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of all women she is best prepared for military service. She knows how to put her ideals into practical use, she has been accustomed to keeping faithful watch while others slept, to making accurate observations and concise and unexaggerated reports of her patients' symptoms, to obeying promptly the orders of her superior officers in the same spirit in which soldiers obey, and to giving orders to those under her and for whose work she is responsible. The fear of personal danger will not keep her from enlisting for war service. She is used to danger, and would be a poor representative of her profession if she were to consider her own safety and comfort first. Infectious diseases did not come in with a state of war, and to this particular danger the nurse is less exposed than many others. would be, because she has learned how to protect herself and others from infection. She knows that it is going to be a difficult undertaking to supply enough nurses for foreign service, that the base hospitals will need a small army like her, and that the cantonments and the sanitary zones surrounding zones surrounding them also call for nursing service. She reads of battles in the trenches, on the sea and ir the air, and she feels a restlessness and longing to be near the front because she has a tremendous pity for the men who are in danger. It is inevitable that many of them be hurt, but the thought of their suffering unnecessarily for want of nursing care which she could and would so gladly give, makes her anxious to share the dangers. The love of adventure and the knowledge of the possession of just the skill and experience needed for the service make the call very strong.

If our nurse happens to be a member of the staff of a nursing organization it may be right for her to go. Probably the other members of the staff are willing to work a little harder or it may be that the establishment of a new branch of work which was planned can be delayed, so that she can be spared for the greater need.

If, however, this nurse should be the one and only representative of her profession in a small city or rural community she will remember that her people need her as never before. The city organization may be able to meet the extra responsibilities with depleted ranks, but what of the community whose whole nursing force departs? The call to remain at her post cannot go unheeded by the conscientious nurse. The effects of war will be felt in all communities large or small. The departure of the men and youths who are enlisting for war service will take from many families their protectors and breadwinners, thus in many instances lowering the family income and standard of living; will bring about abnormal social conditions by sending women and girls into industrial positions, leaving the aged, the prospective mothers, infants. and children without their usual care and comforts, and will cause more than ever before the demands for the services which the public health nurses are giving and are especially qualified by their training to give. In the smaller cities and rural communities there are no agencies or charity organizations and the nurse is the only welfare worker. The absence of physicians who have enlisted for service has also laid upon the shoulders of the public health nurse a few added responsibilities. If after hearing the call to go to the front

this nurse decides to stand by her post, it is not because she is a slacker but because she is a patriot.

One real war problem of the public health nurse is the fact that her community in its enthusiasm for Red Cross work has forgotten her and her needs and the needs of the people at home. It has forgotten that "civilian health is the rock on which military efficiency rests." Dr. Herman Biggs of New York State speaks of the service. of the public health nurse as follows: "If we as a public are to conserve our greatest war resource, the health of our people, the individual must realize the part that obedience to the laws of health plays in the working out of our united destinies. No one can bring this realization to the people that need it most, repeatedly as it must be done, so well as the public health nurse." No loyal American wants this war to last one minute longer than is necessary, and in order to hasten its end, we must do extra work and make special sacrifices, but it will surely weaken. our defense to neglect health work already established at home. Our

men at the front will need tons of sweaters and socks and surgical dressings too, and they can all be made by already busy women if there is no time left for bridge whist and no money left for ten dollar knitting bags in which to carry fifty cents' worth of knitting. Both needs exist and we cannot afford to forget either the public health nursing or the war supplies. The hour of service is at hand.

Arthur Guy Empey, American volunteer in the British Army, says in his book "Over The Top": I can't see any sign of peace for three years. It will be a long war, and every one will be needed. About 30 per cent of the work will

be done by the men in the trenches, the rest must be done at home by the women, by those too old for service and by those physically unfit for fighting. The sooner we realize this the better." For the women who are no longer young enough for active service there is plenty of work. Their wisdom and experience is of value in planning for the country's home needs as well as for the needs of the enlisted men. Some of them have made the supreme sacrifice and have given their sons, and they will be asked to lend their daughters. There are many women who are physically unfit for active service, and more who are held back by insufficient preliminary education. Some are already doing work which it would be inexcusable to leave, and it is the part of patriotism to stand by one's post if by so doing one can serve the country better than by going to the front. But in this United States of ours are thousands of young women who are strong in body, who have had the advantage of a good education, who have no one dependent upon them, and whether the war lasts three years longer or three days longer, one thing is certainproperly qualified nurses will be desperately needed both at home. and abroad for years to come. Should the work of destruction in the European countries end tomorrow, the work of reconstruction could at best but make its beginnings, and thousands of young women with trained minds and skilled hands will be in demand for that service.

At home the field will be unlimited. Our tuberculosis problem will probably grow with every month of the war; we must do more for the health and welfare of our rural mothers and their

babies; Compulsory Health Insurance is on its way, and in this country public health nursing is included in the plan; and 12,000,000 rural school children need physical inspection and school nursing.

If it were possible for young women to take a three weeks' course in nursing and then be ready for service we should probably have many volunteers, but the long course in the hospital is necessary in order to acquire the technical skill and the mental and physical training and discipline as well as the knowledge of the care of the sick. and the prevention of disease. It takes many long months to train soldiers, but they are serving the country the minute they go into training camp; and as soon as a woman enters a nursing school she "becomes part of the nation's war equipment" and is giving patriotic service. Because she is working in the hospital under the supervision of an expert, she may very soon be able to take the place of some graduate nurse who can be spared to go. Columbia University has given its wonderful base hospital for our soldiers' needs, but it might as well have presented the nation with a toy factory if no doctors and nurses can be found to care of those for whom it was given. Untrained and half trained nurses are of no more use at the front than are untrained or half trained soldiers, and judging by the reports no effort is spared to see that the soldier is prepared for the responsibility which he must meet. There is no use in sending burdens when it is burden bearers that are needed, and the woman, like the man, who goes to the front must be able to care for others as well as for herself.

Looking into the future one cannot help wondering what will be the outcome of our struggles and anxieties. As terrible as warfare must necessarily be, the results, we hope, will bring better conditions. For the profession of nursing, we may safely prophesy higher standards, because the public will see that the method of training nurses is partly its responsibility, and better facilities for nursing education will be provided. More and better educated women will enter the nursing schools when schools offer the right opportunities. War already has had a strong influence in the development of the nurse. The Crimean war produced Florence Nightingale, and her vision and ability organized the first training school. Our National Government has recognized the value of the nurse in time of war and has appointed Committees of Nursing on its Council of National Defense. Our Miss Crandall, who is the secretary of the three committees, wrote: "It is particularly fortunate to have established at this time this official connection between the Council of National Defense and the National Associations of Nurses, because it unquestionably offers the greatest opportunity that has ever come to nurses since the days of Florence Nightingale, both to serve humanity and to lift their calling to a new and higher professional status." If war teaches us the dignity of work well done, the vulgarity of extravagance, the prevention of preventable diseases, the sisterhood of women, and the responsibility to all the children of the world; out of its horrors and problems and responsibilities may come a better civilization than the world has yet known.

INSURANCE STATISTICS SHOW GROWTH IN DEATH TOLL OF LOBAR PNEUMONIA

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tibly over the preceding four years. The severe grip epidemic in 1916 may have had some bearing upon this result.

Although prevalent at the early ages, lobar pneumonia is not essentially a disease of early childhood. When it does occur in young children it is very frequently fatal. The disease reaps its greatest harvest at the ages over 65. At these ages it is one of the chief causes of death. The insurance figures, furthermore, show that negroes have a much higher mortality rate than whites. This is true for both sexes and for every period of age. Pneumonia has a higher death rate for male than for females.

WHAT DELAY HAS COST.

Without any intentional desire to do the city of Piqua a great harm, the United States health department has caused to be nationally published a review of the local health situation, as it is affected by the water works, to the great detriment of Piqua.

Everybody here knows that the water supply is bad and always has been and that for years it has been a menace to health but the government report, as it has been treated in a news dispatch from Washington, puts the situation in an exceedingly disagreeable light.

The very thing that this newspaper long ago advocated as a reason for swift action in the water works matter has come to pass — the wide publicity of a condition that the city should not have tolerated.

Nothing was achieved by defeating the bond issue at the election. last year because the state board of health had long before declared that our water supply must be changed and finally, after the people refused to vote for the bonds, the state officials exercised their authority and forced upon the people what they had refused to accept.

Between the time the election was lost and the present time a national expert came here, and now he has added his uncomplimentary findings to those long ago made by the state board, and sent broadcast the information about our unclean water supply to the further detriment of the city.

It all goes to show that the interference with a strictly business administration of a city's affairs brings trouble and that the refusal to accept the advice of competent experts is a mistake

If the new water works bonds had been voted by the people the installation of the plant would long ago have been started and the national expert's survey of the city would have been unnecessary and the city would have been spared the exceedingly disagreeable reflection cast upon our community by publicity that has reached the eyes of thousands of people throughout the country.

Only misfortune has been caused by the delay and additional cost, for there has been a great increase in the price of every piece of material that will enter into the construction of the new plant. It means that more money must be spent to achieve the same result or that every element that was first proposed for the new system can not be utilized as originally planned.

It has been a costly delay and must be cause for the leaders of the opposition to the bond issue to feel that they not only achieved nothing by their opposition but actually brought a misfortune upon the city. Their intentions were no doubt good, in many instances, but rather than pursue individual ideas it would have been better to have accepted the recommendation of the councilmen who had made an investigation and consulted the experts.

There are rumors, that even since the state has ordered a new water supply, that some opponents will seek to interfere with legal proceedings and thus further delay the needed improvement. But it seems inconceivable that any good citizen would take a part in any plan intended to increase the predicament the city is now in.-Piqua Leader Dispatch.

A PROGRAM OF PUBLIC HEALTH FOR CITIES.*
W. C. RUCKER

Assistant Surgeon General, United States Public Health Service.

Considered in its broadest sense, the ultimate reason for cities is public health. Every other reason for which mankind collects itself into more or less permanent aggregations is subsidiary to the basic idea of community protection and betterment of every sort. This protection is external, against the outside world, and internal, each individual against the entire collection of individuals. Since every action which produces a betterment of the conditions under which the community lives and works gives a definite reaction in increased health, it is at once seen that a public health program for cities is in reality nothing more nor less than a complete plan for communal existence.

The collection of individuals into communities without the direct interposition of health protective measures is possible up to the biological limit of individuals per acre. The moment that concentration is increased beyond this point there is increased opportunity for promiscuity with a coincident intercommunication of disease and reduction of the acreage ratio below the biological limit. Therefore.

* Published in Public Health Reports, April 6, 1917.

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