Proper diet is the one effective and rational remedy. The physician is the one to advise in this matter, but the nurse must conduct the observations which are to decide the effectiveness of his methods.

With a breast-fed baby, the mother's diet must be regulated and her bowels kept free. For some unexplained reason the foods which are laxative to the mother make her milk laxative to the child. Fruits are appropriate, especially sweet oranges, apples, peaches, sweet plums, grapes and pineapple; bananas and berries are not desirable. The green vegetables may be eaten-lettuce, spinach, celery, tomatoes (if thoroughly ripe), string beans and tender green peas; such articles as cooked cabbage, baked beans, canned corn, pickled beets, etc., are better omitted. Some of the coarser cereals, as oatmeal, if well-cooked, and graham bread or gems, if served cold, may be used. A full glass of water, either hot or cold, taken in the morning upon rising has an excellent effect.

If regulation of the mother's diet is not sufficient, massage of the baby's abdomen is probably the next best procedure. It should be done gently, with the tips of the fingers (using a very little oil if desired); begin at the right side of the abdomen, and with a kneading or rolling motion work upwards and around, following in a general way the direction of the colon; as the child becomes accustomed to it, deeper pressure may be made, care being taken not to pinch the skin.

Half a teaspoonful of olive oil once or twice a day is an effective and harmless remedy. Or a few teaspoonfuls of oatmeal water (made by boiling a tablespoonful of rolled oats in a quart of water for an hour, and straining) may be used.

To a child of six months or more fruit juice may be given as a laxative. A teaA teaspoonful of orange or pineapple juice, diluted, given twice a day, half an hour before nursing, may be all that is required.

A bottle-fed baby may have oatmeal water added to its food at any age; or, after the

first few months, fruit juice may be given before meals.

These simple remedies almost never fail to relieve habitual constipation; yet they are often neglected because of their very simplicity, or because they are "too much trouble."

Constipation may be relieved temporarily by an enema of plain water, salt solution, or soapsuds, or by a suppository of glycerin or gluten, the latter being preferable for small babies.

A cathartic or laxative drug, even though it be as simple as senna tea, should never be given except upon a doctor's order. These things are not dangerous per se, but the habit of giving them is formed so easily that safety lies only in adherence to a hardand-fast rule.

DIARRHEA.

Diarrhea from one cause or another is a common ailment, with frequent disastrous results. The disaster usually occurs from treating the symptom and not the cause. Diarrhea in any form is due to an irritation of some sort, and will not disappear as long as the source of the trouble is permitted to remain.

A nurse or a mother may, with perfect propriety, give a dose of castor oil upon the appearance of a diarrhea. This will often remove the offending material and right matters. (It is not necessary to disguise castor oil in giving it to small children; they almost invariably take it without difficulty.) Remember that one can hardly give an overdose; a small dose may simply disturb and prolong the looseness of the bowels, when a larger one will relieve in a few hours.

Rice water (made like oatmeal water) may be given before or with food, and frequently is efficient.

Ordinarily, all food should be stopped for several hours, or even for a day, and water only given. Do not immediately resume the feeding of milk, but give albumen water instead. (This is made by stirring, not

beating, the whites of two eggs into six ounces of water.) A baby can live very comfortably on this for some time, and it is safer than to give milk foods.

Cool enemata of plain water are wonderfully effective in all sorts of diarrhea, and may be given by any one with perfect safety. Several ounces given slowly and expelled may be appropriately given every four or five hours. This treatment is especially adapted to older children, and often affords relief when other remedies have failed.

In a case of diarrhea where there is prostration or any constitutional symptoms, the physician should be summoned without loss of time.

DYSENTERY.

In dysentery, the doctor must direct the care. Milk foods are withdrawn, and in their place are given barley or rice water with egg albumen, beef juice, liquid peptonoids, etc. Astringent enemata or colonic flushings are usually ordered, and must be carefully and regularly given. A Kemp tube may be used, if a small enough one can be obtained, or a double catheter; or, the solution may be introduced, and when expelled more given until it returns clear. The double tube is preferable, as it produces less irritation at the anus. The napkins must be changed promptly when soiled, as the stools very readily cause chafing.

The

It is now well established that dysentery is caused by a definite bacterium. nurse must therefore exercise the greatest possible care to avoid the spread of the infection to other children, and must recognize the danger of reinfecting her own patients. It is possible for a dysentery to be kept up almost indefinitely by simple neglect

of cleanliness.

The hands must be washed after each changing of the napkin, and before the preparing or giving of food; also in going from one baby to another. All bedding and clothing, especially the napkins should be well soaked in disinfectant before being sent to the laundry. Dysentery cases should

be isolated, and the nurses who care for them should no nothing for other children.

CHOLERA INFANTUM.

Except in severity, cholera infantum is not unlike other diarrheal conditions. In this disease, and in dysentery, there may be temperature enough to require hydrotherapic measures. A cool sponge bath may be given, just as for a typhoid case, except that the water should not be too cold and the time not over ten minutes. If the child does not bear sponging well, a cold pack may be used; this is done by wrapping the child in a cool wet sheet or large towel, covering with a blanket, and leaving for fifteen or twenty minutes. A "fan bath" may also be employed; the patient is wrapped or covered with the wet sheet or towel and then fanned vigorously, the evaporation producing the fall of temperature. A cool tub bath should not be given to a child.

In these cases the clothing should be very light. A shirt and a diaper is sufficient if the weather is at all warm. A thin slip may be used, but no petticoats or pinning

blankets.

Calomel is commonly given in this disease, and the nurse should not be surprised if large doses are ordered. Children bear very large doses of it in proportion to age.

Colonic flushings of cool salt solution or an astringent are much used. A contindered; for this, one must use a soft rubber uous irrigation of salt solution may be orfountain bag very low, and clamp the tube catheter, insert it pretty high up, hang the so that it will run drop by drop; in this way a large amount will be retained and will be rapidly absorbed.

Milk foods are always abandoned, and nursing babies taken from the breast. No nourishment at all may be given for twentyfour hours, and then some dilute food begun. Plenty of water to drink must always be supplied.

MENINGITIS.

Meningitis, of whatever origin, requires the best of nursing. Cold baths for tem

perature must be gently given; bright light must be excluded from the room; sharp, loud, or sudden noises in the vicinity must be prevented. Sedatives are usually ordered for the convulsions or muscular rigidity, and these frequently require to be given by rectum; great care must be exercised to have them retained. Regularity in feeding and exactness in carrying out orders must be secured. Any new symptom must be promptly reported. These cases need careful watching and two nurses are usually necessary. Under the best possible conditions a large percentage of the cases are fatal. Many of the serious sequelæ can be prevented by good nursing.

(To be continued.)

THE MEDICAL PROFESSION AND THE TRAINED NURSE.*

BY J. C. YOUNG, M.D., M.R.C.S., M.R.C.P., Cuba, N. Y.

As the pendulum of the world's thought

swings backward we see some very remark

able changes which have taken place in the last half century. Especially marked has been the change in the last 25 years. Some scientific investigators claim that this world. is now about six thousand years old. Others claim that this is a mere fraction of the age of the world, and it were better to say sixty thousand, six hundred thousand, six million. Let that be as it may, and while we hope and expect far greater and more important discoveries in the near future than have been in the recent past, yet so far as mankind is at present able to learn no years in all the history of the past have been nearly so good as the years which have been given to us. The question which would naturally come to one's mind as fitting a meeting of this kind is: "Has the advancement in medical

and benefit to mankind through the prevention of disease and suffering, the lengthening and saving of human life, there is a decided and marked advancement.

Then I am but voicing the sentiments of all present when I say that in medical lines the progress and advancement during the last half century exceeds that of any other period.

The whole science and art of medicine and surgery has been and is still undergoing many changes and the trend is toward preventing disease and saving life. At the present time it seems passing strange to look back upon methods of 50 years ago.

We think now about the germ theory of disease; about what antiseptics have done and are still doing in medicine and surgery; what hygiene has done for the prevention of disease and the lengthening of human life; the wonderful difference in the care which is given the sick and suffering to-day and that of half a century ago. While the latter change has taken place with the knowlthe medical profession as a whole, and while edge, with the approval and helpfulness of large figures should be placed upon the

credit side of the ledger for them, yet the credit does not belong to them alone.

The greater part of the progress in the care and management of the sick has been mainly due to the efforts of nurses themselves.

But the medical profession have appreciated the fact that the better the nursing the more likely would their own efforts be to result in success. The nurse furnishes greater relief and with that comes greater means of recovery. The care which is given the sick and suffering to-day was only a dream of the medical profession and others of half a century ago. But they said, We will start a nucleus and create a thought, we will advance a sentiment which we trust will grow and we will do this while we are

and avocations of life?"

If the change is estimated by the safety

*Read before the Eighth District Branch of the Medical Society of the State of New York held at Buffalo, September 25 and 26, 1907.

we can never expect to see the perfection in the care of the sick in our day that we trust will come in later years. While the art of nursing has realized a long and cherished

hope, yet any of us at this time could say the same as was said by others fifty years ago. I have in mind the help and benefit the trained nurse would be to every home where want and poverty is fostered in all its forms. If the trained nurse is so helpful and now considered indispensable in the homes where wealth abounds and where it furnishes every comfort that money can bring, how much greater value would the same services have in homes where there is so little to help the sufferer, homes where poverty, want and sickness preside over the births of the little ones, rock their wretched cradles, and, too often, pile the earth above their little graves. In the days which are to be we hope the nurse will be found in the poor little home as well as in the palace.

The public should take recognizance of this, for nowhere is a nation's humanity and wisdom better shown than in the care they give to their helpless and dependent children. Much has been written and spoken in later years about the duty of the medical profession toward each other, the duty of the medical profession to the public, the duty of the public toward the medical profession, but so far as the speaker has been able to learn very little has ever been said either by voice or pen about the best help in the sick room that the medical profession ever had, that is, the trained nurse. However, when giving the history of any important case, after the age and diagnosis are given, this statement has often been made: "The patient was at once placed under the care of a competent nurse." This of itself speaks volumes for the usefulness of nurses in every important and critical case. When the trained nurse entered upon her duties she became the ally of the physician. Their boats, so to speak, were seen floating along side by side, sometimes in a very quiet sea where we could point out to-day the course which would naturally be followed on the morrow, at other times in a tempestuous sea where anxiety as to what the result will be overshadows all other considerations, where the energies of both physician and nurse are

taxed to the utmost, and where we would be unable to point out one hour the course to be followed the next. But both work with the same object in view—the saving of a human life, and where that is impossible the doing of all that can be done by art until the patient is released by death. The aim of the two professions is one, so that all that touches one will find its prototype in the other.

Something has been said about the overtrained nurse. That to the writer seems a misnomer. It would be just as impossible to have a nurse overtrained as it would be to have a physician or a mechanic over-educated. It may be claimed that the nurse at times believes her knowledge superior to that of the physician and takes upon herself the treatment of the case, ignoring the physician's prescription. This unpleasant state of affairs is by no means to be looked upon as indicating overtraining, but rather undertraining, and the writer finds that such an action is by no means as frequent among trained nurses as among those who do not profess to any training whatever. While the nurse has been regarded with great respect and admiration by most people there has been opposition and deep contempt by a few.

The organization of special work in the line of nursing having for its object the saving of life and the relief of suffering was, not so very long ago, entirely new, and at no distant period unknown.

Something less than fifty years ago a distinguished surgeon made the remark that it was a "myth," that it was "a work of no significance," that if good was done it was not known. As would be expected, its novelty at first brought out some criticism, especially by those who oppose everything. It was claimed that there was no necessity for such a work, and some predicted its early demise. How that has been verified the present standing of nurses as a class in every community will answer. When we contemplate the great good done we feel a pardonable pride in the wisdom shown by Florence Nightingale and others in days gone by. Forty-seven years ago a training

school for nurses was founded by Miss Nightingale in London. Some years later that school was taken as a model by the Bellevue Hospital Training School.

I do not speak as the nurse's champion, for she needs none. But her helpfulness to the medical profession has as a general thing been as unbroken upon her part as it has been appreciated and precious upon ours. Unceasing in her efforts to make the affliction of others more easily borne, anxious when nearly all the world is sleeping, she is watchful and careful to make the treatment a success. The admirable methods of most nurses produce results not otherwise obtainable. They can often see what to the ordinary observer would be no departure from health.

Relief of pain and anxiety, better sleep, more and better nourishment come to the patient, and he is in this way carried through critical periods of disease where he might otherwise succumb.

The good service rendered by nurses cannot be put into figures. The memories of many a sufferer are not confined merely to the sick room, but mingled with recollections of heroic actions, self sacrifice and patience on the part of the nurse. It is a leaf in memory to which the sufferer often loves to turn. The nurse brings the morning light during the dark hours of midnight to many hearts and leaves the impression that, taking the years together, there is, after all, no more night than day. When we hear from the living lips of those whose health has been restored and when we hear from the dying lips of those whose sufferings have been alleviated stories of the nurse's care and patience we must look upon her life as a life of great successes. She stands at the gates of life as humanity enters the world and at the gates of death far oftener than the medical attendant as humanity passes out of the world. If such a life is worthy only of a sneer, then it would be very difficult to say what life, in the nature of human progress and civilization, is worthy of commendation. What the next twenty-five years will bring to the organizations of nurses I will not undertake to tell, but look backward

half a century and see what it was then. Now look and see what it is at present. Look forward and imagine if you can what it will be in years to come. New avenues of work and fresh opportunities are constantly opening up for the trained nurse. One of the great transatlantic lines has recently added the trained nurse to the medical department of its vessels. The trained nurse will soon become as indispensable to the best lines as the ship surgeon now is.

Even should we be inclined to flatter ourselves that the medical profession have taken the lead it must not be supposed that the nursing profession have been far behind.

The speaker wishes that the public were as well able as the medical profession to see how important and necessary to them is every step taken for the betterment of the trained nurse. And I also sincerely trust that the time is not distant when the wellto-do will feel that no organizations or institutions looking to the benefit of mankind are more worthy of financial aid than the one now doing such a worthy work. Everything the medical profession are able to do to render the profession of nursing still more worthy of its name will be time and labor well bestowed. The nurse has over and over again proved herself to be the medical attendant's best helper. And so we take the nurse warmly by the hand not to say goodby, but to say that we welcome you and have long waited and wished for your coming. Our appreciation is hard to express in words, but we wish to assure you that it is most sincere and lasting. And from our present standpoint we will ever keep a warm place in our memory for the organization which has done so much to aid us in our efforts for the relief of suffering humanity.

EXAMINATION questions used by the Nurses' Examining Board of the District of Columbia, October, 1907.

ANATOMY, PHYSIOLOGY AND HYGIENE, (1) Name organs of digestion. (2) Locate ileum and ilium.

(3) What is the pleura, periosteum, peritoneum, tympanum and cornea? (4) What is the medulla oblongata?