violet acts beneficiently in nervousness and insomnia. A soft green may be applied to headaches; the old cure is still practiced in certain parts of England, which exhorts the sufferer to sit and gaze steadfastly at a green field.

Sunlight-yellow is a strong mental stimulant, and somewhat less so primrose yellow. Mauve is a mental sedative. In extreme depression, cardinal red is useful, while rose among the colors is recuperative for the mind.

Effect of Diphtheria on Heart Nineteen cases of diphtheria from a group of eighty studied by McCulloch (American Journal of Diseases of Children, August, 1920) showed evidence of cardiac disturbance. The mortality rate was 100 per cent. Patients whose heart muscle alone is involved depend for their recovery largely on the ability to preserve a cardiac reserve sufficient for their needs. The moment this reserve is used up, cardiac failure results. In these cases evidence was obtained that severe functional changes occur, causing disturbances in the cardiac mechanism. McCulloch says that the occurrence of myocarditis following diphtheria is largely beyond control, although the outcome is determined at least in some cases, by the protection the heart receives during the course of the disease and during convales

Myocarditis due to diphtheria has a definite position among those factors that lead to chronic heart disease later in life.

The Climacteric in Males and Changes

in Prostate Secretions

About ten years later than in women, conditions develop in men which may be called analogous to the climacteric in women. It is not so conspicuous because the function of spermatogenesis does not fail unless life is extremely prolonged and sometimes not then.

The structural basis responsible for these climacteric changes is found in the prostate

gland which shows loss of secretory power and excretory activity. As a consequence there is less resistance to infections and to the tendency towards morbid changes in the body, such as are found in arteriosclerosis, interstitial nephritis, diabetes.-Ristori, Rivista Critica di Clinica Medica.

+

Hoarseness

In sudden loss of the voice or sudden hoarseness, dissolve a piece of borax the size of a pea in the mouth. It will give almost instant relief.-Robbins, in Ellingwood's Therapeutist.

Yeast in the Treatment of Arthritis Deformans

Spencer (Therapeutic Gazette) conIcludes his article as follows:

1. There may be more than one focus of infection, so that careful study should be

made of each case before conclusions are drawn and promises made.

2. Definite improvement has followed the administration of yeast in all of the cases of arthritis deformans studied, and remarkable benefits resulted in one case.

3. Yeast therapy in arthritis deformans deserves further trial. The results in cases so treated should be reported so that accur ate determination of its possible value in this trying disease may be determined.

The Patient's Shampoo

Before washing the convalescent's hair, see that her comb and brush have been

thoroughly washed, dried and sunned; then don't forget, as many do, to give her hairpins, barette, back comb, etc., a good bath in warm soap suds, drying quickly with a soft towel. Then, after the usual careful shampoo, all these articles are clean and ready for the last touches to the toilet. If the comb happens to be an ivory one, a small brush, such as a nail brush, and alcohol will be a better mode of cleaning.The Canadian Nurse,

Massage and Exercises Combined, a permanent Physical Culture Course for Men, Women and Children, by Albrecht Jensen, formerly in charge of Medical Massage Clinics at Polyclinic and other hospitals, New York. With 85 Illustrations. Published by the author, 220 West 42nd street, New York.

In this volume the author places before the public a new system of the characteristic essentials of gymnastic and Indian yogis concentration exercises, combined with scientific massage movements. The simplicity of its technic together with its ready personal application makes it possible for any individual to achieve excellent results from its use. The exercises are chiefly intended for use at home. No gymnastic equipment is necessary, and no expenditure, save that of the time required.

In the chapter, "The Construction and Characteristics of the Combined Massage Exercises," the author summarizes as follows: "First that in the massage exercises the essentials of preliminary gymnasium exercises are included with their resultant benefit. Second, the therapeutic and physiological beneficial effect of scientific massage movements are obtained. Third, the benefit of the essential characteristics of the concentration system originated by the Hindus is secured and in a much more effective, facile and agreeable manner. Fourth, in addition, there accrue the other general advantages which the massage exercises possess. A few of these may be noted: The maximum of effect with the minimum of effort. The stretching, pressing, stimulating and nourishing of the nerves in a natural way. The avoidance of mental fatigue. The longer the exercises are prac

their agreeable nature, and immediate effect. Inasmuch as they are regulatory by the pressure of the hands, they may be adapted to any required degree and thus are equally beneficial to all, from the most developed athlete down to the little child old enough to understand their execution."

The exercises may also be used in different disorders and diseased conditions of the body, of a mild character, in which massage is helpful. It is claimed that these combined exercises improve the circulation of blood and lymph, enrich the blood, burn away fatty tissues, build up muscles, and have a beneficial influence on the nerves and glands, and that they will improve the appearance and figure of both stout and thin. The system has received the indorsement of a number of prominent physicians.

A Course of Lectures on Medicine to Nurses. by Herbert E. Cuff, M. D., F. R. C.. S., Principal Medical Officer to the Metropolitan Asylum's Board, late Medical Superintendent, North Eastern Fever Hospital, Tottenham, London, England. Seventh Edition. With 29 illustrations. P. Blakiston's Son & Co., Philadelphia, Pa.

The fact that this book has reached its seventh edition testifies to the place it holds in nursing literature. To many of our readers the book needs no introduction; to those not familiar with it, it may be stated that it is intended to provide nurses with a work of reference which will enable them intelligently to follow the progress of their cases; to grasp the meaning of symptoms; to understand some of the reasons which influence the physician in his adoption of different methods of treatment, and the

In this seventh edition necessary alterations have been made in order to bring the lectures up to date. A lecture on pulmonary tuberculosis and its treatment in a modern sanatorium has been added.

Short Talks on Personal and Community Health, by Louis Lehrfeld, A. M., M. D., Agent for the Prevention of Disease, Department of Public Health, Philadelphia, Pa., with Introduction by Wilmer Krusen, M. D., L.L. D., Director (1916-1919) Department of Public Health and Charities, Philadelphia, Pa. F. A. Davis Company, Philadelphia, Pa., Publishers.

One way of solving the problems of public health-housing, infant welfare, infectious diseases is to educate the children. 'They are the citizens of to-morrow. They are the books of information to illiterate parents."

This book has been prepared primarily to accomplish this purpose. The health talks

A Pocket Medical Dictionary, by George M. Gould, A. M., M. D. Eighth Edition Revised. 40,000 words. P. Blakiston's Son & Co., Philadelphia, Pa.

This little volume gives the pronunciation and definition of the principal words used in medicine and the collateral sciences, including complete tables of the arteries, muscles, nerves, bacteria, bacilli, micrococci, spirilla, and thermometric scales,, and a new dose-list of drugs and their preparations, in both the English and metric systems of weights and measures, based upon the ninth revision U. S. Pharmacopoeia; also a veterinary dose table.

The most important activities of the 2000 charitable and public welfare organizations in New York City will henceforth be revealed to the public in a new, comprehensive publication, called "Better Times."

"Better Times" has heretofore been the official organ of the United Neighborhood Houses of New York, but beginning with the October issue its scope will be enlarged to cover all private organizations and public departments working for the improvement of social conditions in New York City.

The statement of Mr. Herbert Hoover, who is chairman of the Board of Advisors and Sponsors of "Better Times," says:

"Almost as important as the duty of supporting charitable and social betterment organizations should be the responsibility of

knowing how money so contributed is spent. There are in New York City about 2000 different charitable and social service organizations, which have a combined budget of upwards of $50,000,000 per annum. They are supported by the contributions of some one-third of a million citizens, the majority of whom consider their responsibility discharged when they have signed their name to a check. The activities of these organizations, however, affect every resident in and about this city, and it should be the practice of each citizen to keep himself informed as to these efforts to improve social conditions. A new publication, called "Better Times," will devote itself to this work and will report on the activities of these 2000 organizations."

ALL LETTERS

Dear Editor:

Nursing Problems

The inadequate number of nurses available for bedside nursing coupled with the fact that the majority of hospitals are finding it difficult to secure a sufficient number of pupil nurses is a serious problem from many points of view and one that will require much deep thought and comprehensive study before any definite conclusion is reached as to the real reasons that apparently makes nursing as a vocation no longer so attractive to women. Subsequently an equal amount of care will be required in evolving the proper procedure for eradicating these deleterious influences. Social service, public health and industrial nursing have in a measure helped deplete the ranks of those formerly engaged in the work which once constituted the only legitimate field for their activities, i. e., private duty. This, of course, does not explain the acute shortage of applicants for .admission to the training schools.

The past few years has wrought a change in social conditions and as a consequence we find practically all trades and professions make no restrictions as to sex. Opportunities for women today are increasing and they are not limited in the selection of a calling; the school room and the hospitals are beginning to appreciate the effects of the new order-in short, they are confronted by a condition and not a theory. Therefore in formulating remedial measures this fact should be borne in mind for it is obvious that other fields may appear, or be, more inviting and beyond a question of a doubt the widening of woman's sphere is to a great extent-but not wholly-responsible for the

lamentable lack of interest in the noble work to which Florence Nightingale consecrated her life.

Proponents of a movement to lower entrance standards are of the opinion that such action would in a measure help to ameliorate conditions in respect to procuring possible candidates, but when one stops to sonsider the tendency of the times it seems that the day is not far distant when every boy and girl, not men

tally deficient, will be compelled to complete a high school course, in other words that which will be the minimum required education of the State. The deplorable lack of even the most rudimentary school training evidenced by a large percentage of drafted men examined for service in the late war has served as an incentive for creating new interest in education heretofore neglected. A man or woman with an undevoped intellect in handicapped for life. Thus it would appear that a high school education should be considered a requisite for the potential nurse; the number left out of consideration on account of a deficiency in this respect other things being equal-would be negligible for let it be remembered that the high schools have increased over 450 percent. since 1890 with an attendance that now totals nearly 2,000,000 students. A lowering of standards might do more harm than good since it would in numerous instances act as a temptation to cause many prospective neophytes-who would otherwise spend four years more in the school room-to cast aside their books and at the same time become a deterrent for the type of women now predominating in the profession, namely, the educated and refined, and who are responsible for the esteem which the average American nurse so justly merits-on account of ability-in the estimation of those whose judgment carries more than little weight.

There is no excuse for the almost autocratic authority or incongruous methods quite common in the training schools. This is another cause for influencing desirable women from seriously considering nursing as an attractive life-work. Trivialities are magnified until the mole hill assumes the proportions of the mountain and an inadvertent misdemeanor overlooked in daily life often results in dismissal even though the unfortunate member is about to graduate; she is under the circumstances automatically kept from entering another training school with an indelible blot upon her reputation-though her soul may be white as the driven snow-that even time cannot efface. Many shortcomings of a like nature too numerous to mention often

make the three years spent in a training school quite comparable to a horrible nightmare. The fruits of this shortsighted policy are already beginning to ripen; retribution is at hand. Training schools have failed to advance with the changing times; proper management, to my way of thinking, is of superlative importance, but it has been tragically neglected-it does not measure up to present requisites.

The arduous duties exacted of the nurse in training require an individual of more than average physical development and mentality to successfully weather the-storm, while after the coveted diploma becomes her property she goes out to assist in the battle against disease, anticipating little sympathy and appreciation-often receiving less; is expected to devote consecutive weeks of her time in caring for the sick, with irregular hours of rest and no time for recreation! Is it any wonder that women think twice ere entering a calling that demands such sacrifices? How often could the nurse be given an hour or two for some diversion but such a privilege is not extended since it is contrary to

custom.

In the present emergency the high school prenursing and the Red Cross extension courses are to be commended. However there is not much to be said in favor of cursory correspondence courses since in this system the practical is not embraced, a life many times depends upon the nurse being equal to the unforeseen accident that so frequently occurs, while the woman whose training consists only of what she has learned from the printed page would surely not be equal to the occasion. Necessity of course may compel us to employ expedients far from desirable. It behooves those most conversant with the condition of affairs to contemplate upon the vital importance of drastic action to avert an impending calamity, nevertheless, we have every reason to believe that the sun is still shining brightly behind the dark, threatening clouds and that ultimately a solution of the question will be reached, one that while it may not bring on a nursing millennium will at least be a signal help.

MARGARET A. KANE, R. N.
+

McKinnon's Jejunostomy

Dear Editor:

Having noticed the request of the "Trained Nurse and Hospital Review" for articles describing newer and advanced methods in medicine or surgery, in use in our hospitals, we desire to submit the following description of Dr. McKinnon's "Jejunostomy," as outlined in Dr.

has proved a life saver in many instances, and is worthy of trial, in those cases of postoperative ileus which so often result fatally when otherwise treated.

Acute obstruction of the bowels of more than twenty-four hours' duration is one of the most fatal abdominal conditions the surgeon meets, and carries a frightful mortality. Experimental study of obstruction of the bowels has demonstrated that the cause of death is due to a toxic secretion of the duodenal glands.

The observation of medical men for generations has proved that a high obstruction is more quickly fatal than one lower down. This tends to prove that absorption of the intestinal contents is not the fatal toxic agent, and goes to confirm the findings of experimental investigators.

Reasoning from these hypotheses, the logical treatment of obstruction of the bowels is to drain the duodenum.

Direct drainage of the duodenum is impracticable on account of its anatomical location. Drainage thru the stomach or jejunum is the only alternative.

Jejunostomy on account of its simplicity, and also because it drains the toxic secretions of the duodenum in the most direct manner, is unquestionably the operation to be recommended. It is imperative that the "Jejunostomy" be performed under a local anaesthetic. The reason for this is self evident, when we recall the fact that a general anaesthesia arrests peristalsis for practically twenty-four hours following abdominal section.

The technique of the operation is as follows: (1). Infiltrate a layer of skin over the left rectus muscle, beginning at the margin of the ribs, and extending downward two or three inches.

(2). Make incision through the skin and subcutaneous tissues.

(3). Retract the skin margins and infiltrate the anterior sheath of the rectus and muscles; incise the sheath; separate muscle fibers, and introduce retractors.

(4). Infiltrate posterior sheath of the rectus and peritoneum, pick up with forceps and make an incision into the peritoneal cavity.

(5). Introduce finger and catch the highest loop of small intestines you can reach and deliver a few inches through the wound.

(6). Introduce a purse string suture; have the assistant empty this segment of gut, using his fingers as intestinal clamps.

(7). Puncture the intestine with a sharp knife, introduce tube 25, or 30, French, tighten purse string; stitch tube to gut with one or two