Job was with his affliction. It takes the finest kind of a woman to take care of these folks, and I take off my hat to them. But say! these same angel nurses have a mighty firm hand in managing some of us old soldiers. "Quiet, son," my nurse said yesterday to a fellow who was jumping around too much. And when he started to whine about being kept in bed, she said, "Why, you are our white hope. You are going to get well if you try. I just can't let you ruin your cure." Well, there wasn't a thing to do, but to trot meekly back to his downy. No, that person was not your son. I see the question arising in your eye.

After the morning "Sick Call," some one pushes the huskies, like yours truly, out on the porch for the winter sun. And what an appetite it gives one. The doctor told me this morning that it'd be cheaper for the san to keep the likes of me in the house. He is a jolly Irishman, who had T.B. himself at Saranac for two years. He says the old idea that a man with tuberculosis is a goner is all

rot.

Stevenson, our own Trudeau, and Babson, all had T.B. and did splendid work from their bedrooms. Somehow, after talking to the doctor, one just knows that recovery is just around the corner.

Milk is served at ten if you want it, and dinner at 12. Rest hour from 1 to 3 o'clock, and not a sound is heard all over the house. Visitors come from 3 to 5, and temperatures and supper follow. Afterward, high jinks are served for those well enough, in the living room until 8:30 P. M. Some play cards, some read, some work on their baskets. They call it Occupational Therapy.

Almost anyone can learn to make baskets, and the men are crazier about it than the women. One old farmer made three in one week for his "darters, but was afraid that he could never convince them that he had made them all alone. The superintendent wants every one in the san. to have good time. I guess they think contentment has something to do with recovery from the way they all act. I heard her tell the doctor one day that she prefers nurses who can play as well as work, and that happy nurses mean happy patients. So the nurses have as good a time as anyone at the patient's parties. All the doors are left open, so that every one can hear the fun.

Last week a movie machine came around to the bed patients, and showed pictures on the ceilings. Then song sheets were passed, and we had the queerest community sing ever. Old Peter, the Greek, just learning to read (a nurse is teaching him) mumbling along; young Larry, our 17-year-old baby, grasping the sheet in thin fingers, just smiled, and Eliason, a Swedish soldier, wondered what it all meant. Next to me was a peppy Jack Tar, who sang as lustily as though on his transport. Well, it was music, anyway. Another nurse played the piano and ran away from her chorus, but it was alright. Every one was happy; no one was left out.

It's late. The night nurse is bearing down upon me, laden with hot pigs and milk, and I can see disapproval written on her brow. So, with more about us next time will cease this scrawl. Best love to all.

C. J. G.

In two of our prominent Massachusetts hospitals eight hour duty has been put in service. It may be to try it out, and it may be for all time. (I really wonder who inaugurated such a foolish idea.) As an old nurse, I cannot but wonder what the outcome will be. Will the nurse trained under these conditions understand the pure joy and pride of 18, 21 or even in urgent necessity 24 hour duty, when she has pulled her patient through some of those fights with death that all nurses meet in the work?

Let us take a concrete case. The man of the family has been earning say $75.00 a week. The family consists of himself, wife and three small children. He is renting a six-room flat; so we judge he is paying somewhere near $35.00 a month. His milk bill will be at least $6.00. Then there will be his gas and electric light bills. and his general food bills. Should there be illness, there are laundry bills, and so without one unnecessary expenditure he is using, we will say about $200.00 a month. His wife is taken sick with pneumonia and is very ill indeed, his doctor says a nurse must be had. The man sends for his mother or sister and also for a nurse, which means two more mouths to feed, quite an item in these days. The nurse is one of our new eight hour graduates and has not been trained to even 10 hour duty, but she tries it, leaving the other 14 hours to the family who are already doing their share of work. She is getting say $35.00 a week, and as she is not used. to long hours, and her patient is too ill to leave with an untrained woman, there must be another nurse-which means another $35.00 a week. The man justly looks worried for he has but $5.00 left from his week's salary, and he still has

his druggist and doctor to pay. But never mind, his loved one is cared for 16 hours. out of the 24, if it is costing $70.00 a week to do it. (Picture what this would mean if the breadwinner were the one ill.) This means for two weeks nursing bills alone $140.00. Doctor's bills, two visits a day at $2.00 means $56.00. Just $196.00 actual, unavoidable expense in so short a time. All this is over and above his druggist and household expenses which are still running on. His earnings have been just $150.00 for the same length of time. How is he to meet these expenses?

I can almost hear the young nurse say, "That is not my affair, he should have saved money, and I am giving him good eight hours work." But, speaking from nearly twenty years of nursing experience it is your affair and what are you going to do about it? Are you saving any more money than he is?

The following case came to my notice a short time ago. The man earning $100.00 a month, was taken fatally ill. The wife cared for him day and night a week or more (she also had the care of two children). At the end of this time, it was a nurse or the hospital. The wife thinking it would be cheaper, sent him to the hospital at $15.00 a week; that of course was in a ward. The next day when she went to see him, she was told that as "the patient was delirious there must be a special nurse at night," $35.00 a week more, and only $25.00 had been coming in. This added expense meant $50.00 a week, besides her own living expenses. All bills in that hospital were payable in advance, and so she had to borrow; for what she had saved soon went, and then the funeral expenses had to be paid. The

more than

man did not live long, not three or four weeks, and he carried a small life insurance, about $1,000.00, I think it was. The doctor did not charge one cent for his services, and I know that he was very faithful to the case. The hospital did not run on the eight hour schedule. Can you imagine three nurses, each doing eight hour duty? I don't know what the widow would have done. Unfortunately sickness knows no law of no law of pocketbook or class.

Will the young nurse realize that the eight hour duty and high wages will hardly work out in private cases, except with the wealthy. Is this not trading just a bit on others' pitiful necessity? If she is not trained to understand this, will she work 10 or 12 hours? I know only too well that a nurse earns all that she receives. Nor do I advocate a nurse working to the limit of her strength and endurance. But ours is a work that is not reckoned in hours or dollars, and this we must never lose sight of for one second. It is our valley of vision. For any nurse to work beyond the limit that we all must mark for ourselves, is as bad business as having three nurses in 24 hours on a case, but if a nurse is unable to stand working longer than eight hours, she has no right to go into training.

If this keeps up, I see a larger field than ever for the untrained nurse; nor can we wonder that the man of moderate means will turn to an inferior woman who knows little or no limit to her hours, and does not always demand a set price for her work.

our

I was trained under the rule of 12 hour duty, and we often had to special cases with pupil nurses when others could not be obtained. Nor do I regret it, for it taught me endurance, so that when it became necessary to work longer hours I could do it easily and cheerfully, without making the patient feel a burden or too great a care.

It is also well to consider the wear on

the patient's nerves. No sooner has she

become used to one nurse and her ways, than it is time to change for another, and still another. I can almost hear the young nurse greet this statement with "Oh, they are too sick to know," or they don't mind." But they do mind. I have been ill in a hospital, and know the fret of changing nurses. It tires a patient, for no two nurses are alike, nor do they work the same; although they may be in the same class in the hospital.

Just what is the eight hour graduate going to do when she starts private work? Will she be able to adjust herself quietly and quickly, as a good nurse should, and be a help to the family, rather than an added burden to the already over loaded shoulders?

Have we, I wonder, become infected with the trade worker's idea of little work and big money? Are we forgetting that a profession knows no law of time nor money? Was it for this that Florence Nightingale or Edith Cavell raised the standard of nursing, that it might fail when we were only beginning to see what was before us?

The School Nurse and the Malnutrition

Problem

At the present time the school nurse occupies a strategic place in the widening health movement. Whether she is willing to occupy herself with routine duties, or whether she has vision enough and courage enough to see the opportunity that is hers in improving the health of school children and through them improving the national physique, remains to be seen. We have unfortunately not yet come to the place. where we consider the physical development of the child of equal importance with his school progress. Will we ever get to the point where we will place as much importance to a child's gain in weight as we do to his passing the numerous examinations in the various branches?

Dr. N. O. Pearce, Secretary of the Northwestern Pediatric Association, at the annual meeting of the Minnesota Public Health Association emphasizes especially the need of nutritional clinics in public schools, and his great desire to see in every county in Minnesota a demonstrational clinic conducted along nutritional lines.

"There are," says Dr. Pearce, " twenty million children in schools of the United States. At the time of the first examination of the men for the draft, out of two and one-half million men, one million were turned down as being physically unfit. It is a national calamity that our children reach the prime of life in such poor physical condition. In the East they made surveys; there were sporadic surveys made throughout the country; a more systematic survey was made in the state of New York, and the result of that survey showed that seventy-five per cent of the children were suf

fering from some physical defect and thirtyeight per cent of the defective children were cases of malnutrition. This condition of malnutrition is brought about by faulty habits in home life as well as faulty eating habits. In a few instances it is due to there not being food enough, but in most of the cases it is due to improper food, or improperly prepared food; and the result of these things, together with the large percentage of preventable physical defects. which are found in these children, is that we are rapidly lowering the physical standard of our people.

These are the children who are to grow up to become stunted individuals without proper resistance to disease, with unstable nervous systems, and physically and mentally handicapped from neglect on the part of those responsible for their condition. It it purely a problem of education. We will have to educate the children to know the value of good habits. We should clear up the focal infections in early life. What we would like to do in the State of Minnesota during the next year is to conduct a state-wide nutritional campaign in the schools. It is just as important to have the reports of the children show that the child gained a normal amount in weight as to show that he passed in geography. We are going to try to establish in at least one school in every county a nutritional class which will be a demonstration class to show what can be done for the more severe cases of malnutrition. These classes, we hope, after it has been demonstrated in first one county and then in another, will be continued by the local oranizations in the various communities and eventually it is hoped. that every school may have such a clinic."

The Medical Situation in Rural

Communities

The medical situation in rural communities has been plainly set forth in a memorandum prepared by the New York State Department of Health-a state in which important changes in the health plans are now being put into operation.

"The number of physicians," states the memorandum," in practice in small cities or rural districts is steadily decreasing. Only one-half as many physicians are now being graduated each year from the medical schools of the country as were graduated twenty years ago, and the number of medical schools has decreased more than onehalf. The quality of teaching in the remaining schools has greatly improved; but it is the general opinion of teachers of medicine that the quality of men who are taking up the study of medicine has deteriorated. The rewards in the practice of the profession are not commensurate with the long period of study required, the cost involved, and the self-sacrificing life which the practice of medicine entails.

"To commence the study of medicine at the present time in New York State, a man must not only have been a high school graduate, but must have had at least two years' instruction in an institution of collegiate rank, including courses in biology, physics, chemistry, physiology, psychology, and at least one modern language. A four years' course in a medical school is then required, and at least one and often two years' internship, without compensation, in a hospital. After receiving his degree, before a graduate in medicine can undertake to practise, he must take a licensing examination before the State Board of Medical Examiners. In other words, after a man has finished the course in one of the best high schools he must continue his work for seven or eight years before he can commence to earn his living, and then he learns that the compensation in all professional positions

open to physicians is totally inadequate and relatively much lower than that of other professions, and to fit himself further for a successful career by gaining the experience which is necessary for the successful private practice of medicine he is expected to serve without compensation for most of his professional life on the staff of dispensaries, hospitals, and other institutions. The medical graduate is generally fortunate if he succeeds in making his living after three to five years of practice, when he will probably be more than thirty years

of age.

"More than one-half of the health officers of the state of New York receive as compensation for their health work less than one hundred dollars a year. Fifty-eight districts of the state have appealed to the Health Department to send them physicians, as they were totally without medical service. In one typical rural county where there were fifty-two physicians an investigation by the State Department of Health showed that these physicians had been in practice twenty-eight years on an average, and that during the last ten years only four new physicians had commenced practice in the county. Hence, it requires little vision or imagination to see what will be the condition in that county ten or twelve years from now unless some change in the situation is brought about.

"(2) Not only is medical service wanting in many districts, but trained nurses are also lacking and, where they are available it is becoming more and more impossible for the average individual to obtain or to pay for their services. Many of the trained nurses in the cities and rural districts are now receiving six dollars per day and board. for twelve-hour service. This means that in case of serious illness two nurses are required and the cost is $12 a day plus the board of the nurses. When this expense is added to that of medical services, medicines, and medical supplies, a daily cost of $20, or more, possibly $25 or $30 per day