removed at once from the conditions and environment in which the disease was developed, should be taken direct to some reasonably high altitude and placed in the most favorable surroundings that can be found, should live and sleep entirely out-of-doors, except during storms and very cold weather, should live pleasantly, exercise moderately, should be under the care of a physician, who should systematically apply antiseptic treatment to the lung surface. If it be beneficial to breathe pure air, it must be more so to medicate it and thereby arrest the disease very much more quickly and allow nature to assert herself and recovery to take place.

This change in surroundings must be made at as early a stage as possible. A consumptive must realize that there is not one hour to be lost. He must begin at once to give himself every possible chance for recovery.

One remarkable and fatal feature of this disease is the patient's apparent apathy and indifference to his unfortunate and terrible condition.

Those who realize their danger are always easier to manage and are more hopeful

eascs.

It is useless for consumptives to seek change of climate at an advanced stage of the disease.

T

HE word "hospital" is derived from

the Latin "hospes" (a guest) and was originally an inn or house where pilgrims were entertained. But in the progress of time the sick and infirm resorted to these places so frequently that instead of houses of amusement they became asylums for the sick and wounded.

Our history of the first hospitals dates back many centuries. We know that in Athens there were hospitals five centuries before the Christian era, and long before that time dispensaries were supported by the State. The ancient Mexicans had hospitals in every one of their principal cities, and in India, 325 B. C., at the request of King Osoka a hospital was built at each of the four gates of Patna. Later, not being satisfied with these few, he ordered many others to be built throughout his whole empire. The Chinese were very charitable in their treatment of the sick and infirm. Hospitals were founded as early as 400 A. D. by the nobles and landlords, where patients were skilfully treated by the best of physicians. Even after complete recovery a patient had the privilege of remaining in

these hospitals until he desired to depart. A Roman lady by the name of Fabiola and a great friend of St. Jerome is said to have built the first Christian hospital. This was erected in Rome during the fourth century. The Moors in Spain had excellent hospitals and even trained nurses, at least in obstetrics.

Hospitals nowadays are divided into two classes, general and special.

A general hospital is a place usually thought of as admitting any or all sorts of diseases. This, however, is true of some, but others frequently exclude such cases as smallpox, etc., and many refuse the admittance of any contagious diseases.

Special hospitals embrace several different. branches, such as tubercular, cancerous, obstetrical, etc. Those, however, are not the only branches, as a special hospital, generally speaking, is where "special" diseases are treated. We also find special hospitals exclusively for the treatment of children's diseases.

At the present time we have at least one hospital in every town with a population of

4,000 or over.

A

LL who have had anything to do with the nursing of the insane must rejoice that there is a general and growing appreciation of the importance of the work. If even so far back as 1841 the need was greatly felt by some leading alienists for better attendance upon the insane it is not strange that as physicians have awakened to more interest in those who are mentally ill and asylums have become hospitals, that the feeling has grown. It is now not only realized that we should have more intelligent and sympathetic nurses (instead of attendants) for the sake of the patients' welfare, but it is imperative for the doctors who are making scientific investigation into the nature of mental diseases that they have as nurses for their patients men and women who are capable of intelligently and accurately observing and reporting all symptoms, physical and mental.

The great demand in all the hospitals for the insane to-day is for more nurses of a fine quality of character and education to take up the work and to make a study of it.

Conditions are never sufficiently hard or repulsive in times of waror epidemic, or in the homes of the very poor, to deter the most fastidious and cultured people from devoting their energies to the care of the sick. Why, then, is it that so many shrink from the duty of caring for the most unfortunate of all afflicted humanity?

Why are those who are least able to protect themselves allowed to be at the mercy, oftentimes, of only the ignorant, ill-bred men and women who in many hospitals are the only ones who can be induced to care for the insane? Many times I have tried to answer that query. Is it the long hours and ofttimes poor food? Is it fear of violence? Is it disgust at the obscenity and profanity? Is it

dread of the responsibilities or of the monotony, some or all of which conditions must be endured by a person caring for the insane whether the patients be of high or low degree? No, I am sure not, because these conditions are to be met in differing degrees in many kinds of nursing that are popular. True men and women do not shrink from any kind of service when they are fully aware of a great need to be met.

Then is it ignorance of the state of affairs calling for good, intelligent men and women that makes it so hard to get a sufficient number of the right kind of people to care for our insane? If so, let us dispel the ignorance if possible.

One of the best nurses I ever knew was also the most accomplished woman I have ever happened to meet caring for this class of patients. She had the absolutely necessary qualifications of sympathy,tact, and love for her work, combined with a highly cultured mind. She was fine enough not to despise the drudgery of her work, and took as much pains in doing the hospital ward work as she did in cooking delicacies for some unfortunate patient who must be urged and coaxed to eat or in diverting other tortured minds with her musical, literary or linguistic abilities. There was no class of patients to whom she could not intelligently and effectively minister. There was no class, whether in the sometimes fascinating and interesting phases of exhilaration, or of deepest depression, or sunken in profound dementia, that failed to appeal to her warmest sympathies and cause the most earnest efforts to improve their condition. This I speak of to illustrate that nowhere is there a better field for the exercise of the highest order of character and mind. There is, I believe, no work where so little approbation

and applause are to be looked for. Such stimulus is denied all those who devote themselves to this work.

In this field there must be men as well as women nurses, and what I say applies to both

sexes.

He who would be successful must first appreciate that all insane people are irresponsible in some respect, however rational they may appear to ordinary observers. Here, as nowhere else, must a nurse rely on and follow implicitly all of the doctors' orders. It is the height of presumption and danger to assume any personal resposibility connected with an insane patient contrary to the physician's instructions.

It takes many months, or even years, to become accustomed to the vagaries of a diseased mind and to the possibilities of conduct. A nurse must be forever alert and make his mind serve for the patient as well as for himself. With the irritable and violent he must use tact to avoid struggles if possible, and must never consciously run the risk of a singlehanded encounter. Never, unless the patient attacks another patient or the nurse, is it excusable that a hand-to-hand struggle should occur. The nurse should never let a dangerous patient get behind him, and should never show fear. If a struggle is inevitable the nurse must seize the patient quickly; if he hesitates and stands off he is likely to get kicked. To get behind the patient and cross his arms in front and hold him thus until help comes is the safest position for both patient and nurse in a hand-to-hand struggle. A nurse must never lose his temper, his patient must be treated as he would wish a dear friend treated. To be able to maintain this spirit the nurse must understand somewhat of the nature of the diseases that cause people to act so viciously. If his knowledge and imagination are sufficient to make him comprehend the probable reasons for the patient's actions it is easier for him to maintain a kindly feeling under the most trying circumstances. He

must never threaten a patient nor lie to one. Once detected in an untruth he can never regain the patient's confidence. He must never choke or smother a patient, never kneel on the chest or abdomen, nor grasp the body in a way that is liable to bruise the flesh or break any bones.

To do all these forbidden things seems to be an animal instinct, and it is only intelligent and well-trained nurses who know how to care for violent patients without resorting to such dangerous methods. There should always be a number of nurses within call to assist in the care of such a case.

While holding himself responsible for the patient's welfare a nurse must treat him with all the deference and consideration that his normal condition would entitle him to. When orders that seem to reflect unpleasantly on the patient's own estimate of his condition, deprivation of his valuables, knives, scissors and freedom, must be carried out, there is only one course open to the nurse and that is to throw the responsibility on the physician's shoulders.

It is a nurse's privilege to be as lenient and obliging as he is allowed to be and it is fortunately the doctor who must and can bear the brunt of the consequences of disagreeable orders. However, a nurse is not doing his or her full duty who does not try to make the patient feel that all is done for his best interests with the kindest intentions. It is no use to argue with a patient about his condition. All of his objective symptoms mentally and physically must be accurately reported. In these days doctors attach great importance to the careful observations made by one who is constantly with the patient. Perhaps the most valuable and difficult part of a nurse's work is the care of those who must become chronics. Their future comfort depends much upon the habits of cleanliness that may be formed by the nurse's systematic and conscientious care. Food and drink should be given regularly, the condition of the bowels

carefully looked after, the teeth cleaned, and often it is no easy matter.

Tuke's "History of the Insane in the British Isles" gives a most interesting account of the medical and superstitious treatment of the insane in the olden time. "Herbs were prescribed to be mixed with foreign ale and holy water, while masses were to be sung over the patient." There was in certain parts of the country at one time the custom of bowssening (or ducking) the lunatic. I quote the following description of a patient at a certain pool which was supposed to be curative. The patient was made to stand with his back to the water, and was then by a sudden blow thrown backward into it: "Then a strong fellowe, provided for the nonce, tooke him and tossed him up and doune alongst and athwart the water, untille the patient by forgoing his strength had somewhat forgot his fury. Then was he conveyed to the church and certain masses sung over him, upon which handling, if his right wits returned, St. Nunne had the thanks; but if there appeared small amendment, he was bowssened againe and againe while there remayned in him any hope of life, for recovery."

This treatment seems a very rough antecedent of the hydrotherapeutic measures that every efficient nurse must understand to-day. Massage and electrotherapy must also be understood by the trained nurse.

The care of patients in and out of mechanical restraint is very important. Where it is used the nurse must ever watch for opportunities for removing it safely and for making the patient as comfortable in it as possible.

The more intellectual resources a nurse has with which to divert and entertain the different classes of patients, the more successful will be his or her work. I might add that for the nurse's own welfare he should have a sense of humor, for while we must never ridicule patients we may often laugh with them, and by being cheerful and hopeful ourselves do something to dispel a depressing atmosphere. We must never despair of their recovery, and in this work especially professional honor is important in maintaining silence regarding our patients and their condition.

For all who will train themselves to do this branch of nursing well there are many avenues open for interesting and remunerative. employment.

We are all acquainted with the virtues of the hot water bag, but many persons are not aware of the fact that a sand bag is even better. The way to prepare it is this: Get some clean, fine sand, dry it thoroughly in a kettle on the stove; make a bag about eight inches square, of flannel, fill it with the dry sand, sew the opening carefully together and cover the bag with cotton or linen cloth.

This will prevent the sand from sifting out, and also enable the person using it to heat the bag quickly by placing it on the oven, or on top of the stove. After once using this no further recourse will be had to the hot water bottle or the brick. The sand holds the heat for a long time, and the bag can be tucked up to the back without hurting the invalid.Health.

Ο

UR train runs rapidly along the tracks of the Lehigh Valley Railroad, beside the river which bears the same name, past Mauch Chunk, Lehighton and other small towns nestled in amongst the hills, and at last the train slows up and we hear the conductor saying, "All out for White Haven."

Picking up our belongings we alight, taking in long, deep breaths of the clear, brisk air which greets us, and hastily buttoning up our coats, which have been carelessly left unbuttoned, for it was warm when we left the city at 8.30 A.M.

We wonder, as we glance around the little country station, if the wind ever stops blowing here, for we are having a tussle to keep on our hats.

There are a few station hands lounging about, a farmer or two, with their wagons backed up against the platform, waiting to load up their freight, and the usual array of village girls down to see the noon train come in.

The only other people (beside ourselves) to leave the train are two thin, cadaverouslooking men who walk weakly along, stopping occasionally as they are seized by a hard fit of coughing.

Then our eyes wander up to the hills above us. One might almost imagine that we had come across an army post from the array of white tents which greets our eyes.

"Be yous goin' to the sanitarium?" a voice beside us inquires. To the sanitarium? Certainly we are going and we nod our heads to the man before us, who is somewheres labeled "White Haven Hospital for Poor Consumptives," and follow in his wake.

Soon we are rattling up a village street and beside us sit the two men we had noticed leaving the train.

After passing through the town, we are

jolted over a rough country road, and finally, when we are about to catch our breath, as we strike a smooth piece of road, the driver jerks back his head and says, "We're most there now, but we got one pretty steep piece yet afore we get there," and with that we begin the ascent of a rather high hill. Then when we have held our breath and, incidentally, the side of the wagonette, we suddenly find ourselves rolling along the top of Mt. Yegga, into the grounds of "The Pennsylvania State Hospital for Tuberculosis."

It seems almost as if it were a little town of its own that we find ourselves in the midst of. The larger buildings, which include the dining hall, infirmary and administration building, seem to form a nucleus around which are grouped a long line of regulation army tents which accommodate four patients each. These are for the men. On the other side are the three brick cottages, bright and airy, the women's quarters.

On the slope of the mountain stands what is known as the "barn." This is also used for the men and it was in this building that the sanitarium was first started. In those days it was a barn in the true 'sense of the word, even to the cracks in the walls through which the snow might drift. Now it is nicely finished off inside, and resembles very much a hospital ward.

Here and there throughout the grounds we see small sheds facing the south and lined up under these sheds, in very comfortable-looking steamer chairs, we find the inhabitants of this little mountain top town, taking the "cure." And a happy crowd they appear to be. We hear a chattering of tongues and much laughter, and if we happen to see one who is quiet, it is because he or she has settled comfortably back for a little nap in the sunlight. Of course there is coughing; it would