fails to return for treatment, and notice from another physician is not received that he now has the case under observation, the physician first reporting the case must turn in the name and address to the State Board of Health. Also, the names of those patients that fail to observe precautions to prevent the spread of infections must be reported to the State Board. This authority will then see that the negligent patient receives proper treatment, and if necessary, his quarantine or isolation may be ordered. Immoral women found by physicians to have these infections must have the house in which they live placarded, just as in the case of smallpox, unless she can be removed to some hospital or other place where the treatment of the case can be continued and the spread of the disease prevented. In order that patients may know just what precautions are necessary, a circular of instruction has been prepared and has been furnished to all physicians for distribution to their patients. These circulars also contain advice regarding the proper measures to observe to hasten the cure and prevent the transmission to innocent women and children. A wise provision of the law requires every druggist who sells remedies for these diseases to report the name and address of the purchaser to the State Board of Health once each week. These persons are visited and informed that druggists are not competent to treat such diseases, nor are patients able to treat themselves with patent medicines, and each such patient will be placed under the care of a reputable physician or taken care of through a clinic or institution. Parents or guardians are made responsible under the law for the compliance of minors with the regulations to prevent the spread of infection. One common custom of past practice—sending the patient on to some other town or state—will be controlled under the new law, for the reason that infected persons will require a removal permit before they can change their residence, and also a permit from the health authorities having jurisdiction at the new location before residence can be changed. Failure to secure either of these permits makes the patient guilty of a violation of the law. The period of control of these diseases is determined by definite regulations and shall continue during the time the disease is in an infectious stage. Persons affected with these diseases are prohibited from engaging in certain occupations, the nature of which is such that their infection is likely to be borne to others. Now, there are no provisions of these regulations that are unreasonable or illegal. No publicity will attend any case where reasonable cooperation is secured from the patient. Where a patient insists upon a supposed right to spread loathsome diseases to others, a spread which is declared unlawful by the State Legislature, such a patient, either man or woman, must be controlled by the state, because the right of unbridled license cannot be recognized even by our free democracy. Under this State Board of Health regulation, the Public Health Service is securing the reporting of venereal diseases in two counties of the state where cantonments are located, and are controlling infected persons. A free clinic for treatment and an isolation ward for hospitalization of infected women has been established and are operating satisfactorily. The United States Public Health Service is co-operating with State Boards of Health throughout the entire United States for the control of these diseases, and while this has been started as a part of the program, Public Health in Wartime, there is not a doubt but that intelligent public opinion will demand and secure its continuation after the war is ended. All of the sanitary work that is being done as auxiliary war work has a greater significance than the actual saving of lives, and the resulting prosperity. The great potential value of the work is the education millions of people are receiving in regard to what can be accomplished toward the elimination of disease. This war will be followed by a reconstructive era unprecedented in history. For the past four years, and who knows for how many more years, but little has been, or will be done, throughout Europe and North America to maintain and repair the machinery of civilization, except where it has a bearing upon the winning of the war. When the world has been freed from the menace of the unspeakable Hun, a great and new era of progress, prosperity and creative industry will keep us busy for years. Then will the survivors of the war reap the full rewards of the strenuous efforts that are now being made to conserve the nation's man power. From the army will come millions of men that have been taught that cleanliness of person and surroundings are health creating agencies; men that will know the value of exercise and plain, nourishing food; will know that alcohol and vice undermine the physical and mental development; that will know much about the methods of transmission of diseases by insect carriers and direct contact. From the localities in which vast demonstrations of the value of community sanitation have been carried out will come the support that is needed to secure adequate funds for purchasing public health; will come the desire to have proper laws governing housing of those of moderate means; the elimination of the slums, the dive and the brothel, because these act as foci from which diseases spread, and as foci for those forces that undermine the resisting power of the nation. Therefore, the future will bring a new era of enthusiasm for sanitation. The health department appropriations will be larger; the various political units throughout our country at least will demand full-time, competent, trained health officers and public health nurses; and intelligent control of all communicable diseases, no matter what their nature, so that a world made a decent place in which to live, through the sacrifice of millions of human lives, may also be freed from the menace of preventable diseases. WARTIME DEVELOPMENTS IN PUBLIC HEALTH NURSING Introductory Address by Mrs. Bessie Amerman Haasis, Educational Secretary of the National Organization for Public Health Nursing, New York. During the past year Public Health Nursing has experienced a revolutionary change in its standing with the public. The necessity heretofore has been for the most part to create a demand for such service, while now it is facing such an enormous demand that the creation of a supply is the acute problem. The factors which have stimulated the demand have been as follows: 1. The findings of the draft, of large numbers of physical defects which the surgeons tell us might have been corrected or prevented during school age. This has created, the country over, a great interest in and demand for school medical inspection and school nursing. 2. The Children's Year program of the Federal Children's Bureau, needing for its fulfillment large numbers of nurses to do both general community work and specialized infant welfare nursing. 3. Greatly increased public interest in conservation of health, demand of Red Cross Home Service workers for public health nursing, and of industries for nurses to look after the health of employees. 4. Establishment of public health nursing units in connection with sanitary control of civilians in zones outside the cantonments, under the direction of the United States Public Health Service. 5. Calls for large numbers of public health nurses to inaugurate and carry on tuberculosis clinics and work with patients in their homes in France, also infant welfare work in Paris and throughout France. Public health nurses are having pressure brought to bear on them from every side for service. Most of them are doing very valuable work in their own jobs, which while lacking in glamour, is really indispensable in protecting the health and welfare of the population in this country, on which depends the welfare of our soldiers in the trenches. The demand of friends and strangers that they do the more spectacular service is hard to deny, and they need every bit of moral support in staying where they are. The Red Cross itself has recognized this and is about to give a service badge or chevron to all of its enrolled nurses who are engaged in indispensable service at home, either in public health work, teaching in training schools, or other vital nursing work. This in no sense means exemption, and if conditions abroad become more acute, the balance will have to change, and some of even these workers will have to be sent to actual work in military hospitals. We must help create public sentiment to honor the nurses who are doing the less spectacular thing, but are none the less rendering real war service in sticking to their home jobs, to make the country and its families effective in supporting its military forces. Systematic effort has been made also during the past year to increase the supply of nurses, particularly of public health nurses, but as this takes long periods of time, it has not kept pace with the demand. The Committee on Nursing of the Council of National Defense has systematically sought to stimulate the entrance of women into training schools by public meetings, pamphlets, letters, newspaper publicity and the raising of scholarship funds, and has been successful in recruiting in this year's entering classes about 20 per cent more than the average number entering year by year. The Vassar Training Camp is making an especial appeal to the graduates of the past ten years of our women's colleges, offering them an intensive course of theoretical instruction covering three months, after which they will be received into the best training schools of the country to complete their training courses in two years. This is going to bring into the profession the fine type of women who will be needed more than ever in the work of reconstruction and the already established branches of nursing work, after the war, and is offering to each such recruit the opportunity of "releasing a nurse for the war" within a very few months. The full number of 500 that can be admitted is already almost entirely made up. Other universities are making similar arrangements, though in some instances accepting women of less than college training, notably Western Reserve, University of Iowa and University of Califorinia. The already established eight and four months courses for training public health nurses are being aided by the raising of special scholarship funds, the Red Cross having subsidized two, in Boston and New York, each of which can thus prepare at least 60 nurses a year in addition to their usual numbers, for the public health field. The inclusion of theory and practice in training schools where competent instruction in such subjects is available is being extended and stimulated with the result that several hospitals in Boston, New York City, Richmond and elsewhere, are releasing their senior students to take four months courses as part of their three years' training, and many others are releasing them for two months' experience in social service departments or for field work with some public health organization. To meet the war emergency, a special short term of field work and intensive instruction, covering ten weeks, has been planned by the National Organization for Public Health Nursing, which will assist in its presentation in those states where a state supervisor of public health nursing is or will be appointed, to carefully follow the workers after they are placed in their communities, to continue their instruction and to standardize their work. It is hoped that this state supervision will hold over from the war emergency period and become an integral part of the plan of every state for its health protection, just as public health nursing has been recognized as an integral part of community health protection by the United States Public Health Service. In conclusion, two great needs are apparent. 1. To recognize the value of public health nursing as a war necessity here at home, and to create sentiment against depleting the ranks of those experienced or specially prepared for it, in recruiting for army hospital service. 2. To help maintain the standards of training for public health nursing, and as an aid to this, to persuade communities who wish such nurses to wait till they can get a trained worker, to subsidize if necessary the training of their workers, and to help maintain trained supervision of the work after it is established. SANITARY CONDITIONS ABOUT MILITARY CAMPS AND PARTS PLAYED BY THE PUBLIC HEALTH NURSE Mary E. Lent, Director of Nursing in Extra Cantonment Zones, United States Public Health Service, Washington The United States Public Health Service has taken charge of sanitary conditions in zones surrounding the camps, for the better protection of the health of the troops in the camps. In each of these zones the officer sent by the service seeks to co-ordinate all existing health activities, and by various means to supplement such service as already exists by the employment of other workers—bacteriologists, sanitary inspectors, and nurses, supported by public or private funds, so as to secure a well rounded health protection service. This includes such work as the inspection of all stores handling food and their employees, and while this has been primarily for the protection of the health of the troops, it has also set a new standard which is appreciated and taken advantage of by the civilian population. The elimination of the fly and mosquito breeding groups, the examination of school children for communicable diseases, and many other functions, have thus had a double usefulness. Example of Service It may be of interest to note just how and why one of these zones was established. In the spring and summer of 1917, a typhoid epidemic was in full sway in a certain town. The local health authorities were unable to check it. This town being adjacent to a big army post, they sent out the "S. O. S." In August, 1917, the first government health officer arrived, and a short time after, the American Red Cross had a unit in the field, and work started immediately. Officially each of these zones are known as an Extra Cantonment Zone and Red Cross Sanitary Unit. The personnel of this particular zone consisted of: one medical officer in charge, one assistant surgeon, three United States Public Health Service nurses, three Red Cross nurses, one sanitary engineer, one chief sanitary inspector, one bacteriologist, one assistant, one milk inspector, three sanitary inspectors, one clerk, and one stenographer. Two Ford cars were donated by Henry Ford through the Red |