The grave of Jane A. Delano, "among the American dead at Savenay

where the hills of Brittany rise in the far distance, and the landscape rolls gently with here and there trim gardens, walled-in fruit orchards, and a short, lazily-revolving windmill *

As we know private nursing from actual experience and through observation over a long period of years, there is no class of nurse more valuable or more to be honored than the disinterested public spirited private duty nurse. Her duties are exactly those described by Dr. Crumbine as belonging to the public health nurse. No good nurse who goes to a case of typhoid feels that her duty is done in the mere nursing of the patient. She helps the physician to find the cause of the trouble and she never ceases her efforts to educate the family in methods of hygiene which will prevent similar outbreaks in the future. Her relation to the family of her patient is a vital, not an incidental one. How many a nurse, called for one member of the family, finds others needing care or instruction or enlightenment. Perhaps she is nursing the grandfather, but the school child who is kept indoors after school hours does not escape her observation. He looks pale and has not a childlike vitality. His cold school lunch, his indigestible meals, his lack of fresh air form a sufficient explanation, but it is only after making herself a true friend to the mother, with utmost tact and patience, that the nurse can show her where the child's life must be altered if he is to be kept from illness and grow up to strong manhood. Is not such work worth while? This is public health work, though it does not go by that name. Her influence extends throughout a whole neighborhood in many cases. In obstetrical work, she is doing child welfare work of utmost value, for she is educating a mother from the beginning of the child's life. Her work is done under more trying conditions, often, than is that of the public health nurse, for the latter visits the family, the private nurse must live in it. The private nurse is accused, often, of being mercenary, of working for hire. Do we not all work for hire? Is not every public health nurse on a salary? Could she continue her work if the salary were withdrawn?

Public health work is growing by leaps and bounds and we need the best of nurses for it, but we need the best for our executives and teachers in the hospitals and training schools, and we also need the best in the homes where sickness comes, where one patient is so desperately ill as to need the continual care of a nurse. Nothing but the best will do, anywhere, or the health of the public will suffer as a result. The danger is that by exalting one branch of the profession over another, young graduates may turn from the kind of work for which they are most fitted because they have been taught to despise it. Not all nurses will make good public health nurses, not all will make good executives or teachers. There is a type of nurse peculiarly fitted for the life and death battle with one patient at a time, and she is the best public servant who chooses the kind of work in which she can do most for her fellow men.

WANTED,

ARTICLES ON ANAESTHESIA, LABORATORY WORK, ETC.

A JOURNAL reader who fails to send her name with her request and who is, therefore, barred from the Letter Department, asks for articles from nurses who are doing office work for noted surgeons and medical men, also from nurses who are acting as anaesthetists. These articles would be very welcome for our pages, as are all which deal with practical subjects. There is particular need for information regarding places where courses in anaesthesia may be taken. We have constant inquiries on this point but have limited information to offer.

We like to have our readers tell us what they want to see in the JOURNAL and we like to have them write us about interesting work they are doing or in which they are helping, without waiting for a request. All original articles which are written exclusively for the JOURNAL are paid for at the time of publication. We cannot promise immediate publication, however, as our waiting list of articles is always a long one.

NEWS ITEMS

Occasionally a news item is sent to the JOURNAL with a request for a pil' for inserting it. There is no charge for news items. We are very glad to have them and wish every state were better represented in our columns. We have to reserve the right to condense or omit portions of items, but we should like to have noted in our pages all nursing history of importance and of general interest.

We wish each alumnae and district association would appoint either a committee or an individual who should be responsible for telling of any meetings of special worth and of news regarding their members which is permanent in value, such as appointments to positions, births, marriages and deaths.

Every secretary of a state association should send an announcement of her state meeting two months before it is to be held, and should send an account of the meeting as soon as it is over, while the inspiration is fresh in her memory. Our pages close on the 15th of each month, so news items must be in our hands on that day to ensure their appearing in the next issue of the JOURNAL. Those received after the 15th have to be held for six weeks before publication.

There are some states that appear every month in our news items. There are others that are almost never represented. When a reader looks for items from her own city or state, let her say, "Can't we find someone to send them, so that I may know what is going on?" That is of more use than to think sadly, "The JOURNAL never prints anything from my home town." We cannot print what we do not receive.

THE SOCIALIZATION OF PREVENTIVE MEDICINE THROUGH THE PUBLIC HEALTH NURSE'

BY S. J. CRUMBINE, M.D.

Secretary, State Board of Health, Topeka, Kansas

We hear much, these days, about reconstruction and the conservation of our national resources. This means that we are, at least, awakening to a realization of the fact that we have been prodigal of our resources and spendthrifts of our reserves, in other words, that we have lived for the moment at the expense of the future. This attitude of mind and action must be the result of ignorance, ignorance that comes from lack of training and a lack of appreciation of relative values. We have long been accused by serious-minded thinkers in Europe and in this country of having standards of value whose symbol and sign is the dollar mark. With humiliation and shame we must admit that there has been some truth in the accusation.

Several years ago, a case of foot and mouth disease occurred in a young man in a certain county of Kansas. The associated press spread the information throughout the country. My visit to the case was delayed, pending investigation by a national expert and a confirmation of the diagnosis. When it was certain that the case was really one of foot and mouth disease, in company with the President of the Board, I made a visit to the town in question for the purpose of a thorough study of the case. Imagine my surprise when, after retiring for the night, I was awakened from my slumber by a representative of the United States Department of Agriculture, who had been sent to make a careful investigation to determine whether or not the livestock of this community was safe from infection. I congratulated this trained veterinarian on representing such an efficient department of the public service. Assuring him that there was no danger of transmitting the disease to the neighborhood livestock, I then made inquiry of the government's representative as to whether or not the government had heard of the 3,900 babies who had died in Kansas last year, and the 1,009 Kansas people who had died from tuberculosis that year and if, having heard, they had not sent the government representatives to Kansas to assist in the prevention of these diseases among the people.

This incident is mentioned as an illustration of our ideas of relative values. Kansas cattle and pigs seem to have ample protection

'Read at a meeting of the Northwest Nurses' Association, Glacier Park, Montana, July 15, 1919.

from both the state and federal government, but it is with the greatest difficulty that we can arouse public interest in the vital matter of public health.

Whatever have been our shortcomings in the past, the awful catastrophe of war has made us keenly aware that the foundations of the national defense rest upon the health and strength, in body and mind, of the people.

These complex problems which public health workers are called upon to solve are social and economical before they are medical. In other words, we are now called upon to consider the source and the cause of preventable sickness rather than attempt merely to mitigate its malignant influence. We can see, then, how, with a suddenness that is almost startling, the great public health movement relating to the public health nurse has sprung into existence, the result and the outcome, no doubt, of the social evolution which is making rapid progress in this country.

The visiting nurse was first inaugurated as a philanthropy, primarily to bring medical nursing into the homes of the poor, but we now recognize the evolution, both as to purpose and name, of the visiting nurse into the public health nurse as a powerful means for preventing disease, a mighty adjunct for promoting health, an economic means for preventing ill health among industrial workers and, finally, for extending the principles of health and healing to the out-patient dispensaries, the hospitals, and the rural communities.

I assert that no other public health movement of modern times has made such rapid strides forward and upward as the public health nurse movement, and no work has been productive of such immediate results in easing human suffering among the poor in the prevention of sickness and premature death as has this movement. Such results assure appreciation of service by the public, and permanency of position as a necessary part of modern public health work and social service. This appreciation of the service of the public health nurse has been expressed in an unprecedented demand from schools, municipalities, communities, states, and large industrial corporations which it has been impossible to supply with trained workers.

In consideration of this fact, and in order that those engaged in public health work who have not had special training might have some opportunities along this line, we have added a section on public health nursing to our annual School for Health Officers in Kansas.

Manifestly, then, the business of the public health nurse carries with it great opportunity and tremendous responsibility, for one condition cannot obtain without the other.

The relation of the public health nurse to the individual is usually