HOSPITAL AND TRAINING SCHOOL ADMINISTRATION That nursing has become a profession is a firmly established fact, and with such a status, it must needs consider some of the problems due to the traditions of nursing history, such as the twelve-hour day in schools of nursing, which are not entirely in keeping with the obligations of a profession. The problem which I am about to discuss is how to introduce an eight-hour day into our schools. There is to my mind no argument against the eight-hour day, if it can be adjusted in such a manner as not to cause discomfort to the patient and a large expense to the hospital in the form of a greatly increased personnel. We have learned through the recent experiments of efficiency experts and also through our improved system of organization, that shorter hours increase the amount of work and improve its quality. There is no reason to suppose that the amount of staying power is greater in the individual in the nursing profession than in any other sort of work which calls for an equal amount of mental application, plus supreme, physical effort. There is no university on earth that taxes its students, both mentally and physically, as does the modern school of nursing, with continual application from seven in the morning until seven at night, with two hours off duty during the day. These must be spent in the class room or in preparing lessons for the next day. No college expects its students to attend more than five classes each day, and usually but four; time is allowed, also, for recreation, out-door exercise and rest. The hospital must realize, first of all, that if it maintains a school of nursing, it must assume the responsibility that any teaching center does, which houses an educational institution. Unless that is a firmly understood fact in the minds of the members of hospital boards, they will not be able to see the necessity of adjusting conditions to meet the demands which scientific expansion is fast forcing upon us. The modern school of nursing has created a curriculum which enables the graduate to meet the demands which science and society are putting forth in all branches of the service. This curriculum is not acquired or assimilated over night, but represents hours of study and constant application in a practical form, not for six months, but for three years, and three hundred and sixty-five days of each year, with the exception of two weeks of vacation. The hospital is not like the ordinary college which closes its doors at sundown, but must be kept at the same height of efficiency for twenty-four hours of the day. Nurses are always on duty, an unnatural existence, trying even to those who have had long experience and adjustment to night duty, to say nothing of the young nurse who is absolutely unaccustomed to her surroundings and the trying circumstances which her training entails. It is not even human to expect these young women to remain on duty for twelve hours at night with no relief and often with a cold supper when, during the day, we feel we must make an effort to allow two hours off duty. It seems to me that if any one should have relief it is the night nurse, and she has never been considered. Some schools have arranged an eight-hour day with no thought of the hours at night. It is undoubtedly a very good beginning but far from an ideal, as it is only taking care of half the situation. The following schedule is at present in operation in a three hundred-bed hospital: This schedule allows three hours off duty and one-half hour for each meal, which equals an eight-hour day. Once each week every nurse has one free period from 3 to 7, or four hours, and on Sunday four hours are given off-duty instead of three, thus making the 54hour week for day nurses, as beside an 84-hour week for night nurses. An adjustment of this plan can very easily be made in the following manner. This hospital has a daily average of 250 patients and a school of 125 students, or one student to every two patients. The special departments, as operating rooms, out-patient department, and social service, together with the diet kitchen, decreases the number of nurses for the ward to a ratio of about one to three for private patients, and one to four or one to five for ward patients. Thus a ward of twenty-eight patients carries six nurses during the day and one nurse at night unless there are many very ill, then a second nurse goes on. The wards, by an adjustment of time, can decrease the hours for night nurses to eight, with practically no difficulty, by having one of the regular nurses come on at 2.30 in the afternoon, remaining until 11 at night, when the regular night nurse would come on from 11 to 7. If class comes in the afternoon for this nurse, she could come on one hour earlier. On the private floors it would be necessary to add one nurse, having five instead of four for every fourteen patients, and working out the same time adjustment otherwise. The question of suppers will be brought forward at this point, but by serving the midnight meal at 10.30 it is possible to have a wellcooked hot supper served in the dining room before the nurses go on duty, in place of the mediaeval basket lunch. This provides for those going off duty without discommoding the ward or the nursing service, at an increased cost of maintaining a night cook. This adjustment can be carried on through all special departments with no increase in personnel for wards, and on private floors by one nurse to every fourteen rooms. When hospitals are willing to consider such a plan, we shall cease to hear the wail for student nurses throughout the country because the kind of young women with whom we aspire to fill our schools are not willing to submit to the mediaeval time schedule of twelve-hour duty when every other profession and even the trades are showing greater consideration for conserving human energy than do we. In an address to the employees of the War Department at Washington, Major William J. Mayo said: "Cancer is an abnormal growth of tissue within the body. Certain cells in the embryonic stage fail to develop and perform their nomal functions, and the multiplication of these useless cells form the tumor. What causes the cells to be checked in their normal development is not yet known, although there are several plausible theories. But the predisposing conditions which lead to this abnormal growth are known, and may be controlled. "Thus cancer nearly always forms in some lesion upon the body, such as a wart, a mole, a bruised or infected spot. This lesion becomes irritated, and the growth of abnormal cells begins. "The age of the individual plays an important part in susceptibility to cancer; for the common form of cancer is essentially a disease of later life, when some of the tissues have become weakened. NOTES FROM THE MEDICAL PRESS IN CHARGE OF ELISABETH ROBINSON SCOVIL ABORTING THE GRIPPE.-Dr. L. Duncan Buckley in a letter to the Medical Record, states that he has for many years used phenacetine and bicarbonate of soda in the treatment of influenza with marvelous results. He gives an adult ten grains of phenacetine and twenty grains of bicarbonate of soda every two hours. If commenced when the symptoms first appear, he says it will abort the disease. If there is the least heart depression, a little whiskey is added to the hot water with which the powders are washed down; they are placed dry on the tongue. PROPHYLAXIS OF MALARIA.-An Italian medical journal recommends the use of petrolatum to prevent mosquitoes from biting the skin. They will not touch a surface smeared with it and the person so treated can sleep tranquilly amid myriads of the insects. HEAD COVERING AN AID TO SLEEP.-A writer in the Lancet, believes that a warm night cap assists in producing sleep. Soldiers have found the knitted helmet most soothing and sleep promoting. Our grandfathers' and grandmothers' night caps were worn because they were found to be an aid to sleep; they not only kept the head warm but shut out external sounds that interfered with repose. HUMAN ANTHRAX.-The Journal of the American Medical Association reports the occurrence of several cases of anthrax in the military camps. The probable transmitter of infection was shaving brushes made from the hair of animals which had died of anthrax. Attempts were made to sterilize all brushes on sale in the camps affected, but the methods tried resulted in the destruction of a large part of the brushes, especially of the cheaper kind which were most to blame. A SCHOOL FOR ANESTHETISTS.-In a school established at a large military hospital at Buxton, Derbyshire, medical officers are specially trained as anesthetists. The forms of anesthesia include ether on the open mask, warmed ether vapor by special apparatus, nitrous oxidoxygen, rectal and spinal anesthesia, with some instruction in the use of chloroform, ethyl chloride, and the various methods of using local anesthesia. NEW TREATMENT OF WAR WOUNDS.-In a Paris letter of the Medical Record, mention is made of a new treatment of war wounds, by Dr. Serge Voronoff and Mme. Evelyn Bostwick. They have found by experimentation that there is a gland in the body which dispenses throughout the system secretions that are stronger than those from the thyroid gland. The gland yielding them is obtained by the castration of young rams. Large and deep wounds spread with a pulp made from these glands, heal with a rapidity never known before. Soldiers see their wounds heal in a few days. That this method is successful is shown by the fact that Dr. Carrel has asked Dr. Voronoff and Mme. Bostwick to use their methods at his hospital at Noisiel. CALORIES IN EXTRA FOOD.-In an article on the energy content of extra food in the Boston Medical and Surgical Journal some interesting statistics are furnished. A bar of sweet chocolate, price now six cents, gives ordinarily 200 to 300 calories; 500 calories is nearly onethird of the basal caloric requirements of the average man. An ice cream soda gives from 202 to 467 calories. Sundaes, or college ices, from 300 to 500 calories. Ginger ale furnishes about 150 calories per pint and grape juice about twice as much. An ice cream cone provides about 100 calories for a nickel. THE CHILDREN'S YEAR.-Professor Lucas of the University of California is quoted in the Journal of the American Medical Association as saying, "What I have seen, not only in France but also in England and in this country since returning, has convinced me that now is the psychologic time to develop and coördinate all our child welfare work in this country. I feel that all the different associations which represent the best medical thought in child welfare should certainly get together on a definite, coördinated program for this country and back up our governmental bureaus dealing with child welfare problems." This year in America has already been proclaimed by President Wilson as the children's year, and it will be a great lost opportunity unless some national program which coördinates all the best efforts both private and governmental is worked out and put on a very sound basis. CALOMEL FOR PRURITUS ANI.-A Danish medical journal advocates rubbing dry calomel into the parts for relief from pruritus ani, it is effective even when the affection is of long standing. The calomel adheres until the next day, when it is applied dry, and is much superior to the salve form. SODIUM CITRATE IN PNEUMONIA.-A writer in the New Orleans Medical and Surgical Journal advises the use of large doses of sodium citrate, from forty to sixty grains, every two and a half to three hours, day and night, in pneumonia cases until the lung is completely cleared. If the dosage is stopped a relapse occurs. He had treated thirty-six cases with recovery in every instance. |