when they grow up and go to the city.

In all of these respects the farm baby is fortunate above the lot of the city baby, and it is not without reason that, just as we look to the cereal and vegetable and live-stock_crops of our farm lands to supply the country with foodstuffs, so we look to their baby crops to furnish our cities with the physical and mental and moral backbone that they continually need.

Disadvantages.

Has the farm baby, then, any disadvantages, as compared with the city child? We verily believe he need not have, if only farm parents are alive to their opportunities. We do not know of any positive disadvantages pertaining to the farm as a rearing place for children. Such as he does suffer from are either a perverse failure to utilize the advantages, or else an overdoing of them.

As, for instance, in the matter of heredity. The normal rugged life of the farmer produces a correspondingly rugged strain in the offspring. But it is not altogether uncommon for the farmer and his wife to overdo the strenuous life of

the farm, and thus to break down their strong constitutions, forgetting the duty they owe to their children of bequeathing to them a healthy physique. Of course. the city parents do the same thing, a great deal more often, but the fact is, the farm! baby is worse off in such a case than the city child, because the farm baby is expected to stand up under the same rugged life that should have made his parents strong, whereas the city child escapes a great deal of this physical strenuosity.

Again, in the matter of food. Because the farm affords the possibility of clean, fresh milk, pure air, and wholesome food, it by no means follows that ali farm babies get these things. Farm folks unfortunately, are just as careless as city people in such matters. If they were not, the city babies would fare better. And in this respect, also, the farm baby suffers from neglect more than the city baby, because in the cities there are health boards that look after the milk, but nobody inspects the milk that the farmer gives from his own cows to his own children. Then, as to fresh air, there seems to be a contrary sort of spirit among many farm folks, perhaps in accordance with the proverb that "familiarity breeds contempt." Any country physician will tell you that farm people are the greatest sinners about close rooms of anybody he knows, especially in the case of babies and sick folks. The city mother, doubtless because she knows how scarce an article it is, values fresh air, and gets all that is available. The farm mother, possibly because she has so much of it around her, is too often inclined to shut it out. And the farm baby, deprived of the air that his lusty lungs need in even more abundance than the city child requires, is not infrequently made a victim to tuberculosis and other lung disorders.

And, finally, the quiet, simple life which we spoke of so highly may be overdone, so as to become dull monotony and tiresome routine, which is just as

bad as, if not worse, for the development of the body and mind, than hightension, and produces an abnormal child of even a worse type than the precocious one. There is a general idea that the city mother is usually too busy with social or domestic duties to give personal companionship to her children, while the rural mother gives herself to her family. But our experience has been that there is just as great a tendency for the farmwife to get the "too-busy" habit, as for the city housewife. "All work and no play" is the great menace of the farm life, and it not only makes father and mother "dull boys," but it is injurious to the development of their children. To be sure, it is not such a danger nowadays as it was years ago; and, by the same token, there is less excuse nowadays than formerly. Modern enterprise has put the farm into touch with so many means of diversion and recreation that the farmers family is almost on a par with the city family in this respect.

We point out these possibilities of disadvantage to the farm baby in the hope that our readers will be lead to avoid them, and thus to keep up the high standard of this important crop.

tion of a symposium number on Syphilis for January.

The list of articles reads as follows: "The Influence of Syphilis on Civilization," Wm. Osler, M. D., Oxford University.

"Present Status of the 'Noguchi Test,'" Hidego Noguchi, M. D., New York.

"On the Means of Finding the Spirochaeta Pallida, With Special Reference to the India Ink Method," (From the Laboratory of the Michael Reese Hospital), J. S. Cohn, M. D., Chicago.

"The History and Methods of Application of Ehrlich's Dioxydiamido-arsenobenzol" (from the Royal Institute for Experimental Therapeutics), Lewis Hart Marks, M. D., Frankfurt am Main.

"Recent Progress in the Treatment of Syphilis," H. Hallopeau, M. D. Paris.

"Treatment of Syphilis with EhrlichHata '606'," Abr. L. Wolbarst, M. D., N. Y.

"Syphilis of the Nervous System," Ernest Jones, M. D., Toronto.

"Syphilis and Pulmonary Tuberculosis," Robert H. Babcock, M. D., Chicago. "Syphilis as a Cause of Pauperism," A. Ravogli, M. D., Cincinnati.

"Giant Cells in Syphilis," John A. Fordyce, M. D., New York.

"Personal Observations with the Ehrlich-Hata Remedy '606,'" B. C. Corbus, M. D., Chicago.

"Syphilis and the Public," Isadore Dyer, M. D., New Orleans.

"Sanitary Regulation of Prostitutes," Prince A. Morrow, M. D., New York.

In addition to the above, there will be four "Collective Abstracts" (critical reviews of recent literature in collective form) on (1) Ehrlich Hata. "606," (2) the Cerebrospinal Fluid in Syphilis and Parasyphilitic Diseases, (3) Serum Diagnosis of the Osscous Lesions of Syphilis by the X-Rray.

- A HYPEROPES NEAR VISION. HE question is frequently raised, especially by young refractionists, as to just what is the element in a hyperopes near vision which causes him so much trouble and discomfort. It is quite simple.

The difficulty experienced by hypermetropic subjects in doing near work is caused by the strain on the ciliary muscle. Whereas, an emmetropic subject requires 3 D. of accommodation to work at 33 cms., a subject with, say 4 D. of hypermetropia will require 7 D. Now, let us suppose both subjects to be 20 years of age, i. e., having an accommodative power of 10 D. It has been found by observation that a subject can do prolonged near work if he is able to hold in reserve one-third or one-fourth of his total amplitude. The emmetropic subject could easily exert 6 or 7 D. of accommodation, and has, therefore, no difficulty when only 3 are required. But the hypermetropic one, having one to accommodate 7 D. is evidently just on the borderland of eyestrain.

The subjective determination of the total amount of hypermetropia, especially in young subjects, is difficult, owing to the frequent existence of a spasm of accommodation due to cramp or excessive and involuntary contraction of the ciliary muscle. In such cases, not only does the action of the ciliary muscle conceal the existence of hypermetropia, but it sometimes passes into a condition of tonic contraction in excess of that required for distant vision, so that the eye is maintained in a condition of accommodation for near objects. As this spasmodic contraction cannot be voluntarily relaxed, the eye appears to be myopic. This spasm of accommodation undergoes a partial and sometimes a complete

relaxation in the dark, so that by retinoscopic examination in a dark room, the apparent myopia may be proved fictitious and the existence of hypermetropia diagnosed.

CATECHISM OF REFRACTION. (Continued from Page 730 in the December Number.)

Correction of Myopia.

Q. What is the chromatic test in myopia?

A. In the myopic eye the violet rays, being refracted more quickly than the red, have come to a focus and crossed by the time they reach the retina, while the red rays, being less affected by refraction, have scarcely come to a focus at the retina. Therefore, the appearance of the candle flame is that of a violet margin around a red center.

Q. What is the distance test for myopia?

A. The myopic eye is quite unable to read letters No. 6 at a distance of 6 meters, because the parallel rays which proceed from those letters are focussed before they reach the retina, and as the patient's eye is already in the least convex condition that it is capable of assuming, it has no further means of adjusting itself to the premature focussing of the rays.

N. B.-The astigmatic eye is also unable to distinguish No. 6 at six meters, and it is sometimes hard to differentiate at once between a simple myopic and an astigmatic eye. In astigmatism, however, the inability to decipher the letters is not usually so complete as in myopia: and further tests will disclose the differ

ence.

Q. How are the lenses manipulated in this distance test?

A. Having tried a weak convex lens and found that it makes vision still more

blurred, we try a weak concave lens, and find that this improves the vision, because it delays the focussing of the rays, thus lessening the area of diffusion. We then try successively stronger and stronger concave lenses until we find the one which so delays refraction as to make the rays focus exactly on the retina, thus enabling the patient to read clearly No. 6 type at six meters. This lens makes the rays, as they enter the myopic eye, equivalent to parallel rays entering a normal eye, and is, therefore, the measure and correction of the myopia.

Q. What are the retinoscopy findings in myopia?

A. The rays emerging from the myopic eye are convergent. If the degree of myopia is high, they are very convergent, and will have met and crossed before they reach the observer's eye at one meter; but if the myopia is of a low degree, and the rays only slightly convergent, they will not have met by the time they reach the observer, but they will be tending to meet.

In high myopia, therefore, the shadow will be at once seen to move with the mirror, because the emerging rays have crossed before reaching the observer at one meter. In order to bring the point of reversal at one meter, the focussing must be delayed, and to do this a concave lens is required. The lens which accomplishes this, with the plus 1 D. of the normal algebraically subtracted from it (arithmetically added to it) is the measure of the myopia.

In low myopia of less than 1D. the rays, although convergent, will not quite have met at one meter, and it will still require a plus lens to make them do so, but a lens of less strength than normal. The amount, therefore, that this lens is less than 1 D. is the measure and correction of the myopia.

In myopia of just 1 D., of course, no lens will re required at all to bring the point of reversal at one meter, since the

emerging rays will converge to just the extent necessary to bring them to focus at one meter without any aid.

Q. What does direct ophthalmoscopy show in myopia?

A. The rays emerging from the patient's eye, as stated, are convergent, and, therefore, in the normal, unaccommodated eye of the observer, they will be focussed prematurely, and he cannot get a clear view of the patient's fundus. A convex lens makes matters worse. We, therefore, try successively stronger concave lenses until we find one which will so delay the convergence of the emerging rays as to render them parallel and thus focus them on the observer's retina, as evidenced by his getting a clear view of the fundus. The strength of the lens required to do this is the measure and correction of the myopia.

Q. What do we find under indirect ophthalmoscopy?

A. The rays from the patient's eye, being convergent, will strike the objective lens at a more and more convergent angle, the further the objective is held. from the patient's eye, and will, therefore, be brought to a focus nearer and nearer within the focal length of the objective lens, making the image larger and larger. The weakest concave lens which renders the image the same size, at whatever distance the objective is held from the patient's eye, so that the image neither increases nor decreases in size as we withdraw the objective, is the measure and correction of the myopia.

Q. What are the special considerations of myopia?

A. Myopia is much less common than hyperopia, being in about the proportion of 1 to 15. Since its functional morbid element consists in a constant necessity for relaxing, rather than for exercising, the ciliary muscle, it is not, as a rule, attended with any eye-strain, nor does any latent spasm develop, so that the correction of the error is generally quite simple and straight-forward. As