ceedingly difficult and in fact frequently impossible, but where more than one or two cases occur it becomes easier to locate the source of the infection. In any community the appearance of more than one or two cases of typhoid should call for an investigation by some one familiar with just this kind of work and the State Department of Health will, upon request, make such investigation wherever possible. In serious epidemics, where many cases occur, no time should be lost in appealing to the State Department of Health for assistance.

WARNING IS ISSUED

AGAINST FREAK FOOD

SUBSTITUTION IDEAS As Canada has learned pretty well what war means, the Toronto department of public health warns that there is a certain amount of danger at a time like the present, when everybody is searching for cheap foodstuffs, of being carried away by faddists.

Canadians, for instance, were advised to make use of mushrooms instead of other foods, particularly peas and beans. Whereupon their health officials had to turn around and point out that mushrooms are not easily digested in the stomach. and that absorption in the body of the food material actually present is also very imperfect, one observer finding 33 per cent. of the protein escaping absorption. One-third of the nitrogen present in mushrooms is also in a form useless for the purposes of nutrition.

The fungi such as mushrooms - must therefore be ranked in value with such substances as green vegetables and carrots. That is,

they are useful in giving bulk to other foods, and in offering variety to the diet but practically negligible in providing the needed protein or body building material.

The Germans have tried out many substitutes for the standard articles of diet, but have found it exceedingly difficult to get away from the main sources of supply.

Their efforts have only gone to prove that nature has utilized as storage warehouses for fuel and body building material the seeds of wheat, corn, rice, beans, etc., and the various nuts which we have found to be suitable for food.

The Germans in their searches for substitutes for common articles of food have found that oak leaves contain nearly 15 per cent. protein and 3.8 per cent. of fat; that birch leaves contain 4.3 per cent. of protein and 10.6 per cent. of fat, and that willow leaves contain 13.5 per cent. protein and 3.6 per cent. of fat.

So far, however, it seems they have not found it economically possible to extract this food material. which in the aggregate would amount to a good deal.

Nor can the human being eat leaves and assimilate the food material present any more than he can assimilate hay or straw.

Canadian health officers, then, from their own wartime experience are convinced that the attempt of the world to restore a surplus supply of food must be along the lines of producing great quantities of the concentrated foods already known rather than to expect to find new sources of supply. - Dr. R. H. Bishop, Jr., Cleveland Health Commissioner, in Cleveland Plain Dealer.

UDGING by personal experience, by reading magazine articles on the subject and by constant communication with many nurses in many communities, I should say that the public health nurse had had plenty of problems to solve before the war. Her work being that of a pioneer, brought to her fresh problems and untried responsibilities every day. Not only was it necessary for her to do her daily work, but she was frequently compelled to seek it out, and to prove to an indifferent public or to a group of skeptical physicians or officials that she and her sponsors were not playing with a fad, but that public health nursing had came to stay because the results proved its worth. It was her duty to ever bear in mind the fact that

her reports must be so interesting to her executive committee that the interest could be passed on to those who financed the service, and she could not forget that the patients' affairs and confidences must not be betrayed even to excite interest in the work. One rarely heard of difficulties between the nurse and the patient. If she were a graduate of a good nursing school, her training had taught her to meet graciously almost any kind of at sick, human being as well as his family and friends. Having met so many types in the hospital, it was not hard to meet them in their

homes. Boards of Education and Boards of Health had been in many instances of the greatest help, but unfortunately sometimes the greatest hindrance to the work.

As I try to tabulate the war problems of the public health nurse, I do not find many of them. which did not exist before most of us dreamed of war. Probably no one has any complaint that there is not enough trouble and anxiety and responsibility to go around, and the public health nurse is no exception. We have not yet solved our old problems, many of them have become exaggerated by present war conditions and we have a few new ones added to the list.

The first problem which presents itself to those who are interested in public health nursing is the scarcity of public health nurses. The National Nursing Committee of the General Medical Board of the Council of National Defense has recently made a tabulation of the nursing forces in the country, and the report printed in the last Bulletin of the National Organization for Public Health Nursing, while not complete, is as follows: 79,000 registered nurses in May, 1917.

120,000 others are rendering nursing care.

200,000 persons engaged in nursing. (A large majority of

these are engaged in private nursing.)

6,000 public health nurses. 13,000 students graduated annually.

We hear from all sides that the war has caused the shortage of public health nurses, but looking back a few years one finds that this is not altogether true. Long be fore the Germans invaded Belgium the demand for public health nurses far exceeded the supply. To those of us who have worked for the extension and standardization of public health nursing the greatest difficulty has not been found in gaining the interest of local communities, but in finding properly qualified women to take the positions which are open. Of course the extra demand for nurses for cantonments and sanitary zones surrounding them, for base hospitals and for foreign service greatly exaggerates the problem but it is by no means the cause of it. Aside from any calls for war service, no one could have foretold the increasing demand for public health nurses nor the demands which are already being made upon them. The large city organizations have constantly been extending their nursing services and the small cities and rural communities are establishing nursing centers and calling for trained women to take up the work.

Some of the causes for the shortage of public health nurses are of too long standing to be overcome easily, but we recognize what some of them are, and are trying to get at the root of them. After a three years' hospital course most young graduates feel that they want to earn money as soon as possible; and the thought of spending another year or two in taking a post-graduate course to prepare for

public health nursing or to take a position in some nursing association with a very small salary does not appeal to many of them. From the day of graduation the young nurse can earn twice as much money in private nursing as she can in the usual positions offered public health nurses. One thing we may be sure of nurses who take up public health work do not make their choice for the money there is in it.

Training schools for nurses, which have been established in connection with hospitals, have been dominated by the needs of the hospital and the medical profession, and the education of the nurse has been such as to meet those two needs and no other. There has been insufficient public interest in the character of the training which has been given to nurses in these schools. Practically every effort which has been made to place nursing upon an accepted professional basis has come from the nurses themselves. A change has taken place within the last few years which has created a demand for graduate nurses with social service training as a necessary part of the health organization of a community, and this has brought forth a direct public interest in every circumstance back of the products of the training schools for nurses. The demand for public health nurses has made it imperative for those who seek to supply nurses for positions to know what the current standards of training schools are, and there is dissatisfaction with these standards. Previous education required of applicants for admission is often inadequate and too little attention. is paid to the previous home training. No amount of hospital and (Continued on page 514.)

HE most prevalent illness in

THE

the United States is the common cold, a disease group included under one name and considered of such minor importance that vital statistics do not record the enormous number of persons who annually are subjected to suffering, inconvenience, and economic loss thereby. Remarkable as it may seem, the widespread familiarity with this condition has bred a contempt which hides its seriousness, yet when the sum total of the ravages committed by common colds is made it becomes evident that instead of being a group of trivial affections common colds must be classed as serious diseases.

The phrase "common colds,' like "charity," covers a multitude of sanitary sins, and curiously enough the name has been applied to a group of affections which, far from depending absolutely on cold. are frequently the direct result of living in close, overheated surroundings having a lower relative. humidity than the driest desert known to man.

What is a Cold?

thus producing pneumonia. In this connection it may be pointed out that pneumonia kills more people in the United States than any other disease excepting tuberculosis and heart disease. Many pneumonias begin as a common cold. Colds do not produce tuberculosis, yet unfortunately what is considered as a cold may be in reality the first symptoms of the white plague..

Colds Due Only to Germs

The causes of colds are multiform and not entirely understood. In every case, however, they are dependent upon the growth and activity of living germs which are always received from other people. It is true that almost everybody harbors disease organisms in the mouth and nose, and that these under favorable conditions will produce a cold in their host. But these germs in every case were received from some other person. In other words, colds are infectious. It used to be thought that sitting in a draft or a prolonged stay in the swimming pool would. produce a cold. This is erroneous. but the chilling of the body which the draft produces and the weaken ing of the vital forces caused by too long a swim lower the powers of resistance and permit germs which have hitherto been harmless to their host to produce their disastrous effects.

the simple ordinary coryza, which is a polite running at the nose, to the sore throat, the aching chest, fever, and generally "knocked-out" feeling. The cough, the sneeze, the headache, and the varying degrees of inefficiency which a cold produces are, alas, only too well known. Common colds occur in epidemics and are distinctly contagious. They sweep through an entire household, an entire city, an entire State, attacking the young, the adolescent, the middle aged. and frequently carrying off the aged, the weak, and the debilitated. Schools, factories, stores are suddenly crippled by epidemics of this sort, and the complications and serious disorders following the disease add to the great economic loss produced in this way. Infection of the cavities beneath the cheeks and brows, ear derangements, chronic lung infections, rheumatism, heart disorders, kidney impairment, and depressed vitality may all follow in the train of this widespread infection.

How to Prevent a Cold

To prevent a cold it is necessary. first of all, to keep the body resistance at a high point of efficiency. This means that the body machinery should be kept in good order at all times. Good wholesome food in proper amount, plenty of sleep, the careful attendance to the voiding of the body wastes, the taking of regular exercise in the open air, keeping the body clean, keeping the mouth and nose clean, the avoidance of hot, stuffy, dusty rooms, the avoidance of exposure to sudden changes of temperature, the prevention of the chilling of the body either by cold or wet, are all protective measures. It should be borne in mind, however, that even robust persons may contract colds from people who have them.

The germs of colds leave the body in the secretions of the mouth and nose. They enter the body through the same route. Thus a careless sneezer and the person who does not cover his mouth and nose when he coughs are breeders of these infections. The little living bodies which cause colds are so small that a million could rest on the head of a pin. When a person coughs or sneezes, a fine spray carrying with it untold numbers of these germs is spread into the surrounding atmosphere to a distance. of several feet and may be easily taken into the mouth and nose with the respired air. More direct contact, such as by kissing, the common drinking cup, the common roller towel, by pipes, toys, pencils. fingers, food, and other things which have been contaminated by the mouth and nose secretions of a person having a cold may also carry the disease.

Keep Your Cold to Yourself It is an obligation on the part of persons having colds to see to it that they do not spread these colds to somebody else. The person who neglects to cover his nose and mouth when he sneezes and coughs, the careless spitter, the person who permits his germ-laden discharges. to contaminate things which are going to be handled by other people is a menace to the community. If such a person uses public swimming pools, if he is not amenable to reason and persists in distributing his infection, he should be avoided as a spreader of pestilence.

A good deal has been said about hardening people so that they will not contract colds. There is an element of danger in this, since to expose a weak person to the rigors of cold baths and cold drafts is apt to lower resistance, thus favoring the very condition which it is de