a constant inspiration to the rank and file of the nursing army, proving to them that their service is one worthy of their highest efforts.

It seems now almost superfluous to discuss the nurse as an educator, for if we have rightly divined the mind and spirit of the well educated and well poised nurse we may safely leave her to carry on her educative functions without any prompting from us.. But since your committee has assigned this duty to me, it will be not impertinent to advance a few suggestions as to the scope of the educational work to which the nurse should apply herself.

First, then, let me suggest that the nurse should teach the truth concerning the laws of health and disease-hygiene and prophylaxis. These words of Dr. Burrell in his presidential address to the American Medical Association at their last meeting, although addressed to physicians, may be aptly applied to every trained nurse in our land, and I am glad to quote them because they represent, in part, the convictions of this distinguished physician on the education of the public by the physician :

In what medical subjects should the public be educated? It will be better to teach thoroughly a few important subjects than to attempt to cover too large a field. Let us not be blind to the fact that our scope of usefulness as physicians in dealing with the large discase problems depends in great measure on the co-operation of the public. We must have intelligent co-operation to make our work as effective as may be.

Tuberculosis is still the most pertinent subject on which information should be given.

The public should be informed that at present an early, thorough operation is the most certain way of curing cancer.

The work already accomplished by the public in co-operation with physicians in controlling tuberculosis, ophthalmia neonatorum and scarlet fever comes to every one's mind. The work that has been done in controlling yellow fever in Louisiana by the public and the medical profession is a striking example of educating the people as to the facts concerning disease. The various infectious diseases are obviously ones concerning which the public should be informed.

The people should be educated as to the

necessity of pure air, pure water, and pure food; they should know the hygienic value of bathing.

They should know that hospitals are provided not alone for the care of the sick poor, but that knowledge of disease may be advanced. Take a familiar example in our social life: When it is recognized and brought home to the public that contagious diseases in children are to a degree unnecessary, that by proper sanitation and medical school inspection they may be in large measure prevented, then people will demand that their little ones in public schools shall be protected against disease, which often leaves them invalided and crippled for life. A child among the better classes to-day, until it begins to go to school, is usually free from contagious diseases, but the moment it enters a school it is subjected to dangers from infection which it rarely escapes. To be consistent in our present method of life we might as well expose our children deliberately, as they did in country districts in former times, when a child was sent to a neighbor's to get the measles, as it was a convenient time for him to be sick. The physical and intellectual development of our children is in the public mind, but the possibility of preventing them, by adequate precautions, from having infectious diseases is not appreciated.

The sanitation of churches, places of amusement, vehicles of transportation so intimately concern the public that the essentials of their proper care should be widely known.

When the public is so informed, it will demand a reasonable degree of security from infection. But, it may be said, all the truth is not known regarding these subjects; true, and, therefore, we must be very sure that we tell only the truth.

Again, I would have the nurse uphold the dignity of the medical profession. I use the word dignity in its original sense of worthiness and not in the sense of a false or assumed importance. The medical man needs no halo-indeed, the halo seems to have gone out of style entirely-but he claims the right to be taken seriously and to be spared from the malice of the satirist and the cheap wit of the funny papers. There is a growing tendency in this country to ape the so-called humorists of France and Germany in some of their libellous attacks on the medical profession and its weaknesses. This tendency is reflected in

the gossip of the people, many of whom have but just discovered that the doctors do not always agree, and that their medicines do not always cure. Having found the doctor fallible they proceed to make the most of their discovery and their ridicule goes farther and is remembered longer in some circles than anything that the doctor is likely to say in his defense. The baneful effect of this misdirected smartness is seen in the tendency of a certain element in every community to distrust the word and work of the physician and to take up with all sorts of new fads and isms which promise to do the thing that medical science fails to do. From this source comes much of the opposition to vaccination, quarantine, and other sanitary measures, and even the prejudice against hospitals and trained nurses. The nurse is often in a position to rebuke and counteract this kind of anarchy by the exercise of mere honesty and tact. She need not, for of course she cannot, be blind to the faults and failures of the medical profession, but if she condescends to make capital of them she debases herself and her own profession in the estimation of a scandal-loving public.

The nurse is often asked to give her opinion of some well-advertised nostrum for the cure of cancer, consumption, obesityone or all of them. It is to be hoped that she has read enough in recent literature to form her convictions on these matters, and that she will not fail to make these convictions known and understood.

Above all other things I hold it to be the function of the nurse as an educator to teach people her art. If it is the imperative duty of the physician to teach the great principles of medical science it is no less incumbent on the nurse to teach the principles of nursing. Nursing is not an occult art. The knowledge that you have accumulated through years of schooling and other years of self-education was not sought merely for your own personal benefit but in order that you might share it with others. By imparting this knowledge to those who are eager for it you are engaging in one of

the loveliest forms of philanthropy and you are not impoverishing your own stores. Whether your work is in the slums, the public school or the well appointed home, do not hesitate to answer the inquiring mind any more than to comfort the suffering body. Your services to humanity will be increased many fold by the humbler ministry of those to whom you have imparted some items of your own skill-some bit of information which they would not have learned but for your interest in them. "Freely ye have received, freely give." Has this mandate been reversed by modern ethics?

Right here I wish to put in a special plea for the untrained and uneducated "practical nurse," although I realize that in so doing I shall touch a nerve center that may cause some sharp pain and lead to an outcry from this association. I am too honest a doctor to tell you beforehand that the prodding won't hurt. Now just look, for a moment, at the practical nurses, the experienced nurses, or whatever you call them. They are a motley crowd. Some of them have had absolutely no education and no training for their work. Some of them had from one day to one or two years in a training school, where they must have learned something before they left. Some of them have been specially trained in the private operating room or in the field by some particular doctor; and now he simply "swears by them," of course. Some of them know more, some less. Most of them were attracted to the work by the prospect of fairly steady employment, and most of them, we must admit, are fairly busy now. Perhaps it is not generally known that a large proportion of them are more than half inclined to learn more about their business. They are taking courses, by the scores and hundreds, in the correspondence schools. After one of these courses the nurse generally feels better-and charges a little more. I am one of the last people in the world to affirm that the correspondence school does not improve the untrained nurse, for I believe that if she has any de

sire to increase her efficiency she will get help from what the postman brings her. And yet the only real way to learn nursing is to go to school to a nurse, and that is what many of these nondescript nurses would do if it were made convenient for them.

And so I make bold to renew the suggestion that you have all heard before, viz., that the hospitals and the nurses' organizations provide classes where women can learn a part but not all of the usual course in nursing. I cannot devise any other plan by which the trained nurse can gain the good will of the untrained nurse and maintain any authority over her. The trained nurse ought to control the situation, but at present she seems powerless to do so. I have been assured that this plan is quite impossible of execution, and I have been assured so many times that I am beginning to think that someone will put it into oneration before long. Ever since the first suggestion of this line of educational work, for the good of the public and the untrained nurse, the professional nurse has protested. "The lady protests too much, methinks."

In these few and imperfect suggestions I realize that I have only touched the border of this great theme of education. The genius who said, in a bygone day, "All the world's a stage," would be prompted to say of our modern times as compared with his, "All the world's a School." Go where you will to-day you will meet but two classes of people-the teachers and the taught. Education is the watchword of our civilization. We are all eager to exchange ideas and whenever we are not talking to the transmitter we are pressing the receiver close to our ear.

Fortunately for the trained nurse, she has a message of precious import, she has a school of eager disciples and an opportunity that cannot be surpassed in any other school. Let her be reverent as she deals with the laws and the problems of these wonderful bodies of ours, let her be patient and tactful as she guides humanity out of ignorance and error into a wholesome view

of life, and let her be ever hopeful for she is doing her part in the most momentous campaign of education that the world has ever known.

If any suggestion in this rambling essay of mine can help someone to realize the place that she is to fill in this great school, well and good, if not, I hope that she will no longer wait on the promptings of another, but that the motive will possess her until she has found both a work and a field. For, as Lowell has well said:

STERILIZATION OF LIGATURES.

By a ligature in surgery is meant any material used in a wound or during an operation, for the purpose of co-apting cut tissues or tying vessels. There are two classifications for ligature material, absorbable and non-absorbable. By the former we understand materials that, after a variable length of time in the tissues, disappear by a process of absorption. The latter are those that resist absorption and remain permanently in the tissues where they were placed. Of the absorbable ligatures catgut is by far the most commonly used. Kangaroo tendon is sometimes used where a very great strength and a slow absorption are desirable. The non-absorbable ligatures are more numerous and silk, linen, silkworm gut, silver wire and horsehair are the ma

The series of which this article forms a part is the substance of a short lecture course delivered in the Training School of the Lexington Heights Hospital, in Buffalo. The aim was to give the practical knowledge of bacteriology that is so necessary to nurses in intelligent performance of their duties and also to cover the requirements of the examining board of the State of New York. Many of the terms used are not explained in the text, and such terms were made the subject of question in class. The subject matter also was brought out more fully in the same way by question and discussion.

terials in common use. Each one of these has its especial field of usefulness. In the case of silk and linen their uses are practically the same as they are both well adapted for the same uses.

The use of catgut is so common and it forms such an important part of every operation that a knowledge of its characteristics and its sterilization is of the greatest importance to the nurse. The term catgut is a misnomer so far as its source is concerned. Catgut is made from the intestine of the sheep. The small intestine is used and a layer of tissue which lies directly under the mucous membrane is taken for the purpose. It is known as the sub-inucous layer and its principal feature is the fact that it is composed chiefly of fibrous tissue which is strong and firm. This sub-mucous layer is stripped out and while still moist it is rolled into the strands which after being dried constitute the commercial catgut. Catgut used for the strings of musical instruments must be more carefully prepared and such strands are carefully sandpapered and must be, of course, of uniform size. The catgut is manufactured principally in European countries where labor is cheap. It is a most filthy occupation as may be well imagined. As the catgut is rolled up much of the filth is rolled up with it and consequently throughout a strand of catgut there are germs of almost any variety.

The properties of dry catgut are quite familiar. It is very strong and will withstand a very considerable force when gradually applied. A comparatively light, sudden force will cause it to snap. When catgut is placed in water it takes up the moisture and becomes soft and swollen. This is due to the fact that it is composed largely of a gelatinous substance. When placed in the tissues after a short time the fluids act upon the catgut and soften it and then it becomes absorbed. The two factors determining the rate of absorption are the size of the catgut and the vascularity of the tissues in which it is placed. Even large sizes of catgut cannot be depended upon to remain in the

tissues much over seven days. There are ways of treating the catgut so that it will resist absorption for much longer periods.

It may be readily seen that if there be any germs in the catgut as it begins to become absorbed those germs will be liberated, and finding warmth and a moist culture medium they will grow rapidly. Therefore the first essential for surgical catgut is that it be entirely germ free. Certain American manufacturers recognizing that the manufacture of commercial catgut was such a dirty one now make their own catgut by a process that eliminates much of the germ life and produces a material much better suited for surgery. This catgut when properly sterilized gives an absolutely safe ligature material. The sterilization of catgut is difficult because it is so easily changed by heat and chemicals, rendering it useless for surgical purposes. The most common effect is for the strands to lose their tensile strength. There are a number of methods in use for sterilizing catgut. Some are very simple and some are complicated and only possible with special apparatus. There are two principal methods: one is by using some chemical antiseptic that is allowed to act upon the catgut for a certain period impregnating its substance, and the other is by the action of carefully graded heat.

CHEMICAL STERILIZATION.

Catgut to be sterilized must first be cut into suitable lengths. The length required will depend largely upon the needs and ideas of the surgeon for whom it is prepared. Sizes from 18 to 24 inches are convenient and usually the lengths employed. These strands are ordinarily coiled or sometimes they are rolled upon small glass rods. Where this is done they should not be rolled too tightly.

IODINE CATGUT.

One method now in use which is simple and effective is a method of sterilizing by means of iodine. Iodine is a very penetrating antiseptic and if catgut be allowed to soak in an alcoholic solution or an ether solution, the iodine penetrates the strand

A

and thoroughly sterilizes it. There are several formulæ for "Iodine catgut," and as a matter of fact an alcoholic or an ethereal tincture will serve the same purpose. very good way is the following. The catgut is cut into suitable lengths and coiled. The different sizes of catgut may be held together by a loop of linen or silk. Six drams of the tincture of iodine are taken and added to a pint of ether and into this the catgut is placed and allowed to remain for one week. It is then removed under aseptic conditions and dried and stored in suitable jars.

FORMALIN CATGUT.

Catgut prepared in this way resists absorption longer than ordinary catgut and for this reason is preferred by some surgeons. It is rather difficult to prepare and sometimes the catgut will be very brittle. The strands of gut must be very tightly wound upon reels having one layer to the reel. A 3 per cent. formalin solution is made, using the commercial full strength (40 per cent.) solution for this purpose. Into this solution the catgut is placed for twelve hours. It is then washed in running water for one hour; then placed in cold water, which is brought to the boiling point and boiled for ten minutes. For storing it is placed in absolute alcohol. It is found that the bleached catgut is not as good for this method of preparation as the unbleached.

CHROMIC CATGUT.

When catgut is impregnated with chromic acid, it is found that it resists absorption for a very considerable length of time. The length of time that it will remain will depend upon two factors, the size of the catgut and the time it was allowed to remain in the chromic acid. The details of the process are brief:

First, soak the catgut in ether for about two weeks in order to remove as much of the grease as possible. Second, wind upon reels. Third, place in an aqueous solution of chromic acid 1-3000 and allow it to remain about 24 hours. Fourth,

a saturated solution of ammonium sulphate is then made and the catgut boiled in it for about 25 minutes. It must be raised to the boiling point slowly. It is removed and soaked in sterile water for a few minutes and then placed in jars of an alcoholic solution of bichloride of mercury 1-2000, for storage.

CATGUT STERILIZED BY HEAT.

For sterilizing catgut by means of heat an apparatus must be used that will permit of a very gradual raising of the temperature. If catgut is absolutely dried it will stand a fairly high temperature without injury. By raising the heat slowly the moisture that the catgut may contain is driven off before the heat reaches a point high enough to injure it.

Catgut to be sterilized in this way is wound loosely upon reels. It is then placed in a dry heat sterilizer and the temperature raised to 135 degrees C. From seven to eight hours should be allowed in reaching this temperature. The heat is then removed and the gut allowed to cool gradually. It is best placed in absolute alcohol for storage.

There are a number of other methods, some of which are very complex, and those that have been mentioned will serve as types.

The preparation of non-absorbable sutures is simple and they all may be prepared by boiling. As a rule such sutures are prepared at the time of the operation, although they may well be sterilized and stored. Absolute alcohol is probably the best for that purpose.

(To be continued.)

We should learn in our walks through life, in our mingling in the busy scenes of the world, a lesson of practical wisdom, of kindness, or humility and regard for our fellow-beings.-SAMUEL SMILES.

SUCH food as is most grateful, though not so wholesome, is to be preferred to that which is better though distasteful.-HIPPOCRATES.