home will suffice. Air baths are valuable. In the absence of natural sunlight, exposing the child's entire body to the air for a few minutes each day is helpful. Heliotherapy, whether by natural sunlight or artificial light from the mercury quartz vapor lamp, helps tremendously. When the natural sunlight is available it should be used unless there is something in an occasional case to contraindicate it. When this cannot be had, the artificial light will suffice. This has a definite tonic effect and should be applied in every case unless there is some contraindication. AFTER Prevention Greater than Cure FTER all, it is the prevention of tuberculosis that is important. It is far better to prevent a case than to attempt to treat it once the disease is established. Preventive work is never spectacular; it does not show immediate results. A single nurse may prevent the spread of disease to hundreds of people every year and thus save many lives, much disability, and a great deal of suffering. The surgeon may be called to a home where a patient is suffering severe pain in the right lower quadrant. The patient has appendicitis; he is rushed to a hospital; an operation is performed and the life is saved. This is spectacular work. The physician sees the result, the patient is aware of it, and the public appreciates that a great service has been rendered. But no one knows that the nurse in the community has saved many lives through preventive measures. In preventing tuberculosis in childhood, first in importance is to find the unreported cases which are disseminating the tubercle bacilli. Usually these are among the adults. In the out-patient department of the Lymanhurst School for Tuberculous Children it has not been uncommon to find tuberculosis in a child and upon investigating for contacts among that child's associates find an unsuspected case, perhaps a father, a mother, or some close friend with a positive sputum. Breaking the contact by teaching known cases of tuberculosis how to protect others from their disease is not easy, yet much can be done to protect little children. Most people will make sacrifices and do many things for little folk which they would not do for adults. It is not enough to provide the definite case of tuberculosis with sputum cup and a book of instructions, even if he has had sanatorium experience; he must be visited frequently and in a tactful manner impressed with the importance of carrying out all the measures known to prevent the spread of his germs to the bodies of little children. The incidence of tuberculosis in childhood has been greatly decreased since more attention has been given to the food of children, particularly since efforts have been made to prevent contamination and to insure the cooking of foods and especially pasteurizing and boiling milk. It has been demonstrated beyond all doubt that the pasteurization of milk has tremendously reduced the incidence of bone and joint and lymph node tuberculosis among children. But this disease has not vanished. Here is a preventive measure that we must not only keep in effect but must continue to recommend to the people in places where it has not been adopted. The next step in the prevention of tuberculosis in childhood is to teach the children themselves. This is extremely important. Children are easily impressed and their minds are retentive. They can be taught the importance of washing the hands frequently and keeping from the mouth objects that may be contaminated. They can be taught to keep their bodies strong and their resistance high by using the right foods, observing the proper hours of rest, etc. It is not enough to take tuberculous children and provide schools for them. It is not enough to provide schools for the undernourished, anemic and other children below par. This is important and should be done every place possible, but we must put into the school system such instruction as all children need. It must be made a part of the curriculum over which they are required to pass examinations, just as surely as in mathematics, language, music, etc. It is a poor educational system that teaches boys and girls a life work and then fails to teach them how to keep efficient and strong in order to be able to carry on that life work. 4. Applying and interpreting tuberculin test. 5. Microscopic examination of suspected material; feces very important. 6. Careful physical examination. 7. Well made stereoscopic X-ray films of every chest and films of other suspected parts such as bones and joints. Important factors in the successful treatment of childhood tuberculosis are: 1. Conservation of energy, long nights in bed, rest hours during the day, limitation of physical activities. Strict bed rest for more serious cases. 2. Close medical and nursing supervision. 3. Food of right kind and in right amount for growing child. 4. Window ventilation providing good circulation of air. Temperature of room best at 68 degrees Fahrenheit. Humidity of air best between 40 and 50 per cent. 5. Air baths. 6. Heliotherapy. Important points in the prevention of tuberculosis in childhood are: 1. Finding unreported cases. 2. Breaking contact between children and definite cases. 3. Preventing contamination of foods. 4. Cooking foods, pasteurizing or boiling milk. 5. Introducing into all schools courses which will give children information they need to keep bodies strong and healthy. T What Nurses Have Done THE black portion of each circle shows the percentage of nurses in each of the three main groups who at some time since leaving training school have done private duty, visiting nursing, etc. The diagram should be read across. The first line shows that 100 per cent of all nurses now in private duty, 88 per cent of those now in public health, and 74 per cent of those now holding institutional positions were once private duty nurses. The second line across shows that 41 per cent of the private duty nurses, 33 per cent of the public health, and 37 per cent of the institutional nurses have at some time done hospital floor duty. The remaining three lines should be read in the same manner. It is possible to visit North Dakota without meeting Miss Clark, for Devils Lake is not one of the larger towns, but it is not possible to miss her influence if one is interested in nursing, for she was a charter member of the North Dakota State Nurses' Association and she has been a steady contributor to its plans and activities ever since. Miss Clark, a native of Pennsylvania, took a teacher training course after being graduated from the Friends' Central School of Philadelphia. Graduating from the Presbyterian Hospital School of Nursing in that city, she became a head nurse at her Alma Mater, but the West called her. She held the position of Superintendent of St. Luke's Hospital, Boise, Idaho, for a time before going to the position she has filled for many years, that of Superintendent of the General Hospital at Devils Lake. As a charter member of the State Association, she threw herself wholeheartedly into the effort to secure a nurse practice act and after the passage of the act, she logically became a member of the Board of Nurse Examiners. For more than ten years she has cheerfully carried the burden of the position of Secretary-treasurer of the Board along with her hospital and training school work. To all nurses, everywhere, the editors wish a busy, happy, satisfying Christmas-tide Private Duty and Understanding Ο N page 1043 may be found a diagram showing how 20,000 nurses have participated in the three major types of nursing. Eighty-eight per cent of the Public health nurses in ten states who returned questionnaires to the Grading Committee had at some time been private duty nurses. Almost threefourths of the institutional nurses, approximately seventy-four per cent of those replying, had at some time engaged in that specialty. All have had the basic experience of passing through a school of nursing and there acquiring a common core of knowledge. Many are the interpretations that may be made of the figures shown on page 1043. With so large a foundation of knowledge in common, it would seem logical to expect both public health and institutional nurses to be interested in and sympathetic with the problems of private duty. It would seem equally reasonable to assume that private duty nurses, en masse, would concede that the other groups have a substantial basis of experience on which to build understanding. In actual practice, however, there is apparent a strong tendency to assume that the individual nurse understands only the problems and procedures of the group under whose banner she is at the moment enrolled. The time has come when the internal walls of doubt and distrust, or of mere lack of understanding, must be torn down if the profession as a whole is to move steadily forward. Public health nursing has enormous contributions to make to a wider develop ment of hourly nursing. Institutional nurses have far to go in helping to make graduate duty in hospitals, either in group nursing or in general floor duty, thoroughly desirable. Private duty nurses, themselves, some of whom are now waiting discouragingly long periods for cases, must welcome participation in some of these movements. Private duty may not say to oncoming nurses, "Keep out," any more than the individual who is jostled in traffic may say to other pedestrians, "Stay home-you crowd me." crowd me." The problem is one of reorganization and redistribution. It is a tremendous task. It involves an effort on the part of most nurses to gain new knowledge. It can wisely be approached by each group conceding and recognizing that all the others have a stake in any major professional problem. A third step in behalf of private duty, which is just now suffering from real and uncomfortable growing pains, could come through an honest and active recognition of the moral responsibility of each group, based on that common core of experience and knowledge, to participate vigorously in all professional advances. No group can safely advance either without or at the expense of any other, for there is no more precious thing in nursing than its professional solidarity, which is rooted in nursing's heritage of idealism. Mental Nurses, Attention! THE officers of the Mental Hy giene Section of the American Nurses' Association are actively engaged in a study of the possibilities of |