Changes and Readjustments

All over the world in English-speaking countries changes and readjustments in regard to nurses and their training, are being considered. How and where nurses in training shall live; how many hours of duty for the pupil nurse; shall she be paid while in training, if so how much; shall she receive credit for overtime in emergency; what kind of recreation should she have, 'shall she pay for training as do college students, have less ward work and more theoretical class work; these and a dozen other phases of the subject are receiving careful consideration. In the United States, the question of offering training to two grades of nurses, has entered more or less into the discussions, and also whether in view of the shortage of applicants, a shortening of the training period to two years, plus a probation period of three to six months is desirable, thus leaving the nurse free to spend three to six months in special study of some particular branch of nursing.

In England, the question of "living in " or "living out" has come into some prominence. An experiment is being worked out at the Lambetti Infirmary (London), where opportunity for probationers and pupils to live at home or in lodgings near the hospital was offered to prospective candidates, some sixty candidates offered themselves for the ten vacancies. The probationers were expected to enter into a contract to be at the hospital for specified hours daily. Lectures and class hours were to be over and above the hours of duty in the wards. The probationer is paid two pounds and two shillings weekly, for the first year, with a slight advance in succeed

ing years of training, and pays for her board and lodging or gets it at home. Most of the applicants lived in the vicinity of the hospital. This arrangement makes it possible for the erection of a new building for nurses to be postponed indefinitely.

There are many who believe that it is an unwise arrangement for pupil nurses to live at home. They believe that domestic troubles, illness and various other distractions are likely to interfere with training to a far greater degree than if the nurse lived. in the hospital. Others foresee difficulties through infection being carried to young children in the family, while others dislike the idea of pupil nurses going and coming alone after dark. Still others plead for some modification of the system that will make it possible for graduate nurses and head nurses to live away from the atmosphere of the hospital when off duty.

Whatever may be the case in England, the head nurses in hospitals in the United States and Canada, would find it a costly arrangement if they had to pay for rented apartments and furnishings that were as good as is provided in the average hospital. In places where the rental is not prohibitive, it certainly seems a desirable arrangement for three or four head nurses to occupy a small flat or apartment away from the hospital. It will be many a year before the general conditions become sufficiently settled that a consensus of opinion on all these question can be reached. For the present, it is unlikely that any great number of training schools in America will adopt the plan of having their pupils "live out. Experiments in that direction tried in New York showed no great preponderance of sentiment among prospective candidates for

the freedom offered. When the two methods are carefully considered as to the advantages offered, the balance is very likely to be on the side of the present system of living in the training school building.

A Doctor's View of the Nursing Problem There is no law that we know of to prevent any one from offering a solution to the nursing problem, a large part of which at the present time is wrapped up in the question of how to give decent care to the patients in hospitals of all kinds, and also in homes of all kinds—and publishing the solution as widely as possible. Hence we have offered to us a varied assortment of solutions in the medical press of which you can take your choice freely. Usually the solution is preceded by criticism, more or less severe, of the work of the training school of the present day, and of the product which it is turning out. The editor of Colorado Medicine, in the April (1920) issue, deals with the subject at some length. "The registered nurse," he says, "is a skilled worker hired by the week, for a more or less definite number of hours per day, who accepts no responsibility beyond that of doing as she is told, according to the rules of her training." He goes on to say that "in the results which the present-day system of nursing yields to the public, it is often excessively expensive and at the same time unsatisfactory as to the services rendered. In many households the registered nurse is a poor substitute for the old-fashioned practical nurse, who, on occasion, would keep the house clean, feed and wash the children and generally play the part of mother to the family."

He holds the opinion that all the theoretical knowledge the nurse acquires during her 36 months of training could probably be taught much better during three months of study. He does not hesitate to say that 33 of the 36 months are spent in work that adds nothing to her efficiency; and that "an

intelligent woman could acquire in six months of real scientific education, every essential at present provided by the usual three-year course."

Just here it may not be improper to raise the question as to what makes a nurse efficient. Admitting the importance of careful theoretical training there is a good deal more than that required, to produce the nurse 'who is equal to the emergencies that arise, from long familiarity with similar occasions. The good judgment that renders a nurse a tower of strength to patient and doctor in critical times comes only as the result of experience, and of a wider knowledge of men and things than any nurse can acquire in a few short months. The self-control, the resourcefulness, the quickening of the powers of observation, that the world of today expects from a nurse, have to be patiently acquired. They cannot be purchased. They cannot be learned from books or put on with the uniform.

As a means of solving the nursing problem the Colorado editor advocates a sixmonths' course in which the pupil would be non-resident.

There is nothing specially new in this solution and indeed the shorter course is already being given in a good many places, without thus far materially influencing the present situation.

What about a shorter course for doctors? We are looking for the medical editor who will analyze the six years of college work. now required and set himself the task of weeding out of the medical course all that does not contribute to a doctor's efficiency. We fancy if he seriously attacked this medical problem, he would find himself so busy. that he would not have time to criticise hospitals and nurses for the next few years. There is a shortage of doctors quite as serious in its results on national life as the present scarcity of nurses. The shortage of doctors may not be felt so acutely in large cities, but it is keenly felt in smaller towns

and rural districts. Why not shorten the medical course and weed out the useless requirements that have crept into it? Surely here is a task worthy of any medical editor's best efforts.

Keep Your Friendships in Repair

As a rule, our warmest friendships are formed in youth and early adult life, nurses are so situated that distance often separates them from the friends of earlier days, and unless they are careful to keep their friendships in repair they may find themselves in middle and later life without any of the delightful friendships which mean so much and do so much to enrich our lives.

Few of us have much time for letterwriting unless we try to take time. Even an occasional souvenir card a few times a year, serves to remind our friends that we hold them in our memories, but a souvenir card can never be a real substitute for a letter, however delightful it may be to get it from some one we thought had forgotten our existence.

"A man that hath friends must show himself friendly" and a nurse who does not want to look forward to a friendless old age, should try to keep some of her most desired friendships in repair.

der the auspices of the Nurses' Association of China. It is published both in English and the Chinese language. The editors are Mary J. Hearn, B. A., and Rhea G. Pumphrey, R. N. The subscription price is $1. It is well illustrated. Already they are beginning to talk of hospital social service in China and a beginning has been made in the appointment of Miss Tsang, a recent graduate, to this work. She is assisted by Miss Wu, a senior in the training school of St. Elizabeth's Hospital, Shanghai. Their work thus far has been chiefly follow-up work of the patients who have been in the hospital. It is hoped through this means to relieve the overcrowding in the dispensary and also to prevent a good deal of sickness. District nursing is one of the things which the foreign nurses in China hope to see begun in the near future. One writer states her belief that if maternity district nursing in the larger cities could once get a start it would in time become self-supporting and thus give many mothers who cannot be admitted into the hospitals the benefit of some skilled care.

Opportunity for Discussion

Not the least interesting feature of the article in this issue, "What Is the Matter with the Training School?" by Christine R. Kefauver, Supervisor Industrial Hygiene, Department of Health, New York City, is the bringing up of questions which offer opportunity for profitable discussion. Among the points raised upon which there will be difference of opinion, are the following:The nagging of pupil nurses, uncertainty of the future, standardizing the nurses' wage, living out, already mentioned in the editorial "Changes and Readjustments; " the eight-hour law, making up lost time, sending out of pupil nurses, caring for male patients, grading, etc. We shall hope for a very animated discussion from our read

Feeding Babies According to Their

Weight

Vynne Borland, in The Lancet, thinks it desirable that a more appropriate method of arriving at the necessary feeds should be adopted than by calculating quantities of feeds according to age alone. Therefore it is suggested here that it would be an infinitely better plan to feed a baby in relation to its weight. The present scale is based chiefly on a full-cream dried milk which has been modified to resemble human milk, but others not so modified have answered satisfactorily when given according to scale.

If the suggested scale of feeds is to be adopted it is essential that it should fulfill the following conditions: 1. It must be practicable. 2. It must be easily understood by doctors, nurses, mothers, or any person having charge of the baby. 3. The calculated amount of feed must produce a satisfactory gain in weight per week. 4. The stools must remain normal.

The investigation was carried out primarily on 69 babies of ages ranging from 3 weeks to 81⁄2 months and weights ranging from 6 lb. 71⁄2 oz. to 21 lb. 11/4 oz. The smallest feed which produced a satisfactory gain, the baby otherwise being in good health, was chosen from the clinic cards and noted. In this way 188 feeds at various weights were obtained. These were arranged in successive increasing weights and an endeavor made to produce a simple formula that could be used for guidance.

It has been the practice of the writer to arrange breast-feeding at intervals of 3 hours, 31⁄2 hours, and 4 hours, according to the age of the child and the progress made. The 4-hourly intervals are begun as early as possible. In the case of the 3-hourly

intervals the number of feeds given in the 24 hours is six, in 32-hourly intervals five. feeds, and in 4-hourly intervals five feeds. It has been remarked that in a large number of cases fed every 4 hours four feeds in the 24 hours produce satisfactory results. Accordingly, when a baby is artificially fed this principle is adhered to and only four bottle feeds are given in the 24 hours.

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Hysterical Vomiting

Hurst, in the New York Medical Journal, says that the possibility of hysterical vomiting should always be borne in mind. It should be particularly suspected when no other abdominal symptoms are present as, although a certain amount of abdominal discomfort may be associated with the vomiting, it is often absent, and actual pain is uncommon. A careful abdominal examination should be made, but when some definite organic disease is found, if the vomiting is very persistent and severe the possibility that it is in part hysterical should be remembered, as otherwise the symptoms may persist, although to a diminished degree, after the organic disease has been removed by medical or surgical treatment. A more complete investigation by means of gastric analysis and X-ray examinations should always be made in doubtful cases, but when from the history it is obvious that the condition is hysterical nothing can be gained by such an examination, as in my experience the patient is always satisfied with a plain abdominal examination. A more thorough examination, instead of helping to relieve his mind, may have the contrary effect of making him. think that the physician believes there is something serious the matter with him, and

when told that this is not the case he may believe dreadful things are being hidden from him. Moreover, the discovery of some slight increase or diminution in gastric acidity may lead to the prescribing of diet and drugs to correct this, or the skiagram may show some slight delay in evacuation, atonic dilatation or ptosis, and lead to the recommendation of further dietetic restrictions, rest in bed, massage, or the wearing of an abdominal support, all of which will confirm the idea of disease in the patient's mind. It must be remembered that considerable variations in the chemistry, motility, shape and position of the stomach occur in normal individuals, and a departure from the average normal condition does not always indicate that this is the cause of a symptom, such as vomiting. When, therefore, the general evidence points to the vomiting being hysterical, psychotherapy should be attempted without any other treatment, even if a complete examination has been made and some slight abnormality has been discovered.

Magnesium Sulphate as an Antiseptic The Therapeutic Gazette points out that the fact that a saturated solution of magnesium sulphate has been used during the recent war as an antiseptic dressing for wounds, and also that it is employed externally as a dressing in erysipelas, makes all investigations as to the method of its action of peculiar interest. Northrup, in the Journal of Infectious Diseases, states that women have known for some time that a saturated solution of magnesium sulphate may be used as a substitute for talcum or face powder, and that a small amount of this liquid taken in the palm of the hand and rubbed over the face until dry leaves a bloom" upon the skin, and that if there is a tend

This led Northrup to investigate the influence of magnesium sulphate on the organism commonly found in ordinary pimples, the staphylococcus aureus. It is not necessary to give the details of this research, but it would seem that magnesium sulphate does possess distinct antiseptic power not only in regard to the staphylococcus, but also that this salt inhibits the growth of the strep tococcus in the skin.

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What Iodine Is Good For

Iodine painted under the clavicles in chronic forms of phthisis and chronic bronchitis is of great service in arresting and allaying harassing cough, and in checking the profuse secretions of bronchial tubes and cavities of the lung. Tincture iodine painted over the chest will often relieve

pleurodynic pains where mustard plasters fail. Tincture iodine painted along the course of the sterno-cleido mastoid muscles will relieve paroxysms of asthma and will also keep off attacks.

Iodine ointment, applied to unbroken chilblains, will arrest the harassing itching and burning better than any other remedy. It will cure chilblains in from one to two days. Iodine ointment is the best known remedy for removing non-inflammatory pains of the chest. If the pain is situated in the muscles (myalgia) and these muscles are tender on pressure, while the skin may be pinched without pain, iodine will always relieve or cure. But if the skin is tender on pinching or pressure (pleurodynia), then belladonna ointment or plaster is to be preferred.

Tincture of iodine may be used as an inhalation with signal benefit in certain forms of chronic phthisis, chronic bronchitis, hay fever and acute colds. The strength of the inhalation may be from ten to thirty drops of the tincture to the ounce of water, and used with an atomizer, vaporizer or steam.