Anatomy.

The course in anatomy, four hours per week, was skilfully arranged to run three or four lectures, then a dissecting period, lectures again, followed by a written review of the whole. To cover the essential ground in three months the professor of anatomy was obliged to exert considerable compression under each heading, with the result that the bluejackets had to be unswervingly attentive to keep up the pace. But they stood the drive well. Anatomy started with fundamental definitions, names of surface parts, and outline of the body. then covered structural units, cells, tissues, organs, systems. So much led to epithelial tissues, stratified, transitional, simple, columnar, and connective tissues, areolar, adipose, cartilage, fibrous, reticular, elastic, lymphoid, bone. In equipment the Institute of Anatomy at the University is unsurpassed in America. So with a wealth of wax models and charts to illustrate every point minutely, the men were not slow to absorb the salient points of a lecture. Further, the professor used colored chalks and blackboard frequently to demonstrate structures not otherwise perfectly clear. Laboratory dissection in the foregoing completed the cycle, and led next to a consideration of the skeleton. Here the axial and appendicular divisions were taken up, bones of the skull, the vertebral column, thorax and upper limb, pelvis and lower limb, and the classification of joints. Then another demonstration, an hour of dissecting and reviewing each point emphasized in the lectures. Next the muscles, of face, head and neck, together with those of the chest, abdomen, upper and lower limbs. The membranes and glands, vascular system and blood, introduced the topics of heart and circulation, preparing the bluejackets well for cadaver examination of muscles and heart. Arteries, veins and capillaries followed, with arterial distribution, and a demonstration in dissecting the circulatory system in general. Ensuing were lymph, lymphatic vessels, nodes, ductless glands and function, respiratory apparatus, larynx, trachea. At this point was given a one-hour written review:

1. What muscles form the anterior abdominal wall? Give function.

2. Describe the heart and three kinds of circulation.

3. Define artery, vein, capillary.

4. Name and locate the ductless glands. Describe their functions.

Physiology.

Bronchi and lungs occupied the next lecture, covering the physiology of respiration, and in order, the alimentary canal and the physiology of digestion. Of all the dissecting periods none was more fascinating to the sailors than that which gave them the opportunity to explore the food tract,

"from gullet to colon," as one of the men swiftly phrased it. The urinary system, following, was hardly of less interest, involving the elimination, secretion and characters of urine, then the skin and its appendages, surveying heat-production, loss, distribution and regulation.

The final subjects of the course were the nervous system and the reproductive system. Under the former, neurones, brain, spinal cord and functions. sympathetic nerves, special sense organs of eye, ear, nose, taste, touch, and pain were thoroughly outlined, together with an exhaustive laboratory dissection of the whole.

So much for a three months' war course in anatomy, for sailor medical assistants. I have threaded this course in detail so that the profession might obtain a perspective on a typical subject, than which none is more significant and consequential in the study of medicine. Equal care was exercised by the faculty in mapping the remaining courses, but it would be tedious to physicians to buffet so many ramifications of each, so I shall touch upon only the principal headings, leaving their subdivisions to the abundant imaginations of my readers.

Drug Study and Therapeutics.

Materia medica, therapeutics, and pharmacology were known collectively to the bluejackets by the latter term. This course included three lectures per week and a double period in the laboratory. To begin, six lectures in chemistry were given. Physico-chemical conceptions, carbon compounds, the benzol ring, the common metals according to Mendelejeff. Then general pharmacy-weights and measures, utensils, prescription writing, in order. were discussed; and, demonstrated on animals, general and local anesthetics, soporifics and sedatives, salicylates and antipyretics, with careful notations on dosage and effects. Circulatory stimulants were viewed primarily from their action and modes of administration. Extra attention was given purgatives, bicarbonate of soda and alkali therapy. Specific therapy, after covering quinine, ethylhydrocuprein, emetin and arsenic, focussed on mercury. Lectures on the common antiseptics stressed in conclusion those two great wartime agents, Dakin's solution and dichloramine-T. Each navy man finished this course believing himself better informed than many druggists, and the belief, I think, could be substantiated.

Physiologic Chemistry.

The bluejackets had twenty-nine hours of physiologic chemistry, a study abstruse to the youth; but the youth is a twig susceptible of being bent in the right direction. Sixteen hours were given to the composition, properties and importance of carbohydrates, fats, proteins and inorganic matters, their relations as foods to bodily tissues. The remain

ing time was claimed by digestion, the chemistry and pathology of urine, and by metabolism. Every point was illumined by vivid chemical tests.

In physiology the apprentices studied through lectures and laboratory exercises the muscles and nerves of the animal machine. This work com. prised stimulation and response, types of stimuli. conduction and the nerve impulse, types and chemistry of muscle, demonstration of fatigue, hygiene of muscle and nerve, and rigor mortis. Under the nervous system were given neurones and nerve fibers, afferent and efferent pathways, reflexes, the medulla, cerebellum, and cerebrum. Circulation

took in structure and control of the heart, blood vessels, and the vaso-motor system. The lectures

surgery, and extraction. Aboard ship they will know how to give first aid to fractured jaws, as well as to aching teeth.

Paper Work.

It should be noted that throughout this semester of collegiate instruction the bluejackets were given in addition the specific clerical work incident to the management of a navy sick bay. One double period each week, under the surveillance of a chief pharmacist's mate of broad experience at sea, the hospital apprentices were instructed in compiling the morning reports of sick, the binnacle list, the monthly report to the Bureau of Medicine and Surgery, and in the official procedure for ordering supplies. Too, at the naval hospital of the Minne

To bacteriology was given one entire morning each week. Here was a captivating subject! Every boy is curious to see how B. diphtheriae or B. tuberculosis looks under the 'scope. He is just as inquisitive about the pneumococcus, the staphylococcus, the streptococcus. Aside from the study of these more common pathogens, the hospital sailors learned how to make stains and cultures, then proceeded to such vital subjects as transmission of infection, disinfectants, and the bacteriologic examination of water. This course was followed by a short program of urinalysis-appearance, reactions by litmus, specific gravity, albumin and sugar tests, and sediment.

Dentistry.

At the College of Dentistry, too, the men studied prosthetics, oral hygiene and operative practice, oral

4. By no means negligible is the course in naval clerical procedure, by which the bluejackets learn the modus operandi of the sick quarters aboard a dreadnaught. In every respect these men must be real assistants to surgeons.

apolis detachment, squads of the men were trained in office management by the pharmacist in charge. So these medical bluejackets, now nursing sick comrades on the coast or aboard ship, are perfectly at home in their duties. The innovation by which they received their superlative schooling was not one-sided in its benefits; at no time was the importance of the essential naval drill and classwork swamped by college.

Hospital Work.

This brings us to the actual hospital work which so admirably balanced the teachings of the medical professors. Bandaging was given by the superintendent of nurses, in six periods of ninety minutes each. The men learned the art through actual practice in applying the fillets to one another. In the first lesson, with one- and two-inch bandages, were given such common types as the gauntlet (with and without tips covered), the spica of thumb, and two upper extremity kinds, the spiral reverse and the figure 8. The next lesson, two and one-half inch

widths, the men learned the figure 8 and spiral reverse of foot and leg, the Barton, the double oblique of jaw, and the recurrent head. Then followed the crossed one and both eyes, the mastoid, varied types of Velpeau, 4-tailed, and handkerchief head. The course was completed with å demonstration of adhesive bandages and application and removal of plaster casts.

Dietetics.

In invalid cookery, briefly, the instruction covered liquid, semi-solid, light and general diets, under the guidance of the University Hospital dietician.

"The hardest thing to teach these boys is the points to be observed in service of the food," said the dietician. "They follow my recipes carefully and they make tasty dishes, but they would much rather serve coffee, for instance, in a tin measure than in a china cup. I believe they all must have camped out at some time in their lives, and this

impression every point brought out in the classroom and laboratories of the medical college. The course was in ten lessons, under the direction of the assistant superintendent of nurses. One entire ward was turned over to the exclusive training of the bluejackets, whose assiduous efforts at rubbing health into convalescents created more entertainment than a daily vaudeville. Also, smaller rooms were used for instruction in hypodermic administering, charting, poultice preparation, and for lectures by the internes. An operating room was given over to demonstrations and oral quizzes of the class in two large sections.

Starting with bed-making, with and without patient, the sailors were taught the use of back rest. cradle, air cushion, pillows, pads, swing, and then to take temperature, pulse and respiration. Then bed bath and toilet, care of back, preparation for night, administering medicines, computing and injecting hypodermics. The following lesson showed care of mouth and teeth, washing hair in bed.

5. In small groups the men are taught operation of sterilizers and tanks, and how to prepare sterile dressings.

tendency to favor tin persists from their camping days."

To specify, the bluejackets made for liquid diet such old favorites as peptonized milk, junket, ice cream and sherbet, albuminized beverages, acid and farinaceous beverages, gruels and broth. For the semi-solid lessons they were given cookery of cereals, cream sauce, cream soups, milk toast and simple desserts, while the light diet taught them the preparation of fish, chops, baked potato, green vegetables and baked fruit. General diet, of course, prescribed the cooking of steak, mashed potato, vegetables and farinaceous dessert.

Nursing.

The popularity of the work in practical nursing at the University was distanced in no other course. Here the men saw clearly and with a permanent

6. Saturday afternoon at the barracks of the Hospital Training Corps, U. S. Naval Detachment, Lake Calhoun, Minneapolis.

treatment for pediculosis, disinfection of excreta and bedding, preparation of specimens, charting. What might be called the first phase of this training was rounded off with drill in the application of hot and cold compresses, turpentine stupes, mustard foot bath, making and applying mustard plaster and flax-seed poultice, and the filling and care of hot water bags and ice caps.

Each of the foregoing duties was first explicitly demonstrated by the assistant superintendent and head nurses in the operating room. On the following day the bluejackets themselves proceeded to the ward and showed how much they had remembered. and were marked accordingly.

Pre-operative Preparation.

Preparation for operation and post-operative care followed, then a lesson on lavage, gavage, instillation of drops and irrigation of eye, ear, nose and

throat. Further important training was in the use of the pneumonia jacket, the Priessnitz compress, the cold pack, the sweat bath. An interesting demonstration conducted by the internes included the various enemata, enteroclysis, catheterization and bladder irrigation, shaving patient for operation, application of perineal dressings, precautions in care of venereal cases.

The last two lessons took up preparation for venesection, lumbar puncture, hypodermoclysis, paracentesis of chest and abdomen, and the application of abdominal binders, concluding with technique. for clean and soiled surgical dressings, Buck's extension and use of sand-bags, and the operation of sterilizers and tanks. This work especially dovetails well with the lectures in minor surgery, given

A

the sailors one hour each week.

Meeting Emergencies.

Such a comprehensive course of training is seen at once to fit the navy men for a hundred emergencies. Work embodying vicarious duties of nurse, apothecary and physician sets a pace which tests the mettle of the youth of average intelligence, and when he completes satisfactorily that work, he leaves the prosaic average far behind in the dust. Beginner in this far-reaching beneficence, the University of Minnesota has cut a pattern which beckons emulation in other medical colleges. Professors and nurses alike have evinced anxiety to give their acutest abilities to the righteous end that Uncle Sam's sea-fighters may be kept at the pinnacle of health.

By HENRY W. CHAMPLIN, M.D.,

TOWANDA, PENNA.

S MY TITLE suggests, there are various functions for lenses to accomplish, and my purpose is to emphasize those not commonly known or duly considered. As the laity are especially ignorant in this matter, the medical advisers should be alert to suggest the need of attention to the refraction, muscle balance, the state of the ocular tissues, the condition of the various media, the indications of the fundus, the evidence of constitutional diseases as manifested in the eyes, the probability of headache and numerous other symptoms being due to defective vision, and the constitutional indications of a waste of energy through these organs.

Too often the doctor merely thinks of lenses to relieve vision, and permits his patient to go to some non-medical dealer in glasses. Never is teamwork more satisfactory and efficient than when it includes a medical examination of the eyes by a medical eye specialist.

Errors of Refraction.

Defective refraction, which is the chief reason for wearing glasses, may be attended with perfect vision; so we should remember that good eyesight is not any warrant that glasses are not needed. If we think that lenses are not required when vision seems to be perfect, we are laying the foundation for untold discomfort and ultimate irreparable loss of vision. It is this delusion that makes the present school tests of vision misleading and dangerous. It is this misunderstanding of the facts that encourages the public to take their eyes to other than medical eye specialists for help. Along this line, I must say, too, that there are those wearing lenses right and best for them to wear, but without perfect vision at long range. These are myopes or

near-sighted, who cannot wear the full correction for distance because of making too much strain at the reading distance to overcome all of the minus; those having such an amount of latent eye-strain as to require lenses that at first blur distant vision considerably, and those who have eye defects other than refractive, and therefore not affected by lenses. I desire to impress the reader's mind with the three classes enumerated, because it is a daily matter to have pupils come in from the schools saying that the medical examiner says that they must go somewhere and get better glasses.

Proper Correction.

Now it is easy to give more minus in the one instance and less plus in the second class mentioned, but our duty is to do that which is best for our patients. And to facilitate our work and secure the confidence and co-operation of the general practitioners, THE MEDICAL COUNCIL has kindly offered space for my explanations why we do not always give our patrons clear long-distance vision. As I say, it is easy to do so in all except the third class mentioned, and it does not require an expert to seemingly improve on our work. Indeed, local nonmedical dealers in glasses have heaped upon themselves no end of glory by ruthlessly reducing the plus strength of lenses prescribed by the most competent and experienced medical eye-specialists, thus thwarting the purposes of men of skill and good judgment.

Non-Medical Refractionists.

A non-medical refractionist located where he came in contact with many who were patrons of . the most eminent of our State's metropolis said to me: "Why do I have to reduce the plus correction of all of those big city specialists?" If we may have the enlightened co-operation of physicians, we shall be able to do good work and not have it an

nulled by those so lacking in principles (moral and scientific). The physician who does good eye work and corrects a reasonable amount of the eye-strain as revealed under a cycloplegic, is going to put on lenses that somewhat blur distant vision at first, but which becomes clear as the eyes relax their undue strain. Weaker lenses which the eyes readily accept afford clear vision, but do not relieve headache and other symptoms resulting from latent eyestrain. If we fully explain this matter to our patrons, we have but little trouble; nevertheless, we have the uninformed medical man, the meddlesome neighbors and the charlatans to contend with.

Relieving Undue Strain.

One reason, then, for wearing glasses, even when vision was previously perfect, is to relieve undue strain, as revealed by the cycloplegic or "drops." Every physician having patients with headaches and other symptoms commonly due to eyes should send such cases at once to the oculist for refraction; the general practitioner who follows this plan will please his patients and retain their patronage. Unfortunately, too many hold cases as long as possible, and send to the oculist only as a last resort, thus forever losing their patronage and confidence.

Pupils tested in the schools may show good vision in each eye tested separately, but may not be using both eyes at their study; or the refraction may be unequal and the focus different for each eye. Binocular vision is usually not maintained in such eyes, and the vision consequently deteriorates in one eye from non-use; or if both eyes are used it is at the expense of great discomfort. Correcting lenses are needed, therefore, in all of these cases to equalize and preserve comfortable vision of the two eyes.

Astigmatism.

Also, the vision may be unequal in the different meridians of one eye. We may have better vision in the vertical meridian than in the horizontal; or better in the horizontal or some of the oblique meridians than in the vertical. The vision needs to be evened up with cylinders or compounds of spheres and cylinders. Another reason for wearing glasses. Muscular Imbalance.

Our eyes should blend the images seen by each into one perfect composite picture at the sight center in the brain; this is referred to as binocular vision. As previously stated, inequalities in refraction may prevent successful and comfortable binocular vision, requiring the use of lenses; but inequalities and want of balance of the external or directing muscles of the eyes are the chief causes of failure to maintain single or binocular vision. If the brain gives attention to what both eyes see, two objects appear where there is only one (double vision). The individual so affected learns to ignore

one eye, which soon becomes blind from non-use. But the oculist is able with lenses to correct this trouble and give and preserve good vision for both eyes. This is a good reason why many wear glasses and many more ought to.

Neglect to relieve the conditions already described high degrees of eye-strain and want of balance of the eye muscles-leads to strabismus, squint, or "cross-eye." Lenses correcting the defects mentioned prevent squint, and in childhood eyes are straightened by properly fitted glasses. But after adult years are attained it is impossible to correct the defect with lenses.

Tinted Lenses.

There are those with perfect eyes who have to do fine work at a close distance who are greatly helped by suitable lenses prescribed by a competent medical eye specialist. I desire to emphasize the four words just preceding. Good eyes should be very wary about adopting glasses except as judiciously advised. The same is true with reference to the use of colored and tinted lenses. They may be worn with advantage under advice of an experienced and careful oculist. But it should be known that the cheap colored glasses are always harmful, and should never be used under any cir

cumstances.

Unnecessary Lenses.

A reason why some wear glasses is merely habit. Having a very slight eye defect, or no defect at all, they have been given lenses of little or no refracting power, and have worn them until to omit them from the face seems to produce an aching void or something of that kind. If a lens is broken, such a person will borrow glasses, however ill-fitting, and use them until the broken lens is replaced. I have heard intelligent persons say that they could not get along a moment without some lens habitually worn, though entirely devoid of refractive power. We get no thanks or further patronage if we tell such a person that his lenses are useless.

eyes.

Lenses are now worn considerably by drivers of horses and autos as a matter of protection to the The wind-shield is an improvement in the case of the auto. Much harm comes to eyes from use of dirty lenses. As in the case of dark and colored lenses, only those of good quality should be used.

Do any wear glasses for style, as sometimes charged? Well, not very long; it is too inconvenient and expensive, though the modern eyeglasses and spectacles are so stylish and becoming that one is not much to be blamed for thus adorning himself or herself, as the case may be. However, I recommend that those who consult us leave it to the result of a thorough examination of the eyes and a careful and conscientious consideration of all of the circumstances.